Systemic therapy in advanced cutaneous squamous cell carcinoma (CSCC): The Roswell Park experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19041-e19041
Author(s):  
Anthony Jarkowski ◽  
Ryan B Hare ◽  
Peter Loud ◽  
Jospeh J. Skitzki ◽  
John Michael Kane ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Single Agent ◽  
Locally Advanced ◽  
Final Analysis ◽  
Platinum Drug ◽  
Chi Square ◽  
Primary Tumors ◽  
Kaplan Meier ◽  
Chi Square Test ◽  
Multi Agent

e19041 Background: Treatment of locally advanced unresectable (LAU) or metastaticCSCC (mCSCC) is sub-optimal with a paucity of robust data on systemic therapy. Platinum or fluorouracil-based chemotherapy is commonly used. This retrospective study aimed to evaluate the efficacy and outcomes of patients (pts) with LAU or mCSCC treated with systemic therapy. Methods: Records ofpts with CSCC treated with systemic therapy from Jan ‘01 – Jan ‘11 were reviewed. Response was assessed using WHO criteria. Descriptive results were assessed using Wilcoxon Rank Sum test for ordinal responses and Pearson Chi-square test for categorical responses. Survival was calculated by the Kaplan-Meier method. Results: Of 28 pts identified, 25 pts (M:F – 18:7), median age 66 yrs (39, 85) had required data for final analysis. 11 pts (44%) had facial primary tumors (including 7 of the external ear). 19 pts (76%) had LAU and 6 pts had mCSCC. 17 pts (68%) received multi-agent 1st-line chemotherapy (CT). 72%, 76% and 48% pts received platinum, taxane or cetuximab respectively as part of their regimens. 14 pts got 2nd line therapy and 4 pts received concurrent radiation therapy. Partial response (PR) was 44% and 24% pts had stable disease (SD) for a disease control rate of 68%. With a median follow-up of 42.8m, the median progression-free (PFS) and overall survival (OS) were 5.5m (2.3, 13.2) and 10.9m (5.3, 21.3) respectively; 3-yr OS was 22%. Pts with WHO response had improved PFS (20.8m; 4.4, NR; p<.0001) and OS (37.5m; 10.3, NR; p=.0003) compared to pts with SD/PD (PFS 2.7m; OS 5.9m). Use of platinum-based therapy significantly improved PFS and OS, while taxanes and cetuximab had no impact in this small cohort. 91% (n=10) of pts who had a PR received a platinum drug. There was no difference in PFS or OS between face and non-face primary site CSCC and multi-agent versus single agent therapy. Conclusions: Platinum-based therapy remains a standard option in advanced CSCC management. Agents to improve response rates are needed and future trials should address the role of other therapies in CSCC, including novel targeted and CT combinations.

Multivariate analysis of determinant factors in adjuvant chemotherapy (AC) utilization in patients with stage II colon cancer (CC): Analysis of the National Cancer Database (NCDB).

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 577-577
Author(s):  
Donny V. Huynh ◽  
Shiva Kumar Reddy Mukkamalla ◽  
Ponnandai Sadasivan Somasundar ◽  
Ritesh Rathore
Keyword(s):  
Logistic Regression ◽  
Multivariate Analysis ◽  
Single Agent ◽  
Stage Ii ◽  
Distribution Analysis ◽  
Multiple Logistic Regression ◽  
Chi Square ◽  
Primary Tumors ◽  
Chi Square Test ◽  
Multi Agent

577 Background: Evidence from randomized controlled trials does not support routine use of AC for patients with stage II CC. Clinical guidelines recommend discussion of AC in patients with high-risk disease. In our study, we analyzed NCDB data to determine factors favoring the use of AC in this setting. Methods: NCDB data was extracted on a total of 45,098 patients from 2004 to 2009 with stage II CC. Descriptive characteristics were analyzed using Chi-square test and odds ratios were calculated using multiple logistic regression. Results: Frequency of AC was significantly different among patients belonging to different age groups, tumor laterality, grade, pathologic tumor status (pT), and clinical nodal status (cN) (Chi-square test; p < 0.0001). Age distribution analysis revealed higher frequency of AC administration among patients of 18-64 years compared to those of 65-74 years and older, irrespective of single-agent or multi-agent regimens (p < 0.0001). Multivariate analysis was performed using multiple logistic regression technique. The odds of AC administration increased with increasing pT status, worsening tumor grade, and inadequate lymph node dissection ( < 12 lymph nodes evaluated) (p < 0.0001). AC administration was also more likely with left sided primary tumors (p < 0.0001). Conclusions: Using NCDB data, our analysis reveals conventional factors which are associated with AC administration in patients with resected stage II CC. Use of single-agent vs. multi-agent regimens did not differ, though elderly patients and those without left sided tumors were less likely to receive AC. Oncologists should be able to utilize these findings in discussions with stage II CC patients regarding the use of AC. [Table: see text]

Predictors of poor outcome for transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 4100-4100
Author(s):  
Petra Prins ◽  
Bhavana P Singh ◽  
Samantha Ann Armstrong ◽  
Aiwu Ruth He
Keyword(s):  
Prognostic Factors ◽  
Systemic Therapy ◽  
Strong Association ◽  
Median Number ◽  
Chi Square ◽  
Kaplan Meier ◽  
Chi Square Test ◽  
Student’S T ◽  
Poor Outcomes ◽  
Relevant Factors

4100 Background: The use of TACE in select patients with BCLC stage B HCC has been shown to improve survival. Despite this, it remains unclear which patients will benefit from repeated TACE versus switching to systemic therapy upon disease progression. The purpose of this study is to identify prognostic factors that predict poor outcomes in patients who receive TACE. Methods: In this single-institutional retrospective analysis, patients with unresectable HCC were treated with TACE between 2007-2016. Relevant factors such as staging by BCLC stage B, Child-Pugh score, vascular invasion (VI), tumor thrombus (TT), AFP levels, and number of TACE treatments within six months from the initiation of TACE were analyzed using either Pearson’s chi-square test or the student's t-test. The Kaplan-Meier method was used for survival analysis. Results: Patients (n = 176) underwent TACE; 45% had stage I-II disease, 42% were BCLC stage B prior to TACE, 71% were Child-Pugh A, 21% had extrahepatic spread, 34.7% had VI, and 26% had TT. The median number of TACE treatments was 2 (range, 1- 6). The median overall survival (mOS) was 43 months (m) (95% CI 31.3-54.7) and mOS from start of TACE was 34m (95% CI 26.2-41.8). Elevated AFP (>400) correlated with decreased mOS (25m vs. 35m, p=0.041). Similarly, the presence of TT correlated with poor outcomes (25m vs. 37m, p=0.015). The mOS was also negatively impacted by having 3 or more TACE treatments within a 6 m period (25m vs. 38m, p = 0.09). AFP >400, TT, and interval between TACE were all independent factors in this multivariate analysis, resulting in a shorter mOS of approx. 2 years compared to 3 years in patients without these negative prognostic factors. There was a strong association with both elevated AFP and TT (Chi square p=0.009). Conclusions: Elevated AFP (>400), the presence of TT, and a need for 3 or more TACE treatments within 6 months appear to be independent predictors for shorter mOS in patients receiving TACE. Patients with these poor prognostic factors tend to have more aggressive HCC, and earlier initiation of systemic therapy might provide benefit to these patients. A larger study is needed for confirmation of these findings.

scholarly journals The role of phosphoprotein phosphatases catalytic subunit genes in pancreatic cancer

2021 ◽  
Vol 41 (1) ◽  
Author(s):  
Junjie Hang ◽  
Steven Yuk-Fai Lau ◽  
Ruohan Yin ◽  
Lina Zhu ◽  
Siyuan Zhou ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Prognostic Value ◽  
Chi Square ◽  
Catalytic Subunits ◽  
Beneficial Effects ◽  
Phosphoprotein Phosphatases ◽  
Kaplan Meier ◽  
Chi Square Test ◽  
Independent Cohort

Abstract Compelling evidence suggests that phosphoprotein phosphatases (PPPs) are involved in a large spectrum of physiological and pathological processes, but little is known about their roles in pancreatic cancer. We investigated the expression level, prognostic value, and potential function of PPPs with data from Oncomine, GEPIA, THPA, and TCGA databases and an independent cohort of patients with pancreatic cancer. Among all the PPP catalytic subunits (PPPcs), the transcription levels of PPP1CA, PPP1CB, PPP3CA, PPP3CB, and PPP4C were higher in pancreatic cancer than in normal pancreas (P&lt;0.01, fold change &gt; 2). Kaplan–Meier analysis showed that high transcription levels of PPP1CA, PPP1CB, PPP2CA, PPP2CB, PPP3CA, and PPP4C correlated with poorer survival. In contrast, patients with high levels of PPP3CB, PPP3CC, PPP5C, PPP6C, and PPEF2 had much better prognoses. Data from THPA and patients with pancreatic cancer enrolled in our hospital also confirmed the prognostic value of PPP1CA, PPP1CB, PPP2CA, PPP2CB, PPP3CA, PPP3CB, and PPP6C at the protein level. In addition, the Pearson Chi-square test showed that PPP3CB level was significantly correlated with T and N stages. GO and KEGG analyses showed that the genes and pathways related to the pathogenesis and progression of pancreatic cancer were greatly affected by alterations in PPPcs. Results of the present study suggest that PPP1CA, PPP1CB, PPP2CA, PPP2CB, and PPP3CA have deleterious effects but PPP3CB, PPP5C, and PPP6C have beneficial effects on pancreatic cancer.

scholarly journals Clinical Relevance of PD-L1 Expression and CD8+ T Cells’ Infiltration in Patients With Lung Invasive Mucinous Adenocarcinoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiaoling Xu ◽  
Na Li ◽  
Ding Wang ◽  
Wei Chen ◽  
Yun Fan
Keyword(s):  
Mucinous Adenocarcinoma ◽  
Target Therapy ◽  
Tumor Infiltrating Lymphocytes ◽  
Egfr Mutations ◽  
Chi Square ◽  
Genetic Characteristics ◽  
Kaplan Meier ◽  
Chi Square Test ◽  
Cox Proportional Hazard Regression ◽  
Invasive Mucinous Adenocarcinoma

BackgroundInvasive mucinous adenocarcinoma (IMA) of the lung is a rare and distinct subtype of adenocarcinoma. At present, people have no idea whether IMA patients can benefit from immunotherapy and target therapy; thus there is an urgent need to clarify the immune microenvironment and genetic characteristics of this cohort.MethodsA total of 31 IMA patients matched with 27 non-mucinous adenocarcinoma (non-IMA) patients were enrolled in this study, and clinical data was collected. The expression of PD-L1, CD8+ tumor-infiltrating lymphocytes (TILs) and ALK was determined by immunohistochemistry. Polymerase Chain Reaction was used to determine the mutations of EGFR. The Chi-square test, Kaplan–Meier method and Cox proportional hazard regression model were used to explore the correlations between these clinicopathological variables, survival and identify risk factors.ResultsOf the patients with IMA 9.7% (3/31) revealed positive PD-L1 expression and 35.5% (11/31) showed CD8+ TIL infiltration, which were markedly lower than that of non-IMA group [PD-L1: 48.1% (13/27); CD8: 81.5% (22/27)]. Moreover, five (16.1%) patients in IMA group and 10 (37.0%) patients in non-IMA group had EGFR mutations, and nine (29.0%) patients in IMA group and zero (0.0%) patient in non-IMA group had ALK rearrangements. Additionally, we observed that IMA patients with CD8+ TIL infiltration had a worse prognosis than CD8-negative group (P = 0.024). Multivariate analyses showed that CD8 was an independent prognostic factor for patient’s survival (HR = 5.60, 95% CI: 1.35–23.22, P = 0.017).ConclusionPatients with IMA have down-regulated expression of PD-L1 and less CD8+ TIL infiltration in tumor microenvironment. Besides, a lower frequency of EGFR mutations was detected in patients with IMA than non-IMA patients while a higher rate of ALK rearrangements was found. Our results provide important reference for therapy of lung IMA.

scholarly journals Prognostic Significance of NBEAL2 in Liver hepatocellular carcinoma

2021 ◽  
Author(s):  
Yanghui Wen ◽  
Hui Su ◽  
Wuke Wang ◽  
Feng Ren ◽  
Haitao Jiang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Expression Profiles ◽  
Prognostic Significance ◽  
The Cancer Genome Atlas ◽  
Clinicopathological Parameters ◽  
Chi Square ◽  
Kaplan Meier ◽  
Chi Square Test ◽  
Liver Hepatocellular Carcinoma ◽  
The Relationship

Abstract Background: NBEAL2 is a member of the BEACH domain–containing protein (BDCP) family and little is known about the relationship between NBEAL2 and malignancy.Methods: We downloaded the Gene expression profiles and clinical data of Liver hepatocellular carcinoma(LIHC) form the Cancer Genome Atlas (TCGA) dataset. The expression difference of NBEAL2 in LIHC tissues and adjacent nontumor tissues was analyzed by R software. The relationship between NBEAL2 expression and clinicopathological parameters was evaluate by Chi-square test. The effect of NBEAL2 expression on survival were assessed by Kaplan–Meier survival analysis and Cox proportional hazards regression model. GSEA was used to explore the potential molecular mechanism of NBEAL2 in LIHC.Results: Up-regulation of NBEAL2 expression was detected in the LIHC tissue compared with adjacent nontumor tissues(P < 0.001). The chi-square test showed that no significant correlation between the expression level of NBEAL2 and various clinicopathological parameters (including T, N and M classifications) were detected. The Kaplan–Meier curves suggested that lower NBEAL2 expression was related with poor prognosis. The results of Multivariate analysis revealed that a lower expression of NBEAL2 in LIHC was an independent risk of poor overall survival (HR, 8.873; 95% CI, 1.159-67.936; P = 0.035). GSEA suggested that multiple tumor-related metabolic pathways were evidently enriched in samples with the low-NBEAL2 expression phenotype. Conlusion: NBEAL2 might act as an tumor suppressor gene in the progression of LIHC but the precise role of NBELA2 in LIHC needs further vertification.

Overcoming resistance to anti-PD-1 with tumor agnostic NBTXR3: From bench to bed side.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 2591-2591
Author(s):  
Tanguy Y. Seiwert ◽  
Colette Shen ◽  
Jessica M. Frakes ◽  
Jiaxin Niu ◽  
Jared Weiss ◽  
...  
Keyword(s):  
T Cell ◽  
Tumor Cell ◽  
Tumor Regression ◽  
Single Agent ◽  
Locally Advanced ◽  
Cd8 T Cell ◽  
Intratumoral Injection ◽  
Post Treatment ◽  
Primary Tumors ◽  
Systemic Control

2591 Background: Despite recent advances, resistance to immune checkpoint inhibitors (ICI), observed in over 80% of treated patients, is currently the main challenge in immuno-oncology. Intense efforts are being made to identify combination therapies that could improve ICI response rates. NBTXR3, a novel radioenhancer administered by direct intratumoral injection (ITI), is designed at the nanoscale to increase radiation therapy (XRT) dose deposit within tumor cells and subsequent tumor cell killing, without increasing toxicity to surrounding healthy tissue. Here we present evidence that NBTXR3 activated by XRT primes the immune system, producing an anti-tumor response, including activation of the cGAS-STING pathway, that overcomes anti-PD-1 resistance both in mice models and patients. Methods: Abscopal assays were conducted in immunocompetent mice. Anti-PD-1 sensitive or resistant tumor cell lines, were injected in both flanks of mice. Intratumoral injection of NBTXR3 (or vehicle) followed by XRT was performed in right flank (primary) tumors only. Some mice also received anti-PD-1 injections. Tumor growth was monitored, and tumor immune cell infiltrates analyzed by immunohistochemistry (IHC). Separately, in the phase II/III randomized Act.in.Sarc [NCT02379845] trial patients with locally advanced soft tissue sarcoma (STS) received either NBTXR3+XRT or XRT alone followed by tumor resection. Pre- and post-treatment tumor samples from patients in both groups were analyzed by IHC and Digital Pathology for immune biomarkers. The safety and efficacy (RECIST 1.1/iRECIST) of NBTXR3 plus stereotactic body radiotherapy (SBRT) in combination with anti-PD-1 is being evaluated in three cohorts of patients with advanced cancers [NCT03589339]. Results: Pre-clinical studies demonstrated that NBTXR3+XRT induces an immune response not observed with XRT alone and enhances systemic control. IHC showed significant increase of CD8+ T-cell infiltrates in both NBTXR3+XRT treated and untreated tumors compared to XRT alone. Similarly, increased CD8+ T-cell and decreased FOXP3+ Treg density (pre- vs post-treatment) was observed in tumor tissues from STS patients treated with NBTXR3+XRT. Furthermore, NBTXR3+XRT in combination with anti-PD-1 improved local and systemic control in mice bearing anti-PD-1 resistant lung tumors, as well as reduced the number of spontaneous lung metastases. Preliminary efficacy data from the first in human trial of NBTXR3+XRT in combination with anti-PD-1 showed tumor regression in the majority of patients (8/9). Of note, tumor regression was observed in 6/7 pts who had progressed on prior anti-PD-1. Conclusions: The clinical efficacy of NBTXR3+XRT has been demonstrated as a single agent. We now demonstrate that it potentiates anti-PD-1 treatment to overcome resistance mechanisms. These results highlight the potential of NBTXR3+XRT to positively impact the immuno-oncology field. Clinical trial information: NCT03589339.

CIP4 Expression is Associated With The Prognosis in Colorectal Cancer

2020 ◽  
Author(s):  
Keqian Zhang ◽  
Tianqi Mao ◽  
Zhicheng He ◽  
Xiaojiao Wu ◽  
Yu Peng ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Lymphatic Invasion ◽  
Chi Square ◽  
Interacting Protein ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Chi Square Test ◽  
Student’S T

Abstract Background: This study was conducted to detect the expression of Cdc42 interacting protein 4 (CIP4) in patients with colorectal cancer (CRC), and explore the role of CIP4 in prognosis of CRC patients.Methods: The expression of CIP4 mRNA was determined by quantitative real-time PCR (qRT-CPR) and compared by student’s t-test between groups. Relationships of clinical characteristics and CIP4 expression were analyzed by Chi-square test. Kaplan-Meier curves were used to estimate the overall survival of CRC patients. And Cox regression analysis was conducted to identify the prognostic biomarkers for CRC patients.Results: The qRT-PCR results showed that CRC tissues were detected with significantly high CIP4 mRNA expression compared with adjacent normal controls (P<0.0001). The overexpression of CIP4 in CRC tissues was influenced by distant metastasis (P=0.021), lymphatic invasion (P=0.012) and TNM stage (P=0.006). But, other clinical factors including age, gender, differentiation and tumor site were proved to have no obvious effects on CIP4 expression (all, P>0.05). The survival curves showed that patients with high CIP4 expression generally lived shorter than those with low CIP4 expression (P<0.001). In addition, the multivariate analysis revealed that differentiation (P=0.044, HR=1.631, 95%CI=1.013-2.626) and CIP4 expression (P=0.000, HR=5.283, 95%CI=3.138-8.893) were of great prognostic significance for CRC patients.Conclusion: Taken together, up-regulation of CIP4 in CRC tissues represented poor prognosis for patients.

scholarly journals Microsurgical rhizotomy for trigeminal neuralgia in MS patients: technique, patient satisfaction, and clinical outcomes

2019 ◽  
Vol 130 (6) ◽  
pp. 1877-1888
Author(s):  
Mark G. Bigder ◽  
Sandeep Krishnan ◽  
E. Francis Cook ◽  
Anthony M. Kaufmann
Keyword(s):  
Trigeminal Neuralgia ◽  
Treatment Failure ◽  
Rank Test ◽  
Control Group ◽  
Chi Square ◽  
Time To Treatment ◽  
Pain Scores ◽  
Kaplan Meier ◽  
Time To Treatment Failure ◽  
Chi Square Test

OBJECTIVEPatients with multiple sclerosis (MS)–associated trigeminal neuralgia (TN) have higher recurrence and retreatment rates than non-MS patients. The optimal management strategy and role for microsurgical rhizotomy (MSR) for MS-TN remains to be determined. The aim of this study was to report time to treatment failure (TTF) and pain scores following MSR compared to percutaneous and Gamma Knife procedures.METHODSTime to treatment failure was analyzed after MSR (n = 14) versus prior procedures (n = 53) among MS-TN patients. Kaplan-Meier curves and log-rank test were utilized to compare TTF after MSR versus prior procedures using the same cohort of patients as their own control group. Subsequent analysis compared TTF after MSR to TTF after 93 other procedures among a second cohort of 18 MS-TN patients not undergoing MSR. BNI pain scores were compared between MSR and other procedures among the MS-TN cohort using a chi-square test.RESULTSTTF was significantly longer after MSR than after other procedures in the MSR cohort (median TTF 79 vs 10 months, respectively, p < 0.0001). Similarly, TTF was longer after MSR than after prior procedures in the non-MSR cohort (median TTF 79 vs 13 months, respectively, p < 0.001). MSR resulted in a higher proportion of excellent pain scores when compared to other procedures in the non-MSR cohort (77% vs 29%, p < 0.001). Probability of treatment survival was higher after MSR than after other procedures at all time points (3, 6, 12, 24, 36, and 48 months). There were no deaths or major complications after MSR.CONCLUSIONSTTF was significantly longer following MSR compared to prior procedures in MS-TN patients. Additionally, a higher proportion of patients achieved excellent BNI pain scores after MSR.

Embolization versus embolization and systemic therapy in patients with hepatocellular carcinoma and metastatic disease: A retrospective analysis.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 363-363 ◽  
Author(s):  
Sunnie Kim ◽  
Karen T. Brown ◽  
Yuman Fong ◽  
Stephen Barnett Solomon ◽  
Joanne F. Chou ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Retrospective Analysis ◽  
Systemic Therapy ◽  
Survival Benefit ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Arterial Embolization ◽  
Combined Modality ◽  
Kaplan Meier

363 Background: Transarterial chemoembolization (TACE) provides a survival benefit in a subset of patients with unresectable hepatocellular carcinoma (HCC). Even though data are lacking, patients with metastatic HCC (mHCC) are sometimes treated with transarterial therapies to address the hepatic disease. Sorafenib is a standard treatment for patients with mHCC. Methods: A retrospective analysis was conducted on patients diagnosed with HCC who had undergone hepatic arterial embolization (HAE) between 2006 and until 2013. Overall survival (OS) was calculated from date of HAE to date of death and estimated by Kaplan Meier Methods. Patients alive at their last follow up date were censored. Results: Of 243 patients who had undergone HAE at MSKCC during the study period, 36 patients had mHCC on initial diagnosis. Of these, 22 received HAE only, while 14 received HAE plus systemic therapy at some time during their whole treatment course. Conclusions: Patients with mHCC who underwent HAE alone had a poor OS. These data suggest that there maybe a survival benefit in patients with mHCC treated with transarterial therapies add to systemic therapy that is given at some time during their whole treatment course. These results contrast with recent data on the use of combined modality in locally advanced disease. Further studies of combined modality therapy in the setting of mHCC may be warranted. [Table: see text]

Real-world systemic therapy utilization in Medicare patients with locally advanced or metastatic urothelial carcinoma.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 415-415
Author(s):  
Michaela Ann Dinan ◽  
Mihaela Georgieva ◽  
Rahul Shenolikar ◽  
Charles D. Scales
Keyword(s):  
Urothelial Carcinoma ◽  
Systemic Therapy ◽  
Medical Condition ◽  
Single Agent ◽  
Locally Advanced ◽  
Upper Urinary Tract ◽  
Individual Agent ◽  
Medicare Patients ◽  
Metastatic Urothelial Carcinoma ◽  
Locally Advanced Tumors

415 Background: Several immunotherapies recently have been approved for the treatment of locally advanced or metastatic bladder cancer that is prevalent in older adults. Utilization patterns in Medicare patients have not been examined and can provide an important context for emerging therapies. Methods: We conducted a retrospective analysis of SEER-Medicare beneficiaries diagnosed with locally advanced (T3-T4, N1-N3, M0) or metastatic urothelial carcinoma (any T, any N, M1) of the bladder or upper urinary tract from 2008 to 2012 and further characterized patients undergoing initial chemotherapy (within 30 days of diagnosis). Individuals receiving neoadjuvant chemotherapy were excluded. Results: A total of 3569 patients met study criteria. Among these, 48% received chemotherapy within 2 years of diagnosis. Receipt of chemotherapy was associated with younger age (median 75 vs 80 years, P< .001) and fewer comorbid conditions, including diabetes (12% vs 16%), renal disease (6% vs 11%), and congestive heart failure (4% vs 8%). A total of 977 patients received chemotherapy, of which 38% had distant metastatic disease and 65% had locally advanced tumors. Most patients had no (70%) or only a single (14%) comorbid medical condition. These patients most commonly received doublet chemotherapy (67%) followed by single-agent (17%) or triple-agent (10%) treatment. Gemcitabine was the most common individual agent received as part of initial chemotherapy (81%), followed by carboplatin (50%), cisplatin (38%), and docetaxel or paclitaxel (each 13%). The most common combination received was gemcitabine/carboplatin (42%) followed by gemcitabine/cisplatin (36%). Conclusions: Only half of Medicare patients with advanced urothelial carcinoma received systemic therapy. Most received a platinum doublet regimen. Gemcitabine in combination with platinum-containing chemotherapy was the preferred treatment. Ongoing assessment of the risks and benefits of emerging treatments for Medicare patients may be warranted with the introduction of targeted and/or immune therapies.

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