Incidence of peritoneal carcinomatosis in recurrent plasmacytoid urothelial carcinomas (PUC) of the bladder: A retrospective analysis of patient outcomes at M. D. Anderson Cancer Center (MDACC).

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 297-297
Author(s):  
Farshid Dayyani ◽  
Mark F. Munsell ◽  
Arlene O. Siefker-Radtke
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Peritoneal Carcinomatosis ◽  
Retrospective Analysis ◽  
Median Survival ◽  
Cancer Center ◽  
Initial Surgery ◽  
Poor Outcomes ◽  
Long Term Survivors ◽  
Peritoneal Lining

297 Background: PUC are a rare subset of urothelial cancers with a paucity of available literature regarding their clinical behavior. Methods: Retrospective analysis of outcomes among all patients (pts) with predominant PUC (pPUC) seen at MDACC from 1999-2010. Results: 31 pts with pPUC histology were identified (median age:63.5yrs; 83.3% male; TNM stage:cT1N0,n=4;cT2N0,n=8;cT3b-4aN0,n=6; cT4b, N+ or M+ n = 13). Median survival for all pts was 17.7mo (Stage I-III vs IV: 38.1 vs 13.3mo). Of 18 pts with potentially surgically resectable PUC (<=pT4aN0M0) 7 received neoadjuvant chemotherapy,10 had initial surgery, and one was treated with TURBT alone. Despite pathologic downstaging in 67% of pts treated with neoadjuvant chemotherapy relapses were common and there was no difference in survival between pts treated with neoadjuvant chemotherapy compared to initial surgery, even though adjuvant chemotherapy was given in 7 patients. Only 1 pt in pCR remains in remission >18 mo after surgery. The most common site of recurrence was in the peritoneum (13/18pts), with relapses occurring even in those with pCR at surgery. At least 4 pts developed CNS involvement with lepto-meningeal disease. In pts presenting with metastatic disease who were treated with chemotherapy, the median survival was 12.6 months. Conclusions: Plasmacytoid bladder tumors are a very aggressive subset with overall poor outcomes. Though chemotherapy sensitive with downstaging seen with neoadjuvant chemotherapy, there are few long-term survivors. There is a strong predilection for recurrences along the peritoneal lining, and peritoneal carcinomatosis should remain high on a clinician’s differential when patients develop obstructive bowel symptoms.

scholarly journals Causes of Discontinuation and Long-Term Outcomes of Patients with CLL after Discontinuing Ibrutinib

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4390-4390 ◽  
Author(s):  
Preetesh Jain ◽  
Philip A Thompson ◽  
Michael Keating ◽  
Zeev Estrov ◽  
Alessandra Ferrajoli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Median Time ◽  
Median Survival ◽  
Research Funding ◽  
Molecular Mechanisms ◽  
Cancer Center ◽  
Long Term Outcomes ◽  
Treatment Naïve ◽  
Poor Outcomes

Abstract Introduction: Ibrutinib is approved for treatment of patients (pts) with treatment-naïve or relapsed CLL. We previously reported poor outcomes for pts discontinuing ibrutinib; however, long-term outcomes were not reported. Methods: We present the outcomes for 90 pts who discontinued ibrutinib from a total of 320 pts treated with ibrutinib-based regimens on clinical studies from 2010-15 at M.D. Anderson Cancer Center. Results: Ninety (28%) pts discontinued ibrutinib. Forty pts (44%) were alive at the time of last follow up; 50 (56%) have died. Among the 90 pts, 47 received ibrutinib monotherapy, 31 ibrutinib plus rituximab and 12 ibrutinib with bendamustine and rituximab; 80 pts were relapsed/refractory (r/r) and 10 were treatment-naive. The median time to discontinuation for the 90 pts was 15 months (range 1.2-54), 19 months (5-47) for the untreated and 14.5 months (1.2-54) for r/r pts. Overall, causes and median time for discontinuation were: disease transformation [n=9, 10%; 13.2 mo.]; progressive CLL [n=19, 21%; 22.3 mo], intolerance/toxicity [n=29, 32%;16 mo]; transition to commercial supply (n=5;26 mo.); miscellaneous [n=28, 31%; 10.4 mo] (9 stem cell transplantation, 8 other cancers, 2 sudden death, 6 sepsis and previous comorbidities, 3 unknown). Reasons for discontinuation after first-line ibrutinib were - disease transformation [n=2]; intolerance [n=6; 3 atrial fibrillation and arrhythmias, 2 bleeding and 1 pneumonia]; transition to commercial supply (n=1) and death due to unknown cause (n=1). In r/r pts, reasons for discontinuation were: disease transformation [n=7]; intolerance [n=24; 3 atrial fibrillation, 2 bleeding and 1 pneumonia]; progression [n=19], 27 miscellaneous reasons and 4 for commercial supply. Characteristics of pts who discontinued due to intolerance and progression/transformation are summarized in Table-1. Median time to discontinuation was 16 months (1.2-49 months) for intolerance and 19 months (2-54 months) for progression/transformation. Survival of pts according to the cause of discontinuation is shown in Figure-1A. Median survival of pts was: 33 months for intolerance,16 months in progressive disease and 2 months in disease transformation. Survival of pts according to prior treatment status is shown in Figure-1B. We then assessed response to subsequent therapies among the 19 pts who developed progressive CLL on ibrutinib. Eight of 19 pts (42%) responded to subsequent therapy:5/8 (62%) achieved PR on venetoclax-based therapies (3/5 also failed idelalisib prior to commencing venetoclax); 2/8 (25%), responded to ofatumumab monotherapy;1/10 patients treated with idelalisib or duvelisib-based therapy responded. Conclusions: Ibrutinib discontinuation is common. Subsequent survival correlates with reason for discontinuation; disease transformation has very poor outcome, while patients who develop progressive CLL have a median survival of 16 months. Development of effective salvage strategies for patients with progression/ transformation on ibrutinib therapy is of critical importance. Ideally, these strategies should be guided by the knowledge of the molecular mechanisms of resistance in each patient. Of note, response rates to venetoclax-based therapy were relatively favorable. Despite having superior outcomes to those patients who progress, those who develop treatment-limiting toxicity have a median survival of 33 months and development of guidelines for managing toxicity to allow continued therapy is of importance, as is developing successful salvage options for those unable to continue. # at baseline Disclosures Thompson: Pharmacyclics: Consultancy, Honoraria. Jain:Incyte: Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Celgene: Research Funding; Servier: Consultancy, Honoraria; Abbvie: Research Funding; Pharmacyclics: Consultancy, Honoraria, Research Funding; BMS: Research Funding; Novimmune: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Genentech: Research Funding; Seattle Genetics: Research Funding; ADC Therapeutics: Consultancy, Honoraria, Research Funding; Infinity: Research Funding. Burger:Roche: Other: Travel, Accommodations, Expenses; Janssen: Consultancy, Other: Travel, Accommodations, Expenses; Gilead: Research Funding; Portola: Consultancy; Pharmacyclics, LLC, an AbbVie Company: Research Funding. O'Brien:Pharmacyclics, LLC, an AbbVie Company: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria. Wierda:Novartis: Research Funding; Acerta: Research Funding; Gilead: Research Funding; Genentech: Research Funding; Abbvie: Research Funding.

Mortality After Cure of Testicular Seminoma

2004 ◽  
Vol 22 (4) ◽  
pp. 640-647 ◽  
Author(s):  
Gunar K. Zagars ◽  
Matthew T. Ballo ◽  
Andrew K. Lee ◽  
Sara S. Strom
Keyword(s):  
Observation Interval ◽  
Cancer Center ◽  
Standardized Mortality Ratio ◽  
Testicular Seminoma ◽  
Term Survival ◽  
Risk Of Death ◽  
Cancer Management ◽  
Long Term Survivors

Purpose To determine the incidence of potentially treatment-related mortality in long-term survivors of testicular seminoma treated by orchiectomy and radiation therapy (XRT). Patients and Methods From all 477 men with stage I or II testicular seminoma treated at The University of Texas M.D. Anderson Cancer Center (Houston, TX) with postorchiectomy megavoltage XRT between 1951 and 1999, 453 never sustained relapse of their disease. Long-term survival for these 453 men was evaluated with the person-years method to determine the standardized mortality ratio (SMR). SMRs were calculated for all causes of death, cardiac deaths, and cancer deaths using standard US data for males. Results After a median follow-up of 13.3 years, the 10-, 20-, 30-, and 40-year actuarial survival rates were 93%, 79%, 59%, and 26%, respectively. The all-cause SMR over the entire observation interval was 1.59 (99% CI, 1.21 to 2.04). The SMR was not excessive for the first 15 years of follow-up: SMR, 1.30 (95% CI, 0.93 to 1.77); but beyond 15 years the SMR was 1.85 (99% CI, 1.30 to 2.55). The overall cardiac-specific SMR was 1.61 (95% CI, 1.21 to 2.24). The cardiac SMR was significantly elevated only beyond 15 years (P < .01). The overall cancer-specific SMR was 1.91 (99% CI, 1.14 to 2.98). The cancer SMR was also significant only after 15 years of follow-up (P < .01). An increased mortality was evident in patients treated with and without mediastinal XRT. Conclusion Long-term survivors of seminoma treated with postorchiectomy XRT are at significant excess risk of death as a result of cardiac disease or second cancer. Management strategies that minimize these risks but maintain the excellent hitherto observed cure rates need to be actively pursued.

Effect of Cytokine Therapy on Survival for Patients With Advanced Renal Cell Carcinoma

2000 ◽  
Vol 18 (9) ◽  
pp. 1928-1935 ◽  
Author(s):  
Robert J. Motzer ◽  
Madhu Mazumdar ◽  
Jennifer Bacik ◽  
Paul Russo ◽  
William J. Berg ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Survival Time ◽  
Median Survival ◽  
Renal Cell ◽  
Interleukin 2 ◽  
Interferon Alfa ◽  
Cytokine Therapy ◽  
Survival Times ◽  
Long Term Survivors

PURPOSE: To evaluate the relationship between treatment with cytokine therapy and survival, investigate the effect of nephrectomy on survival, and identify long-term survivors among a cohort of 670 patients with advanced renal cell carcinoma (RCC). PATIENTS AND METHODS: A total of 670 patients with advanced RCC treated on 24 clinical trials of systemic chemotherapy or cytokine therapy were the subjects of this retrospective analysis. Treatment was categorized as cytokine (containing interferon alfa and/or interleukin-2) in 396 patients (59%) and as chemotherapy (cytotoxic or hormonal therapy) in 274 (41%). Among the 670 patients, those with survival times of greater than 5 years were identified as long-term survivors. RESULTS: Patients treated with cytokine therapy had a longer survival time than did those treated with chemotherapy, regardless of the year of treatment or risk category based on pretreatment features. The median survival times for favorable-, intermediate-, and poor-risk patients were 27, 12, and 6 months for those treated with cytokines and 15, 7, and 3 months for those treated with chemotherapy, respectively. The magnitude of difference in median survival was greater in the favorable- and intermediate-risk groups. The median survival time was less than 6 months in the poor-risk group for both treatment programs. Median survival time was 14 months among patients with prior nephrectomy plus time from diagnosis to treatment greater than 1 year versus 8 months among those with time from diagnosis to treatment less than 1 year, regardless of pretreatment nephrectomy status. Thirty patients (4.5%) among the 670 patients were identified as long-term survivors; 12 were free of disease after nephrectomy and treatment with interferon alfa, interleukin-2, or surgical resection of metastasis. CONCLUSION: The low proportion of patients with advanced RCC who achieve long-term survival emphasizes the need for clinical investigation to identify more effective therapy.

scholarly journals A Retrospective Analysis of Long-Term Survivors with Metastatic Pancreatic Ductal Adenocarcinoma

2013 ◽  
Vol 24 ◽  
pp. ix47
Author(s):  
H. Hayashi ◽  
S. Kondo ◽  
S. Shiba ◽  
Y. Sakamoto ◽  
C. Morizane ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Retrospective Analysis ◽  
Ductal Adenocarcinoma ◽  
Long Term Survivors

Analysis of financial sustainability of survivorship clinics led by advanced practice providers.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11560-11560
Author(s):  
Maria Alma Rodriguez ◽  
Guadalupe R. Palos ◽  
Katherine Ramsey Gilmore ◽  
Paula A. Lewis-Patterson ◽  
Patricia Chapman ◽  
...  
Keyword(s):  
Physician Assistants ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Advanced Practice ◽  
Survivorship Care ◽  
Manage Care ◽  
Recovery Percentage ◽  
Long Term Survivors ◽  
Delivery Models

11560 Background: Disease specific Survivorship Care Clinics (SCs) have been established within a comprehensive cancer center. Clinics are staffed by Advanced Practice Providers (APPs), Physician Assistants and Advanced Practice Registered Nurses, with experience in the management of each disease type. To determine the sustainability of this model of survivorship care, we analyzed the professional fees’ revenue generated by APPs’ billings for 6 clinics and then compared the APPs’ salaries across all clinics. Methods: A retrospective analysis was conducted of 6 survivorship clinic’s patient volumes and clinic days supported by APPs from 9/1/16-4/30/17. The full FTE salary of the APPs, including benefits were prorated to the time dedicated to each of the SCs. Institutional financial data was used to align professional fees to actual reimbursements received. Salary recovery percentage was calculated as the ratio of reimbursement received to prorated FTE salary. Results: Table shows variation in APPs’ salary commensurate to FTE proportion. Results also indicate there was an average of 99% professional fee recovery. Clinics with an FTE proportion > 0.5 had recovery higher than the anticipated prorated salary, suggesting there is a threshold to maximize efficacy and sustainability. Conclusions: APPs professional fees for care provided to cancer survivors are reimbursable, across disease types or payers, and proportionally supports their salaries. Our findings suggest delivery models based on APPs to manage care of long-term survivors can be self-supporting.[Table: see text]

Improvement in the standard treatment for experimental glioma by fusing antibody Fc domain to endostatin

2011 ◽  
Vol 115 (6) ◽  
pp. 1139-1146 ◽  
Author(s):  
Rachel Grossman ◽  
Betty Tyler ◽  
Lee Hwang ◽  
Patti Zadnik ◽  
Bachchu Lal ◽  
...  
Keyword(s):  
Median Survival ◽  
Control Group ◽  
Systemic Delivery ◽  
Convection Enhanced Delivery ◽  
Delivery Methods ◽  
Recombinant Human Endostatin ◽  
Tumor Implantation ◽  
9L Gliosarcoma ◽  
Long Term Survivors

Object Brain tumors pose many unique challenges to treatment. The authors hypothesized that Fc-endostatin may be beneficial. It is a newly synthesized recombinant human endostatin conjugated to the Fc domain of IgG with a long half-life (weeks) and unknown toxicity. The authors examined the efficacy of Fc-endostatin using various delivery methods. Methods Efficacy was assessed using the intracranial 9L gliosarcoma rat model treated with Fc-endostatin for use in rodents (mFc-endostatin), which was administered either systemically or locally via different delivery methods. Oral temozolomide (TMZ) was administered in combination with mFc-endostatin to determine if there was a beneficial synergistic effect. Results Intracranial delivery of mFc-endostatin via a polymer or convection-enhanced delivery 5 days after tumor implantation increased median survival, compared with the control group (p = 0.0048 and 0.003, respectively). Animals treated weekly with subcutaneous mFc-endostatin (started 5 days post–tumor implantation) also had statistically improved survival as compared with controls (p = 0.0008). However, there was no statistical difference in survival between the local and systemic delivery groups. Control animals had a median survival of 13 days. Animals treated either with subcutaneous mFc-endostatin weekly or with polymer had a median survival of 18 and 15 days, respectively, and those treated with oral TMZ for 5 days (Days 5–9) had a median survival of 21 days. Survival was further increased with a combination of oral TMZ and mFc-endostatin polymer, with a median survival of 28 days (p = 0.029, compared with TMZ alone). Subcutaneous mFc-endostatin administered every week starting 18 days before tumor implantation significantly increased median survival when compared with controls (p = 0.0007), with 12.5% of the animals ultimately becoming long-term survivors (that is, survival longer than 120 days). The addition of TMZ to either weekly or daily subcutaneous mFc-endostatin and its administration 18 days before tumor implantation significantly increased survival (p = 0.017 and 0.0001, respectively, compared with TMZ alone). Note that 12.5% of the animals treated with weekly subcutaneous mFc-endostatin and TMZ were long-term survivors. Conclusions Systemically or directly (local) delivered mFc-endostatin prolonged the survival of rats implanted with intracranial 9L gliosarcoma. This benefit was further enhanced when mFc-endostatin was combined with the oral chemotherapeutic agent TMZ.

Neoadjuvant Chemotherapy Before Liver Resection for Patients With Unresectable Liver Metastases From Colorectal Carcinoma

2005 ◽  
Vol 23 (9) ◽  
pp. 2038-2048 ◽  
Author(s):  
Gregory D. Leonard ◽  
Baruch Brenner ◽  
Nancy E. Kemeny
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Colorectal Carcinoma ◽  
Liver Metastases ◽  
Systemic Chemotherapy ◽  
Hepatic Arterial Infusion ◽  
Current Data ◽  
Prognostic Scores ◽  
Unresectable Liver Metastases ◽  
Long Term Survivors

Colorectal carcinoma is one of the most common cancers in the world, and more than 50% of these patients develop liver metastases. Despite recent advances, systemic chemotherapy for metastatic disease without the use of surgery is considered palliative, as there are rarely long-term survivors. However, patients who are candidates for surgical resection of their liver metastases can have a prolonged survival or possibly a cure. Consensus guidelines on criteria for resection and prognostic scores help facilitate patient selection, yet only 25% of patients with liver metastases are considered to have resectable metastases. Neoadjuvant chemotherapy has been explored in an attempt to render more patients candidates for resection. First reports using neoadjuvant systemic chemotherapy in patients with unresectable disease found that 13% to 16% of patients could be rendered resectable. Efforts to increase response rates using hepatic arterial infusion or biologic agents may increase resection rates. This review summarizes the current data on neoadjuvant chemotherapy, the rationale for this approach, potential complications, and future prospects.

scholarly journals RETROSPECTIVE ANALYSIS OF LONG-TERM SURVIVAL OUTCOMES OF PRIMARY CYTOREDUCTION AND NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH OVARIAN CANCER STAGE IIIC–IV

2018 ◽  
Vol 8 (3) ◽  
pp. 86-94 ◽  
Author(s):  
A. S. Tjulandina ◽  
A. A. Rumyantsev ◽  
K. Y. Morkhov ◽  
V. M. Nechushkina ◽  
S. A. Tjulandin
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Retrospective Analysis ◽  
Low Frequency ◽  
Progression Free Survival ◽  
Long Term Results ◽  
Survival Outcomes ◽  
Stage Iiic ◽  
Term Survival

The choice of treatment strategy in patients with stage IIIC‑IV ovarian cancer (OC) remains the subject of numerous discussions. The reason for this is the unsatisfactory results of randomized trials and the low frequency of primary complete debulking surgery in these studies. We conducted a retrospective analysis to evaluate the survival outcomes in patients with OC stage IIIC–IV (n=314) who underwent treatment between 1995 and 2017. The median progression free survival for primary surgery was 15.6 months, after interval debulking – 11.5 months (p=0.002, HR 0.61: 95 % CI 0.39–0.81). The primary cytoreduction significantly increased the median of overall survival by 19.6 months: from 38.0 months after interval debulking up to 57.6 months after primary cytoreduction (p=0.04, HR 0.64: 95 % CI 0.41–0.99). An increase in the number of optimal interval debulking does not lead to an improvement in the long-term results of treatment in the group of patients after neoadjuvant chemotherapy. Our analysis over the past 20 years has shown that improvement in treatment outcomes is only observed in the primary cytoreduction group due to an increase in the number of complete optimal cytoreductive surgery.

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