Adult granulosa cell tumors (GCT): 56 years of clinicopathologic outcomes including FOXL2 mutational status.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5536-5536
Author(s):  
Michelle Wilson ◽  
Roseanne Rosario ◽  
Kathryn F. Chrystal ◽  
Kathryn Payne ◽  
Barrie David Evans ◽  
...  
Keyword(s):  
Hormonal Therapy ◽  
Survival Data ◽  
Early Stage ◽  
Stage I ◽  
Stage Iii ◽  
Disease Stage ◽  
Late Relapse ◽  
Mutation Status ◽  
Mutational Status ◽  
Risk Of Relapse

5536 Background: GCT account for 2-3% of ovarian cancers with a tendency for late relapse. Treatment is primarily surgical. The role of chemotherapy and hormonal therapy is more controversial. The FOXL2 mutation (402C→G) has been identified as a potential driver mutation and may be useful in diagnosis and treatment. Methods: We performed a retrospective review of GCT patients (pts) referred to the Auckland Gynae-Oncology Multidisciplinary Team from 1955 to 2011. Baseline characteristics, clinical course, histopathology and survival data was recorded. FOXL2 mutation status was determined by DNA sequencing, and correlated with clinical data. Results: 56 GCT pts were identified. Median (med) age 48.6 years (y) (22-86). Stage I were 82.1%. 48% of tumours were ≥10cm. Med follow up was 10.0y (0.2-40.4). 25 pts progressed, med time to progression (TTP) was 4.5y (0.1-17.7). Med progression free survival was 14.5y. Med overall survival (OS) was 21.8y but med disease specific survival was not reached. 9/18 pts died of disease. Stage III GCT and size ≥10cm had a higher risk of relapse (RR 3.1 and 2.9) and death (RR 8.2 and 8.6) respectively. 17/46 (37%) Stage I pts progressed. Med TTP was 8.3y (1.3 to 17.7), med OS was 29.0y. Stage I relapse rate was higher in tumours ≥10cm (RR 3.9 p<0.01). 12/17 1st relapses were treated with surgery. 10/17 pts received ≥1 line of chemotherapy and 7 ≥1 hormonal therapy. Clinical benefit rates (CR, PR and SD>6m) for first-line chemotherapy was 25% and 71% for hormones. All 7 Stage III pts progressed with med OS of 6.3yr (0.2-12.3y). Currently the FOXL2 mutation statuses are known for 18 patients. 89% carried the mutation. Homozygous, heterozygous and wild-type mutations had no difference in risk of relapse or death. Further FOXL2 mutation analysis is ongoing. Conclusions: This long term series confirms the protracted natural history of this disease. Early stage GCT, despite progression has a good prognosis with med OS >25y. Stage and tumour size remain the most consistent prognostic factors. Whilst surgery remains the mainstay of therapy, the high response rate to hormonal therapy deserves investigation. Currently the FOXL2 mutation status does not appear prognostic but this needs further research.

scholarly journals International Study of Primary Mucinous Ovarian Carcinomas Managed at Tertiary Medical Centers

2018 ◽  
Vol 28 (5) ◽  
pp. 915-924 ◽  
Author(s):  
Jennifer J. Mueller ◽  
Henrik Lajer ◽  
Berit Jul Mosgaard ◽  
Slim Bach Hamba ◽  
Philippe Morice ◽  
...  
Keyword(s):  
Early Stage ◽  
Statistical Tests ◽  
Stage Iv ◽  
Stage I ◽  
Stage Iii ◽  
Oncologic Outcomes ◽  
Disease Stage ◽  
Ovarian Carcinomas ◽  
Early Stage Disease ◽  
Medical Centers

ObjectiveWe sought to describe a large, international cohort of patients diagnosed with primary mucinous ovarian carcinoma (PMOC) across 3 tertiary medical centers to evaluate differences in patient characteristics, surgical/adjuvant treatment strategies, and oncologic outcomes.MethodsThis was a retrospective review spanning 1976–2014. All tumors were centrally reviewed by an expert gynecologic pathologist. Each center used a combination of clinical and histologic criteria to confirm a PMOC diagnosis. Data were abstracted from medical records, and a deidentified dataset was compiled and processed at a single institution. Appropriate statistical tests were performed.ResultsTwo hundred twenty-two patients with PMOC were identified; all had undergone primary surgery. Disease stage distribution was as follows: stage I, 163 patients (74%); stage II, 8 (4%); stage III, 40 (18%); and stage IV, 10 (5%). Ninety-nine (45%) of 219 patients underwent lymphadenectomy; 41 (19%) of 215 underwent fertility-preserving surgery. Of the 145 patients (65%) with available treatment data, 68 (47%) had received chemotherapy—55 (81%) a gynecologic regimen and 13 (19%) a gastrointestinal regimen. The 5-year progression-free survival (PFS) rates were 80% (95% confidence interval [CI], 73%–85%) for patients with stage I to II disease and 17% (95% CI, 8%–29%) for those with stage III to IV disease. The 5-year PFS rate was 73% (95% CI, 50%–86%) for patients who underwent fertility-preserving surgery.ConclusionsMost patients (74%) presented with stage I disease. Nearly 50% were treated with adjuvant chemotherapy using various regimens across institutions. The PFS outcomes were favorable for those with early-stage disease and lower but acceptable for those who underwent fertility preservation.

International Staging System (ISS) Is Superior to Durie-Salmon (DS) Staging in Predicting Overall Mortality in Multiple Myeloma (MM)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2745-2745 ◽  
Author(s):  
Sikander Ailawadhi ◽  
Taimur Sher ◽  
Mehul Patel ◽  
Lyudmyla Derby ◽  
Terry Mashtare ◽  
...  
Keyword(s):  
Survival Data ◽  
Staging System ◽  
Stage I ◽  
Stage Iii ◽  
Disease Stage ◽  
Cell Transplant ◽  
Transplant Patients ◽  
Stage Disease ◽  
Staging Systems ◽  
International Staging System

Abstract Background: Despite recent therapeutic advancements, multiple myeloma (MM) remains an incurable disorder. Disease stage is the most commonly used parameter to determine tumor burden, need for treatment initiation and survival outcome. In this context the International Staging System (ISS) proposed in 2005 is considered a good predictor of overall survival (OS) and is reported to be more objective than the previous Durie-Salmon staging system (DSS). To date there has been no direct comparison to determine which of these is superior in predicting OS or mortality. Furthermore, ISS was defined prior to the routine availability of novel agents and primarily included MM patients who had undergone autologous stem cell transplant. Whether ISS has similar predictive value in non-transplant patients has not been reported. We investigated the ability to predict OS and mortality of these two staging systems in non-transplant patients with MM. Methods: All MM patients seen at RPCI between January 2004 and June 2007 were included in the analysis. Clinical staging was done as per the DSS and ISS in all patients. Descriptive baseline demographic data and survival data were collected. A 0.05 nominal significance level was used in all hypothesis testing. Results: A total of 170 consecutive patients were evaluated. None of the patients had undergone a stem cell transplant for their MM diagnosis. Survival data was available on 144 patients which are reported in this analysis. Of these 48% (n=69) were females and 52% (n=75) were males, with a median age of 60 years (range 35–83). The DSS revealed a distribution as follows: stage IA (21; 14.6%), stage IB (1; 0.7%), stage IIA (23; 16%), stage IIB (1; 0.7%), stage IIIA (81; 56.2%) and stage IIIB (17; 11.8%). The distribution as per ISS was stage I (76; 52.8%), stage II (31; 21.5%) and stage III (37; 25.7%). A Cox proportional hazards model was fit to compute a generalized R-square (Gen R2) statistic for the two staging systems and to compute hazard ratios (HR). The Gen R2 for DSS was 0.0259, while for ISS was 0.0461. Thus, by themselves, the two staging systems were not particularly predictive of OS. Comparison was then made by separating stage III (advanced stage disease) from stage I and II for both DSS and ISS. The estimated hazard of death for DSS I/II patients was not significantly different from the estimated hazard of death for DSS III patients (HR=0.48; 95% CI 0.2,1.14; p=0.09), while the estimated hazard of death for ISS I/II patients was significantly different from that for ISS III patients (HR=0.43; 95% CI 0.21,0.85; p=0.01). Exact odds ratios (OR) were computed between dichotomized DSS or ISS stage with patient status at years 1, 2 and 3 of follow up. Survival analysis at 1-year, 2-year and 3-year time point included 112, 93 and 77 patients, respectively. At 1-year, the sample odds of death for stage I/II patients were significantly different from the sample odds of death for stage III patients in both, the DSS (OR=0.32; 95% CI 0.1,0.93; p=0.02) and ISS (OR=0.25; 95% CI 0.08,0.25; p=0.005). At 2-year as well, this difference was significant for both, DSS (OR=0.32; 95% CI 0.1,0.98; p=0.03) and ISS (OR=0.18; 95% CI 0.06,0.63; p=0.002). At 3-year though, the DSS was no longer able to predict a significant difference in the sample odds of death between stage I/II and stage III patients (OR=0.4; 95% CI 0.11,1.34; p=0.11), while the sample odds of death as per the ISS were still significantly different (OR=0.21; 95% CI 0.04, 0.78; p=0.01). Conclusions: Our data from a prospective large cohort of non-transplant MM patients suggests that ISS is more predictive of overall mortality than the DSS. Furthermore, when comparing advanced stage disease (stage III) with early-stage disease (stage I/II), the DSS may only be able to predict short-term survival, while ISS is able to effectively predict survival over a prolonged period. Figure Figure

scholarly journals Actual survival after resection of primary colorectal cancer: results from a prospective multicenter study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Inge van den Berg ◽  
Robert R. J. Coebergh van den Braak ◽  
Jeroen L. A. van Vugt ◽  
Jan N. M. Ijzermans ◽  
Stefan Buettner
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
Multicenter Study ◽  
Survival Data ◽  
Standard Therapy ◽  
Tumor Grade ◽  
National Registry ◽  
Stage I ◽  
Stage Iii ◽  
Curative Intent

Abstract Background Colorectal cancer is the third most common type of cancer in the world. We characterize a cohort of patients who survived up to 5 years without recurrence and identify factors predicting the probability of cure. Methods We analyzed data of patients who underwent curative intent surgery for stage I–III CRC between 2007 and 2012 and who had had been included in a large multicenter study in the Netherlands. Cure was defined as 5-year survival without recurrence. Survival data were retrieved from a national registry. Results Analysis of data of 754 patients revealed a cure rate of 65% (n = 490). Patients with stage I disease and T1- and N0-tumor had the highest probability of cure (94%, 95% and 90%, respectively). Those with a T4-tumor or N2-tumor had the lowest probability of cure (62% and 50%, respectively). A peak in the mortality rate for older patients early in follow-up suggests early excess mortality as an explanation. A similar trend was observed for stage III disease, poor tumor grade, postoperative complications, sarcopenia, and R1 resections. Patients with stage III disease, poor tumor grade, postoperative complications, sarcopenia, and R1 resections show a similar trend for decrease in CSS deaths over time. Conclusion In the studied cohort, the probability of cure for patients with stage I–III CRC ranged from 50 to 95%. Even though most patients will be cured from CRC with standard therapy, standard therapy is insufficient for those with poor prognostic factors, such as high T- and N-stage and poor differentiation grade.

scholarly journals Conditional Survival and Cure of Patients With Colon or Rectal Cancer: A Population-Based Study

2020 ◽  
Vol 18 (9) ◽  
pp. 1230-1237 ◽  
Author(s):  
Seyed M. Qaderi ◽  
Paul W. Dickman ◽  
Johannes H.W. de Wilt ◽  
Rob H.A. Verhoeven
Keyword(s):  
Rectal Cancer ◽  
Colon Cancer ◽  
Population Based ◽  
Stage I ◽  
Stage Iii ◽  
Disease Stage ◽  
Conditional Survival ◽  
Population Based Study ◽  
Pathologic Stage ◽  
Number Of Patients

Background: The increasing number of colorectal cancer (CRC) survivors need survival estimates that account for the time already survived. The aim of this population-based study was to determine conditional survival, cure proportions, and time-to-cure (TTC) of patients with colon or rectal cancer. Materials and Methods: All patients with pathologic stage I–III CRC treated with endoscopy or surgery, diagnosed and registered in the Netherlands Cancer Registry between 1995 and 2016, and aged 18 to 99 years were included. Conditional survival was calculated for those diagnosed before and after 2007. Cure proportions were calculated using flexible parametric models. Results: A total of 175,384 patients with pathologic stage I (25%), II (38%), or III disease (37%) were included. Conditional 5-year survival of patients with stage I, II, and III colon cancer having survived 5 years was 98%, 94%, and 92%, respectively. For patients with stage I–III rectal cancer, this was 96%, 89%, and 85%, respectively. Statistical cure in patients with colon cancer was reached directly after diagnosis (stage I) to 6 years (stage III) after diagnosis depending on age, sex, and disease stage. Patients with rectal cancer reached cure 0.5 years after diagnosis (stage I) to 9 years after diagnosis (stage III). In 1995, approximately 42% to 46% of patients with stage III colon or rectal cancer, respectively, were considered cured, whereas in 2016 this percentage increased to 73% to 78%, respectively. Conclusions: The number of patients with CRC reaching cure has increased substantially over the years. This study’s results provide valuable insights into trends of CRC patient survival and are important for patients, clinicians, and policymakers.

Patterns of lung cancer in people living with human immunodeficiency virus (HIV): A retrospective, single-center study in Washington, D.C.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21154-e21154
Author(s):  
Margaret Pruitt ◽  
Rajesh Naidu Janapala ◽  
Faysal Haroun
Keyword(s):  
Lung Cancer ◽  
Late Stage ◽  
Early Stage ◽  
Primary Lung Cancer ◽  
Large Cell ◽  
Molecular Data ◽  
Stage I ◽  
Stage Iii ◽  
Small Cell Lung ◽  
Neuroendocrine Cancer

e21154 Background: Lung cancer is the leading cause of cancer death and the most common non-acquired immune deficiency syndrome defining malignancy in people living with HIV (PLWH). Disparities in outcomes have been observed despite lung cancer mortality reportedly decreasing in the general population over the last decade due to lower rates of smoking and the advent of novel therapies. To better understand the current trend in lung cancer in PLWH, we explored demographic characteristics, comorbidities, and lung cancer pathology and molecular data in this population. Methods: A retrospective search of patient charts was conducted from 2004 to January 2021 using billing codes for HIV and primary lung cancer. Patients who had incorrect HIV or primary lung cancer diagnoses were excluded. Results: The search yielded 45 patients, of which 11 were excluded as described above: 66% were males, 82% African American, and 18% Caucasian. About two-thirds of patients were living in zip codes with predominantly low to medium household incomes. The median pack years of patients diagnosed with Stage I or II non-small cell lung cancer (NSCLC) was 40, Stage III or IV NSCLC was 20, early stage small cell lung cancer (SCLC) was 30, and late stage SCLC was 60. The median time between HIV and lung cancer diagnoses was 21.7 years for Stage I or II NSCLC, 17.1 years for Stage III or IV NSCLC, 15.2 for early stage SCLC, and 13.3 for late stage SCLC. Of 26 patients with viral load (VL) data, 21 (80.7%) had VL less than 500 when lung cancer was diagnosed. Of the 33 charts with available pathology data, there were 16 adenocarcinomas, 6 squamous carcinomas, 3 adenosquamous carcinomas, 1 large cell neuroendocrine cancer, 4 SCLCs, 1 mesothelioma, and 2 unspecified NSCLCs. Of 19 patients with a histologic grade, 11 had a high-grade tumor (57.9%). For the NSCLCs, 8 were Stage I (28.5%), 2 Stage II (7.1%), 8 Stage III (28.5%), 9 Stage IV (32.1%), and 1 with an unspecified stage. One SCLC was early stage and the remaining 3 were late stage. Five patients had brain metastasis. Molecular data or PDL-1 expression was available for 10 adenocarcinomas (62.5%), 1 adenosquamous (33%), 3 squamous carcinomas (50%), and the large cell neuroendocrine cancer. An EGFR mutation was detected in 2 cancers. ALK rearrangement was found in 1. Other mutations were detected. Two cancers were in each PDL1 expression category: < 1%, 1-50%, and > 50%. Conclusions: Our study suggests that PLWH with lung cancer continue to have high rates of smoking. Viral load was well controlled. A range in stages of lung cancer was observed including earlier stages. Although molecular data was limited, available EGFR and ALK gene alterations, and PD-L1 expression prevalence were on par with that of the general population. With advancements in lung cancer treatment, additional research is needed in the PLWH population to better understand and mitigate disparities.

Clinical pathways implementation in a community-based oncology practice: Real-world outcomes in patients with non-small cell lung cancer segmented by disease stage at diagnosis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18719-e18719
Author(s):  
Natalie R. Dickson ◽  
Karen Beauchamp ◽  
Toni S. Perry ◽  
Ashley Roush ◽  
Deborah Goldschmidt ◽  
...  
Keyword(s):  
Treatment Initiation ◽  
Clinical Pathways ◽  
Stage Iv ◽  
Treatment Patterns ◽  
Stage I ◽  
Stage Iii ◽  
Disease Stage ◽  
Stage At Diagnosis ◽  
Small Cell Lung ◽  
Stage Iv Disease

e18719 Background: Clinical pathways have been introduced as tools to optimize cancer care delivery, but evidence of their value in the real world is limited. This retrospective study was performed to assess treatment patterns and clinical outcomes in patients with non-small cell lung cancer (NSCLC) before and after pathway implementation at Tennessee Oncology (TO). Methods: Chart data were abstracted for patients (≥18 years) diagnosed with Stage I-IV NSCLC who initiated first-line (1L) systemic treatment at a TO clinic and had follow-up for ³6 months or until death. Patients were divided into two cohorts: pre-pathways (treatment initiation 2014–2015) and post-pathways (treatment initiation 2016–2018). Patient characteristics, treatment patterns, and outcomes were described and compared across cohorts. An exploratory study endpoint was the evaluation of outcomes based on disease stage at diagnosis. Results: Among 501 patients (251 pre-pathways and 250 post-pathways), most had advanced or metastatic NSCLC at diagnosis (Stage III: 40%; Stage IV: 42%). Chemotherapy comprised almost all 1L systemic therapy used pre-pathways (Stage I/II: 100%; Stage III: 96%; Stage IV: 83%). Post-pathways, chemotherapy remained the most common 1L therapy in patients with Stage I/II (89%) and Stage III (72%) disease, but among patients with Stage IV disease, use of chemotherapy decreased (47%) and immuno-oncology (IO) therapy alone or in combination became common (45%). Median duration of 1L therapy was longer post-pathways in patients with Stage III (2.1 months vs 1.4 months pre-pathways; P < 0.01) and Stage IV disease (3.3 months vs 2.3 months pre-pathways; P < 0.01) but did not differ among Stage I/II patients. Median progression-free survival was significantly longer post-pathways in patients with Stage IV disease (7.0 months vs 4.2 months pre-pathways; P < 0.05), but not in other disease-stage subgroups. Median overall survival increased non-significantly post-pathways for all disease stage subgroups (Stage I/II: 26 months vs 20 months pre-pathways; Stage III: 26 months vs 20 months; Stage IV: 10 months vs 9 months). For each disease stage, rates of severe adverse events were similar between cohorts. Conclusions: While outcomes for patients diagnosed with Stage III/IV NSCLC were generally improved following the implementation of clinical pathways, this change coincided with a dramatic shift in available treatment options. Improvements post-pathways were mainly observed in patients diagnosed with advanced disease. Thus, differences in outcomes between pre-pathways and post-pathways cohorts in our study are more likely attributable to other evolving practices in cancer care, particularly the availability of newer, more effective treatments such as IO therapy as part of standard practice, than implementation of the clinical pathways.

QIM19-124: Does Virtual Navigation Improve Care Continuity and Compliance in Patients With Early Stage Colon Cancer?

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM19-124
Author(s):  
Dayna Crawford ◽  
Brook Blackmore ◽  
Jeremy Ortega ◽  
Erica Williams
Keyword(s):  
Colon Cancer ◽  
Cancer Patients ◽  
Early Stage ◽  
Stage I ◽  
Stage Iii ◽  
Nccn Guidelines ◽  
Care Continuity ◽  
Colon Cancers ◽  
Follow Up Care

Background: Colon cancer is the 3rd most common cancer in men and women combined, with an occurrence rate of 4.49% for men and 4.15% for women. The 2018 expectation is 50,630 deaths related to colon cancer in the United States (American Cancer Society Facts and Figures 2018). Early detection is increasing with nearly 45% of colon cancers diagnosed as stage I/II (Sarah Cannon Cancer Registry 2015). Treatment for early stage I/II colon cancer patients usually involves surgery then surveillance. On-site navigators perform their duties by patient need and barriers to care. Late stage III/IV colon cancer patients require more assistance and face more barriers, which often leaves early stage I/II patients without an advocate. This disparity can lead to lower rates of follow-up care for early stage I/II patients. Sarah Cannon created a program for virtual colon navigation (VCN) to determine if early stage I/II patients benefit from a virtual navigator who offers support by phone throughout their disease process. Objectives: The goal was to increase early stage I/II patients’ knowledge of their cancer and convey the importance of compliance with follow-up care, such as repeat colonoscopy as recommended by their physician and NCCN Guidelines. Methods: By developing software that utilizes artificial intelligence, Sarah Cannon created an automated process to identify colon cancer patients at the time of diagnosis. This technology then routes positive pathology reports to a VCN who contacts the early stage I/II patients by telephone, ensuring patient connection to the suitable physician for treatment. The VCN helps patients understand their diagnosis, provides education, assesses barriers to care, connects to resources, provides emotional support, and offers assistance with follow-up for physician visits, imaging and procedures such as colonoscopies, based upon NCCN Guidelines and physician guidelines. The VCN also connects stage III/IV patients with an on-site navigator in their region for more hands-on navigation. Results: Through September 2018, Sarah Cannon navigated 734 colon cancers, 332 stage I/II and 402 stage III/IV. With our increased capacity, Sarah Cannon/HCA maintained a 98% rate of follow-up care with new diagnoses of all stages of colon cancer. Conclusions: The VCN program allowed Sarah Cannon/HCA to improve care continuity and compliance based upon NCCN Guidelines for early stage I/II colon cancer patients throughout 5 regions and 37 facilities.

Characteristics and outcomes of extranodal NK/t-cell lymphoma (ENKL): A North American (NA) multi-institutional experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8060-8060
Author(s):  
Lauren Shizue Maeda ◽  
Jessica L. Geiger ◽  
Kerry J. Savage ◽  
Jim Rose ◽  
Lauren C. Pinter-Brown ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
Early Stage ◽  
Combined Modality Therapy ◽  
Progression Free Survival ◽  
T Cell Lymphoma ◽  
Stage I ◽  
Stage Iii ◽  
Cell Transplant ◽  
Early Stage Disease

8060 Background: ENKL is a rare and aggressive subtype of peripheral T-cell lymphoma. Due to its geographic predilection there is a paucity of data on clinical experiences from non-Asian countries. The purpose of this study was to analyze characteristics and outcomes of patients (pts) with ENKL identified from major academic centers in NA. Methods: Pts with newly diagnosed CD56+ ENKL were retrospectively identified. Analyses included disease characteristics, ethnicity, therapy, and outcomes. Results: 115 pts (63.5% Caucasian, 20% Asian, 16.5% other) were identified across 10 centers diagnosed between 5/1990-5/2011 (Era 1: pre-2000, n=16; Era 2: 2000-2005, n=45; Era 3: post-2005, n=54). Median age was 52 years (19-88). 75 (65%) had stage I/II disease and were treated with combined modality therapy (CMT) n=48, chemotherapy (CT) n=14 or radiotherapy (RT) n=14. 40 pts had stage III/IV disease and were treated with CT (n=23), CMT (n=12) or RT (n=5). CT regimens used alone or in CMT were either anthracycline-based (n=68) or other (n=29). 63% of stage I/II pts and 40% with stage III/IV achieved complete remission (CR). 30 pts underwent a stem cell transplant (SCT); 14 in first CR and 16 at progression/relapse (autologous, n=21; allogeneic, n=9). Pts with stage I/II disease had a better progression-free survival (PFS) and overall survival (OS) compared with stage III/IV (12 vs 5.2 months (p=0.003) and 41.5 vs 8.9 months (p<0.0001), respectively). For all stages, treatment with CMT compared with CT or RT alone was also associated with better PFS and OS, 18.0 vs 3.9 months (p<0.0001), and 41.5 vs 10.2 months (p=0.002) respectively. Non-anthracycline-based regimens were associated with better PFS (p=0.001) and OS (p=0.045). No survival differences were seen between Asian and non-Asian pts. Conclusions: This series represents one of the largest experiences of ENKL in NA. Our data are consistent with Asian studies in: 1) majority of pts present with early stage disease; 2) overall poor outcome; 3) superiority of CMT and non-anthracycline regimens. Advances in understanding biology and international collaborative efforts are required to improve outcome in this rare entity.

Practice patterns in the use of adjuvant therapy for post-menopausal early-stage breast cancer in the pre- and post-Oncotype DX era.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e21032-e21032
Author(s):  
Asma Latif ◽  
Alexander C. Small ◽  
Erin L. Moshier ◽  
Kerin B. Adelson ◽  
George Raptis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Hormonal Therapy ◽  
Practice Patterns ◽  
Early Stage ◽  
Predictive Biomarkers ◽  
Oncotype Dx ◽  
Stage I ◽  
Adjuvant Therapies ◽  
Gene Assay

e21032 Background: Personalized oncology offers the promise of selectively applying therapeutics to patients most likely to benefit, while sparing those unlikely to benefit from potentially toxic therapies. Oncotype DX is a 21-gene assay utilized to identify hormone-receptor positive (HR+), node negative, breast cancer (Br CA) patients who may be successfully treated with adjuvant hormonal therapy alone. We hypothesized that practice patterns with adjuvant therapy have changed since the commercial availability of Oncotype DX in 2004. Methods: The Public National Cancer Database was queried to identify patients age ≥ 50 with stage I or II Br CA diagnosed from 2000 to 2008. Patients were classified by adjuvant therapy including hormone, chemotherapy, hormone and chemotherapy, and no hormone or chemotherapy. Log-binomial regression was used to estimate prevalence ratios for the proportion of patients receiving adjuvant therapies from 2000-2003 compared to 2004-2008. Results: 833,018 patients age ≥ 50 with stage I or II Br CA were identified. The application of adjuvant therapies for the periods pre- and post-availability of Oncotype DX are detailed in the Table. Conclusions: There has been significant increase (13%) in the use of hormonal therapy alone as adjuvant therapy for patients age ≥ 50 with HR+ stage I-II Br CA since commercial availability of Oncotype DX. While this has been slightly offset by a decrease in the use of chemotherapy plus hormonal therapy, there has been a larger decrease in the use of “no adjuvant therapy”. Data regarding predictive biomarkers should be captured by registries in an effort to determine the true impact of these tests on treatment utilization. [Table: see text]

Neuroendocrine carcinoma of the cervix: A single institution’s experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15585-e15585
Author(s):  
Megan Preston ◽  
Georgia Anne-Lee McCann ◽  
David M. O'Malley ◽  
Christina Boutsicaris ◽  
Larry J. Copeland ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Metastatic Disease ◽  
Survival Data ◽  
Early Stage ◽  
Stage I ◽  
Stage Ii ◽  
Advanced Stage ◽  
Single Institution ◽  
Early Stage Disease ◽  
Stage Disease

e15585 Background: Neuroendocrine carcinomas (NEC) of the cervix comprise only 2% of all cervical cancers. As a result, prospective data is limited and treatment guidelines rely on literature from lung NEC. The objective of this study was to examine and report on our experience in the management of this rare, aggressive disease. Methods: This was an IRB-approved, single-institution, retrospective review. Study criteria included patients with cervical NEC diagnosed between 1990-2011. Demographic, treatment and survival data was collected. Progression-free survival (PFS) and overall survival (OS) was defined as the time from date of initial treatment until progression or death respectively, or date of last contact. Results: A total of 24 patients met inclusion criteria. The median age at diagnosis was 43. Median PFS was 13.6 months and median OS was 16.4 months. The majority of patients had advanced-stage disease (61% stage II-IV, 39% stage I). Of the 9 patients with stage I disease, 4 were treated with platinum + etoposide-based neoadjuvant chemotherapy and 5 were treated with initial radical surgery. Seven of the 9 patients had post-operative adjuvant therapy consisting of chemotherapy, chemo-radiation or radiation only. Seven of the 9 patients (78%) were alive at last follow-up. Of the two patients who were deceased, one had metastatic disease found at surgery and the other declined adjuvant therapy and died of recurrence. Patients with stage II-IV disease (n=15) had a median PFS and OS of 11.5 and 12.1 months, respectively. Only 2 had no evidence of disease at last encounter. The remainder died without achieving remission. Patients with metastatic disease had significantly worse survival when compared to those with loco-regional disease with a median OS of 8 vs. 28 months (p = .03), respectively. Conclusions: We report one of the largest single-institution experiences of neuroendocrine cervical cancer. Advanced-stage patients had a poor prognosis regardless of therapy. However, multi-modality therapy in early-stage disease resulted in an excellent prognosis (78% survival) for these rare, highly aggressive tumors. These findings support the goal of curative intent for early-stage disease using multi-modality therapy.

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