Expectations of cure among patients with advanced genitourinary cancer treated with immunotherapy.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 591-591
Author(s):  
Cristiane Decat Bergerot ◽  
Paulo Gustavo Bergerot ◽  
Errol James Philip ◽  
Joann Hsu ◽  
Nazli Dizman ◽  
...  
Keyword(s):  
Well Being ◽  
Complete Response ◽  
Survey Study ◽  
Considerable Proportion ◽  
Clinical Counseling ◽  
Programmed Death ◽  
Medical Oncologists ◽  
Programmed Death 1 ◽  
Line Of Therapy ◽  
Anxiety Depression

591 Background: Over the past 15 years, considerable progress has been made in systemic therapy options for genitourinary (GU) cancers. In diseases such as metastatic renal cell carcinoma (RCC) and urothelial cancer (UC), immunotherapeutic strategies such as programmed death-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibition have elicited durable responses, albeit in a minority of patients. We examined expectations for clinical outcome with immunotherapy among patients with advanced GU cancers. Methods: A survey study was conducted in patients with advanced GU cancers initiating PD-1/PD-L1 inhibitors from October 2017 to September 2018. Patients were screened prior to initiation of immunotherapy for their expectation of cure (divided into 4 quartiles), symptoms of anxiety and depression (PROMIS-A and PROMIS-D), and quality of life (QOL; FACT-G). For purposes of the survey, cure was equated to a durable complete response. Differences in frequency of anxiety, depression and QOL were compared amongst subsets of patients divided by expectation of cure. Results: Among 60 patients, median age was 67, 72% were male and 81% were married. Types of cancer included RCC (69%), UC (19%) and prostate cancer (12%). The majority were in the 1st or 2nd line of therapy (40% and 31%, respectively). Despite extensive counseling from GU medical oncologists, 23% of patients thought that cure was “very likely”, defined as in the range of 76-100%. Approximately 70% of patients estimated cure in the range of 0-25%, in line with clinical counseling. These patients had higher rates of anxiety (P = 0.01), depression (P = 0.002) and poorer QOL (P = 0.003) compared to patients who felt cure was very likely. Conclusions: A considerable proportion of patients with advanced GU malignancies harbor unrealistic expectations around the potential benefit of immunotherapy. Although a first instinct may be to remedy these expectations, it is important to bear in mind that these patients had better emotional well-being and QOL. We will validate these findings and assess these parameters longitudinally in an upcoming SWOG trial for patients with mRCC receiving upfront immunotherapy.

scholarly journals Recurrent Gallbladder Carcinoma With pMMR/MSS Achieved a Complete Response Following Camrelizumab Combined With Apatinib: A Case Report

2022 ◽  
Vol 11 ◽  
Author(s):  
Liting Zhong ◽  
Xiaoyu Liu ◽  
Zelei Li ◽  
Xuebing Zhang ◽  
Yuli Wang ◽  
...  
Keyword(s):  
Gallbladder Carcinoma ◽  
Complete Response ◽  
Limited Data ◽  
Effective Treatment Option ◽  
Tumor Mutation Burden ◽  
Angiogenic Therapy ◽  
Mutation Burden ◽  
Programmed Death ◽  
Programmed Death 1 ◽  
Durable Complete Response

Gallbladder carcinoma (GBC) with proficient mismatch repair (pMMR)/microsatellite stable (MSS) is associated with limited response to programmed death-1 (PD-1) inhibitor monotherapy. Limited data of PD-1 blockade combined with anti-angiogenic therapy in GBC are reported. One recurrent GBC patient with pMMR/MSS was treated with camrelizumab plus apatinib. After 4 cycles of combination therapy, the patient achieved a durable complete response with manageable toxicity. The next-generation sequencing and immunohistochemistry analysis showed that tumor mutation burden (TMB) was 7.26 mutants/Mb and PD-L1 expression was 10% (tumor proportion score) and 20% (immune proportion score). This case suggests that camrelizumab in combination with apatinib may be an effective treatment option for GBC patients with pMMR/MSS status, who have moderate expression of TMB and PD-L1. Additionally, TMB and PD-L1 expression may serve as potential biomarkers for predicting PD-1 inhibitor response of GBC. Furthermore, this needs to be verified in future studies.

scholarly journals Hypofractionated Stereotactic Re-Irradiation with Pembrolizumab and Bevacizumab in Patients with Recurrent High Grade Gliomas: Results from a Phase 1 Study

2020 ◽  
Author(s):  
Solmaz Sahebjam ◽  
Peter A Forsyth ◽  
Nam D Tran ◽  
John A Arrington ◽  
Robert Macaulay ◽  
...  
Keyword(s):  
Phase 1 ◽  
Progression Free Survival ◽  
Complete Response ◽  
Recurrent Glioblastoma ◽  
High Grade ◽  
Programmed Death ◽  
Programmed Death 1 ◽  
High Grade Gliomas ◽  
Grade 3 ◽  
Recommended Phase Ii Dose

Abstract Background Radiotherapy may synergize with programmed death 1 (PD-1)/PD-1 ligand (PD-L1) blockade. The purpose of this study was to determine the recommended Phase II dose, safety/tolerability, and preliminary efficacy of combining pembrolizumab, an anti-PD-1 monoclonal antibody, with hypofractionated stereotactic irradiation (HFSRT) and bevacizumab in patients with recurrent high grade gliomas (HGGs). Methods Eligible subjects with recurrent glioblastoma or anaplastic astrocytoma were treated with pembrolizumab (100 or 200 mg based on dose level Q3W) concurrently with HFSRT (30 Gy in 5 fractions) and bevacizumab 10 mg/kg Q2W. Results Thirty two patients were enrolled (bevacizumab naïve, n = 24; bevacizumab resistant, n = 8). The most common treatment-related adverse events (TRAEs) were proteinuria (40.6%), fatigue (25%), increased alanine aminotransferase (25%), and hypertension (25%). TRAEs leading to discontinuation occurred in 1 patient who experienced a grade 3 elevation of aspartate aminotransferase. In the bevacizumab naïve cohort, twenty patients (83%) had a complete response (CR) or partial response (PR). The median overall survival (OS) and progression-free survival (PFS) were 13.45 months (95% CI: 9.46-18.46) and 7.92 months (95% CI: 6.31-12.45), respectively. In the bevacizumab resistant cohort, PR was achieved in 5 patients (62%). Median OS was 9.3 months (95% CI: 8.97-18.86) with a median PFS of 6.54 months (95% CI: 5.95-18.86). The majority of patients (20/26 pts; 77%) had tumor-cell/tumor-microenvironment PD-L1 expression <1%. Conclusions The combination of HFSRT with pembrolizumab and bevacizumab in patients with recurrent HGG is generally safe and well tolerated. These findings merit further investigation of HFSRT with immunotherapy in HGGs.

PS02.182: EFFECTIVENESS OF ANTI-PD-1 ANTIBODY MONOTHERAPY FOR THE PRIMARY MALIGNANT MELANOMA OF THE ESOPHAGUS: A CASE REPORT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 173-174
Author(s):  
Hiroto Muroi ◽  
Masanobu Nakajima
Keyword(s):  
Case Report ◽  
Malignant Melanoma ◽  
Conflicts Of Interest ◽  
Complete Response ◽  
Primary Malignant Melanoma ◽  
Innovative Strategies ◽  
First Case ◽  
Positron Emission ◽  
Programmed Death ◽  
Programmed Death 1

Abstract Background Primary malignant melanoma of the esophagus (PMME) is extraordinarily rare with a high prevalence of malignancy and poor prognosis, and a standard therapy remains to be established. Since conventional therapeutic methods have been limited in their effects on treatment outcomes, innovative strategies for treating PMME are being explored, especially molecular targeting strategies. The programmed death 1 (PD-1) protein/programmed death ligand-1(PD-L1) inhibitor nivolumab is a promising agent for various cancers. To our knowledge, this is the first case report of PMME where a complete response was achieved using nivolumab. Methods We report an 80-year-old woman who was diagnosed with PMME with bone metastasis and lymph node metastases. Although dacarbazine combined chemotherapy was performed and continued for six cycles, the primary tumor deteriorated and liver metastases appeared. The patient then received nivolumab monotherapy (2 mg/kg, once every three weeks). Results After three cycles, nivolumab monotherapy for PMME resulted in a complete response as shown by positron emission tomography, computed tomography, and esophagogastroduodenoscopy. Conclusion In our case, nivolumab exerted a curative effect on PMME, thus suggesting that nivolumab can be effective in the treatment of this rare disease. Disclosure All authors have declared no conflicts of interest.

Racial disparities in the use of programmed death-1 checkpoint inhibitors.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3068-3068 ◽  
Author(s):  
Jeremy O'Connor ◽  
Kathi Seidl-Rathkopf ◽  
Aracelis Z. Torres ◽  
Paul You ◽  
Nathan C. Nussbaum ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Systemic Therapy ◽  
Checkpoint Inhibitors ◽  
Advanced Melanoma ◽  
Smoking History ◽  
National Network ◽  
Programmed Death ◽  
Treatment Type ◽  
Programmed Death 1 ◽  
Line Of Therapy

3068 Background: There are concerns about racial disparities in access to trials of new cancer drugs, including the programmed death 1 checkpoint inhibitors (anti-PD1s). It is unknown whether these disparities extend to anti-PD1 treated patients in real-world practice. Methods: We used retrospective data from Flatiron Health’s electronic health record database, which includes more than 250 cancer clinics and 1.5 million patients with cancer. We identified patients diagnosed after January 1, 2011 who underwent systemic therapy for: advanced non-small cell lung cancer (aNSCLC; n = 13,473), metastatic renal cell carcinoma (mRCC; n = 1,537), and advanced melanoma (n = 1,221). Within each cohort, we identified treatment type (anti-PD1 versus non-anti-PD1). Therapy lines containing study drugs were excluded. We used logistic regressions to model the use of anti-PD1s by race, adjusting for factors such as age, sex, stage at diagnosis and line of therapy. Results: Of 16,231 patients in our sample, 4,643 (28.6%) were treated with anti-PD1s. Racial distributions differed for anti-PD1 treated patients compared to non-anti-PD1 treated patients in the aNSCLC cohort (Table: p < 0.01), but not in the mRCC cohort (p = 0.84) or the advanced melanoma cohort (p = 0.96). In bivariate analyses of patients with aNSCLC, anti-PD1 treatment was associated with other race, male sex, stage II at diagnosis, squamous histology, smoking history and line of therapy (all p < 0.05). Adjusted models showed there were no significant differences in likelihood of receiving anti-PD1s when comparing black and white patients undergoing systemic therapy for aNSCLC (aOR for black vs. white: 0.86, 95% CI 0.72-1.02), mRCC (aOR 0.90, 95% CI 0.53-1.49), or melanoma (aOR 2.02, 95% CI 0.42-14.59). Conclusions: Among patients undergoing systemic therapy in a large national network of cancer clinics, we found no significant racial disparities in the use of anti-PD1s. [Table: see text]

scholarly journals Case Report: Complete Response of Primary Massive Hepatocellular Carcinoma to Anti-Programmed Death Ligand-1 Antibody Following Progression on Anti-Programmed Death-1 Antibody

2021 ◽  
Vol 12 ◽  
Author(s):  
Gang Liu ◽  
Wenxuan Zhou ◽  
Xiaoli Li ◽  
Lijie Guo ◽  
Tingting He ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Combination Therapy ◽  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Complete Response ◽  
Programmed Death Ligand 1 ◽  
Programmed Death ◽  
Progression Of Disease ◽  
Antibody Immunotherapy ◽  
Programmed Death 1

Hepatocellular carcinoma (HCC) is an aggressive liver tumor that occurs due to chronic liver disease, and it has a high mortality rate and limited treatment options. Immune checkpoint inhibitors have been successfully introduced and used in cancer therapy, among which inhibitors of programmed death ligand-1 (PD-L1) and its receptor programmed death-1 (PD-1) are commonly administered for HCC as combination therapy, including combined anti-angiogenic and immunotherapy combination therapy. We report a case of a primary massive HCC patient with portal hepatic vein tumor thrombus who had a good response to atezolizumab in combination with bevacizumab, following progression of disease on combined immunotherapy with pembrolizumab and lenvatinib. This case demonstrates for the first time that an HCC patient who is resistant to anti-PD-1 antibody immunotherapy can benefit from anti-PD-L1 antibody immunotherapy, providing a potentially promising strategy for the treatment of HCC.

Associations Between Dutch LGBT Hate Crime Experience, Well-Being, Trust in the Police and Future Hate Crime Reporting

2020 ◽  
Vol 51 (3) ◽  
pp. 171-182
Author(s):  
Allard R. Feddes ◽  
Kai J. Jonas
Keyword(s):  
Psychological Distress ◽  
The Netherlands ◽  
Hate Crime ◽  
Well Being ◽  
Crime Victims ◽  
Crime Reporting ◽  
Survey Study ◽  
Psychological Well Being ◽  
Building Trust ◽  
Reporting Intentions

Abstract. LGBT-related hate crime is a conscious act of aggression against an LGBT citizen. The present research investigates associations between hate crime, psychological well-being, trust in the police and intentions to report future experiences of hate crime. A survey study was conducted among 391 LGBT respondents in the Netherlands. Sixteen percent experienced hate crime in the 12 months prior. Compared to non-victims, victims had significant lower psychological well-being, lower trust in the police and lower intentions to report future hate crime. Hate crime experience and lower psychological well-being were associated with lower reporting intentions through lower trust in the police. Helping hate crime victims cope with psychological distress in combination with building trust in the police could positively influence future reporting.

Faktor yang Memengaruhi Kualitas Hidup Pasien dengan Penyakit Jantung Koroner

1970 ◽  
Vol 4 (2) ◽  
Author(s):  
Aan Nuraeni ◽  
Ristina Mirwanti ◽  
Anastasia Anna ◽  
Ayu Prawesti ◽  
Etika Emaliyawati
Keyword(s):  
Quality Of Life ◽  
Heart Disease ◽  
Cardiac Rehabilitation ◽  
Beck Depression Inventory ◽  
Well Being ◽  
Anxiety Scale ◽  
Seattle Angina Questionnaire ◽  
Spiritual Well Being ◽  
Anxiety Depression

Prevalensi Penyakit Jantung Koroner (PJK) terus mengalami peningkatan setiap tahunnya dan menjadi masalah kesehatan utama di masyarakat saat ini. PJK berdampak terhadap berbagai aspek kehidupan penderitanya baik fisik, psikososial maupun spiritual yang berpengaruh terhadap kualitas hidup pasien. Isu kualitas hidup dan faktor-faktor yang berhubungan didalamnya belum tergambar jelas di Indonesia. Tujuan dari penelitian ini adalah mengidentifikasi faktor yang memengaruhi kualitas hidup pada pasien PJK yang sedang menjalani rawat jalan. Faktor-faktor yang diteliti dalam penelitian ini meliputi jenis kelamin, tingkat penghasilan, revaskularisasi jantung, rehabilitasi jantung, kecemasan, depresi dan kesejahteraan spiritual. Kecemasan diukur dengan Zung Self-rating Anxiety Scale, depresi diukur dengan Beck Depression Inventory II, kesejahteraan spiritual diukur dengan kuesioner Spirituality Index of Well-Beingdan kualitas hidup diukur menggunakan Seattle Angina Questionnaire. Penelitian ini menggunakan rancangan kuantitatif deskriptif dan analitik multivariatedengan regresi logistic. Diteliti pada 100 responden yang diambil secara randomdalam kurun waktu 1 bulan di Poli Jantung. Hasil penelitian menunjukkan faktor yang memengaruhi kualitas hidup pada pasien PJK adalah cemas (p) 0,002; Odd Ratio(OR) 4,736 (95% confidence interval(CI), 1,749 – 12,827); depresi (p) 0,003; OR 5,450 ( 95% CI, 1,794 – 16,562); dan revaskularisasi (p) 0,033; OR 3,232 (95% CI, 1,096 – 9,528). Depresi menjadi faktor yang paling berpengaruh terhadap kualitas hidup pasien PJK. Faktor yang memengaruhi kualitas hidup pada pasien PJK meliputi depresi, cemas dan revaskularisasi. Dari ketiga variabel tersebut depresi merupakan variabel yang paling signifikan berpengaruh, sehingga manajemen untuk mencegah depresi perlu mendapatkan perhatian lebih baik lagi dalam discharge planningataupun rehabilitasi jantung.Kata kunci: Cemas, depresi, faktor yang memengaruhi, kualitas hidup, spiritual.Factors Influenced the Quality of Life among Patients Diagnosed with Coronary Heart Disease AbstractCoronary Heart Disease (CHD) has affected multidimensional aspects of human live nowadays. Yet, quality of life and factors associated with quality of life among people who live with heart disease has not been explored in Indonesia. This study aimed to identify factors influenced the quality of life among people with CHD received outpatient services. Those factors are gender, income, revascularization, cardiac rehabilitation, anxiety, depression and spiritual well-being. Zung Self-rating Anxiety Scale was used to measure anxiety where depression level measured using Beck Depression Inventory II. Spirituality index was used to measure spiritual well-being. The quality of life level was measured using the Seattle Angina Questionnaire. This study used quantitative descriptive with multivariate analysis using logistic regression. 100 respondents were randomly selected from the Cardiac Outpatient Unit. Findings indicated factors influenced the quality of life of CHD patients using a significance of ƿ-value < 0.005 were: anxiety (ƿ=0,002, OR = 4,736, 95% CI, 1,749 – 12,827); depression (ƿ=0,003; OR=5,450, 95% CI, 1,794 – 16,562); and revascularizations (ƿ=0,033; OR=3,232, 95% CI, 1,096 – 9,528). Depression was considered as the most significant factor; therefore, managing depression is a priority in the discharge planning or cardiac rehabilitation programme. Keywords: Anxiety, depression, quality of life, spiritual, well-being.

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