Colorectal carcinoma (CRC) management approach in octogenarians and over a single institute experience.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 575-575
Author(s):  
Emmet Jordan ◽  
Amy Murphy ◽  
Seamus Coyle ◽  
Miriam O Connor ◽  
Paula Calvert ◽  
...  
Keyword(s):  
Performance Status ◽  
Single Agent ◽  
Stage Iv ◽  
Stage Iii ◽  
Management Approach ◽  
Ageing Population ◽  
Single Institution ◽  
Co Morbidity ◽  
Stage Iv Disease ◽  
Clinical Tools

575 Background: The incidence of CRC increases with age. Future numbers are projected to rise due to an ageing population. Little data exists on chemotherapy in those ≥80 years (yrs) with CRC, a subgroup rarely included in clinical trials. The purpose of this study was to evaluate chemotherapy use, feasibility and tolerability in patients ≥80 yrs with CRC in a single institution. Methods: CRC diagnosed in those ≥80 yrs in a single institution in Ireland , from 2004 -2009, was determined. Clinicopathological data collected included age, gender, morphology, stage, and treatment including surgery, radiation or chemotherapy. In those receiving chemotherapy tolerance was determined by dose delays, reductions and number of completed cycles. Results: 83 cases of CRC were identified; 80-89 yrs (n=78), 90-100 yrs (n=5). Median age was 84 yrs (range 80-102), 38/83 (45.8%) were female. 59 cases of colon and 24 cases of rectal cancer were seen. Stage at diagnosis included IV (n=18), III (n=21), II (n=38) and I (n=6). For stage IV disease 4/18 (22%) received chemotherapy. Median overall survival for those with stage IV disease who received chemotherapy was 317 days (range 64-487) versus 169 days (range 30-473) for supportive care. 3/21(14%) stage III patients received chemotherapy. Median survival for stage III disease who received chemotherapy was 1193 days (range 432-1640) compared to 641 days who did not (range 0-1640). All patients with stage IV disease received single agent (SA) treatment (capecitabine n=3, cetuximab n=1). Treatment of stage III disease included: XELOX n=1, 5Fluorouracil/Leucovorin n=1, capecitabine n=1). 3/6 (50%) had dose reductions (n=4) and delays (n=7) in treatment. 1 patient completed scheduled adjuvant treatment. 1 patient with metastatic disease received second and third line treatment (SA irinotecan, cetuximab). Data including performance status, co morbidity will be presented. Conclusions: The uptake of chemotherapy in this cohort is low. Although the rates of treatment modifications are high, those treated appear to benefit. Better clinical tools are needed to differentiate those older patients likely to benefit from systemic therapy and those better served by supportive measures alone.

Sequencing of single-agent (SA) docetaxel (T) and gemcitabine (G) therapy for patients (pts) with advanced non-small cell lung cancer (NSCLC): Results of three consecutive randomized trials

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7035-7035
Author(s):  
C. Manegold ◽  
N. Thatcher ◽  
C. Kortsik ◽  
G. Koschel ◽  
J. Mezger ◽  
...  
Keyword(s):  
Randomized Trials ◽  
Response Rate ◽  
Performance Status ◽  
Single Agent ◽  
Stage Iv ◽  
Time To Progression ◽  
Eligibility Criteria ◽  
Stage Iv Disease ◽  
Line Setting ◽  
To Receive

7035 Background: Standard doublet chemotherapy (DCT) is often clinically inappropriate. Since T and G show efficacy and favourable toxicity as SAs in 1st- and 2nd-line setting, sequencing of T and G may be an equally effective alternative to DCT for palliation. Three studies (S1-S3) were conducted: two to identify an optimal SA-sequence (S1/S2), and one to compare sequential SA to a platin-free doublet (S3). Methods: Common eligibility criteria included histologically confirmed stage IIIB or IV, performance status (PS) 0–2, and no prior chemotherapy. S1/S2 examined treatment feasibility (TF) of G or T with introduction of the opposite agent in case of progression. TF was defined as pt ability to receive ≥2 cycles (cyc) of 1st-line and if progressive ≥2 cyc of 2nd-line therapy and to survive ≥7 months (mos). In S1, G 1000 mg/m2 and T 35 mg/m2 was given on days (d) 1, 8, 15 (q4w) and in S2, G 1250 mg/m2 (d 1, 8) and T 100 mg/m2 (d 1; q3w). In S3, pts received G 1000 mg/m2 (d 1, 8) and T 75 mg/m2 (d 1; q3w) either concomitantly (G+T; 6 cyc) or sequentially (G→T; 3 cyc each). Primary endpoint of S3 was clinically relevant haematotoxicity (CRHT) defined as thrombocytopenia with platelet transfusions, anaemia with RBC-transfusions or febrile neutropenia with i.v. antibiotics (IVAB). Results: 819 pts were included (1998–2004): 85% of pts had stage IV disease and PS≤1. In S1 and S2 for (G→T)/(T→G) respectively: TF was 28/20% and 38/49% (p=.04); median survival (MS) was 9.0/5.0 mos (p=.03) and 6.3/8.6 mos; and median time to progression (TTP) was 4.3/2.2 mos and 2.4/3.3 mos. In S3, CRHT occurred less frequently with SA therapy (p<.001), transfusions and IVAB treatment days were less common. QoL also favoured SA therapy. For (G+T)/(G→T), MS was 7.3/7.4 mos, response rate was 33/22% (p=.05) and TTP was 6.3/4.9 mos (p=.04). Conclusions: Sequencing modern SA was effective and well tolerated. Weekly T and G regimens seem less feasible than 3-weekly but compared to the nonplatinum doublet CRHT and IVAB are reduced with better QoL and cost-effectiveness. [Table: see text]

Ten-year follow-up of patients receiving cisplatin, doxorubicin, and cyclophosphamide chemotherapy for advanced epithelial ovarian carcinoma.

1989 ◽  
Vol 7 (2) ◽  
pp. 223-229 ◽  
Author(s):  
G P Sutton ◽  
F B Stehman ◽  
L H Einhorn ◽  
L M Roth ◽  
J A Blessing ◽  
...  
Keyword(s):  
Ovarian Carcinoma ◽  
Survival Data ◽  
Single Agent ◽  
Stage Iv ◽  
Epithelial Ovarian Carcinoma ◽  
Stage Iii ◽  
Second Look ◽  
Stage Iv Disease ◽  
The Difference

Fifty-six patients were randomly assigned to receive either one-day cisplatin, doxorubicin, and cyclophosphamide (PAC) chemotherapy (PAC-I) or five-day PAC (PAC-V) for advanced epithelial ovarian carcinoma. Follow-up has been 120+ months or to death. Ninety-one percent had either suboptimal stage III or stage IV disease and 55% had grade 2 or 3 lesions. Two patients died of toxicity and were free of disease at autopsy. A third patient died of congestive heart failure with no disease at 103 months. Additionally, eight patients had a negative second-look laparotomy, and three (37.5%) are alive with no evidence of disease (NED) 133 to 144 months after diagnosis. Five patients (62.5%) died of disease 2 to 123 months after negative second-look. Patients with optimal stage III disease had a longer median progression-free interval (PFI) and survival (33.3 and 44.5 months, respectively) than those with suboptimal or stage IV disease (16.4 and 22.5 months, respectively), and the difference in median PFI is significant (P less than .02). Patients with ascites at diagnosis had a shorter median PFI and survival (14.7 and 18 months) than those without ascites (30.0 and 33.0 months). Both differences were significant (PFI, P less than .04; survival, P = .005). PAC produces response rates that are superior to those obtained historically with single-agent alkylating therapy. Late recurrences after negative second-look laparotomy suggest that 5-year survival data may be inadequate in ovarian carcinoma.

A study on thromboembolism of patients with pancreatic cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 262-262 ◽  
Author(s):  
Kwan Yu LAM ◽  
Kirsty Lee ◽  
Charing Chong ◽  
Anthony WH Chan ◽  
Tony Mok ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Metastatic Disease ◽  
Performance Status ◽  
Stage Iv ◽  
Stage Ii ◽  
Stage Iii ◽  
Chinese Patients ◽  
Pancreatic Cancers ◽  
Stage Iv Disease

262 Background: There have been studies on the association between thromboembolism (TE) and pancreatic cancer in Caucasian patients. This study aims to study the TE in Chinese patients with pancreatic cancer. Methods: This study retrospectively reviewed consecutive patients with confirmed diagnoses of pancreatic cancers from 2010-2015 in the Prince of Wales Hospital in Hong Kong. Patients with radiologically confirmed TE were identified. Corresponding information related to the type and site of TE were recorded. Predictive factors for the TE were studied by multivariate analysis. Results: Total 372 patients with pancreatic cancer were identified. In the cohort, the diagnoses of cancers were made by histology in 225 (60.5%) of them while others were made by radiology. The stage was as follows: 15 (4.1%) stage I; 113 (30.4%) stage II; 47 (12.7%) stage III and 196 (52.7%) stage IV. Total 55 (14.7%) patients had TE after diagnosis of pancreatic cancer. Of these 55 patients, 33 (60%) and 18 (32.7%) had venous and arterial events, respectively. For patients with TE, 27 (49.1%) were treated with anti-coagulants, and 13 (23.6%) had surgery within 2 years. The median time from surgery to the development of TE was 1.06 years. Patients with ECOG ≥2 and metastatic disease (HR 2.92, 95% CI 1.58-5.37; HR 6.90, 95% CI 3.63-13.14 respectively) had a higher risk of developing TE. Patients with venous, arterial, or both types of TE did not have significantly different overall survival. Poor prognostic factors for overall survival include ECOG ≥2 (HR 2.80, 95% CI 2.18-3.60) and tumour stage (stage II disease HR 1.36, 95% CI 0.70-2.62; stage III disease HR 1.85, 95% CI 0.92-3.70; stage IV disease HR 4.92, 95% CI 2.58-9.36). The presence of TE equated to a worse overall survival (median overall survival 148 vs. 228 days, HR 1.03, 95% CI 0.75-1.40, P=0.87), which was statistically insignificant. Conclusions: TE was similarly high in Chinese patients with pancreatic cancer. Patients with poorer performance status and metastatic disease had a greater risk of developing TE. Patients with TE had a worse overall survival (which was statistically insignificant) compared to patients without TE.

Colorectal cancer (CRC) among very elderly ( > 80 yo) patients (pts): A Brazilian single institution cohort.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 507-507 ◽  
Author(s):  
Marcela Crosara Alves Texeira ◽  
Kelsen Moura ◽  
Pedro Cabral ◽  
Suelen Medeiros Silva ◽  
Allan Andresson Lima Pereira ◽  
...  
Keyword(s):  
Single Agent ◽  
Stage Iv ◽  
Tumor Location ◽  
Single Institution ◽  
Very Elderly ◽  
First Line Therapy ◽  
Stage Iv Disease ◽  
Historic Data ◽  
Reported Data ◽  
Ecog Ps

507 Background: Approximately 60% of all cancers and 70% of the mortality occurs in pts aged 65 years and over. Despite that, there is a significant lack of evidence regarding the safety and efficacy of treatments for this part of the population. Our goal is to profile very elderly (VE) pts with gastrintestinal malignancies to highlight research opportunities and improve cancer care among this growing population. Methods: We retrospectively analyzed very elderly pts that attended at Sírio Libanês Hospital in Brazil in a 3 year period and had colorrectal cancer (CRC) diagnosed. We collected information from electronic medical charts on age, gender, ECOG-PS, staging, and surgery. We also gathered information about the type of treatment and survival from diagnosis. Results: Of 88 consecutive VE GI cancer pts, 40 (45,4%) were found to have CRC being 29 colon and 11 rectum. 14 patients were considered to have right sided tumors and 26 left sided. Among CRC pts, the median age was 82, 5 yo and 21 (52.5%) were men. ECOG-PS at diagnosis was 0/1 in 29pts, 19 (47.5%) presented as stage IV disease and 27 pts had surgery of the primary site. As treatment 23(57.5%) received chemotherapy, being 4 adjuvant and 19 palliative. Single agent fluoropyrimidine was the first line therapy in 47%, chemotherapy doublet in 42%, 26% pts received anti-VEGF. Six patients with rectal cancer received chemoRT. The median survival among the stage IV CRC pts was 27.5ms. Conclusions: This cohort is one of the few reported data on VE population cancer, the incidence of cancer in this age group is high and deserve to be more characterized in both trials and retrospective data. Interestingly, those patients seem to benefit from treatments likewise historic data from average age patients. Treatment details, tumor location, pathology, and survival curves will be presented.

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.

T-cell lymphomas: immunologic, histologic, clinical, and therapeutic analysis of 63 cases.

1988 ◽  
Vol 6 (10) ◽  
pp. 1584-1589 ◽  
Author(s):  
B Coiffier ◽  
F Berger ◽  
P A Bryon ◽  
J P Magaud
Keyword(s):  
T Cell ◽  
Clinical Presentation ◽  
Performance Status ◽  
Stage Iv ◽  
Poor Performance ◽  
Large Cell ◽  
Response To Therapy ◽  
Poor Performance Status ◽  
T Cell Lymphomas ◽  
Stage Iv Disease

Sixty-three patients with T-cell lymphoma (TCL) were analyzed to correlate morphological and immunological features with clinical presentation, response to therapy, and survival. Clinical presentation was severe, with 59% of patients having stage IV disease, 60% B symptoms, 35% poor performance status, 44% large tumoral mass, and 40% a high number of extranodal localizations. Morphological subtypes were small-cell in four cases, diffuse-mixed in 29 cases, monomorphic medium-sized in two cases, immunoblastic in 21 cases, anaplastic large-cell in four cases, and unclassified in three cases. Immunological phenotypes were immature T in 11 cases, CD4 in 26 cases, CD8 in 13 cases, and undefined (CD4 + CD8) in ten cases. Response to therapy was poor except for the 39 patients treated by an intensive and sequential regimen (non-Hodgkin's lymphoma [LNH]-80 or LNH-84) that gave a 77% complete remission (CR) rate with a 23% relapse rate. Median survival was 35 months. No correlation was found between morphological subtypes and other variables. Helper (CD4) phenotype seemed to have a better prognosis than other phenotypes. Variables associated with long survival for all the patients were localized disease and absence of large tumoral mass and for the subgroup of patients treated by the LNH regimens CD4 phenotype, absence of B symptoms, absence of a large tumoral mass, and less than two extranodal sites of disease.

Prognostic factors and outcome of incompletely resected invasive thymoma following radiation therapy.

1994 ◽  
Vol 12 (7) ◽  
pp. 1484-1490 ◽  
Author(s):  
I F Ciernik ◽  
U Meier ◽  
U M Lütolf
Keyword(s):  
Survival Rate ◽  
Spindle Cell ◽  
Local Treatment ◽  
Stage Iv ◽  
Local Tumor Control ◽  
Stage Iii ◽  
Tumor Control ◽  
Invasive Thymoma ◽  
Local Tumor ◽  
Stage Iv Disease

BACKGROUND Stage III and stage IV thymomas with significant macroscopic infiltration to the neighboring structures are rarely completely resectable. It therefore remains unclear to what extent tumors must be surgically debulked to improve prognosis. PATIENTS AND METHODS We reviewed the cases of 31 patients with incompletely resected invasive thymoma and residual macroscopic disease who were referred to postoperative irradiation. Survival and local tumor control were analyzed. All patients were treated between 1958 and 1990 with megavoltage irradiation at doses ranging from 42 to 66 Gy. The shortest follow-up time for living patients was more than 5 years. RESULTS The overall median 5-year survival rate was 45%. Eighteen stage III patients had a 5-year survival rate of 61% and a 10-year survival rate of 57%. Thirteen patients had stage IV disease and 5- and 10-year survival rates of 23% and 8%, respectively. Univariate and multivariate analyses confirmed a worse prognosis for stage IV disease. Epithelial or spindle-cell thymoma was associated with stage IV disease. Twenty-two percent of patients with stage III disease had epithelial or spindle-cell thymoma, versus 69% of patients with stage IV disease (P = .02 for univariate and P = .05 for multivariate analysis). Initial tumor diameter greater than 10 cm correlated with poor prognosis in the univariate analysis (P = .05). However, more importantly, debulking of tumor did not significantly improve outcome when compared with patients who received biopsy only. The median survival rate of patients with stage IVa disease did not differ from that of those with stage IVb disease. Mediastinal control was achieved in 23 patients (74%). Stage IV disease did not correlate with an increase in local treatment failure after irradiation, although epithelial or spindle-cell thymoma predisposed for local treatment failure (46% v 11%; P = .04 in univariate and P = .055 in multivariate analysis). CONCLUSION Tumor debulking leaving macroscopic residual thymoma, as opposed to biopsy alone, does not improve prognosis when followed by radiation. Radiation therapy for local tumor control is most effective in nonepithelial-predominant thymomas.

Follicular lymphoma: prognostic factors for response and survival.

1986 ◽  
Vol 4 (10) ◽  
pp. 1470-1480 ◽  
Author(s):  
C J Gallagher ◽  
W M Gregory ◽  
A E Jones ◽  
A G Stansfeld ◽  
M A Richards ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Poor Prognosis ◽  
Single Agent ◽  
Stage Iv ◽  
Poor Response ◽  
Stage I ◽  
Stage Ii ◽  
Response To Treatment ◽  
Stage Iv Disease ◽  
Short Courses

One hundred forty-eight patients with newly diagnosed follicular lymphoma were treated over a 12-year period. Twenty-two patients received radiotherapy for stage I and II disease, followed by adjuvant chemotherapy in 14 patients. One hundred thirteen were treated at presentation with short courses of chemotherapy, most often with single-agent chlorambucil for bulky stage II and stages III and IV disease. Thirteen patients were managed expectantly until there was evidence of disease progression. The median survival was 9 years. Patients treated with radiotherapy for stage I and II disease had an 83% relapse-free survival, but those with bulky stage II or stages III and IV disease treated with chemotherapy pursued a remitting and relapsing course with a 70% response rate at initial and subsequent retreatments, but a median duration of remission of 4 years in stage III and 1 year in stage IV disease (P = .041). Patients were observed in relapse and retreatment was administered as appropriate, once every 33 months on average. Poor prognosis patients could be identified by a combination of the presentation characteristics: B symptoms, hepatosplenomegaly, anemia, and abnormal liver function. These factors predicted a poor response to treatment and correlated with a short survival. Histologic subgroups were not associated with differences in survival, but transformation to a diffuse high-grade lymphoma was observed in 23 of the 72 patients (32%) at risk, with a median follow-up of 6 years and 6 months, and was associated with a very poor prognosis. The present treatment strategy has proved successful for most patients with localized disease and those older patients with indolent small volume disseminated follicular lymphoma. New approaches are being investigated for the younger poor prognosis patients.

Combination of Rituximab, Bortezomib and Hyper-Fractionated Cyclophosphamide (RBC) in “True” Elderly Patients with Advanced Mantle Cell Lympoma.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4448-4448 ◽  
Author(s):  
Roberto Guariglia ◽  
Giuseppe Pietrantuono ◽  
Oreste Villani ◽  
Maria Carmen Martorelli ◽  
Fiorella D’Auria ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Single Agent ◽  
Significant Proportion ◽  
Stage Iv ◽  
Elderly Subjects ◽  
High Dose ◽  
Molecular Response ◽  
Mantle Cell ◽  
Stage Iv Disease ◽  
Hodgkin's Lymphomas

Abstract Mantle-cell lymphoma (MCL) is recognized as a distinct clinico-pathologic entity, accounting for 3–10% of all non-Hodgkin’s lymphomas, with median overall survival not exceeding 3–4 years. Patients with MCL are typically older adults with a male predominance and usually present with stage IV disease. The neoplastic cells are characterized as CD20+ CD5+ CD23−, with a t(11;14)(q13;q32) and cyclin D1 overexpression on immunohistochemistry. The current, most diffused regimens for the treatment of MCL include either R-CHOP or R-HyperCVAD, followed by autologous stem cell transplantation or observation, depending on the patient’s eligibility. However, considering that MCL is frequently diagnosed in elderly subjects with relevant co-morbidities, high dose chemotherapy or the use of drugs with potential cardiotoxicity, such as anthracyclines, may result not feasible in a significant proportion of patients. In this setting, recent data suggest that the proteasome inhibitor bortezomib is well tolerated and has significant single-agent activity in patients with MCL. Thus, we evaluated safety and efficacy of the RBC regimen, a 21-day cycle, anthracycline-free combination of rituximab (375 mg/m(2) on day 1), bortezomib (1.3 mg/m(2) on days 1, 4, 8, and 11) and hyper-fractionated cyclophosphamide (600 mg/m(2)/d given as a double, three-hour infusion on days 1–3) in “true” (≥ 75 year-old) elderly patients with advanced MCL. Diagnosis was made according to standard histological, phenotypic and molecular criteria. The results of an early analysis on feasibility in the first six patients enrolled (3 male, 3 female) are reported here. Mean age was 79.8 years (range 75–84). All patients had stage IV disease, evidencing extranodal localizations (n. 2) or marrow/leukemic involvement (n. 4). IPI score was 2 in three patients, 3 in two patients and 4 in one patient. Three patients received RBC as first line therapy, the others were treated at relapse after (R)-CHOP- like regimens. Hematological toxicities consisted in grade 1 (n. 2) and grade 2 (n. 1) thrombocytopenia, while one patient experienced grade 3 neutropenia, requiring G-CSF support. No extra-hematological toxicities higher than grade 1 were observed. Full doses of RBC were constantly administered. One patient, who presented with a WBC count > 200.000/μl, died during the first cycle due to progressive disease; another patient showed an initial response in extranodal sites and then progressed before the fourth planned cycle. The remaining four patients received six cycles: one patient achieved a partial response and three obtained a complete response, one of whom showing a molecular remission using PCR for t(11;14) bcl-1/IgH determination. All responders (66.6%) maintain their remission phase 7–10 months after the start of RBC treatment. Although very preliminary, these results indicate that RBC regimen is feasible, well tolerated and may be effective (including the possibility to obtain molecular response) in very elderly patients with advanced MCL. Larger and more mature data will be presented at the Meeting.

Limited Benefit Gained From Inferior Vena Cava Filter Insertion In Patients With Advanced-Stage Cancer

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1147-1147
Author(s):  
Asem Mansour ◽  
Yousef Ismael ◽  
Hikmat Abdel-Razeq
Keyword(s):  
Cancer Patients ◽  
Survival Data ◽  
Vena Cava ◽  
Stage Iv ◽  
Stage Iii ◽  
Advanced Stage ◽  
Ivc Filter ◽  
Filter Placement ◽  
Stage Iv Disease ◽  
Filter Insertion

Abstract Introduction Cancer and its treatment are recognized risk factors for venous thromboembolism (VTE). Inferior Vena Cava (IVC) filters are utilized to provide mechanical thromboprophylaxis to prevent pulmonary embolism (PE) or to avoid bleeding from systemic anticoagulation in high risk patients. Patients and Methods This study was performed at a stand-alone, Joint Commission International (JCI)-accredited comprehensive cancer center. Hospital database was searched for all patients discharged with IVC filter insertion. Additionally, the radiology database was queried for cancer patients undergoing IVC filter placement. Results A total of 107 cancer patients; 59 (55.1%) males and 48 (44.9%) females who had their IVC filter inserted and followed up at our institution were included. The mean age (±SD) of the whole group was 50.8 (± 14.2) years. All patients had active cancer; the most common primary sites were gastrointestinal 32 (29.9%), brain 16 (15.0%) lung 13 (12.1%) and gynecological tumors 11 (10.3%). Majority of the patients had advanced-stage disease; out of 86 patients with identifiable TNM stage (Tumor, Node, Metastasis), 81 (94.2%) patients had locally-advanced stage III or metastatic stage IV disease, whereas only 5 (5.8%) had stages I or II disease. During the 6 weeks prior to IVC filter placement, 74 (69.2%) patients were on active anticancer therapy with 45 (42.1%) were on chemotherapy and 7 (6.5%) were on radiotherapy. Nineteen (17.8%) of the patients had surgical intervention for their cancer while only 3 (2.8%) were on hormonal therapy. The remaining 33 (30.8%) patients were on hospice and palliative care service with 18 (16.8%) were already placed “DNR” (Don't Resuscitate). Prior to IVC filter insertion, a diagnosis of DVT was made on 76 (71.0%) patients while 14 (13.1%) had PE; the other 17 (15.9%) had both DVT and PE. Contraindication to anticoagulation was the main indication for IVC filter placement reported in 85 (79.4%), while 18 (16.8%) had their filter inserted because of failure of anticoagulation (had DVT and/or PE while on therapeutic doses of anticoagulation). Other indications included large, free-floating iliocaval thrombus and poor compliance with anticoagulation. Filters were placed utilizing the jugular approach in 86 (80.3%) while 18 (16.8%) had their filter placed through a femoral approach. Complications following IVC filter placement occurred in 14 (13.1%); majority were recurrent DVT in 10 (9.3%), PE in 3 (2.8%) and filter thrombosis in one patient. Following IVC filter insertion, 42 (39.3%) were also anticoagulated; majority (86%) with LMWH (enoxaparin or tinzaparin). Twenty (47.6%) of these anticoagulated patients were considered, at the time of IVC filter insertion, as having a contraindication to anticoagulation. Survival data following IVC filter insertion was available for 100 patients. The median survival for the whole group was 2.39 months (range: 0.03-60.2). The median survival for patients with stage III and IV disease were 7.97 (1.90-17.08) and 1.31 months (0.92-2.20), respectively; p=0.0119; (Figure) Few patients had stage I and II disease (two had stage I while three others had stage II disease) and thus were excluded from survival analysis. Among the 59 patients with stage IV disease for whom survival data was available, 23 (39.0%) survived less than a month, while 40 (67.8%) survived less than three months. Survivals of patients with stage III disease were better with only one out of 20 patients (5.0%) survived less than a month, while 14 (70.0%) survived more than three months. Conclusions Cancer patients with advanced-stage disease may gain little benefit from IVC filter insertion, so disease stage and life expectancy should be taken in consideration prior to filter placement. Disclosures: No relevant conflicts of interest to declare.

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