Multidisciplinary management of pancreatic adenocarcinoma with isolated pulmonary metastases.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 384-384
Author(s):  
Supriya K. Jain ◽  
Cheryl Meguid ◽  
Stephen Leong ◽  
Barish H. Edil ◽  
Martin McCarter ◽  
...  
Keyword(s):  
Overall Survival ◽  
Pancreatic Adenocarcinoma ◽  
Metastatic Disease ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Median Number ◽  
Metastatic Pancreatic Adenocarcinoma ◽  
Isolated Lung ◽  
Investigational Agents ◽  
Long Term Survivors

384 Background: Metastatic pancreatic adenocarcinoma (PAC) with isolated pulmonary metastases has recently been associated with prolonged overall survival. The purpose of this study was to review multi-disciplinary management and outcomes of these patients. Methods: Patients with PAC with pulmonary-only metastases were queried between 2012 to 2015 from a prospective single-institutional database. Results: Ten patients (median age: 71 yrs) were identified. Median number of lung metastases at diagnosis was 3 (range: 1 to innumerable). Seven patients had biopsy-proven lung metastases. Five presented with synchronous metastatic disease and five developed metachronous lung metastases as their first site of progression. Median time to progression between diagnosis of primary cancer to diagnosis of pulmonary metastases was 15 months (range: 4 to 31). Seven patients are alive as of this analysis. Median overall survival (OS) of this series (including two patients diagnosed 3 and 6 months ago) is 17 months, with longest overall survival = 40+ months (patient is still alive). All patients received gemcitabine-based chemotherapy; however, systemic regimens differed and included investigational agents. 3 of 5 patients with metachronous metastases underwent pancreaticoduodenectomy and are long-term survivors (34-40+ months). 2 of these 3 patients had diagnostic VATS of lung metastases and are alive with overall survival of 36+ months (resection of 2/3 nodules) and 34+ months (resection of all visible disease). Two patients with metachronous disease underwent neoadjuvant chemotherapy and pancreatic SBRT with progression to lung prior to planned surgery (OS: 30 months (deceased) and 6+ months (recently diagnosed)). 0 of 5 patients with synchronous metastatic disease had surgical resection; 3 of 5 received pancreatic SBRT. 3 of 10 patients are deceased due to visceral disease (14 months), pulmonary failure (18 months), and unknown causes (30 months). Conclusions: We report a recent single-institutional series of PAC with isolated lung metastases. Our data support that metastatic PAC patients with isolated pulmonary metastases have prolonged overall survival and suggest that local intervention may be beneficial.

ISOLATED PULMONARY METASTASES: EVOLUTION OF THE TREATMENT TECHNOLOGIES

2019 ◽  
Vol 65 (5) ◽  
pp. 645-652
Author(s):  
Aleksandr Mikhnin ◽  
T. Van ◽  
Tatyana Dubinina ◽  
Oleg Mamontov ◽  
Yelena Levchenko ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Regional Chemotherapy ◽  
High Dose ◽  
Primary Cancer ◽  
Isolated Lung ◽  
Metastatic Lung ◽  
Long Time ◽  
Treatment Technologies

The lung is the most commonly attacked organ in metastatic disease. In many patients who were successfully cured of primary cancer, pulmonary metastases for a long time may be the only, and sometimes the final manifestation of the disease. This kind of dissemination is known as isolated lung metastases. The prognosis for untreated patients with pulmonary metastases is unfavorable: 5-year survival does not exceed 5%. This survey considers the evolution of technologies for the treatment of isolated metastatic lung lesions from surgical metastasectomy to combined methods of high-dose regional chemotherapy.

Evaluating survival in patients with pancreatic adenocarcinoma and lung metastasis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16237-e16237
Author(s):  
Jason Cham ◽  
Aren Ebrahimi ◽  
David Jacob Hermel ◽  
Samantha R. Spierling Bagsic ◽  
Darren Sigal
Keyword(s):  
Pancreatic Cancer ◽  
Health System ◽  
Pancreatic Adenocarcinoma ◽  
Lung Metastasis ◽  
Metastatic Disease ◽  
Lung Metastases ◽  
Secondary Outcome ◽  
Number Of Patients ◽  
Isolated Lung ◽  
Significant Difference

e16237 Background: Pancreatic adenocarcinoma most commonly metastasizes to the liver and peritoneum, yet can occasionally metastasize to the lungs in an isolated fashion. Anecdotal evidence suggests that patients who have isolated metastatic disease to the lungs have improved outcomes. We sought to investigate whether pancreatic cancer lung metastasis is associated with improved survival. Methods: We conducted a retrospective review of patients within the Scripps Health system with pathologically confirmed pancreatic adenocarcinoma from 2017 to 2020. Primary sites of metastatic disease were identified with imaging, and when available, confirmed by pathology. A subgroup of 101 patients from a total cohort of 598 patients was further refined to only include patients with lung and/or liver primary metastases (N=68). Analyses were conducted on subgroups defined by metastatic sites of disease in the liver only, lung only and combined liver+lung. Primary and secondary outcome analyses compared isolated lung versus liver/liver+lung. Overall survival (OS) was defined from the date of diagnosis to date of death or most recent follow up, and recurrence free survival (RFS) from the time of diagnosis to date of recurrence. Each survival outcome was analyzed using Cox Proportional Hazards tests. Additionally, proportions of each subgroup (lung v. liver/liver+lung) that had recurrence or were deceased were reported and compared by Fisher’s exact tests. Results: No significant differences were observed in OS (HR 1.91, CI 0.66 – 3.73; p= 0.311) or RFS (HR 0.98, CI 0.42 – 2.30; p= 0.968) between patients with primary lung metastases versus those with either liver or liver+lung metastases (reported as hazard ratios of liver/liver+lung relative to lung only). Although there was no overall statistically significant difference, the kaplan-meier curve for OS appears to show improved survival for patients with primary lung metastasis initially but then ultimately shows worse survival compared to liver only metastasis at later time points. Please see Table.Conclusions: We found no difference in survival outcomes among pancreatic cancer patients with only lung metastasis at diagnosis compared to patients with hepatic metastasis. However, we do observe that patients with lung metastases seem to have improved survival initially. This study was conducted on a small set of the total number of patients with pancreatic adenocarcinoma within the Scripps Health system. Further analysis is ongoing to confirm the trend we observe in this study.[Table: see text]

Investigate the efficacy of immunotherapy for treatment of pancreatic adenocarcinoma (PDAC) with mismatch repair deficiency (dMMR).

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 415-415
Author(s):  
Arish Noor ◽  
Luis E. Aguirre ◽  
Kirsten Blue ◽  
Trenton Avriett ◽  
Estrella M. Carballido ◽  
...  
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Metastatic Disease ◽  
Checkpoint Inhibitors ◽  
Objective Response ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Complete Response ◽  
Median Number ◽  
Cancer Center ◽  
Duration Of Response

415 Background: Immune checkpoint inhibitors (ICI) have been approved in solid tumors with dMMR. However, only limited data are available for PDAC with dMMR given the rarity of dMMR in PDAC. We evaluated efficacy of ICIs in PDAC with dMMR. Methods: Retrospective clinical and pathologic data were collected for patients (pts) with pancreatic adenocarcinoma from May 2017 to June 2020 at Moffitt cancer center. Results: We identified 10 pts with dMMR PDAC. The median age was 64.5 years (range: 42-86) and 4 pts were male. 4 pts had resectable disease, 3 had locally advanced and 3 had metastatic disease at initial diagnosis. MSH6 deficiency (def) was found in 2 cases, PMS2 def in 2, MLH/PMS2 def in 5, and MSH2/MSH6 in 1. 7 pts were treated with ICIs. 3 pts had locally advanced and 4 had metastatic disease when they started ICIs. 5 received Pembrolizumab (pem), 1 received ipilimumab/ nivolumab (ipi/nivo), and 1 received pem then ipi/nivo after progressive disease (PD) on pem. The median number of prior lines of chemotherapy was 1 (range 0-2). 6 pts were evaluable, and 1 had rapid disease progression after 1 dose of pem. Among 6 evaluable pts, 3 had an objective response (1: complete response and 2: partial response), and 2 had stable disease (SD). Median progression-free survival was 8.2 mo, and median overall survival was not reached with median follow-up (FU) of 6.8 mo. The median duration of response was not reached with a median FU of 22.6 mo. The pt with CR remained disease-free for up to 22 months. The pt whose treatment was switched to ipi/nivo after PD on pem achieved SD > 4mo on ipi/nivo. While on immunotherapy, one patient with ipi/nivo developed immunotherapy associated rash requiring systemic steroids, and another on pem developed hypothyroidism requiring levothyroxine. Conclusions: This series suggest ICIs can provide durable clinical efficacy in pts with dMMR PDAC.

scholarly journals Clinical significance of skeletal muscle density and sarcopenia in patients with pancreatic cancer undergoing first-line chemotherapy: a retrospective observational study.

2020 ◽  
Author(s):  
In-Ho Kim ◽  
Moon Hyung Choi ◽  
In Seok Lee ◽  
Tae Ho Hong ◽  
Myung Ah Lee
Keyword(s):  
Skeletal Muscle ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Pancreatic Adenocarcinoma ◽  
Cox Regression ◽  
First Line ◽  
Poor Overall Survival ◽  
Skeletal Muscle Index ◽  
Muscle Density ◽  
Metastatic Pancreatic Adenocarcinoma

Abstract Background To investigate the clinical impact of sarcopenia and skeletal muscle density among patients with metastatic pancreatic adenocarcinoma who underwent palliative first line gemcitabine-based chemotherapy. Methods A total of 330 patients with metastatic pancreatic adenocarcinoma who were treated with palliative first line gemcitabine-based chemotherapy between January 2010 and March 2017 were included in this study. Sarcopenia and skeletal muscle density status were identified by L3 vertebra level skeletal muscle index in cm 2 /m 2 and muscle attenuation in Hounsfield units using computed tomography. Results A skeletal muscle index to skeletal muscle density comparison revealed a positive correlation (R 2 = 0.058, P<0.001). Kaplan–Meier analysis showed that low skeletal muscle density was associated with poor overall survival. Multivariate analysis using Cox regression showed that low skeletal muscle index and low skeletal muscle density were poor prognostic factors for overall survival, respectively. Co-presence of low skeletal muscle index and low skeletal muscle density had more powerful prognostic implication for overall survival. Grade 3 or higher toxicity of chemotherapy was more frequently observed in patients with low skeletal muscle index and low skeletal muscle density. Overall survival was not associated with skeletal muscle density status among patients who were chemotherapy responders (complete or partial responses). However, among non-responders (stable or progressive disease), low skeletal muscle density groups had significantly poorer overall survival than did the high skeletal muscle density groups. Conclusions Sarcopenia and skeletal muscle density status can be considered a prognostic factor in patients with metastatic pancreatic adenocarcinoma who receive palliative first line gemcitabine-based chemotherapy. Severe chemotherapy toxicity occurred in the sarcopenia and low skeletal muscle density groups. Our data suggest that comprehensive assessment of skeletal muscle parameters may be more useful prognostic factors.

scholarly journals Clinical significance of skeletal muscle density and sarcopenia in patients with pancreatic cancer undergoing first-line chemotherapy : a retrospective observational study.

2020 ◽  
Author(s):  
In-Ho Kim ◽  
Moon Hyung Choi ◽  
In Seok Lee ◽  
Tae Ho Hong ◽  
Myung Ah Lee
Keyword(s):  
Skeletal Muscle ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Pancreatic Adenocarcinoma ◽  
Cox Regression ◽  
First Line ◽  
Poor Overall Survival ◽  
Skeletal Muscle Index ◽  
Muscle Density ◽  
Metastatic Pancreatic Adenocarcinoma

Abstract Background: To investigate the clinical impact of sarcopenia and skeletal muscle density among patients with metastatic pancreatic adenocarcinoma who underwent palliative first line gemcitabine-based chemotherapy.Methods: A total of 330 patients with metastatic pancreatic adenocarcinoma who were treated with palliative first line gemcitabine-based chemotherapy between January 2010 and March 2017 were included in this study. Sarcopenia and skeletal muscle density status were identified by L3 vertebra level skeletal muscle index in cm2/m2 and muscle attenuation in Hounsfield units using computed tomography.Results: A skeletal muscle index to skeletal muscle density comparison revealed a positive correlation (R2 = 0.058, P<0.001). Kaplan–Meier analysis showed that the low skeletal muscle density was related to poor overall survival. Multivariate analysis using Cox regression showed that low skeletal muscle index and low skeletal muscle density were poor prognostic factors for overall survival, respectively. Co-presence of low skeletal muscle index and low skeletal muscle density had more powerful prognostic implication for overall survival. Grade 3 or higher toxicity of chemotherapy was more frequently observed in patients who have a low skeletal muscle index and low skeletal muscle density. Overall survival was not related to skeletal muscle density status among patients who were chemotherapy responders (complete or partial responses). However, among non-responders (stable or progressive disease), low skeletal muscle density groups had significantly poorer overall survival in comparison with high skeletal muscle density groups.Conclusions: Sarcopenia and skeletal muscle density status can be considered a prognostic factor in patients with metastatic pancreatic adenocarcinoma who received palliative first line gemcitabine-based chemotherapy. Severe chemotherapy toxicity occurred in the sarcopenia and low skeletal muscle density groups. Our data suggest that a comprehensive assessment of skeletal muscle parameters may be more useful prognostic factors.

scholarly journals Incidence and Survival of Thyroid Cancer with Lung Metastasis

2021 ◽  
Author(s):  
Miaochun Zhong ◽  
Xianghong He ◽  
Lingfei Cui ◽  
Kefeng Lei
Keyword(s):  
Overall Survival ◽  
Thyroid Cancer ◽  
Brain Metastasis ◽  
Bone Metastases ◽  
Lung Metastasis ◽  
Lung Metastases ◽  
Statistical Significance ◽  
Cancer Specific Survival ◽  
Isolated Lung ◽  
Significant Difference

Abstract Background: Thyroid cancer (TC) is common malignancy. Lung metastasis is one of the top metastases for TC. The incidence and survival rates of TC with lung metastasis remains unclear.Methods: Data on TC with lung metastasis and other site-specific metastases were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The chi-square tests were employed to compare the clinicopathological characteristics among patients with different sites of metastases. Kaplan-Meier analysis and log-rank tests were used for survival analysis. A Cox proportional model was used for multivariate analyses of the patient population. Statistical significance indicated by a two-tailed P value < 0.05. Results: A total of 77322 patients with TC and known sites of distant metastases were identified from 2010-2016. The probability of isolated lung metastasis was significantly higher than that of isolated distant metastasis to other sites among TC patients (P < 0.05). Patients with isolated lung metastases had worse overall and thyroid cancer-specific survival compared to patients with isolated bone metastases (P < 0.05). There was a slight difference in thyroid cancer-specific survival between patients with lung metastasis and patients with liver metastasis(P=0.0496), while there was no significant difference in overall survival. (P >0.05). There was no significant difference in overall survival or thyroid cancer specific survival between patients with lung metastasis and those with brain metastasis (P > 0.05). Multivariate analysis revealed that white race was associated with better outcomes in terms of both endpoints in the lung metastasis population.Conclusions: The incidence of lung metastasis from TC was higher than that of other organ metastases. Thyroid cancer patients with isolated lung metastases have worse outcomes compared to patients with isolated bone metastases and liver metastases, whereas is similar to brain metastasis. There was the worst survival outcome on patients with multi-organ metastases.

Effect of low-molecular-weight heparin on survival in patients with advanced pancreatic adenocarcinoma

2007 ◽  
Vol 98 (08) ◽  
pp. 434-439 ◽  
Author(s):  
Muhammed Ayvaz ◽  
Stefan Wagenpfeil ◽  
Florian Eckel ◽  
Roland Schmid ◽  
Christian Lersch ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Overall Survival ◽  
Pancreatic Adenocarcinoma ◽  
Median Survival ◽  
Metastatic Disease ◽  
Hazard Ratio ◽  
Low Molecular Weight ◽  
Significant Difference ◽  
Chemotherapeutic Treatment ◽  
Advanced Pancreatic Adenocarcinoma

SummaryThis retrospective analysis aimed to identify whether low-molecular- weight heparins (LMWH) might improve survival in patients receiving chemotherapeutic treatment for advanced pancreatic adenocarcinoma.Two hundred forty-three patients who had received chemotherapy for advanced pancreatic adenocarcinoma were identified from a prospectively maintained database. Of these, 30 patients had to be excluded from analysis due to insufficient documentation. Of the remaining 213 patients 94 patients had been treated with LMWH, whereas 119 patients served as controls. Outcome was assessed in relation to overall survival, which was calculated from the date of initiation of chemotherapy to the date of death.There was no significant difference (hazard ratio, 0.8; 95% confidence interval (CI), 0.6 to 1.1; P=0,2) between the two groups in terms of overall survival. The median survival was 7.1 months (95% CI,5.8–8.4 months) in the LMWH group and 5.9 months (95% CI, 5.1–6.7 months) in the non-LMWH group. A positive effect of LMWH was seen in patients with metastatic disease (hazard ratio for LMWH vs. non-LMWH, 0,6; 95% CI, 0,4 to 0,8; P=0,006) in contrast to those without metastatic disease (hazard ratio for LMWH vs. non-LMWH, 1; 95% CI, 0.6 to 1.7; P=0,96).The median survival of patients with metastatic disease was 6,6 months (95% CI, 5–8,2 months) and 3.8 months (95% CI, 2.5–5.1 months) for the LMWH group and the non-LMWH group, respectively. In conclusion, we found for metastatic pancreatic adenocarcinoma a survival advantage for patients receiving LMWH. Nevertheless, our observations need confirmation by prospective randomized studies.

A phase IIb, randomized, controlled, multicenter, open-label study of the efficacy and immune response of GVAX pancreas vaccine and CRS-207 compared to chemotherapy or to CRS-207 alone in adults with previously treated metastatic pancreatic adenocarcinoma (ECLIPSE Study).

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. TPS489-TPS489 ◽  
Author(s):  
Dung T. Le ◽  
Andrea Wang-Gillam ◽  
Vincent J. Picozzi ◽  
Todd S. Crocenzi ◽  
Michael Morse ◽  
...  
Keyword(s):  
T Cells ◽  
Pancreatic Adenocarcinoma ◽  
Metastatic Disease ◽  
Single Agent ◽  
P Value ◽  
Prior Chemotherapy ◽  
Pancreatic Cancer Cells ◽  
Metastatic Pancreatic Adenocarcinoma ◽  
Clinical Responses ◽  
Previously Treated

TPS489 Background: A prime-boost vaccination strategy using GVAX pancreas vaccine and CRS-207 is showing activity in patients with metastatic pancreatic adenocarcinoma (PDA). GVAX is composed of lethally-irradiated, allogeneic pancreatic cancer cells modified to express GM-CSF. GVAX induces a response against multiple tumor antigens and is given after low-dose cyclophosphamide (CY) to inhibit regulatory T cells. CRS-207 is live-attenuated Listeria monocytogenes engineered to express the tumor-associated antigen mesothelin. CRS-207 boosts responses against mesothelin and stimulates both innate and adaptive immunity by activating T cells and NK cells. Results from a phase 2 study demonstrated CY/GVAX plus CRS-207 improved overall survival (OS) compared to CY/GVAX alone (p-value<0.05; Le, GI ASCO 2014). Methods: This is a phase 2b study comparing CY/GVAX and CRS-207 to chemotherapy or to CRS-207 alone in patients with previously-treated metastatic PDA. Patients will be enrolled in two cohorts: 150 patients into a primary cohort of patients with at least two prior chemotherapy regimens for metastatic disease (third + line) and 90 patients into an exploratory cohort of patients with only one prior chemotherapy regimen for metastatic disease (second line). Patients will be randomized in a 1:1:1 ratio to receive 2 doses of CY/GVAX and 4 doses of CRS-207 (Arm A), six doses of CRS-207 (Arm B) or physician’s choice of single-agent chemotherapy (Arm C). The primary objective is to compare OS between Arms A and C in the primary cohort. Secondary/exploratory objectives include: comparison of OS in both primary and exploratory cohorts between all treatment arms, assessment of safety and clinical responses (tumor assessments and CA19-9 levels) and correlation of Lm- and mesothelin-specific T cell and other immunological responses with clinical responses. Updated enrollment will be reported. (Sponsor: Aduro BioTech, Inc.; NCT02004262). Clinical trial information: NCT02004262.

The impact of metastasis location on overall survival among patients with renal cell carcinoma.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 621-621
Author(s):  
Devin Patel ◽  
Fady Ghali ◽  
Margaret Meagher ◽  
Margaret Meagher ◽  
Aaron Bradshaw ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Bone Metastases ◽  
Cell Carcinoma ◽  
Metastatic Disease ◽  
Renal Cell ◽  
Lung Metastases ◽  
Univariate Analysis ◽  
The Impact ◽  
Disease Location

621 Background: Current staging guidelines define all patients with metastatic renal cell carcinoma (RCC) as a singular group. We sought to compare the impact of metastatic disease location on overall survival (OS) in patients with RCC. Methods: We queried our institutional database of consecutive patients with metastatic RCC. A confirmatory analysis was performed using the National Cancer Database (NCDB) for cases between 2010 to 2015. Only cases from which all metastatic disease location was known were used. Patients were grouped into having brain or bone metastases, liver or lung metastases or other metastases. From our institutional database, we performed a univariate analysis to determine the impact of metastasis location on OS. From the NCDB, univariable and multivariable Cox proportional hazards and Kaplan-Meier survival analysis with log-rank testing was performed. Multivariable models were adjusted for age, comorbidity, race, gender, and treatment with either palliative care, chemotherapy or immunotherapy. Results: A total of 95 patients were analyzed from our institutional database, with 30 (31.9%) having brain/bone metastases, 20 (21.3%) having lung/liver metastases, and 44 (46.8%) having other site metastases. On univariate analysis, patients with brain/bone metastases had significantly worse OS (HR 1.87; 95% CI 1.01-3.47). However, no significant difference was seen in patients with liver/lung metastases (HR 1.44; 95% CI 0.64-3.27). A total of 25,528 patients met inclusion for our NCDB analysis, of which 12,119 (47.5%) had brain/bone metastases, 10,004 (39.2%) had liver/lung metastases, and 3,405 (13.3%) had other site metastases. On univariate analysis, patients with lung/liver (HR 1.46; 95% CI 1.38-1.53) and patients with bone/brain (HR 1.69; 95% CI 1.60-1.77) had progressively worse OS with non-overlapping confidence intervals. Multivariable analysis again showed that patients with lung/liver disease (HR 1.51; 95% CI 1.43-1.59) and brain/bone disease (HR 1.66; 95% CI 1.60-1.75) had progressively worse OS. Conclusions: Our results highlight the heterogeneity of patients with metastatic renal cell carcinoma. Location of metastatic disease may drive differences in survival.

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