Neoadjuvant cytoreductive treatment with BRAF/MEK inhibition of prior unresectable regionally advanced melanoma to allow complete surgical resection: REDUCTOR trial.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 9587-9587 ◽  
Author(s):  
Stephanie A. Blankenstein ◽  
Maartje W. Rohaan ◽  
W. Martin. C. Klop ◽  
Bernies Van Der Hiel ◽  
Bart A. Van De Wiel ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Metabolic Response ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Stage Iv ◽  
Advanced Melanoma ◽  
Stage Iii ◽  
Advanced Stage ◽  
Pet Ct ◽  
Cytoreductive Treatment

9587 Background: The aim of this study is to evaluate the potency of short-term neoadjuvant cytoreductive therapy with dabrafenib and trametinib (BRAF and MEK inhibitor respectively) to allow radical surgical resection in patients with unresectable BRAF-mutated, locally advanced stage III or oligometastatic stage IV melanoma. Methods: A total of 25 patients with BRAF-mutated, unresectable locally advanced stage III or oligometastatic stage IV (≤3 metastases) melanoma will be treated with dabrafenib and trametinib for 8 weeks. Response evaluation by positron emission tomography/computed tomography (PET/CT) will occur at 2 and 8 weeks. If sufficient downsizing occurs, surgical resection will be performed. Biopsies for translational research will be taken at baseline and 2 weeks. The dissection specimen will be stored at 8 weeks. Results: Currently 20 patients have been included. Of these, 2 patients showed PD upon treatment and did not proceed to surgery. In 17/18 (94%) patients resection was possible after neoadjuvant treatment, of which 16 (94%) were R0 resections. Median follow-up time is 28 months with a median recurrence free survival of 9 months in patients undergoing surgery. The 1-year overall survival (OS) was 94% and 2-year OS 82%. Median OS was not reached. Metabolic response rates (RR) on PET/CT at 8 weeks were: 4 (20%) CR, 14 (70%) PR, 0 (0%) SD, 2 (10%) PD. Pathologic RR differed: 7 (35%) CR, 7 (35%) PR, 3 (15%) SD, 0 (0%) PD and in 3 patients (15%) no pathologic response was measured, since no resection was performed. Most patients (85%) experienced any toxicity, of which 50% was grade 1, 20% grade 2 and 3 patients (15%) experienced grade 3 toxicity. The most common reported toxicity was fever. Conclusions: Neoadjuvant dabrafenib and trametinib shows to be a potent cytoreductive treatment, allowing radical resection of metastases in 16/20 (80%) patients with prior unresectable locally advanced melanoma. Patients with no recurrence remained disease-free for a prolonged period of time. If there was recurrent disease, this usually occurred within months after surgery and this may present an opportunity for further tailored adjuvant therapy. Clinical trial information: NTR4654.

Deferral of rectal surgery following a continued response to preoperative chemoradiotherapy (Watch and Wait) study: A phase II multicenter study in the United Kingdom.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 489-489 ◽  
Author(s):  
S. K. Yu ◽  
G. Brown ◽  
R. J. Heald ◽  
S. Chua ◽  
G. Cook ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Surgical Resection ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Clinical Staging ◽  
Pet Ct

489 Background: Neoadjuvant chemoradiotherapy (CRT) and surgical resection are standard components of therapy for patients locally advanced rectal cancer (T3,T4 or N+) in UK. In 15%-30% of patients treated pre-operatively with CRT will develop pathological complete response (CR). The time from completion of CRT to maximal tumour response is as yet unknown. This study is the first prospective study to attempt to identify the percentage of patients who can safely omit surgery and the safety of deferred surgery in patients who achieve clinical complete response post CRT. Of the 59 patients required for the study, this provides an update on 19 patients entered. Methods: Patients with locally advanced rectal cancer requiring neoadjuvant treatment are identified in the multidisciplinary meet (MDT). Patients undergo CRT using a minimum of 50.4Gy in 28 # daily conformal CT planned CRT with concomitant Capecitabine at 825mg/m2 BD. MRI pelvis and body CT are repeated 4 weeks post CRT and rediscussed at MDT. If there is a good partial response or CR, patients are considered for Deferral of Surgery Study. Based on the pre treatment clinical staging, patients are considered for adjuvant chemotherapy as per NICE guidance. At any point of the study, if there is histology proven tumour regrowth or progression, patient undergo surgery. Results: 10 (53%) patients remain in CR. 6 (32%) patients underwent surgical resection with clear margin after detection of tumour regrowth at from 2-23 months post CRT. 5 out of 6 of the patients with tumour regrowth underwent PET CT as per protocol, and all tumour regrowth in those 5 patients were detected by PET CT, i.e. FDG avid disease. The pathological stages on these 6 patients were ypT2N0 CRM negative in 5 and ypT3N0 CRM negative in 1. 3 (15%) patients with tumour regrowth refused surgery. Conclusions: In the 19 recruited patients, all the patients with tumour regrowth underwent surgical resection with clear margins. PET CT appears a useful tool for detecting tumour regrowth. The median time for tumour regrowth is 17.5 months post CRT. The trial will be successful if at least 11/59 patients are able to safely omit surgery. Accrual of patients continues. No significant financial relationships to disclose.

Outcome of Bone Marrow Biopsy in Patients with Diffuse Large B-Cell Lymphoma Patients Staged by Combined 18 FGD-PET/CT Scan

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4207-4207
Author(s):  
Rasha Abdel Tawab Hamed ◽  
Rami Kotp ◽  
Eric Turecotte ◽  
Baseem Sawan ◽  
Annie Morine
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Conflicts Of Interest ◽  
False Negative ◽  
Stage Iv ◽  
B Cell Lymphoma ◽  
Stage I ◽  
Stage Iii ◽  
Advanced Stage ◽  
Pet Ct

Abstract DLBCL represents 1/3 of non-Hodgkin lymphoma, in 60% of the cases the disease presented in advanced stage (III-IV). Extranodal organs are involved in 40% of cases; BM involvement in 11% to 27% of cases. BMB is an invasive procedure, & it also could represent false negative result in patients with patchy pattern of involvement or if involvement else where the routine biopsy site. Study included 102 patients, above the age of 18 years, confirmed to have newly diagnosed DLBCL with no any other malignancy. Every patient had a baseline PET-Ct, bone marrow biopsy. PET-CT detected BM infiltration in 23 patients, i.e 22.5%. BMB were positive in 20 patients, while PET-CT showed BM involvement in 23 patients.- 94 patients had concordant negative ( 75 patients ) or positive ( 19 patients), PET-CT & BMB results. One patient had positive BMB and negative PET-CT. All patients with stage I & II had concordant PET-CT & BMB results One patient graded stage III by PET-CT showed 1-2% BM infiltration & upstaged to stage IV. Of the 49 patients graded stage IV by PET-CT, 3 had positive BM involvement PET-CT and negative BMB. the sensitivity of PET-CT was 95%, the specificity of PET-CT was 96.2%. the PPV was 86.4% & the NPV was 98.7%. PET-CT showed 95.9% accuracy. Our results suggest PET-CT as a powerful tool to evaluate BM infiltration in patients with DLBCL, with overall concordance exceeding 94% (100%for stage I & II ). For patients with advanced stage IV disease, PET-CT was able to retrieve patients with BM involvement & false negative BMB. Disclosures No relevant conflicts of interest to declare.

Current and future therapeutic approaches in locally advanced (stage III) non[ndash ]small cell lung cancer

2002 ◽  
Vol 29 (3 Suppl 12) ◽  
pp. 10-16 ◽  
Author(s):  
Angela Davies ◽  
David R. Gandara ◽  
Primo Lara ◽  
Zelanna Goldberg ◽  
Peter Roberts ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Small Cell ◽  
Stage Iii ◽  
Advanced Stage ◽  
Therapeutic Approaches ◽  
Small Cell Lung

scholarly journals Role of 18F-PET-CT to predict pathological response after neoadjuvant treatment of rectal cancer

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Riccardo Caruso ◽  
Emilio Vicente ◽  
Yolanda Quijano ◽  
Hipolito Duran ◽  
Isabel Fabra ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Fdg Pet ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Standardized Uptake Value ◽  
Tumour Regression Grade ◽  
Pet Ct ◽  
Significant Difference ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Objectives Neoadjuvant chemoradiation (nCRT) is universally considered to be a valid treatment to achieve downstaging, to improve local disease control and to obtain better resectability in locally advanced rectal cancer (LARC). The aim of this study is to correlate the change in the tumour 18F-FDG PET-CT standardized uptake value (SUV) before and after nCRT, in order to obtain an early prediction of the pathologic response (pR) achieved in patients with LARC. Data description We performed a retrospective analysis of patients with LARC diagnosis who underwent curative resection. All patients underwent a baseline 18F-FDG PET-CT scan within the week prior to the initiation of the treatment (PET-CT SUV1) and a second scan (PET-CT SUV2) within 6 weeks of the completion of nCRT. We evaluated the prognostic value of 18F-FDG PET-CT in terms of disease-free survival (DFS) and overall survival (OS) in patients with LARC.A total of 133 patients with LARC were included in the study. Patients were divided in two groups according to the TRG (tumour regression grade): 107 (80%) as the responders group (TRG0-TRG1) and 26 (25%) as the no-responders group (TRG2-TRG3). We obtained a significant difference in Δ%SUV between the two different groups; responders versus no-responders (p < 0.012). The results of this analysis show that 18F-FDG PET-CT may be an indicator to evaluate the pR to nCRT in patients with LARC. The decrease in 18F-FDG PET-CT uptake in the primary tumour may offer important information in order for an early identification of those patients more likely to obtain a pCR to nCRT and to predict those who are unlikely to significantly regress.

scholarly journals Neutrophilia as prognostic biomarker in locally advanced stage III lung cancer

PLoS ONE ◽  
2018 ◽  
Vol 13 (10) ◽  
pp. e0204490 ◽  
Author(s):  
Antoine Schernberg ◽  
Laura Mezquita ◽  
Angela Boros ◽  
Angela Botticella ◽  
Caroline Caramella ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Prognostic Biomarker ◽  
Locally Advanced ◽  
Stage Iii ◽  
Advanced Stage

Current and future therapeutic approaches in locally advanced (stage III) non-small cell lung cancer

2002 ◽  
Vol 29 (3) ◽  
pp. 10-16 ◽  
Author(s):  
Angela Davies ◽  
David R. Gandara ◽  
Primo Lara ◽  
Zelanna Goldberg ◽  
Peter Roberts ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Small Cell ◽  
Stage Iii ◽  
Advanced Stage ◽  
Therapeutic Approaches ◽  
Small Cell Lung

scholarly journals Moist Exposed Burn Ointment Effectiveness for Capecitabine Associated Grade II and III Hand Foot Syndrome on Stage III Colonic

2021 ◽  
Vol 9 (B) ◽  
pp. 971-974
Author(s):  
Budhi Ida Bagus ◽  
Nunik Agustriani ◽  
Rieva Ermawan ◽  
Suwardi Suwardi ◽  
Amru Sungkar ◽  
...  
Keyword(s):  
Single Agent ◽  
Locally Advanced ◽  
Common Adverse Effect ◽  
Dose Intensity ◽  
Stage Iii ◽  
Advanced Stage ◽  
Chemotherapy Agent ◽  
Palmoplantar Erythrodysesthesia ◽  
Hand Foot Syndrome ◽  
Grade Ii

Background:Hand-foot syndrome (HFS), also known as palmoplantar erythrodysesthesia, is a common adverse effect of the fluoropyrimidine chemotherapy agent capecitabine. Hand-foot syndrome of any grade is reported to affect 43% to 71% of patients treated with single-agent capecitabine chemotherapy. Although not life-threatening, it can have adverse effects on the quality of life (QoL) and daily living activities of a patient.  Sometimes the dose interruptions and reductions required after observation of HFS can also impact on dose intensity and treatment outcomes.  As an option for the treatment of this case, we would reported our preliminary study of the effectiveness of moist exposed burn ointment (MEBO) for stage II and III HFS.   Methods:  We will evaluate the clinical sign and symptoms of hand foot syndrome grade II and III associated with capecitabine as adjuvant chemotherapy agent on advanced stage colorectal cancer.  All patients with HFS will treated with topical MEBO twice daily, the clinical improvement of the symptoms will be recorded.   Results: We reported 8 cases of grade II and III hand foot syndrome, 2 patients were grade III HFS and the others were grade II.  These symptoms occurred after 2 until 3 months after capecitabine administration for locally advanced (stage III) colonic adenocarsinoma.  Topical MEBO were used twice a day for 3 months, pain reduction was achieved with no capicetabine dose interruption and reduction during chemotherapy period.  Allergic reaction was not found during and after MEBO application in this case.   Conclusion:Moist exposed burn ointment was an effective treatment option in managing hand foot syndrome, better option in reducing the pain without interrupting the capecitabine doses.

Role of 18F-PET-CT to Predict Pathological Response After Neoadjuvant Treatment of Rectal Cancer

2021 ◽  
Author(s):  
Riccardo Caruso ◽  
Emilio Vicente ◽  
Yolanda Quijano ◽  
Hipolito Duran ◽  
Isabel Fabra ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Fdg Pet ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Standardized Uptake Value ◽  
Disease Free Survival ◽  
Pet Ct ◽  
Significant Difference ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Objectives: Neoadjuvant radiochemotherapy (nCRT) is universally considered to be a valid treatment to achieve downstaging, improve local disease control and obtain better resectability in locally advanced rectal cancer (LARC). The aim of this study is to correlate the change in tumor 18F -FDG PET-CT standardized uptake value (SUV) before and after nCRT, in order to obtain an early prediction of pathologic response (pR) achieved in patients with LARC.Data description: We performed a retrospective analysis of patients with LARC diagnosis who underwent curative resection. All patients received nCRT and surgical treatment was carried after 8/12th. All patients underwent a baseline 18F -FDG PET-CT scan within the week prior to the initiation of the treatment (PET-CT SUV1) and a second scan (PET-C T SUV2) within six weeks of the completion of nCRT. Furthermore, we evaluated the prognostic value of 18F -FDG PET-CT in terms of disease free survival (DFS) and overall survival (OS) in patients with LARC.A total of 133 patients with LARC were included in the study. Patients were divided in two groups according to the TRG (tumor regression grade): 107 (80%) as Responders group (TRG0-TRG1) and 26 (25%) as the No-Responders group (TRG2-TRG3). We obtained a significant difference in Δ%SUV between the two different groups responders vs no responders (p<0.012).The results of this analysis have shown that 18F-FDG PET-CT may be an indicator in order to evaluate the pR to nCRT in patients with LARC. The decrease in 18F-FDG PET-CT uptake in the primary tumor may offer primary information in order to early identify those patients more likely to obtain a pCR to nCRT and predict those unlikely to regress significantly.

Observed survival benefit with limited exposure of durvalumab in unresectable stage III non-small cell lung cancer at a large community-based institution.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e20539-e20539
Author(s):  
Deepak Vadehra ◽  
Christopher R Pallas ◽  
Donald Moore ◽  
Jeryl Jean Villadolid ◽  
Myra M. Robinson ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Survival Benefit ◽  
Locally Advanced ◽  
Small Cell ◽  
Stage Iii ◽  
Advanced Stage ◽  
Small Cell Lung ◽  
Fda Approval ◽  
The Pacific ◽  
Stage Iii Nsclc

e20539 Background: The PACIFIC trial ushered in a paradigm shift in the management of unresectable, non-metastatic non-small cell lung cancer (NSCLC), demonstrating improvement in 12,24,36-month overall survival (OS) and leading to the 2018 FDA approval for durvalumab in unresectable or locally advanced stage III NSCLC. With almost 3 years of FDA approval, we performed a retrospective analysis of patient experiences and outcomes at Levine Cancer Institute analyzing patient data to assess survival and potential points of clinical significance. Methods: Patients over the age of 18, who met criteria similar to the PACIFIC trial (i.e. unresectable or locally advanced stage III NSCLC) from February 2018 through September 2020 were analyzed. Those who were receiving active treatment at the data cutoff were excluded. Patient characteristics, prior treatment, durvalumab administration, immune-related adverse events (irAEs), and efficacy data were summarized and evaluated. OS and progression free survival (PFS) were evaluated with Kaplan Meier methods. Results: A total of 159 patients were evaluated. 40.9% were female and 59.1% were male. The median age was 67 (range 38-83 years). Of note, 86.8% of patients were white, whereas 13.2% were nonwhite. 50.3% patients experienced an irAE. The most common reasons for discontinuation of durvalumab were completion (at least 24 doses), progressive disease, or toxicity (33.3%, 30.8%, 26.4%, respectively). The median number of doses of durvalumab received was 14 (range 1-26 doses). The median PFS was 15.3 months with 12-and 24-month PFS being 54% and 41.1 %, respectively. Median OS was 42 months with 12-and 24-month OS being 78.1% and 67.8%, respectively. Our analysis compared outcomes in those who completed adjuvant durvalumab versus those who did not complete adjuvant therapy (Table). Conclusions: Data shows the best survival in those who completed durvalumab (comparable to historic values) and novel data shows a perceived survival benefit in those completing 12 doses compared to those who did not. Thus, partial treatment may provide a survival advantage. Further multivariate analysis will look for possible correlations to increased immune events and inability to complete therapy. Further investigation will delve into this cohort’s small proportion of non-white patients, evaluating for possible barriers to care that may lead to more patients being diagnosed with stage IV NSCLC.[Table: see text]

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