Neoadjuvant and adjuvant, floxuridine, leucovorin, oxaliplatin, and docetaxel (FLOD) in patients with locally advanced operable gastroesophageal adenocarcinoma: A phase II study with pathologic responses and long term follow-up.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 124-124
Author(s):  
Bach Ardalan ◽  
Miriam Gombosh ◽  
Dido Franceschi ◽  
Eli Avisar ◽  
Danny Yakoub ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Neoadjuvant Therapy ◽  
Residual Disease ◽  
Locally Advanced ◽  
Pathological Response ◽  
Complete Pathological Response ◽  
Term Survival ◽  
Chemotherapy Patients

124 Background: A complete pathological response to neoadjuvant chemotherapy without the use of radiation has infrequently been reported in operable chemo-naïve stage III gastro esophageal adenocarcinoma patients. Methods: Twenty-nine patients were enrolled in this study. Neoadjuvant therapy consisted of Floxuridine, Leucovorin, Oxaliplatin, and Docetaxel and was administered in 2, four week cycles. Chemotherapy consisted on day one and day fifteen; Oxaliplatin, Docetaxel, FUDR, and Leucovorin. The latter two drugs were given concurrently over twenty four hours. On day eight, chemotherapy consisted of Docetaxel, FUDR, and Leucovorin. Following therapy, patients underwent surgical resection. Those patients having residual disease were offered adjuvant chemotherapy. Patients having a complete pathological response were not offered any further therapy. Results: Twenty-four out of twenty-nine patients completed neoadjuvant therapy and underwent esophagectomy. Two were declared inoperable after treatment. Three patients died prior to surgery. The median follow-up of all patients is now sixty months. The median overall survival has not been reached at sixty months. Five yr actual OS is 51%. Clinical response to neoadjuvant therapy was seen in (72.4%) patients. Complete pathological response to neoadjuvant therapy was seen in (16.7%) who are disease free at sixty month follow-ups. Seven out of twenty-four patients achieved partial pathological response (29.1%) and received adjuvant chemotherapy. They are all alive (100%). Eight patients achieved less than partial pathological response and received adjuvant chemotherapy, four out of eight are alive at sixty months (50%). Grade three and four toxicities were seen in sixteen out of twenty nine patients during neoadjuvant therapy. Grade three and four toxicities were seen in six out of fourteen patients during adjuvant therapy. Conclusions: Our chemotherapy regimen of Floxuridine, Leucovorin, Oxaliplatin and Docetaxel (FLOD) has resulted in long term survival in patients with adenocarcinoma of the esophagus. Clinical trial information: NCT00448760.

A controlled pilot study of high-dose methotrexate as postsurgical adjuvant treatment for primary osteosarcoma.

1984 ◽  
Vol 2 (3) ◽  
pp. 152-156 ◽  
Author(s):  
J H Edmonson ◽  
S J Green ◽  
J C Ivins ◽  
G S Gilchrist ◽  
E T Creagan ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adjuvant Chemotherapy ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Term Survival ◽  
Dose Methotrexate ◽  
Primary Osteosarcoma ◽  
Chemotherapy Patients ◽  
One Year

Thirty-eight patients whose primary extremity or limb girdle osteosarcomas had been completely excised (37 amputations, one limb sparing procedure) were allocated at random to two treatment groups receiving respectively regular follow-up examinations plus a high-dose methotrexate (HDMTX) regimen or regular follow-up without primary adjuvant chemotherapy. Although the vincristine, HDMTX, leucovorin regimen was generally quite tolerable when given at three-week intervals for one year and most of the chemotherapy patients followed the planned HDMTX dose escalations from 3 to 6 to 7.5 g/m2, delayed methotrexate excretion limited dosage escalations in 25%. An estimated 52% of the 38 patients were surviving five years after randomization and an estimated 42% remained continuously relapse-free after five years. No significant differences between the outcomes of the 20 treated and the 18 untreated patients were apparent; however, power to detect differences was low. Furthermore, no significant differences in postmetastasis survival were apparent between the 12 treated and 10 untreated patients who relapsed. Approximately 20% of these failing patients appear to have been salvaged for long-term survival. This pilot study of HDMTX confirms the continuing need for controlled clinical trials in determining the therapeutic value of adjuvant chemotherapy programs for patients with primary osteosarcoma.

Pancreas resection for unresectable locally advanced pancreatic cancer (LAPC): Resection rate in the era of FOLFIRINOX and GEM+nabPTX.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 317-317
Author(s):  
Shinichiro Takahashi ◽  
Masafumi Ikeda ◽  
Naoto Gotohda ◽  
Yuichiro Kato ◽  
Masaru Konishi
Keyword(s):  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Specific Treatment ◽  
Tumor Vessel ◽  
Resection Rate ◽  
Term Survival ◽  
Radio Therapy ◽  
Prospective Database

317 Background: Resection for unresectable LAPC after down-staging by chemo(radio)therapy sometimes leads to long-term survival in highly selected pts. However, neither the pts who have best possibility for resection nor resection rate according to the specific treatment were elucidated in LAPC. Methods: A retrospective single-institutional study. From a prospective database, 130 pts received any treatment for LAPC from Jan. 2010 to Mar. 2015 were identified. Main criteria for unresectability were tumor contact with superior mesenteric artery, celiac axis or common hepatic artery > 180°, aortic involvement, and unreconstructible portal vein /superior mesenteric vein due to marked invasion. All MDCT findings before and during treatment of 130 pts were reviewed to check the resectability by a surgeon. Conversion rate to resection according to treatment and situation of tumor-vessel contact before treatment were analyzed. Conversion was considered when tumor was down-staged to borderline resectability. Results: Of 130 pts, gemcitabine (GEM) was administered as initial treatment to 75; GEM and erlotinib to 18; modified FOLFIRINOX to 15; S-1 and concurrent radiotherapy (S1/RT) to 12; GEM and nab-paclitaxel (GEM+nabPTX) to 4; and other regimens to 6. Six patients underwent resection after down-staging. Of the 6 pts (4.6%), 4 received S1/RT, and 1 each received GemErlo and FOLFIRINOX. Furthermore, 7 pts (5.4%) seemed to deserve further examination to check resectability because marginal resectability was shown in follow up MDCT during treatment. Resection rates among treatments were not different significantly. On the other hand, unresectability because of single-vessel invasion and the tumor-vessel contact less than 360° at the same time before treatment showed best opportunity for conversion to resection. The 6 resected pts (MST 30m) showed marginal superiority over unresected 124 pts (MST 16m) in survival (p = 0.17). Conclusions: Resection rate of LAPC did not increase significantly even after FOLFIRINOX or GEM+nabPTX treatment. Pts with LAPC due to single tumor-vessel contact less than 360° have best chance of convert to resection after effective treatment.

Randomized trial of amifostine in locally advanced non-small cell lung cancer (NSCLC) patients receiving chemotherapy and hyperfractionated radiation (HRT): Long-term survival results of Radiation Therapy Oncology Group (RTOG) 9801

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7529-7529
Author(s):  
B. Movsas ◽  
J. Moughan ◽  
C. Langer ◽  
M. Werner-Wasik ◽  
N. Nicolaou ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Radiation Therapy Oncology Group ◽  
Disease Free Survival ◽  
Rank Test ◽  
Term Survival ◽  
Long Term Survival ◽  
Patient Reported ◽  
Nsclc Patients

7529 Purpose: This analysis was conducted to address the potential antitumor effect of amifostine (AM) in NSCLC patients enrolled on RTOG-9801. The long-term survival results of RTOG-9801 are presented here. Methods: 243 patients (pts) with stage II/IIIAB NSCLC received induction paclitaxel (P) 225 mg/m2IV days 1, 22 and carboplatin (C) AUC 6 days 1, 22 and then concurrent weekly P (50 mg/m2) and C (AUC 2) and HRT (69.6 Gy at 1.2 Gy BID). Pts were randomly assigned to AM 500 mg IV 4x/week or no-AM during chemoradiation. Treatment differences for overall and disease-free survival (OS & DFS) were analyzed with the log-rank test; Gray's test was used for time to progression (TTP). Results: 118 pts were randomly assigned to receive AM and 121 to no-AM (4 pts were ineligible). The median follow-up for pts still alive is 52.3 months (mo) for the AM-arm and 58.3 mo for the no-AM arm (16.6 vs 17.9 for all pts). There are no significant differences in OS, DFS or TTP between arms. The median survival, 3-yr, and 5-yr OS are 17.1 mo, 27% and 17% (AM-arm) vs 18.4 mo, 28% and 16% (no-AM arm) (p=0.97). Grade 3/4/5 late-RT toxicities are similar (11%/3%/2% AM-arm vs 14%/4%/2% no-AM arm). Conclusion: While an earlier publication reported that amifostine did not reduce objective measures of severe esophagitis in RTOG-9801, patient-reported outcome analyses suggested a possible advantage to AM with decreased pain and swallowing symptoms (J Clin Oncol 23:2145–2154, 2005). This long-term follow-up analysis on survival shows no evidence of tumor radioprotection due to amifostine. The promising 5-yr OS suggests that induction paclitaxel/carboplatin (P/C) followed by concurrent RT and weekly low-dose P/C is comparable to other regimens using cisplatin doublets at higher dosages every 3–4 weeks. Research supported by NCI and Medimmune Oncology. No significant financial relationships to disclose.

Long-term survival of patients receiving multimodality neoadjuvant therapy for resectable or borderline resectable pancreatic ductal adenocarcinoma.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 309-309
Author(s):  
Kinsey McCormick ◽  
Samuel H. Whiting ◽  
Grace Gyurkey ◽  
Wui-Jin Koh ◽  
Mika Sinanan ◽  
...  
Keyword(s):  
Neoadjuvant Therapy ◽  
Survival Rates ◽  
Ductal Adenocarcinoma ◽  
Wound Complications ◽  
R0 Resection ◽  
Surgical Morbidity ◽  
Borderline Resectable ◽  
Term Survival

309 Background: While surgery offers the only chance for cure in localized PDA, outcomes remain poor for those who have undergone surgical resection (SR). Neoadjuvant therapy (NATx) has several advantages, including early treatment of micrometastatic disease, the potential for tumor downstaging, and improved selection of patients (pts) for surgery by excluding those with chemotherapy-refractory disease. Methods: We report long-term follow-up on consecutive pts with resectable or borderline resectable (R/BR) PDA treated at our institution with an off-protocol, but defined regimen of multi-modality NATx. Demographic, clinical and outcomes data were extracted from medical records. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan-Meier analysis. Results: 16 pts with R/BR PDA were treated with NATx; median follow-up is now 41 months (mo) (7.9-91.5). The median age was 57, 50% were female, and all had an ECOG PS <2. Fourteen (88%) had BR disease, and 9 (56%) had radiographic evidence of nodal involvement. All pts received NA gemcitabine, docetaxel and capecitabine and 13 (81%) also received NA chemoradiotherapy with capecitabine +/- oxaliplatin. 14 pts (88%) underwent SR; of those, 11 (79%) received adjuvant chemotherapy. The median decline in CA19-9 over the course of NATx was 80%. An R0 resection was achieved in 11 pts (79%), and there were 2 pCR. To date, 12 pts have died, 4 are alive (including 2 with CA19-9 >1000 at dx), and 3 are without recurrence. The mPFS and mOS were 27.4 and 41 mo, respectively. 1- and 3-year survival rates were 94% and 56%, respectively. When analyses were restricted to pts who underwent SR, the mPFS and mOS were 29 mo and 47.8 mo, respectively. There were no surgery-related deaths. 3 pts had postoperative wound complications. Conclusions: In this series of mostly BR pancreatic cancer pts, treatment with multi-modality NATx resulted in an almost doubling of mOS when compared to historical controls. NATx was also safe, and did not increase surgical morbidity or mortality. Based on these encouraging results, a phase II protocol of multi-modality NATx for R/BR PDA was initiated and has now completed accrual.

Long-term survival outcomes of intravenous versus intraperitoneal chemotherapy in the treatment of advanced ovarian cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 6046-6046 ◽  
Author(s):  
Rachel Soyoun Kim ◽  
Manjula Maganti ◽  
Marcus Bernardini ◽  
Stephane Laframboise ◽  
Sarah E. Ferguson ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cox Regression ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Regression Analysis

6046 Background: The role of intraperitoneal (IP) chemotherapy in the management of advanced ovarian cancer has been questioned given emerging evidence showing lack of survival benefits. The objective of this study was to compare the long-term survival associated with IP chemotherapy at a tertiary cancer center. Methods: We reviewed the long-term survival records of 271 women with stage IIIC or IV high-grade serous ovarian cancer treated with primary cytoreductive surgery (PCS) followed by IP or intravenous (IV) chemotherapy between 2001-2015 with a minimum follow-up of 4 years. 5-year progression free (PFS) and overall survival (OS) rates were compared using Kaplan-Meier survival analysis and covariates were evaluated using Cox regression analysis. Results: Women who received IP chemotherapy after PCS (n = 91) were more likely to have undergone aggressive surgery (p < 0.001), longer surgery (p < 0.001), and had no residual disease (p < 0.001) compared to the IV arm (n = 180). Median follow-up was 51.6 months. Five-year PFS was 19% vs. 18% (p = 0.63) and OS was 73% vs. 44% (p = 0.00016) in the IP vs. IV arms, respectively. After controlling for covariates in a multivariable model, the use of IP was no longer a significant predictor of OS in the entire cohort (p = 0.12). In patients with 0mm residual disease, PFS was 28% vs. 26% (p = 0.67) and OS was 81% vs. 60% (p = 0.059) in IP (n = 61) vs. IV (n = 69), respectively. In patients with residual of 1-9mm, PFS was 30% vs. 48% (p = 0.076) and OS was 60% vs. 43% (p = 0.74) in IP (n = 29) vs. IV (n = 31), respectively. Conclusions: IP chemotherapy showed a trend towards improved survival over conventional IV chemotherapy, especially in patients with no residual disease. Given the retrospective nature and small numbers in this study, prospective non-randomized cohort studies are warranted to evaluate the role of IP chemotherapy in advanced ovarian cancer.

scholarly journals Analysis of Fluorouracil-Based Adjuvant Chemotherapy and Radiation After Pancreaticoduodenectomy for Ductal Adenocarcinoma of the Pancreas: Results of a Large, Prospectively Collected Database at the Johns Hopkins Hospital

2008 ◽  
Vol 26 (21) ◽  
pp. 3503-3510 ◽  
Author(s):  
Joseph M. Herman ◽  
Michael J. Swartz ◽  
Charles C. Hsu ◽  
Jordan Winter ◽  
Timothy M. Pawlik ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Ductal Adenocarcinoma ◽  
Adjuvant Chemoradiotherapy ◽  
Johns Hopkins Hospital ◽  
Term Survival ◽  
Grade 3 ◽  
Adenocarcinoma Of The Pancreas ◽  
Final Cohort

PurposeTo examine the efficacy of adjuvant chemoradiotherapy after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PC) in patients undergoing resection at Johns Hopkins Hospital (JHH; Baltimore, MD).Patients and MethodsBetween August 30, 1993, and February 28, 2005, a total of 908 patients underwent PD for PC at JHH. A prospective database was reviewed to determine which patients received fluorouracil (FU) -based CRT. Excluded patients had metastatic disease, died 60 or fewer days after PD, received preoperative therapy, an experimental vaccine, adjuvant chemotherapy or radiation alone. The final cohort includes 616 patients.ResultsThe median follow-up was 17.8 months (interquartile range, 9.7 to 33.5 months). Overall median survival was 17.9 months (95% CI, 16.3 to 19.5 months). Groups were similar with respect to tumor size, nodal status, and margin status, but the CRT group was younger (P < .001), and less likely to present with a severe comorbid disease (P = .001). Patients with carcinomas larger than 3 cm (P = .001), grade 3 and 4 (P < .001), margin-positive resection (P = .001), and complications after surgery (P = .017) had poor long-term survival. Patients receiving CRT experienced an improved median (21.2 v 14.4 months; P < .001), 2-year (43.9% v 31.9%), and 5-year (20.1% v 15.4%) survival compared with no CRT. After controlling for high-risk features, CRT was still associated with improved survival (relative risk = 0.74; 95% CI, 0.62 to 0.89).ConclusionThese data suggest that adjuvant concurrent FU-based CRT significantly improves survival after PD for PC when compared with patients not receiving CRT. These data support the use of combined adjuvant CRT for PC.

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