Healthcare (HC) utilization and costs in patients (pts) with newly diagnosed metastatic thyroid cancer (mTC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17082-17082 ◽  
Author(s):  
A. Berger ◽  
J. Edelsberg ◽  
K. Chung ◽  
A. Ngyuyen ◽  
D. Stepan ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Metastatic Disease ◽  
Index Date ◽  
Average Length ◽  
Treatment Strategies ◽  
Treatment Modalities ◽  
Newly Diagnosed ◽  
Office Visits ◽  
Antibody Testing

17082 Background: mTC is relatively rare and little is known about treatment patterns or HC costs in patients with newly diagnosed disease. Methods: Retrospective longitudinal cohort study. Using a large (∼14 million covered lives) US health-insurance claims database, we identified a cohort of pts with diagnoses of thyroid cancer (ICD-9-CM diagnosis codes 193.XX) and distant metastatic disease (197.XX-198.XX) between 1/1/2003 and 12/31/2005 (“study period”); the date of first mention of metastatic disease was designated the “index date”. All pts were required to be =18 years of age as of their index date and to have been continuously enrolled in the database for =6 months prior to this date. Pts were followed from their index date until health plan disenrollment (for any reason) or end of the study period, whichever occurred first. Utilization of HC services and costs (total reimbursed amount including pt liability) were then examined during each quarter of follow-up (eg, first 3 months of follow-up=Q1). Results: 183 pts met all study entry criteria. Mean (±SD) age was 51.5 (11.8) years; mean duration of follow-up was 344 days (median=275 days). Most common management/treatment strategies during Q1 included: imaging [eg, US/CT of the neck (49.7%)], thyroglobulin/thyroglobulin antibody testing (25.7%); radiation therapy (23.0%); I131 therapy (19.1%); thyroid surgery (12.6%); chemotherapy (10.9%); lymphadenectomy (8.7%); and bisphosphonate therapy (3.8%). In addition, during Q1, pts averaged 9.5 office visits (95% CI, 8.2, 10.9) and 0.6 hospitalizations (95% CI, 0.5, 0.7); for pts hospitalized during Q1, average length of stay was 6.6 (95% CI, 4.9, 8.4). Costs during the first 2 years of follow-up are presented in the table ; inpt care represented 43% of total HC costs. Conclusions: Many different treatment modalities are used in pts with newly diagnosed mTC; the cost of such care is substantial. [Table: see text] [Table: see text]

Prognostic Value Of GELF Criteria and FLIPI2 For Newly Diagnosed Follicular Lymphoma Receiving R-CHOP Chemotherapy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4368-4368
Author(s):  
Satsuki Murakami ◽  
Harumi Kato ◽  
Kazuhito Yamamoto ◽  
Hirofumi Taji ◽  
Daiki Hirano ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Cross Validation ◽  
Risk Group ◽  
Clinical Stage ◽  
Tumor Burden ◽  
Stage Ii ◽  
Treatment Modalities ◽  
Newly Diagnosed ◽  
Combined Model

Abstract Follicular lymphoma (FL) is the most frequent low-grade lymphoma and survival duration is heterogeneous. Follicular lymphoma international prognostic index 2 (FLIPI2) is a useful prognostic tool for the identification of patients with FL at different risk in the rituximab era. On the other hand, Groupe d’Etude des Lymphomas Folliculaires (GELF) criteria is defined for patients in whom immediate therapy is necessary. In this study, we determined the value of FLIPI2 and GELF criteria as prognostic tools for follicular lymphoma. Among 181 consecutive FL patients newly diagnosed in our institute from 2000 to 2011, data of FLIPI2 and GELF criteria were available for 147 patients. Of the 147 patients, a total of 102 patients were diagnosed as clinical stage II to IV and received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) based chemotherapy. The remaining 45 patients were treated with CHOP like regimens or other treatment modalities. Of the 102 patients who had rituximab usage, 2 patients (2%) received rituximab maintenance therapy. Detailed patients characteristics were shown in Table 1. Survival analysis was carried out using the Kaplan–Meier product-limit method.Table 1Baseline patients’ characteristics (stage ≥II, received R-CHOP)ALL (n=102)Cross-validation cohort (n=65)n (%)n (%)Sex (Male)45 (44)33 (51)Median age (range)58.5 (39-84)58 (39-79)Age (>60)38 (37)24 (37)ECOG PS (>1)2 (2)1 (2)Stage ≥III85 (83)52 (80)Bulky (≥7 cm)19 (19)13 (20)Serum LDH level (>normal)29 (28)19(28)Histology (Grade1/2/3)15/74/1110/46/8FLIPI2Low17 (17)14 (22)Intermediate58 (57)38 (58)High27 (26)13 (20)GELF criteria (High)56 (55)32 (49)Rituximab maintenance2(2)1(2) First, we performed analysis using 102 patients who were diagnosed as clinical stage II to IV and received R-CHOP based chemotherapy. With a median follow-up of 6.3 years (range: 0.7-14.0 years), the 6-year overall (OS) and progression-free survival rates (PFS) of the 102 patients were 89% (95%CI: 78 to 98) and 62% (95%CI: 51 to 71), respectively. According to FLIPI2, three risk groups (low risk, intermediate risk and poor risk) were separated in OS analysis. Estimated 6-year OS rates in patients with high and low tumor burden defined by GELF were 82% and 98%, respectively (P=0.02, Log-rank). PFS rates of patients with high tumor burden defined by GELF criteria were worse compared to those with low tumor burden (53% vs. 72%, p=0.02, Log-rank). When we divided patients into two group using both FLIPI2 and GELF criteria (FLIPI2-GELF combined model), patients, who had high tumor burden defined by GELF criteria and who were classified intermediate risk or poor risk group defined by FLIPI2 (FLIPI2-GELF high) showed worse OS rates compared to the remaining (FLIPI2-GELF low) patients (83% vs. 95%, p=0.03, Log-rank). Patients with FLIPI2-GELF high also represented worse PFS rates compared to FLIPI2-GELF low patients (51% vs. 72%, p<0.01, Log-rank). The results suggested that FLIPI2-GELF combined model could more precisely separate patients into each risk group. For validation, we next performed cross-validation analysis using 65 patients who were diagnosed as clinical stage II to IV and received R-CHOP based chemotherapy. The patients were selected from the first cohort of 102 cases (Table 1). With a median follow-up of 6.2 years (range: 0.7-14.0 years), estimated 6-year OS rates in patients with high and low tumor burden defined by GELF were 80% and 97%, respectively (P=0.03, Log-rank). Estimated 6-year PFS rates in patients with high and low tumor burden defined by GELF were 51% and 66%, respectively (P=0.12, Log-rank). Using FLIPI2-GELF combined model, estimated 6-year OS rates in patients with FLIPI2-GELF high and low were 78% and 97%, respectively (P=0.02, Log-rank). Estimated 6-year PFS rates in patients with FLIPI2-GELF high and low were 47% and 68%, respectively (P=0.04, Log-rank). In 147 cases treated with R-CHOP, CHOP based regimens,or other treatment modalities, FLIPI2-GELF combined model also could divide the two group in OS (p=0.01) and PFS (p<0.01) analyses. In conclusion, we confirmed GELF criteria could be used for reproducible prognostic tool for newly diagnosed follicular lymphoma receiving R-CHOP based chemotherapy. GELF criteria combined with FLIPI2 might be a more precise and repeatable prognostic indicator for survival after first-line therapy in patients with follicular lymphoma. Disclosures: No relevant conflicts of interest to declare.

Treatment patterns among patients with higher-risk myelodysplastic syndromes in a real-world setting: Electronic medical record (EMR)-based data.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 247-247
Author(s):  
Bruce Jeffrey Dezube ◽  
Jill Bell ◽  
Aaron Galaznik ◽  
Eileen Farrelly ◽  
Marlo Blazer ◽  
...  
Keyword(s):  
Real World ◽  
Index Date ◽  
Treatment Guidelines ◽  
Specific Treatment ◽  
Cell Transplant ◽  
Newly Diagnosed ◽  
Limited Information ◽  
Nccn Guidelines ◽  
Real World Setting

247 Background: Treatment decisions in MDS are based on a prognostic scoring system that divides pts into five distinct risk categories (NCCN 2016). Treatment guidelines for HR MDS pts include hypomethylating agents (HMAs) alone (azacitidine & decitabine), high-intensity induction chemotherapy (IC), & stem cell transplant (SCT) alone or after HMAs. Limited information is available on how these recommendations are applied in practice. This study evaluated the real-world treatment of HR MDS pts. Methods: Newly diagnosed HR MDS pts who were ≥18 years old & initiated first-line therapy (1LT) were retrospectively identified from a large United States EMR database between 1/1/2008 & 7/31/2015. As complete cytogenetics were not available in the database, HR was based on: ICD coding: ≥1 inpatient claim with an HR MDS ICD-9/10 code (ICD-9 code: 238.73; ICD-10 codes: D46.20, D46.21, D46.22), or ≥2 outpatient claims with an MDS ICD-9/10 code, or an adapted HR MDS algorithm (NCCN Guidelines in Oncology for MDS v.1.2016; Greenberg, et al. Blood. 2012;120:2454-65; Schanz et al. J Clin Oncol. 2012;30:820-9). The first MDS claim served as the index date. 1LT was defined as an MDS-specific treatment initiated on or after the index date. Pts were followed until death, progression to acute myeloid leukemia (AML), loss to follow-up, or end of study (9/30/2015). Results: 720 newly diagnosed HR MDS pts were identified; of these, 229 (32%) pts received MDS-specific treatment. Median time to treatment was 22 days (interquartile range [IQR]: 10, 74). HMAs were the most common agents in the 1LT with 60% (n= 138) & 24% (n=54) receiving azacitidine & decitabine, respectively. Lenalidomide was used in 7.4% of pts (n=17), 4.8% received SCT alone (n=11), & 3.9% (n=9) received IC. At median follow-up of 9.4 months (IQR: 4.3, 18.4), 38% (n=86) died & 28% (n=63) progressed to AML. Conclusions: Despite guidelines, most HR MDS pts in a real-world setting were not treated with MDS-specific treatment. Among treated pts, 1LT with HMAs & azacitidine predominated. Subsequent research is needed to understand reasons for lack of treatment.

scholarly journals Thrombosis and Risk of Mortality in Newly Diagnosed High-Risk Polycythemia Vera: An Analysis of the Medicare Claims Database in the United States

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 9-10
Author(s):  
Naveen Pemmaraju ◽  
Aaron T. Gerds ◽  
Shreekant Parasuraman ◽  
Jingbo Yu ◽  
Anne Shah ◽  
...  
Keyword(s):  
High Risk ◽  
Median Time ◽  
Research Funding ◽  
Index Date ◽  
Newly Diagnosed ◽  
Publicly Traded ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
History Of

Background Polycythemia vera (PV) is a myeloproliferative neoplasm (MPN) associated with an increased risk of thrombotic events (TEs), a major cause of morbidity and mortality. Patients aged ≥60 years and/or with a history of thrombosis are considered to have high-risk PV. There is limited contemporary, real-world evidence exploring the effect of TEs on mortality in patients with PV. The aim of this analysis was to compare the risk of mortality in patients newly diagnosed with high-risk PV who experienced a TE vs those who did not experience a TE. Study Design and Methods All data from the Medicare Fee-for-Service (FFS) claims database (Parts A/B/D) from January 2010-December 2017 were used to identify patients with a PV diagnosis (all high risk based on cohort being ≥65 years of age) with ≥1 inpatient or ≥2 outpatient claims. The index date was the date of the first qualifying PV claim. Patients with a PV diagnosis or use of cytoreductive therapy within 12 months before the index date (pre-index period) were excluded; ≥12-months continuous medical and pharmacy enrollment pre-index dates was required. The study sample was categorized into TE and non-TE groups based on the occurrence of any of the following events during follow-up: deep vein thrombosis, pulmonary embolism, ischemic stroke, acute myocardial infarction, transient ischemic attack, peripheral arterial thrombosis, or superficial thrombophlebitis. TEs were evaluated from the index date to the end of follow-up. Cox regression analyses with time-varying effects were used to assess mortality risk among patients with PV, with post-index TE as a time-dependent variable, stratified by pre-index TE, and adjusting for patient demographic characteristics and comorbid conditions. Results A total of 56,176 Medicare FFS beneficiaries with PV diagnoses met inclusion criteria. The median age was 73 years, 51.9% were men, and 90.7% were white; 10,110 patients (18.0%) had a history of TE before diagnosis (ie, pre-index). In the follow-up period, 20,105 patients (35.8%) had a TE and 36,071 patients (64.2%) did not have a TE. In the comparison between the TE vs non-TE groups, the median (range) age (75.0 [65-104] vs 73.0 [65-106] years, respectively), mean (SD) Charlson comorbidity index score (3.1 [2.6] vs 2.2 [2.3]), and percentage of patients with a history of cardiovascular events (34.1% vs 23.8%), bleeding (13.3% vs 10.4%), or anemia (28.6% vs 23.4%) were higher (Table 1). Among all patients with PV, the median time from diagnosis to first post-index TE was 7.5 months. Among those with pre-index TE (n=10,093), median time from index to first post-index TE was 0.6 months, whereas patients without pre-index TE (n=46,083) had a median time to first post-index TE of 14.2 months. Among all patients with TE during follow-up, the most common TEs were ischemic stroke (47.5%), transient ischemic attack (30.9%), and acute myocardial infarction (30.5%). The risk of mortality was increased for patients who experienced a TE compared with those who did not (hazard ratio [HR; 95% CI], 9.3 [8.4-10.2]; P&lt;0.0001). For patients who experienced a pre-index TE, the risk of mortality was increased for patients who experienced a subsequent TE during follow-up compared with patients who did not (HR [95% CI], 6.7 [5.8-7.8]; P&lt;0.0001). Likewise, for patients who did not experience a pre-index TE, the risk of mortality was increased for patients who experienced a TE during follow-up compared with patients who did not (HR [95% CI], 13.1 [11.4-15.0]; P&lt;0.0001). Conclusions In this real-world study, approximately one-third of patients with newly diagnosed high-risk PV experienced a TE during follow-up and had a 9-fold increased risk of mortality vs those who did not experience a TE. TE risk mitigation remains an important management goal in patients with PV, particularly in those with prior TE. Disclosures Pemmaraju: Samus Therapeutics: Research Funding; Celgene: Honoraria; SagerStrong Foundation: Other: Grant Support; Affymetrix: Other: Grant Support, Research Funding; MustangBio: Honoraria; Blueprint Medicines: Honoraria; LFB Biotechnologies: Honoraria; Plexxikon: Research Funding; Novartis: Honoraria, Research Funding; AbbVie: Honoraria, Research Funding; Stemline Therapeutics: Honoraria, Research Funding; Pacylex Pharmaceuticals: Consultancy; Daiichi Sankyo: Research Funding; Incyte Corporation: Honoraria; Roche Diagnostics: Honoraria; Cellectis: Research Funding; DAVA Oncology: Honoraria. Gerds:Sierra Oncology: Research Funding; Celgene: Consultancy, Research Funding; Gilead Sciences: Research Funding; Imago Biosciences: Research Funding; Pfizer: Research Funding; CTI Biopharma: Consultancy, Research Funding; Roche/Genentech: Research Funding; Apexx Oncology: Consultancy; AstraZeneca/MedImmune: Consultancy; Incyte Corporation: Consultancy, Research Funding. Parasuraman:Incyte Corporation: Current Employment, Current equity holder in publicly-traded company. Yu:Incyte Corporation: Current Employment, Current equity holder in publicly-traded company. Shah:Avalere Health: Current Employment. Xi:Incyte Corporation: Other: Avalere Health is a paid consultant of Incyte Corporation; Avalere Health: Current Employment. Kumar:Avalere Health: Current Employment; Incyte Corporation: Other: Avalere Health is a paid consultant of Incyte Corporation. Scherber:Incyte Corporation: Current Employment, Current equity holder in publicly-traded company. Verstovsek:Gilead: Research Funding; Incyte Corporation: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; CTI Biopharma Corp: Research Funding; Promedior: Research Funding; Roche: Research Funding; AstraZeneca: Research Funding; Blueprint Medicines Corp: Research Funding; Genentech: Research Funding; Sierra Oncology: Consultancy, Research Funding; Protagonist Therapeutics: Research Funding; ItalPharma: Research Funding; PharmaEssentia: Research Funding; NS Pharma: Research Funding; Celgene: Consultancy, Research Funding.

scholarly journals An Update of the Appropriate Treatment Strategies in Anaplastic Thyroid Cancer: A Population-Based Study of 735 Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Nai-si Huang ◽  
Xiao Shi ◽  
Bo-wen Lei ◽  
Wen-jun Wei ◽  
Zhong-wu Lu ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Distant Metastasis ◽  
Cox Regression ◽  
Early Stage ◽  
Locally Advanced ◽  
Treatment Strategies ◽  
Anaplastic Thyroid Cancer ◽  
Treatment Modalities ◽  
Cox Regression Analysis ◽  
Adjacent Structures

Background. Anaplastic thyroid cancer (ATC) responds poorly to conventional therapies and requires a multidisciplinary approach to manage. The aim of the current study is to explore whether aggressive treatment is beneficial, especially the appropriate extent of surgery in ATC. Methods. Patients diagnosed with ATC from 2004 to 2014 were identified from the Surveillance, Epidemiology, and End Results (SEER) database and included in our study. Results. A total of 735 ATC patients were identified. The two-year overall survival (OS) rates for stage IVA, IVB, and IVC patients were 36.5%, 15.6%, and 1.4%, respectively. By directly comparing eight treatment modalities, we found that surgery+radiotherapy RT±chemotherapy was the most effective treatment strategy. surgery+chemotherapy and RT+chemotherapy had comparable results (hazard ratio HR=1.461, 95% confidential interval (CI): 0.843-2.531, P=0.177). Multivariate Cox regression analysis also showed increased mortality risk in patients with increased age (HR=1.022, P<0.001), tumor extension to adjacent structures (HR=1.649, P=0.013), and distant metastasis (HR=2.041, P<0.001), while surgery+RT (HR=0.600, P=0.004) and chemotherapy (HR=0.692, P=0.010) were independently associated with improved OS. Further analysis revealed that patients undergoing total/near-total thyroidectomy (TT) had superior OS to those receiving less than TT (P<0.001). In subgroup analysis, the benefit of TT remained significant in patients with tumors larger than 4.0 cm (HR=0.776, 95% CI: 0.469-0.887, P=0.007), with adjacent structure extension (HR=0.642, 95% CI: 0.472-0.877, P=0.005), including trachea and major vessels, but not in patients with early phase local disease such as tumor≤4.0 cm or tumor within the thyroid or with minimal extrathyroidal extension. Patients with very locally advanced disease or distant metastasis could not benefit from TT as well. Conclusions. In operable cases, surgery+RT±chemotherapy was the optimal treatment modality. Otherwise, RT+chemotherapy was the appropriate strategy. However, TT was not beneficial for very early stage or metastatic ATC.

Retrospective analysis of outcomes among more than 1,000 patients with newly diagnosed anaplastic oligodendroglial tumors

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 2014-2014
Author(s):  
A. B. Lassman
Keyword(s):  
Statistical Significance ◽  
Treatment Strategies ◽  
Marrow Transplant ◽  
Phase Iii ◽  
Newly Diagnosed ◽  
Oligodendroglial Tumors ◽  
Medical Centers ◽  
Kaplan Meier ◽  
Early Results

2014 Background: Treatment of anaplastic oligodendroglial tumors is controversial. Early results of randomized trials suggest chemotherapy (CT) with procarbazine-lomustine-vincristine (PCV) before or after radiotherapy (RT) improves progression-free but not overall survival (OS) versus RT alone. It is unknown if CT alone affects outcome versus CT&RT, or if temozolomide (TMZ) compares favorably with PCV. Methods: We retrospectively identified adults with newly diagnosed anaplastic oligodendroglioma (AO) or oligo-astrocytoma (AOA) seen at 17 medical centers from 1981–2007 exclusive of phase III or bone marrow transplant trials. Data were updated January 1, 2009. Survivals were estimated by Kaplan-Meier method and compared with log-rank. Results: There were 1054 patients: 594 men, 460 women; median age 42 (18–88); 661 with AO, 443 with AOA. Treatment was: observation (82, 8%), RT alone (n = 210, 20%), RT then chemotherapy (283, 27%), RT + CT concurrently (118, 11%), CT alone (205, 19%), CT then RT (137, 13%), or other (19, 2%). Median time to progression (TTP) and OS were 2.8 and 6.5 years, respectively, with median follow up of 4.1 years (0.03–20.8) on surviving patients (n = 560, 53%). 1p19q co-deletion was observed in 292 (48%) and no deletion in 232 (38%) of 606 tested tumors. Co-deletion predicted longer median TTP (4.2 vs. 1.8 years for no deletion, p = 0.0002) and OS (8.4 vs. 3.3 years, p < 0.0001). Median TTP was longer following CT&RT (sequential or concurrent) than CT alone (3.7 vs. 2.6 years, p = 0.0007), but median OS did not differ (6.6 vs. 7.1 years, p = 0.8); co-deletion was more common with CT alone than CT&RT (p < 0.0001, χ2), although restricting analysis of CT&RT versus CT to the co-deletion cohort yielded analogous results (median TTP 7.2 vs. 3.8 years, p = 0.011; OS 7.9 vs. 10.4 years, p = 0.26). Median TTP was longer following PCV alone (7.6 years, n = 17) than TMZ alone (3.3 years, n = 65) with co-deletion (p < 0.02); median OS was also longer (not reached, vs. 7.1 years), but did not reach statistical significance (p = 0.07 log-rank). Conclusions: 1p19q co-deletion predicted improved outcome. Treatment strategies varied widely. CT alone did not appear to shorten OS versus CT&RT. PCV may be superior in efficacy to TMZ. Multivariate analyses and additional 1p19q testing are in progress. [Table: see text]

Prognostic factors in men receiving androgen deprivation therapy (ADT) for recurrent prostate cancer: Using absolute PSA and PSA doubling time (DT) to guide timing of ADT initiation.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 129-129
Author(s):  
Praful Kumar Ravi ◽  
Jeffrey Karnes ◽  
Laureano J Rangel ◽  
Lance C. Pagliaro
Keyword(s):  
Prostate Cancer ◽  
Prognostic Factors ◽  
Metastatic Disease ◽  
Multivariable Analysis ◽  
Treatment Strategies ◽  
Prognostic Indicators ◽  
Limited Data ◽  
Early Progression ◽  
Radical Therapy

129 Background: ADT is the first-line treatment for men experiencing recurrence after undergoing radical therapy for prostate cancer. However, timing of ADT initiation is controversial and there are limited data on prognostic factors in patients starting ADT. Methods: We identified consecutive men who underwent radical prostatectomy (RP) for localized prostate cancer at our institution between 1987 and 2007 and who subsequently received salvage ADT. Early progression on ADT was defined as development of metastatic disease within 2yrs of initiation. The primary outcomes of interest were cancer-specific (CSS) and overall survival (OS). Results: A total of 2418 men were included. Median age at RP was 64yrs and median follow-up was 13.9yrs. 48% and 20% of men had pathologic Gleason scores of 7 and 8-10 respectively. The median PSA was 2.6ng/ml, while 385 men (16%) had metastatic disease at receipt of ADT. Overall, 1060 men (44%) developed clinical metastases, with 625 (59%) of these doing so within 2yrs of starting ADT. On multivariable analysis, longer PSA DT before ADT was associated with lower odds of early progression on ADT (DT 3-9mths, OR = 0.19; DT ≥9mths, OR = 0.10, both p < 0.001). 10- and 20-year CSS were 89% and 70%, and 10- and 20-year OS were 82% and 40% respectively. Independent predictors of lower CSS included metastatic disease at time of ADT (HR = 2.60), PSA at ADT of 5-50ng/ml (HR = 2.68) and > 50ng/ml (HR = 4.33, all p < 0.001), while longer PSA DT was associated with higher CSS (DT 3-9mths, HR = 0.54; DT ≥9mths, HR = 0.45, both p < 0.001). PSA at ADT of 5-50ng/ml (HR = 3.10) and > 50ng/ml (HR = 5.20, both p < 0.001) were independent predictors of OS. Conclusions: PSA DT < 3mths and absolute PSA at ADT initiation of ≥ 5ng/ml are adverse prognostic indicators in men receiving salvage ADT for relapse after RP. For patients with these features, their risk of early progression and death should be part of a discussion about the timing of ADT and consideration given to more aggressive treatment strategies. Conversely, men with biochemical relapse who have longer DT and PSA < 5ng/ml are at lower risk and could make an informed decision to defer ADT initiation.

Osteoclast-like giant cell tumors of the pancreas: Clinical characteristics, genetic testing, and treatment modalities.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16752-e16752
Author(s):  
Benjamin Edward Ueberroth ◽  
Alex John Liu ◽  
Rondell P. Graham ◽  
Mohamad Bassam Sonbol ◽  
Thorvardur Ragnar Halfdanarson
Keyword(s):  
Genetic Testing ◽  
Cell Carcinoma ◽  
Giant Cell ◽  
Surgical Resection ◽  
Metastatic Disease ◽  
Mayo Clinic ◽  
Treatment Modalities ◽  
Giant Cell Carcinoma ◽  
Carcinoma Of The Pancreas

e16752 Background: Undifferentiated osteoclast-like giant cell carcinoma of the pancreas is an aggressive malignancy only described by a few case reports in the literature. In this study, we sought to better characterize this entity by examining patients seen at Mayo Clinic. Methods: This study identified patients with osteoclast-like giant cell carcinoma of the pancreas using Mayo Clinic databases (MN, AZ, FL) from the year 2000 to present. Patient demographics, genetic data, and treatment modalities were reviewed. Kaplan-Meier analysis was used to evaluate median overall survival (mOS) for the cohort as well as mOS and mPFS for treatment subgroups. Results: 15 patients were identified (9 female, 6 male). Median age at diagnosis was 59 years and mOS for all patients was 11.0 mos (95% CI 6.2-15.7 mos). 3 patients (20%) had metastatic disease at diagnosis with the liver being the most common site (n = 3). Metastatic disease was associated with significantly shorter OS (3.5 vs. 14.1 mos, p = 0.005; HR 7.98 [95% CI 1.43-44.4]) compared to locoregional disease (LRD). 4 patients underwent genetic testing. The most common mutation was CDKN2A (n = 3), followed by TP53 (n = 2) and KRAS (n = 2). 13/15 patients had detailed follow-up information. 6/7 patients undergoing chemotherapy received a gemcitabine-based regimen as first line: with capecitabine (n = 2), with nab-paclitaxel (n = 2), or as monotherapy (n = 2). 1 patient received FOLFIRINOX. In patients with LRD and adequate follow-up (n = 11), 8/11 underwent surgical resection and had longer OS compared to those without resection (17.0 vs. 8.4 mos, p = 0.09). No surgical patients received neoadjuvant chemotherapy. 5/8 received adjuvant chemotherapy, 2 did not undergo chemotherapy, and 1 was lost to follow-up after surgery. PFS from time of surgery was 15.3mos (95% CI 5.0-25.6mos). 6 patients (40%) were alive at time of analysis; all 6 underwent surgical resection. Conclusions: Osteoclast-like giant cell carcinoma of the pancreas is a rare malignancy with a poor prognosis, even when diagnosed at an early stage. OS for patients of all stages in this study was less than 1 year suggesting prognosis may be even worse than that of pancreatic adenocarcinoma. The optimal therapy remains unknown but most patients received similar chemotherapy as in adenocarcinoma. Patients with LRD amenable to surgical resection experienced a PFS over 1 year from surgery, possibly associated with OS benefit, however overall prognosis is poor. Further study is warranted on a larger scale to better understand disease course and treatment options.

RADT-06. RADIOTHERAPY FOR BRAIN METASTASES FROM THYROID CANCER: A RETROSPECTIVE COHORT STUDY

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi42-vi42
Author(s):  
Erik Blomain ◽  
Scott Berta ◽  
Nicholas Hug ◽  
Duc Giao ◽  
Antonio Meola ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Brain Metastases ◽  
Radiation Necrosis ◽  
Local Failure ◽  
Competing Risk ◽  
Treatment Modalities ◽  
Leptomeningeal Disease ◽  
Risk Of Death ◽  
Anaplastic Histology

Abstract PURPOSE/OBJECTIVE(S) Brain metastases from thyroid carcinoma are rare. Although stereotactic radiosurgery (SRS) is a standard of care for patients with brain metastases across many histologies, the current NCCN guidelines do not support a universal role for this modality in thyroid cancer. MATERIALS AND METHODS Thyroid cancer patients with brain metastases treated with radiotherapy at our institution from 2002-2020 were studied. Cumulative risk of local failure, distant intracranial failure and radiation necrosis were calculated using a competing risk of death analysis and censored at the last imaging follow-up. Overall survival was analyzed using Kaplan-Meier method. Stratified cox regression was used to study per-lesion outcomes. RESULTS We identified 34 patients with 203 treated brain metastases. 179 (88.2%) lesions were of differentiated histology; the remainder were anaplastic histology. Four patients received whole brain radiotherapy (WBRT) while 30 patients received SRS (SFED 22, interquartile (IQ) range 20-22). Of the patients receiving WBRT, one (25%) had anaplastic histology, and the median number of lesions was 15 (as compared to 2 for SRS). Median follow up among survivors was 32.3 months and median survival was 10.8 months. There were no observed failures (local or distant intracranial) observed at 1 year in the 24 metastases with anaplastic histology, although competing risk of death was high (91.7%). The 1 year cumulative incidences of local failure and distant intracranial failures were 9.8% (95CI 5.7%-13.9%) and 35.0% (95CI 29.0%-41.0%), respectively, in differentiated tumors. 6 (10.2%) of the distant intracranial failures were new cases of leptomeningeal disease. The 1 year risk of radiation necrosis was 15.5%. Of these cases, most were Grade 2 (57.1%); 3 (42.9%) were Grade 4 (there were no Grade 1 or 3 events). CONCLUSION In the largest known cohort of thyroid cancer brain metastasis patients, radiotherapy and SRS appear to be safe and effective treatment modalities.

The lines of loco-regional therapies received and the healthcare economic burden of patients newly diagnosed with hepatocellular carcinoma in the United States.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 286-286
Author(s):  
Brian Seal ◽  
Abdulla M. Abdulhalim ◽  
Melissa Lingohr-Smith ◽  
Jay Lin
Keyword(s):  
Radiation Therapy ◽  
Economic Burden ◽  
Healthcare Costs ◽  
Index Date ◽  
The United States ◽  
Newly Diagnosed ◽  
Ablative Therapy ◽  
Regional Therapy ◽  
The Us

286 Background: Hepatocelluar carcinoma (HCC) is one of the fastest growing causes of cancer-related deaths in the US. The objectives of this study were to examine the lines of loco-regional therapies received and the healthcare economic burden of patients newly diagnosed with HCC in the US. Methods: Patients (≥18 years of age) diagnosed with HCC who received ≥1 loco-regional therapy (index date) after diagnosis were identified from the MarketScan Commercial and Medicare Supplemental databases (July 1, 2013-May 31, 2018). Patients were required to have ≥6 months of continuous insurance enrollment before the index date and ≥1 month after (follow-up period). The follow-up period was censored when patients received any systemic therapy. During the follow-up periods, the number of patients who received radiation therapy, ablative therapy, and embolization procedures (transarterial embolization/chemoembolization [TAE] and radioembolization [TARE]) were examined. All-cause and HCC-related healthcare costs (total and patient out-of-pocket [OOP] payments per patient per month [PPPM]) were also measured. Results: Among the 2,101 patients newly diagnosed with HCC who received ≥1 loco-regional therapy, median age was 64 years and 75.0% were male; the mean follow-up duration was 11.5 months. During the follow-up periods, 28.1% (n = 590) received radiation therapy, 27.3% (n = 574) ablative therapy, and 77.3% (n = 1,623) embolization therapy (TAE: 68.7% [n = 1,443]; TARE: 20.7% [n = 434]); 30.9% of patients received multiple loco-regional therapies. During the follow-up periods, total all-cause healthcare costs were a mean of $20,316 (OOP: $378) PPPM, of which 70.7% ($14,359; OOP: $227 PPPM) were HCC-related. The breakdown of healthcare costs is shown in the table. Conclusions: According to the findings of this large-scale real-world analysis of patients newly diagnosed with HCC in the US, a vast majority received at least one embolization procedure. The monthly healthcare economic burden of patients with HCC treated with local-regional therapies is relatively high. [Table: see text]

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