Young-onset pancreas cancer (PC) in patients less than or equal to 50 years old at Memorial Sloan Kettering (MSK): Descriptors, genomics, and outcomes.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 774-774 ◽  
Author(s):  
Anna M. Varghese ◽  
Isha Singh ◽  
Ritu Raj Singh ◽  
Marinela Capanu ◽  
Joanne F. Chou ◽  
...  
Keyword(s):  
Stage Iv ◽  
Acinar Cell Carcinoma ◽  
Molecular Characteristics ◽  
Wild Type ◽  
Young Onset ◽  
Entire Cohort ◽  
Kaplan Meier ◽  
Stage Iv Disease ◽  
Somatic Alterations ◽  
Neuroendocrine Cancers

774 Background: For individuals ≤ 50 years old, cancer incidence is increasing, particularly gastrointestinal and obesity related cancers (Sung, Lancet Public Health 2019). Limited details are known about young onset PC. Herein, we report the epidemiologic, pathologic, and molecular characteristics of PC in patients (pts) ≤ 50 years. Methods: MSK institutional database was queried for medical and treatment history, genomics, and outcomes in pts ≤ 50 years old diagnosed with PC between January 2008 and July 2018. Neuroendocrine cancers were excluded. Overall survival (OS) from date of PC diagnosis was estimated using Kaplan-Meier methods. Results: N = 450 pts ≤ 50 years old with a diagnosis of PC were identified. Ninety-six percent had adenocarcinoma, and 4% had acinar cell carcinoma/other histologies. Table summarizes demographics. Median OS was 16 months in the entire cohort and 11.3 months in stage IV disease. For N = 236 pts diagnosed after 2014, 119 (50%) underwent successful somatic testing with at least one alteration identified, and 21/119 tumors were RAS wild-type with identification of several actionable alterations (NRG1 fusions (n=2), NTRK fusions (n=2), IDH1 R132C (n=1), and microsatellite unstable tumors (n=1) ). N = 114 pts had germline testing (routine after 2015), and 33/114 (29%) had pathologic germline alterations, including BRCA1/2 (n=18), CHEK2 (n=3), PALB2 (n=3), ATM (n=2), MLH1 (n=1), and MSH3 (n=1). Conclusions: Pathogenic germline alterations are present in a substantial percentage of pts with young onset PC, and actionable somatic alterations were seen frequently in the subgroup of young onset PC RAS-wild type tumors. These observations underpin the need for germline and somatic profiling in PC. [Table: see text]

Evaluation of different MET genotypes as biomarkers for immunotherapy outcomes in NSCLC patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21032-e21032
Author(s):  
Xuanzong Li ◽  
Linlin Wang
Keyword(s):  
Checkpoint Inhibitors ◽  
Progression Free Survival ◽  
Rank Test ◽  
Wild Type ◽  
Exact Test ◽  
Entire Cohort ◽  
Kaplan Meier ◽  
Tumor Mutational Burden ◽  
The Difference ◽  
Nsclc Patients

e21032 Background: Previous studies suggested that MET exon 14 ( METex14) mutation regarding as a distinct subset was sensitive to MET-inhibitors, but poorly response to immunotherapy. Conversly, MET non-exon-14 (non-ex14) mutations including those undetermined functions and affecting the kinase or extracellular domains were found to be associated with the resistance to MET-inhibitors. However, therapeutic strategies for MET-non-ex14 mutant cancer are still largely unknown, and the relationship between MET-non-ex14 mutations and the efficacy of immune checkpoint inhibitors (ICIs) has never been reported. Using two public ICIs-treated cohorts, we aimed to assess the role of MET mutations including both METex14 and MET-non-ex14 mutations in NSCLC patients undergoing ICIs therapy. Methods: A total of 385 ICIs-treated NSCLC patients were enrolled to our study. MET mutations were defined as any nonsynonymous mutations, and we divided them into METex14 and MET-non-ex14 mutation subsets according to the mutated-position on MET. Kruskal-Wallis test was used to analyze the difference of tumor mutational burden (TMB) score, and the Fisher’s exact test was applied to compare the rates of durable clinical benefit (DCB). Log-rank test was used to analyze the differences between Kaplan-Meier survival curves. Results: In the entire cohort, we found that 17 patients (17/385, 4.4%) had MET mutations, most of which were pure METex14 mutations (10/17, 58.8%). The median TMB of patients in the entire NSCLC cohort was 6.89 mut/Mb. MET-non-ex14 mutant patients (7/385, 1.8%) possessed a significantly higher TMB than METex14-mutant (10/385, 2.6%) and MET wild-type (368/385, 95.6%) sub-cohorts, respectively (median TMB, 17.92 mut/Mb versus 4.17 mut/Mb, p = 0.008; 17.92 mut/Mb versus 6.96 mut/Mb, p = 0.01, respectively). DCB was more common in patients harbored MET-non-ex14 mutations than patients with METex14 mutations and MET wild-type (66.7% versus 14.3%, p = 0.103; 66.7% versus 29.9%, p = 0.075, respectively). We found that patients with MET-non-ex14 mutations had a numerically longer progression free survival (PFS) than those with METex14 mutations and MET wild-type (p = 0.169). Moreover, the PFS was significantly longer in MET-non-ex14-mutant subgroup than patients with METex14 mutations (median PFS, 9.1 versus 2.1 months, p = 0.025). Correspondingly, the overall survival (OS) was significantly longer in MET-non-ex14-mutant subgroup than their wild-type counterparts (median OS, not reached versus 11 months, p = 0.039). Additionally, patients with MET-non-ex14 mutations exhibited relatively better OS versus METex14-mutant patients (median OS, not reached versus 18 months, p = 0.175). Conclusions: MET-non-ex14 mutations were associated with higher TMB, improved DCB rate, and could act as a favorable prognostic biomarker in ICIs-treated NSCLC patients.

scholarly journals CMET-38. PREVALENCE AND SURVIVAL OUTCOMES OF UROTHELIAL CARCINOMA BRAIN METASTASES

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi60-vi60
Author(s):  
Vasileios Kavouridis ◽  
Maya Harary ◽  
Timothy Smith ◽  
David Braun ◽  
Bryan Iorgulescu
Keyword(s):  
Brain Metastases ◽  
Urothelial Carcinoma ◽  
Urothelial Cancer ◽  
Lung Metastases ◽  
Multivariable Analysis ◽  
Stage Iv ◽  
Median Number ◽  
Kaplan Meier ◽  
Stage Iv Disease ◽  
Brain Involvement

Abstract BACKGROUND Urothelial carcinoma is a common malignancy with ~79,000 new cases diagnosed annually. However, urothelial brain metastases (UBM) are encountered uncommonly. Herein we evaluate their national prevalence, predictors, and treatment outcomes in the contemporary era. METHODS The characteristics, management, and overall survival (OS) of UBM patients (2010–2015) were evaluated using the National Cancer Database, which comprises >70% of all newly diagnosed cancers in the U.S. OS was analyzed with Kaplan-Meier methods and log-rank tests. National outcomes were compared to our institutional cohort of UBMs. RESULTS Out of 208,600 patients diagnosed with urothelial carcinoma, 8.4% presented with stage IV disease--of these only 216 (1.2%) had BMs at the time of diagnosis. Patients presenting with bone, liver, or lung metastases were more likely to present with synchronous BMs. Brain involvement demonstrated significantly worse median OS (3.9mos, 95%CI: 3.1–4.9) than non-BM stage IV disease (10.9mos, 95%CI: 10.6–11.2, p< 0.001). Compared to non-BM stage IV disease, UBMs were more likely to have surgery for metastatic disease and receive radiotherapy (p< 0.001); but were less likely to have primary resection or chemotherapy. In multivariable analysis of stage IV urothelial cancer, BMs demonstrated significantly worse OS (HR 1.43, 95%CI: 1.20–1.72, p< 0.001). In our institutional data, 10 urothelial cancer patients developed BMs; of which 7 were male, median age and KPS at diagnosis were 64.9yo (IQR 56.4–72.0) and 85 (IQR 75–100). Four patients had synchronous metastases; the median number of BM lesions was 2 (IQR 1–2), with a median size of 2.6cm (IQR 1.6–3.3). All 10 underwent GTR, 3 also with SRS and 7 with WBRT, associated with a median OS of 16.5mos. CONCLUSIONS Our results confirm the rarity of UBMs and suggest that BM screening may only be indicated in stage IV patients with neurological symptoms. Systemic therapies demonstrate improved OS in these patients.

Outcomes and toxicities among octogenarians and nonagenarians with colorectal cancer (crc) treated with chemotherapy or concurrent chemoradiation - a single institution study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 13514-13514
Author(s):  
J. Yu ◽  
N. M. Reddy ◽  
A. Rajput ◽  
J. Smith ◽  
G. Yang ◽  
...  
Keyword(s):  
Median Survival ◽  
Stage Iv ◽  
Kaplan Meier ◽  
Phase Ii Studies ◽  
Metastatic Setting ◽  
Stage Iv Disease ◽  
Life Threatening ◽  
Chemotherapy Dose ◽  
Dose Reductions ◽  
Grade Iii

13514 Background: Chemotherapy is associated with an improved overall survival with acceptable toxicities in patients ≥ 70 years. However, little to no data exists regarding feasibility and tolerability of chemotherapy and/or radiation in CRC patients ≥ 80 years. The purpose of this study was to identify the trends of increased toxicity in this subgroup of patients. Methods: A retrospective study on patients ≥ 80 yrs treated for CRC with either chemotherapy alone or chemoradiation during the period of 1996- 2005 at Roswell Park Cancer Institute was conducted. Survival analysis was performed using the Kaplan-Meier method. Results: 29 patients were identified. 8 patients were diagnosed as having rectal cancer and received combined chemoradiation. 21 patients had colon cancer and received chemotherapy alone either in the adjuvant or metastatic setting. The median age was 82 years (range: 80–93). The median survival for all stages receiving chemo and/or radiation therapy was 37 months (95% CI: 27–53). The median survival for patients with stage IV disease was 6 months (95% CI: 5–33). Grade III/IV GI toxicities were seen in 59% (95% CI: 37–72%) of patients. Grade III/IV hematologic toxicities were seen in 17% (95% CI: 8–37%) of patients. Empiric chemotherapy dose reductions were implemented, starting the first cycle, in 90% (95% CI: 72–96%)of patients. Therapy had to be withheld in 34% (95% CI: 19–52%) of patients by more than 1 week due to toxicities in the first 2 months of treatment. Conclusions: Our study, demonstrates a higher rate of toxicities than previously reported for patients ≥ 70 years. This has occurred despite an initial dose-reduction in the majority of the treated population (90%). Octogenarian and nonagenarian CRC patients experienced a higher rate of GI toxicities during treatment, some of which were life threatening. This data supports the urgent need to conduct prospective studies to identify treatment recommendations for patients ≥ 80. Data from larger elderly phase II studies with median ages < 80 should not be extrapolated to octogenarians and nonagenarians. No significant financial relationships to disclose.

Long-term maintenance capecitabine and celecoxib improved clinical outcomes by targeting colorectal cancer micrometastasis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14513-14513
Author(s):  
M. Zhang ◽  
S. Curley ◽  
C. Ng ◽  
B. Kurland ◽  
S. Krishnan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Stage Iv ◽  
Complete Response ◽  
Kaplan Meier ◽  
Stage Iv Disease ◽  
Disease Site ◽  
Colorectal Cancer Patients

14513 Background: Role of mainteance therapy after achieving complete response (CR) remain undefined for patients with metasatic colorectal cancer. We studied prognostic and treatment factors including maintenance capecitabine and celecoxib (XCEL) in all 19 unresectable metastatic colorectal cancer patients (pts) who had CR from the prior XCEL study. Methods: Event charts are used to summarize the timeline of the various treatments. Kaplan-Meier survival estimates and univariate log-rank tests were used to evaluate RFS and OS as time from CR. Prognostic and treatment factors included: tumor size, metastasis number (9 solitary disease), site (13 being extrahepatic), stage on diagnosis (stage II versus III/IV), disease free interval prior to stage IV disease, surgery (5 R0, 3 R1–2 resections), lactate dehydrogenase levels, first-line irinotecan chemotherapy, radiation (9 pts ≥ 45 Gy, 3 Pts < 45 Gy), and maintenance XCEL (duration 0–50.3 months). Results: Nine of 19 patients experienced recurrence (median 13 months after CR), and 4 died during the follow-up period (median 31 months after CR). The 2-year RFS for the unresected and R1–2 resected patients was 71% versus 20% for the R0 resected patients (p = 0.07). This paradoxical RFS pattern corresponded to a RFS advantage for maintenance XCEL (p = 0.002), but not any other prognostic or treatment factors. All relapses occurred in situ following discontinuation of XCEL except for the surgical cases. Patients undergoing maintenance XCEL also benefited in OS (p = 0.04). The median OS from XCEL and from onset of metastasis reached 51.9 months (95% CI, 45 months- not reached [NR]) and 73.3 months (95% CI, NR-NR months) respectively. Conclusions: Maintenance XCEL targets colorectal micrometastases and produces a paradoxical RFS and OS advantage among the high-risk unresected/R1–2 resected patients than R0 resected patients. Prospective studies are warranted to validate roles of maintenance XCEL in the treatment of colorectal micrometastases. No significant financial relationships to disclose.

Pancreatic ductal adenocarcinoma (PDAC), BRCA: Detailed analysis and outcomes of cohort from Memorial Sloan Kettering Cancer Center (MSK).

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 708-708
Author(s):  
Parisa Momtaz ◽  
Catherine Anne O'Connor ◽  
Joanne F. Chou ◽  
Marinela Capanu ◽  
Kenneth H. Yu ◽  
...  
Keyword(s):  
Stage Iv ◽  
Ductal Adenocarcinoma ◽  
Cancer Center ◽  
Clinicopathologic Characteristics ◽  
Entire Cohort ◽  
Disease Biology ◽  
Kaplan Meier ◽  
Significant Difference ◽  
History Of ◽  
Associated Malignancy

708 Background: Given encouraging responses of platinum agents and poly-ADP ribose polymerase inhibitors (PARPi) in BRCA mutated (mut) PDAC, we sought to identify patients (pts) with BRCA mut PDAC treated at MSKCC and to evaluate outcome. Methods: Institutional database at MSK with IRB approval was queried for PDAC germline (g) or somatic (s) BRCA1/2 mut. Genomic profiling, clinicopathologic characteristics and outcomes were collected. Overall survival (OS) from diagnosis was estimated using Kaplan-Meier method. Results: n = 126 with BRCA1/2 mut PDAC were identified between 1/2011-12/2018. n = 77 (61%) male and median age of 62 (range 24-85) at diagnosis. n = 78 (62%) had g BRCA mut (n = 21 BRCA1; n = 57 BRCA2). n = 54 (43%) had a family history of BRCA-related malignancies; 35pts (28%) with a personal history of other BRCA-associated malignancy. n = 66 (52%) AJCC stage IV; of these 43pts (65%) received platinum-based therapy with a partial response (PR) in 35pts (81%); median duration 7 months (m) (range 0.5-39m). n = 40 (32%) received ≥ 4 lines of therapy (range 1-6 lines). n = 44 (35%) received PARPi and 11% (n = 14) received immunotherapy. Median OS for the entire cohort 32.1 m (95% CI 23.9, 42.6). Median OS for stage I-II 49.9m (95% CI 38.5,-); stage III 43m (95% CI 33.9,-) and stage IV 19.1m (95% CI 19.1 16.1,25.8). We did not observe a statistically significant difference in OS between BRCA1 vs BRCA2 pts. Conclusions: BRCA mut PDAC constitutes a small but likely distinct biologic subgroup. Improved OS was notable relative to historical data, possibly due to the integration of platinum and PARPi therapy and possibly due to contribution from disease biology. [Table: see text]

Outcomes of appendiceal adenocarcinomas compared to right and left-sided colorectal adenocarcinomas: An analysis from the National Cancer Database (NCDB).

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 42-42
Author(s):  
Kanika Gupta Nair ◽  
Wei Wei ◽  
Michael Cruise ◽  
Katherine Tullio ◽  
Bassam N. Estfan
Keyword(s):  
Stage Iv ◽  
Stage I ◽  
Disease Stage ◽  
Rank Test ◽  
National Cancer Database ◽  
Kaplan Meier ◽  
Stage Iv Disease ◽  
The Difference ◽  
The Right ◽  
Colorectal Adenocarcinomas

42 Background: Appendiceal carcinomas (AC) account for 1-2% of colorectal cancers (CRC) and are generally treated like other CRC. However, there is limited data to guide treatment. While AC originate on the right side of the colon, it is unclear if they behave like as right-sided CRC (R-CRC). We seek to learn how AC differ from right versus left-sided CRC (L-CRC). Methods: We identified histologically confirmed cases of appendiceal and colorectal adenocarcinomas with information about stage and overall survival (OS) diagnosed between 2004 and 2016 from the National Cancer Database. Kaplan-Meier method and log-rank test were used to estimate and compare OS. Results: 833,939 patients met our inclusion criteria: 15,138 (1.8%) AC, 447,551 (53.7%) L-CRC, 308,794 (37.0%) R-CRC, and 62,456 (7.5%) transverse CRC (T-CRC). Median age at diagnosis of all patients was 68 years (range:18-90); AC was lowest at 61 years for stage I-III disease and 58 years for stage IV disease. Stage IV AC was more common in females 3628/5739 (63.22%). AC had the best OS among site groups in stage I-III. Median OS for stage I-III AC was 128.8 months (95% CI: 117.9-139.0), with 5-year OS rate of 0.69 (95% CI: 0.67-0.70); L-CRC median OS was 111.6 months (95% CI: 110.9-112.4), with 5-year OS rate of 0.681 (95% CI: 0.680-0.683); R-CRC median OS was 88.5 months (95% CI: 87.8-89.1), with 5-year OS rate of 0.613 (95% CI: 0.611-0.615); and T-CRC median OS was 86.2 months (95% CI: 84.7-87.6), with 5-year OS rate of 0.608 (95% CI: 0.604-0.613) (p <0.0001) (Table). Similar difference was observed in stage IV patients (Table). Conclusions: Patients with AC had significantly better OS for stages I-III and stage IV compared to patients with L-CRC, R-CRC, and T-CRC, though outcomes were more similar to L-CRC. The difference is more evidence for patients with stage IV disease. T-CRC had similar OS to R-CRC, as anticipated. [Table: see text]

scholarly journals OTHR-04. INCIDENCE AND SURVIVAL OUTCOMES IN UROTHELIAL CARCINOMA BRAIN METASTASES

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i18-i19
Author(s):  
Vasileios Kavouridis ◽  
Maya Harary ◽  
Timothy Smith ◽  
David Braun ◽  
Bryan Iorgulescu
Keyword(s):  
Brain Metastases ◽  
Urothelial Carcinoma ◽  
Urothelial Cancer ◽  
Lung Metastases ◽  
Multivariable Analysis ◽  
Stage Iv ◽  
Median Number ◽  
Kaplan Meier ◽  
Stage Iv Disease ◽  
Brain Involvement

Abstract INTRODUCTION: Urothelial carcinoma is a common malignancy with ~79,000 new cases diagnosed annually. However, urothelial brain metastases (UBM) are encountered uncommonly. Herein we evaluate their national prevalence, predictors, and treatment outcomes in the contemporary era. METHODS: The characteristics, management, and overall survival (OS) of UBM patients (2010–2015) were evaluated using the National Cancer Database, which comprises &gt;70% of all newly diagnosed cancers in the U.S. OS was analyzed with Kaplan-Meier methods and log-rank tests. National outcomes were compared to our institutional cohort of UBMs. RESULTS: Out of 208,600 patients diagnosed with urothelial carcinoma, 8.4% presented with stage IV disease--of these only 216 (1.2%) had BMs at the time of diagnosis. Patients presenting with bone, liver, or lung metastases were more likely to present with synchronous BMs. Brain involvement demonstrated significantly worse median OS (3.9mos, 95%CI: 3.1–4.9) than non-BM stage IV disease (10.9mos, 95%CI: 10.6–11.2, p&lt; 0.001). Compared to non-BM stage IV disease, UBMs were more likely to have surgery for metastatic disease and receive radiotherapy (p&lt; 0.001); but were less likely to have primary resection or chemotherapy. In multivariable analysis of stage IV urothelial cancer, BMs demonstrated significantly worse OS (HR 1.43, 95%CI: 1.20–1.72, p&lt; 0.001). In our institutional data, 10 urothelial cancer patients developed BMs; of which 7 were male, median age and KPS at diagnosis were 64.9yo (IQR 56.4–72.0) and 85 (IQR 75–100). Four patients had synchronous metastases; the median number of BM lesions was 2 (IQR 1–2), with a median size of 2.6cm (IQR 1.6–3.3). All 10 underwent GTR, 3 also with SRS and 7 with WBRT, associated with a median OS of 16.5mos. CONCLUSION: Our results confirm the rarity of UBMs and suggest that BM screening may only be indicated in stage IV patients with neurological symptoms. Systemic therapies demonstrate improved OS in these patients.

Wild-type APC and prognosis in metastatic colorectal cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 223-223
Author(s):  
Chongkai Wang ◽  
Ching Ouyang ◽  
Jaideep Singh Sandhu ◽  
Michael Kahn ◽  
Marwan Fakih
Keyword(s):  
Genomic Analysis ◽  
Stage Iv ◽  
Multivariate Model ◽  
Braf V600e ◽  
Genomic Alteration ◽  
Molecular Characteristics ◽  
Wild Type ◽  
Public Database ◽  
Prognostic Implication ◽  
Data Set

223 Background: Somatic mutations at adenomatous polyposis coli ( APC) gene, found in ~75% of colorectal cancers (CRC), are under-represented in microsatellite instable (MSI-H) tumors. While several studies have suggested worse outcomes for CRC patients (pts) with wild-type APC ( APC-WT), the prognostic implication of this genomic alteration in metastatic CRC (mCRC) is not well defined. Methods: APC prognostic value was evaluated in 331 stage IV microsatellite stable (MSS) CRC pts treated in our institution. Next-generation genomic analysis (FoundationOne) was used to characterize the molecular characteristics of APC-WT and mutant APC ( APC-MT) pts. Findings were validated on a public database of stage IV colon cancer from MSKCC. Results: APC-WT was present in 26% of mCRC patients. In comparison to APC-MT population (n = 244), APC-WT pts (n = 87) tended to be younger (median age: 49 vs. 58 years), right-sided (44% vs. 24%), BRAF-V600E mutated (25% vs. 5%), p53 WT (38% vs. 21%) and RAS WT (66% vs. 53%). APC-WT tumors were associated with other Wnt activating alterations ( CTNNB1, FBXW7, RNF43, ARID1A and SOX9). Among those, RNF43 and CTNNB1 were more significantly represented in the APC-WT vs APC-MT population (12% vs 1% and 11% vs 3%, respectively). APC-WT pts had a worse overall survival (OS) than APC-MT pts (30 vs 48 months, HR = 1.809, 95% CI 1.260-2.596, p < 0.0001). Using a multivariate model correcting for primary tumor location, RAS and BRAF status, APC-WT was predictive of poor survival (HR = 1.7, p = 0.001) in our data set. The prognostic implication of APC-WT on OS were confirmed further in a similar multivariate model of 433 stage IV pts from MSKCC public database (HR = 1.6, P = 0.01). Conclusions: APC-WT is associated with poor OS in MSS mCRC regardless of RAS, BRAF status. Compared with APC-MT mCRC tumors, APC-WT tumors were associated with other activating alterations of Wnt pathway, including RNF43 and CTNBB1.

Real-world patterns of care among patients with metastatic pancreatic cancer (mPC).

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 666-666
Author(s):  
Eileen Mary O'Reilly ◽  
Andy Surinach ◽  
Zheng Wu ◽  
Paul Cockrum
Keyword(s):  
Pancreatic Cancer ◽  
Stage Iv ◽  
The Third ◽  
Kaplan Meier ◽  
Metastatic Setting ◽  
Treatment Gaps ◽  
The Us ◽  
Stage Iv Disease ◽  
Liposomal Irinotecan ◽  
Third Line

666 Background: Pancreatic cancer is the third deadliest cancer in the US and mPC has a 2.9% 5-year survival. The analyses herein describe treatment patterns, trends in usage, and overall survival (OS) in mPC. Methods: Using the Flatiron Health EHR-derived database, data were extracted and analyzed for patients with mPC (pts) between Jan 1, 2014 and Jun 30, 2019. The database includes de-identified data from over 280 cancer clinics (~800 sites of care) representing more than 2.2 million U.S. cancer patients available for analysis, with 80% of pts from community centers and 20% from academic centers. Lines of therapy in the metastatic setting are derived from structured medication records. OS from metastatic diagnosis was reported using the Kaplan-Meier method. Results: 7,666 pts with mPC were identified. 5,687 (74.2%) received therapy in the metastatic setting. Pts who didn’t receive therapy in the metastatic setting were more likely to be older (p < 0.0001) and less likely to have been diagnosed initially with stage IV disease (p < 0.0001) than pts who were treated. The frequency of (1L) regimens were gemcitabine plus nab-paclitaxel (GnP) 46.8%, FOLFIRINOX (FFX) 24.1%, gemcitabine monotherapy 9.3%, and FOLFOX 3.8%. Gemcitabine monotherapy use was 12.9% in 2014 and 7.3% in 2018. GnP (31.4%), FFX (12.3%), FOLFOX (11.4%), and liposomal irinotecan (nal-IRI) + 5-FU/LV (10.2%) were the most frequent second line (2L) regimens. Between 2015 and 2018 nal-IRI based regimens increased from 6% to 17.6% in 2L. In the third line (3L) setting nal-IRI + 5FU/LV (19.3%), GnP (12.1%), FOLFOX (11.4%), and FFX (9.1%) were the most common treatments. Aggregate median OS (mOS) for treated pts was 8.1 mos (95% CI 7.8 – 8.4), and mOS for untreated pts was 2.8 mos (2.6 – 3.0), p < 0.0001. Conclusions: Survival for mPC is improving and practice patterns are changing. GnP is the most commonly used 1L regimen, followed increasingly by nal-IRI + 5-FU/LV in 2L and 3L. Further studies are necessary to understand the treatment gaps for pts with mPC. [Table: see text]

scholarly journals Survival Outcomes and Predictors for Patients who Failed Chemoradiotherapy/Radiotherapy and Underwent Salvage Total Laryngectomy

2021 ◽  
Vol 18 (2) ◽  
pp. 371
Author(s):  
Ming-Hsien Tsai ◽  
Hui-Ching Chuang ◽  
Yu-Tsai Lin ◽  
Tai-Lin Huang ◽  
Fu-Min Fang ◽  
...  
Keyword(s):  
Total Laryngectomy ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Stage Iv ◽  
Oncologic Outcome ◽  
Positive Margin ◽  
Definitive Treatment ◽  
Kaplan Meier ◽  
Stage Iv Disease ◽  
Risk Patients

Background: To assess the presence of adverse pathological features at the time of salvage total laryngectomy (TL) associated with oncologic outcome. Methods: Ninety patients with persistent/locally recurrent disease and who subsequently underwent salvage TL after definitive treatment by radiation alone (RTO) or concurrent chemo-radiation (CCRT) from 2009 to 2018 were retrospectively enrolled. Kaplan–Meier methods were used to estimate overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). Results: Lymphovascular invasion (LVI), perineural invasion, positive margin, and stage IV disease were associated with worse survival in the univariate analysis. In the multivariate analysis, the presence of LVI and positive margin were both independent negative predictors in OS (LVI: adjusted hazard ratio (aHR) = 2.537, 95% CI: 1.163–5.532, p = 0.019; positive margin: aHR = 5.68, 95% CI: 1.996–16.166, p = 0.001), DSS (LVI: aHR = 2.975, 95% CI: 1.228–7.206, p = 0.016); positive margin: aHR = 11.338, 95% CI: 2.438–52.733, p = 0.002), and DFS (LVI: aHR 2.705, 95% CI: 1.257–5.821, p = 0.011; positive margin (aHR = 6.632, 95% CI: 2.047–21.487, p = 0.002). Conclusions: The presence of LVI and positive margin were both associated with poor OS, DSS, and DFS among patients who underwent salvage TL after failure of RTO/CCRT. The role of adjuvant therapy for high-risk patients after salvage TL to improve the chance of survival requires more investigation in the future.

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