Differences in presentation and management patterns in patients with hepatocellular carcinoma (HCC): Data from HCC registry in Asia.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 229-229
Author(s):  
Pierce K. H. Chow ◽  
Lequn Li ◽  
Jiangtao Li ◽  
Fan Jia ◽  
Hee-Jee Wang ◽  
...  
Keyword(s):  
South Korea ◽  
Treatment Strategies ◽  
Cancer Staging ◽  
Treatment Modalities ◽  
First Line ◽  
Real World Data ◽  
First Line Therapy ◽  
Target Sample Size ◽  
Common Cancer ◽  
Younger Age

229 Background: HCC is the 6th most common cancer worldwide with > 70% of cases in Asia. There is limited real-world data on the diagnosis, treatment modalities, outcomes and treatment costs in HCC. Methods: The HCC Registry in Asia (AHCC08) is a multi-country longitudinal cohort study of HCC patients diagnosed between 2013 and 2019. Target sample size is 2500 from 9 geographies: China, Singapore, South Korea, Japan, Taiwan, Australia, New Zealand, Hong Kong, and Thailand. We present initial data on diagnosis, etiology, stage at presentation, and treatment modalities of HCC from China [CN] (5 centers), Singapore [SG] (3 centers), South Korea [SK] (4 centers), and Japan [JP] (2 centers). Results: 657 patients (436 CN; 102 SG; 85 SK; 34 JP) were evaluated in August 2018. Patients from China were diagnosed at a younger age, while patients from Japan were diagnosed at an older age (mean age 51 years CN; 67 years SG; 58 years SK; 68 years JP). The highest proportion of regular alcohol drinkers were from Japan (16% CN; 21% SG; 24% SK; 50% JP) and occasional drinkers from China (20% CN; 17% SG; 12% SK; 15% JP). 77% had Hepatitis B across the 5 geographies, with the highest incidence in China (93%), followed by South Korea (68%). 27% were diagnosed using AASLD/APASL imaging criteria, with the highest utilization in Singapore (66% AASLD; 80% APASL) and South Korea (64% AASLD; 20% APASL). Later-stage patients (according to Barcelona Clinic Liver Cancer staging guidelines) were more predominant in Japan (Stage C: 28% CN, 16% SG, 8% SK, 41% JP; Stage D: 0.5% CN, 0% SG, 1% SK, 3% JP). Relatively few radiofrequency ablations were carried out as the first-line therapy across the 5 geographies (2% CN; 5% SG; 2% SK; 0% JP). In China, liver resection was preferred in first-line HCC treatment (65% CN vs 28% SG, SK, and JP aggregated), followed by loco-regional (27% CN vs 7% SG, SK, and JP aggregated) and systemic therapy (2% CN vs 10% SG, SK, and JP aggregated). Conclusions: There is considerable variation in presentation and management patterns between the 5 geographies. These data will benefit policymakers, companies and clinicians in improving policies and developing treatment strategies for HCC. (ClinicalTrials.gov: NCT03233360).

scholarly journals The Optimal First-Line Therapy ofHelicobacter pyloriInfection in Year 2012

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Chao-Hung Kuo ◽  
Fu-Chen Kuo ◽  
Huang-Ming Hu ◽  
Chung-Jung Liu ◽  
Sophie S. W. Wang ◽  
...  
Keyword(s):  
Rescue Therapy ◽  
Treatment Strategies ◽  
Sequential Therapy ◽  
Antibiotics Resistance ◽  
First Line ◽  
First Line Therapy ◽  
Metronidazole Resistance ◽  
Rescue Treatment ◽  
New Treatment ◽  
H Pylori

This paper reviews the literature about first-line therapies forH. pyloriinfection in recent years. First-line therapies are facing a challenge because of increasing treatment failure due to elevated antibiotics resistance. Several new treatment strategies that recently emerged to overcome antibiotic resistance have been surveyed. Alternative first-line therapies include bismuth-containing quadruple therapy, sequential therapy, concomitant therapy, and hybrid therapy. Levofloxacin-based therapy shows impressive efficacy but might be employed as rescue treatment due to rapidly raising resistance. Rifabutin-based therapy is also regarded as a rescue therapy. Several factors including antibiotics resistance, patient compliance, and CYP 2C19 genotypes could influence the outcome. Clinicians should use antibiotics according to local reports. It is recommended that triple therapy should not be used in areas with high clarithromycin resistance or dual clarithromycin and metronidazole resistance.

Management of refractory myeloma: a review.

1988 ◽  
Vol 6 (5) ◽  
pp. 889-905 ◽  
Author(s):  
A C Buzaid ◽  
B G Durie
Keyword(s):  
Protein Concentration ◽  
Response Rate ◽  
Clinical Problem ◽  
Initial Therapy ◽  
M Protein ◽  
Treatment Modalities ◽  
High Dose ◽  
First Line ◽  
First Line Therapy ◽  
New Treatment

Management of refractory myeloma represents a common and challenging clinical problem. Approximately 30% to 50% of patients with multiple myeloma do not respond to first-line therapy, and those who initially achieve a remission will eventually relapse. Surprisingly, there is no routinely accepted approach to patients with refractory disease. Therefore, we review the literature in an attempt to provide an overview of the published results and outline our treatment recommendations for such patients. We suggest the following: (1) for truly resistant patients (ie, those who clearly progress with initial therapy), administration of high-dose or pulsed glucocorticosteroids is the best treatment, with an expected response of 40% (defined as a greater than or equal to 50% reduction in monoclonal [M]-protein concentration); (2) for patients who relapse during therapy or relapse within 6 months of stopping the initial treatment, the VAD regimen (vincristine, doxorubicin, and dexamethasone) is one of the most effective salvage therapies, resulting in an approximately 75% response rate (greater than or equal to 50% reduction in M-protein concentration); (3) for patients who relapse within more than 6 months of stopping therapy (unmaintained remission), reinitiation of the initial therapy represents an excellent alternative, leading to recontrol in 60% to 70% of patients (greater than or equal to 50% reduction in M-protein concentration). If progression is observed or if there is response and then relapse in this setting, VAD chemotherapy can be administered again. (4) Patients who fail second-line salvage therapies should enter well-designed clinical trials to evaluate new treatment modalities. If this is not feasible, alpha-interferon or "systemic" radiotherapy are recommended in selected cases.

scholarly journals What does first-line therapy mean for paediatric multiple sclerosis in the current era?

2020 ◽  
pp. 135245852093764
Author(s):  
Yael Hacohen ◽  
Brenda Banwell ◽  
Olga Ciccarelli
Keyword(s):  
Multiple Sclerosis ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Cognitive Outcome ◽  
First Line ◽  
First Line Therapy ◽  
Highly Active ◽  
Paediatric Multiple Sclerosis ◽  
The Impact

Paediatric multiple sclerosis (MS) is associated with higher relapse rate, rapid magnetic resonance imaging lesion accrual early in the disease course and worse cognitive outcome and physical disability in the long term compared to adult-onset disease. Current treatment strategies are largely centre-specific and reliant on adult protocols. The aim of this review is to examine which treatment options should be considered first line for paediatric MS and we attempt to answer the question if injectable first-line disease-modifying therapies (DMTs) are still an optimal option. To answer this question, we review the effects of early onset disease on clinical course and outcomes, with specific considerations on risks and benefits of treatments for paediatric MS. Considering the impact of disease activity on brain atrophy, cognitive impairment and development of secondary progressive MS at a younger age, we would recommend treating paediatric MS as a highly active disease, favouring the early use of highly effective DMTs rather than injectable DMTs.

Reassessment of treatment modalities for paediatric patients with chronic immune thrombocytopenia

2009 ◽  
Vol 29 (02) ◽  
pp. 171-176 ◽  
Author(s):  
G. Janssen ◽  
A. Borkhardt ◽  
H. J. Laws
Keyword(s):  
Lupus Erythematosus ◽  
Immune Thrombocytopenia ◽  
Spontaneous Recovery ◽  
Treatment Modalities ◽  
First Line ◽  
Second Line Therapy ◽  
Chronic Itp ◽  
First Line Therapy ◽  
Line Therapy ◽  
Acute Form

SummaryApproximately 70% of children have the acute form of immune thrombocytopenia (ITP), which is defined by recovery within six months of presentation with or without treatment. Chronic ITP is to be reserved for patients with platelets < 100 000/μl for more than twelve months and exclusion of other diagnosis like systemic lupus erythematosus or bone marrow failures. In children, the chance of spontaneous recovery is 52% after diagnosis of chronic ITP. The Intercontinental Childhood ITP Study group recommends that children without bleeding may not require therapy regardless of their platelet count. Whereas in patients with bleeding symptoms first line therapy is defined and includes steroids or immunoglobuline, second line therapy in refractory patients with significant hemorrhagic problems is unclear. Guidelines recommend splenectomy, but for more than 50 years patients and physicians look for pharmacological alternatives. It may be that rituximab is a promising option which has been proven to be effective with few adverse effects. Till now the treatment has focused on immunomodulation. Research has now focused on stimulating platelet production. In this review we discuss old and new therapy modalities for children with cITP.

Chemotherapy Alone Is Effective to Treat Localized and Disseminated Ocular Adnexa Lymphomas

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2709-2709
Author(s):  
Wei-Li Ma
Keyword(s):  
Prognostic Factors ◽  
Old Age ◽  
Lacrimal Gland ◽  
Treatment Strategies ◽  
High Grade ◽  
Advanced Stage ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
High Grade Transformation

Abstract Background: The treatment strategies for ocular adnexa lymphomas (OALs), including conjunctiva, orbital, and lacrimal gland lymphomas, remain controversial. In this study, we assessed the efficacies and outcomes of different modality treatment, including chemotherapy, radiotherapy, and surgery for OALs. Methods and Materials: Between Jan. 1990 to Dec. 2013, patients receiving first-line chemotherapy (oral alkylating agents, rituximab-based treatment, or CHOP [cyclophosphamide, doxorubicin, vincristine, and steroid]-like regimens), radiotherapy (30 to 50 Gy, in 1.8- to 2.0- Gy per daily fractions), and surgery for newly diagnosed OAL were included in this study. The clinicopathologic features, including patients' characteristics, primary lymphoma locations, pathology subtypes, treatment modality, event-free survival (EFS) following first-line therapy, and OS (OS) were analyzed. Results: There were 56 men and 37 women with median age of 58 years were included. Of them, 79 patients (85%) were diagnosed with low-grade mucosa-associated lymphoid tissue (MALT) lymphoma, 5 (5%) with high-grade transformed MALT lymphoma, and 9 (10%) with diffuse large B cell lymphoma. Orbit was the most common involved location (45 patients, 48%), followed by conjunctiva (35 patients, 38%), and lacrimal gland (13 patients, 14%). Of 79 patients with stage I-IIE1 disease, 22 received chemotherapy, 34 with radiotherapy, and 23 patients with other modality treatments (18 with surgery, 4 with combined radiotherapy and chemotherapy, and 1 with intra-lesional injection of rituximab). The 5-year EFS for chemotherapy, radiotherapy, and other modality treatment was 89.2%, 89.7%, and 83.1%, respectively, whereas the 5-year OS for chemotherapy, radiotherapy, and other modality treatment was 100%, 90.4%, and 87.5%, respectively. Of 14 patients with stage IIE2 to IV disease, the 5-year EFS for chemotherapy alone (n=9) and combined radiotherapy and chemotherapy (n=5) were 68.6%, 80%, respectively, whereas the 5-year OS for both group was 80.0%. Among 42 patients receiving radiotherapy, 7 (16.7%) patients developed cataract, 4 (9.5%) patients with keratitis, and 2 (4.8%) patients with maculopathy. In multivariate analysis, high-grade transformation (P=0.049) was the significant factor for shorter EFS of 1st -line treatment. Old age (> 60 years) (p = 0.014), advanced stage (stages III and IV) (p = 0.03), and high-grade transformation (p = 0.018) were the prognostic factors of poor OS. Conclusions: In addition to radiotherapy, our data indicate that chemotherapy as first-line therapy provides good disease control and less radiotherapy-associated side effects for patients with stage I to IIE1 OALs. Old age, advanced stage, and high-grade histology subtype remain poor prognostic factors for OALs, and new treatment strategies for these patients are warranted. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Use of Sensitive Imaging Modalities for Cervical Cancer Staging in Japan

2019 ◽  
Vol 11 (3) ◽  
pp. 75
Author(s):  
Takahiro Higashi ◽  
Tomone Watanabe ◽  
Momoko Iwamoto ◽  
Mikio Mikami
Keyword(s):  
Cervical Cancer ◽  
Cancer Staging ◽  
Stage Ii ◽  
Imaging Modalities ◽  
First Line ◽  
Figo Staging ◽  
First Line Therapy ◽  
Line Therapy ◽  
Pet Ct ◽  
Stage Stage

The International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer did not take into account any of the findings determined by imaging modalities as part of the staging work-up. However, in the Japanese clinical settings, computed tomography (CT) and magnetic resonance imaging (MRI) are frequently used. In this study, we aimed to describe the pretreatment use of sensitive imaging modalities in Japan in order to assess the future adaptability of the FIGO staging system.Data from September 2012 to December 2014 were collected from the National Database of the Hospital-Based Cancer Registry and health insurance claims data. A total of 280 hospitals participated. From the database, all patients with cervical cancer who received first-line therapy at the participating hospitals were analyzed. The proportions of patients who had CT, MRI, and positron emission tomography-CT (PET-CT) before receiving the first-line therapy were calculated. For comparison, the proportions of patients who had undergone cystoscopy and/or proctoscopy -- examinations that are incorporated into the FIGO system -- were also calculated. A total of 13 668 patients were included; 77.3% of patients had early stage (stage 0 or I) disease. Among all patients, 88.5% had undergone CT, MRI, or PET-CT before receiving the first-line therapy. Additionally, over 90% of patients with advanced-stage (stage II&ndash;IV) disease had undergone CT. Conversely, only 21.0% of patients with stage II&ndash;IV disease were reported to have undergone cystoscopy and/or proctoscopy. Promoting a resource-stratified approach in the cervical cancer staging is warranted.

Patterns of pharmaceutical therapy in advanced melanoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20014-e20014 ◽  
Author(s):  
Aikaterini Bilitou ◽  
Zhongyun Zhao ◽  
Beth L. Barber ◽  
Genevieve Sian Clapton ◽  
Deborah Saltman
Keyword(s):  
Braf Mutation ◽  
Standard Of Care ◽  
Advanced Melanoma ◽  
Treatment Modalities ◽  
Second Line ◽  
Wild Type ◽  
First Line ◽  
Pharmaceutical Therapy ◽  
First Line Therapy ◽  
Line Therapy

e20014 Background: Since 2011, two therapies that provide novel approaches to the treatment of advanced (unresectable or metastatic) melanoma have been introduced to the market: ipilimumab for second line and vemurafenib for BRAF mutation-positive melanoma. It is not known how the new drugs influence treatment; this study investigated current treatment patterns in advanced melanoma. Methods: A clinician-validated, web-based survey was administered between August and November 2012 to clinicians who treat advanced melanoma in France, Germany, Italy, Spain, and the UK. Respondents were asked about their treatment of patients in the previous 12 months, including treatment modalities and pharmaceutical therapies used, and factors that affect treatment choice. Results: 150 oncologists and dermatologists completed the survey, 30 in each country. Pharmaceutical therapy was more commonly used than other treatment modalities and varied by stage of disease. A high proportion of patients with late stage of disease were treated with pharmaceutical therapy in Germany (85% in M1B) and France (83% in M1C). Among the countries, 51% (Italy) to 87% (France) of respondents test BRAF mutation status. In patients with wild-type BRAF tumors, dacarbazine, which has not been shown to provide any overall survival benefit, was the most commonly used drug for first-line therapy in all countries. In mutated BRAF tumors, vemurafenib was the most commonly used drug in first line therapy in 3 of 5 countries. There was no standard of care in second line for either patients with wild-type or mutated-BRAFtumors; therapies used included fotemustine, temozolomide, interferon, paclitaxel, and ipilimumab. Conclusions: Treatment options for patients with advanced melanoma are limited, particularly for patients with wild-type BRAF disease. In second line, there does not appear to be an established standard of care: a range of treatments are used, including several not indicated for melanoma.

scholarly journals A Rare Case Report of Metastatic Urothelial Carcinoma to Skull with Significant Reossification after Pembrolizumab

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 987
Author(s):  
Yung-Hao Liu ◽  
Meng-Han Chou ◽  
En Meng ◽  
Chien-Chang Kao
Keyword(s):  
Urothelial Carcinoma ◽  
Adrenal Glands ◽  
First Line ◽  
Case Presentation ◽  
First Line Therapy ◽  
Common Cancer ◽  
Line Therapy ◽  
Painful Sensation ◽  
Rare Case Report ◽  
Metastatic Urothelial Carcinoma

Background: Urothelial carcinoma ranks as the fourth most common cancer in men in the U.S; upon diagnosis, 10–15% have metastasized, mostly to lymph nodes, liver, lung, bone, and adrenal glands. Very few cases of skull invasion have been reported, and there is no established definite treatment. Case presentation: A 64-year-old Taiwanese male presented with metastatic urothelial carcinoma (mUC) of bladder with skull invasion. A sunken forehead without painful sensation could be palpated. After failure of chemotherapy, the patient received immunotherapy pembrolizumab, and complete remission of distant metastasis with reossification of osteolytic skull were noted. Conclusion: Immunotherapy has been reported to show significant remission in mUC, but mostly in solid organs or bone. While skull metastasis usually suggests late progression of the disease, immunotherapy has fewer systemic adverse effects than chemotherapy, and should be taken into consideration as a first-line therapy.

scholarly journals Ethnic Disparities in Waldenström's Macroglobulinaemia in the United Kingdom - Analysis from the Wmuk Rory Morrison Registry

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1977-1977
Author(s):  
Aisha S Patel ◽  
Jahanzaib Khwaja ◽  
Helen McCarthy ◽  
Guy Pratt ◽  
Jaimal Kothari ◽  
...  
Keyword(s):  
Ethnic Minorities ◽  
Research Funding ◽  
Ethnic Disparities ◽  
First Line ◽  
Advisory Committees ◽  
First Line Therapy ◽  
The United Kingdom ◽  
Younger Age ◽  
The Uk ◽  
Asian Cohort

Abstract Introduction: Waldenström's Macroglobulinaemia (WM) is a rare indolent B-cell lymphoma characterised by lymphoplasmacytic infiltrate with an IgM paraproteinaemia. Approximately 400 patients (pts) are diagnosed annually in the United Kingdom (UK). National and regional registries provide important insights on the epidemiology and clinical features of this distinct uncommon disorder. Previous authors from the United States have reported significant differences in age at diagnosis and overall survival (OS) in WM between ethnic groups from Surveillance, Epidemiology and End Results data [1]. We aimed to determine baseline demographics, symptoms and survival outcomes across different ethnic groups in the UK. Methods: We retrospectively reviewed data from the WMUK Rory Morrison Registry, collating descriptive data of WM as well as non-IgM Lymphoplasmacytic lymphoma (LPL) cases from 20 centres across the UK, diagnosed between June 1978 and May 2021. Research ethics approval was obtained. Results: 732 pts with documented ethnicity were included here. Ethnicity was categorised in accordance with the UK National Census. Those other than the White cohort (662/732; 90%) were collectively termed 'Ethnic Minorities' (EM) (70/732; 9%): 39/70 (56%) Asian (13 Indian, 6 Chinese, 4 Pakistani, 16 other); 19/70 (27%) Mixed (1 White & Black African, 1 White & Asian, 1 Arab, 16 other); 12/70 (17%) Black (6 Caribbean, 3 African, 3 other). Baseline characteristics are displayed in table 1. EM presented at a significantly younger age compared to White cohort (60 vs 64 years, p=0.01) and had a significantly lower paraprotein at diagnosis (11 vs 18g/L, p=0.05). MYD88 L265P mutation tested in 250 pts (34%): positive in the majority 218/250 (87%) and notably less common in EM (p=0.09), most significantly in the Asian cohort compared to White (67% v 88%, p=0.01). The EM cohort had a smaller proportion of WM diagnoses compared to White cohort (77% vs 93%, p=0.02) with the Asian cohort accounting for the highest proportion of non-IgM LPL (15% vs 4%, p=0.002). Bone marrow trephine infiltration at diagnosis was lower in the EM cohort compared to the White cohort, although not statistically significant (25% vs 37%, respectively; p=0.10). IPSSWM scores were similar throughout. Approximately half of both the White & EM cohorts were asymptomatic at diagnosis. The most common presenting symptoms in EM were anaemia-related (10/34; 29%), B symptoms (6/34; 18%) and fatigue (4/34; 12%). 6/18 (33%) of Asians presented with cryoglobulinaemia, amyloid, nephropathy or acquired von Willebrand's Disease. Of EM, 51/70 (73%) had treatment, 35/51 (69%) within the first year from diagnosis with time to treatment 2 months (range 0-364). Time to next therapy was 14 months. Median lines of therapy were 2 (range 1-8). The most common indication for first line therapy was lymphoma-related (16/39; 41%) followed by paraprotein-related (peripheral neuropathy, hyperviscosity and autoimmune) (13/39; 33%). First line therapies included Bendamustine-Rituximab (BR; 8/49; 16%), Dexamethasone Rituximab Cyclophosphamide (DRC; 7/49; 14%) and R-CHOP (5/49; 10%) with smaller proportions receiving Rituximab monotherapy, Cladribine + Rituximab or Fludarabine + Cyclophosphamide + Rituximab (FCR) (3/49 (6.1% each). Two of 41 (5%) of EM had first treatment as a part of a clinical trial, compared to 16/156 (10%) of the White cohort (p=0.28). Response to first line therapy was similar between the White & EM cohorts (Table 1). For EM, at a median follow up of 7 years, 17 died (1/17; 6% disease related). Median OS was not reached (Figure 1). Estimated 5-year and 10- year OS was 91% (95% CI 96-80%) and 75% (95% CI 85-60%), respectively. Conclusions: This first report on ethnic disparities in WM and non-IgM LPL in the UK identified key differences in presentation of disease. Ethnic minorities present at a younger age, with a lower paraprotein. The Asian cohort had a greater proportion of non-IgM LPL cases and fewer MYD88 mutated cases. A small proportion of Ethnic Minorities have treatment on a clinical trial which may warrant further attention. Further analysis including associations with socioeconomic status, deprivation indices and comorbidities are ongoing. Ailawadhi, Sikander et al. "Outcome disparities among ethnic subgroups of Waldenström's macroglobulinemia: a population-based study." Oncology vol. 86,5-6 (2014): 253-62. doi:10.1159/000360992 Disclosures McCarthy: Janssen: Honoraria; Astra zenica pharmaceuticals: Honoraria; Amgen: Honoraria. Pratt: Amgen: Consultancy; Binding Site: Consultancy; BMS/Celgene: Consultancy; Gilead: Consultancy; Janssen: Consultancy; Takeda: Consultancy. El-Sharkawi: AbbVie: Honoraria, Other: Travel Support, Ad boards; AstraZeneca: Honoraria, Other: Ad boards; Janssen: Honoraria, Other: Ad boards; Roche: Honoraria; Takeda: Honoraria; Novartis: Other: Travel Support; ASTEX: Other: Ad boards; Beigene: Other: Ad boards; Kyowa Kirin: Other: Ad boards. Linton: Genmab: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Aptitude Health: Honoraria; Hartley Taylor: Honoraria; Celgene: Research Funding; BeiGene: Research Funding; University of Manchester: Current Employment. Gatto: Roche: Consultancy. D'Sa: Janssen Cilag: Honoraria, Research Funding; BeiGene: Honoraria, Research Funding; Sanofi: Honoraria.

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