Surveillance of postchemotherapy subcentimeter residual retroperitoneal mass (RRM) in metastatic nonseminomatous germ cell tumor (mNSGCT).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 391-391
Author(s):  
Cody Cotner ◽  
Susan Hilton ◽  
Ronac Mamtani ◽  
Thomas J. Guzzo ◽  
David J. Vaughn
Keyword(s):  
Complete Response ◽  
Salvage Chemotherapy ◽  
University Of Pennsylvania ◽  
Retroperitoneal Lymph Node Dissection ◽  
Exact Test ◽  
Nonseminomatous Germ Cell Tumor ◽  
Decision Methods ◽  
The University ◽  
Post Hoc

391 Background: Approximately 30 – 60% of patients with mNSGCT treated with cisplatin-based chemotherapy (CBCT) achieve a complete response (CR), defined as normalization of serum tumor markers with either no RRM or a RRM < 1 cm. While there is universal agreement that patients with a RRM ≥ 1 cm should undergo retroperitoneal lymph node dissection (RPLND), many institutions, including ours, recommend surveillance for patients who achieve a CR. However, studies have not defined which axis of the RRM should be considered when making this decision. Methods: The electronic medical records (2007 – 2017) at the Hospital of the University of Pennsylvania (HUP) were searched to identify good-risk mNSGCT patients treated with CBCT who achieved a CR and underwent surveillance. Consistent with RECIST 1.1, we define a CR as no RRM or a RRM < 1 cm in the transaxial short axis (TSA). We do not consider the transaxial long axis (TLA) or the craniocaudal axis (CCA). A post-hoc review was performed by a blinded radiologist and the RRM dimensions in the TSA, TLA, and CCA were recorded. Differences in the frequency of recurrence between groups with a RRM < 1.0 cm and ≥ 1.0 cm in the TLA and CCA were assessed using the Fischer exact test. Results: 39 patients met study criteria and were included. At a median follow-up of 50.8 months, only 2 patients (5.1%) recurred. Both were successfully treated with RPLND and salvage chemotherapy. Post-hoc review of imaging: median TSA 6 mm (range, 0-11); median TLA 8 mm (range, 0-14); median CCA 11 mm (range, 0-34). Thirteen (33%) and 27 (69%) patients had a RRM ≥ 1 cm in the TLA and CCA, respectively. There were no statistically significant differences in the risk of recurrence between patients with a RRM < 1.0 cm and ≥ 1.0 cm in the TLA (p=0.54) or CCA (p=0.53). Conclusions: Surveillance is an effective strategy in patients with mNSGCT and a post-chemotherapy RRM < 1.0 cm in the TSA. Our study suggests that referencing the TSA and not the TLA or CCA in this decision-making may avoid unnecessary post-chemotherapy RPLND.

Outcomes of advanced HL with ABVD: The University of Pennsylvania experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18529-e18529
Author(s):  
Meghna S. Trivedi ◽  
David Bajor ◽  
Tahamtan Ahmadi ◽  
Jakub Svoboda ◽  
Alison W. Loren ◽  
...  
Keyword(s):  
Salvage Therapy ◽  
Standard Therapy ◽  
Prognostic Score ◽  
Stage Iv ◽  
Retrospective Chart Review ◽  
Complete Response ◽  
Salvage Chemotherapy ◽  
University Of Pennsylvania ◽  
The University

e18529 Background: Hodgkin Lymphoma (HL) is considered a curable malignancy with standard therapy using the doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) regimen. Even with standard therapy, the relapse rate for patients with advanced HL (stage IIB and higher) remains significant. The International Prognostic Score (IPS) uses 7 adverse prognostic factors (serum albumin, hemoglobin, male sex, age, stage IV disease, leukocytosis, and lymphopenia) to predict outcomes in advanced HL. Methods: We performed a retrospective chart review of all patients evaluated at the University of Pennsylvania for primary HL from July 2006 to June 2011. Of 257 patients, 26 were identified as those with advanced HL who initiated ABVD treatment at the University of Pennsylvania. The study outcomes were defined by RECIST criteria. The 26 patients were stratified by IPS and outcomes were evaluated. Results: 22 of 26 patients (85%) achieved lasting complete response (CR) after receiving treatment with ABVD with a median length of follow-up of 2.93 years. Three patients had primary refractory disease. Of these patients, two (IPS 1-2) achieved CR with salvage therapy. The third patient (IPS 5) had initial partial response (PR) to ABVD then continued to have relapsed disease after 4.50 years of follow-up. One patient (IPS 5) relapsed 2.74 years after receiving ABVD and at best had PR with salvage chemotherapy. Conclusions: ABVD was effective in achieving CR; however, 4 patients were unable to achieve lasting CR from ABVD alone. Two patients with IPS of 1 and 2 eventually achieved CR from salvage therapy. Two patients with IPS of 5 were unable to achieve lasting CR. Based on this data, IPS of 5 was associated with worse outcome. Use of IPS may be helpful to identify patients needing more intensive initial therapies. [Table: see text]

Changing treatment paradigms in the era of targeted therapies.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 518-518
Author(s):  
Philipp Marius Papavassilis ◽  
Edwin Herrmann ◽  
Laura-Maria Krabbe ◽  
Lothar Hertle ◽  
Martin Boegemann ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Rank Test ◽  
P Value ◽  
Line Treatment ◽  
New Agents ◽  
Exact Test ◽  
Significant Survival ◽  
Significant Difference ◽  
The University

518 Background: Our goal was to describe the change of treatment paradigms for metastatic renal cell carcinoma (mRCC) since targeted therapy became available in 2006. Methods: In this cohort population study we retrospectively investigated all mRCC patients who were treated with targeted therapy between 06/2006 and 06/2012 in the Department of Urology of the University of Münster. To distinguish nominal variables Fisher's exact test was used, in other respects Pearson's χ² test. For metrical variables the Mann-Whitney-U-Test was used. The log-rank test was chosen to derive differences between two or more groups with regard to survival. A p value <0,05 was considered statistically significant. Results: 50/158 (31.6%) patients with a median follow-up of 362 days were initially treated with immunotherapy. The most often used second line treatment after immunotherapy was sorafenib (29 patients, 58.0%). As first line treatment sunitinib was chosen most frequently (68 patients, 63.0%). There was no statistically significant difference in survival between the patients who were treated with immunotherapy and those who were not (572 vs. 554 days, p=0,745). 134 (84.4%) patients received cytoreductive nephrectomy before systemic treatment start. Comparing the survival curves there was a significant survival benefit in favor of nephrectomized patients (632 vs. 169 days, p<0,0001). Conclusions: After introduction of the new agents treatment paradigms have changed substantially. Immunotherapy is used only rarely. Cytoreductve nephrectomy should continue to be regarded as standard treatment.

Adjuvant etoposide plus cisplatin (EP) for pathologic stage (PS) II nonseminomatous germ cell tumor (NSGCT).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 567-567
Author(s):  
Deaglan Joseph McHugh ◽  
Samuel Funt ◽  
Deborah Silber ◽  
Andrea Knezevic ◽  
Sujata Patil ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Mature Teratoma ◽  
Survival Rates ◽  
Complete Response ◽  
Median Number ◽  
Cancer Center ◽  
Retroperitoneal Lymph Node Dissection ◽  
Survival Outcomes ◽  
Ps Ii ◽  
Nonseminomatous Germ Cell Tumor

567 Background: The risk of relapse after primary retroperitoneal lymph node dissection (RPLND) for patients (pts) with PS IIA NSGCT is 10-20% and increases to over 50% for pts with PS IIB NSGCT. Cisplatin-based chemotherapy reduces the relapse risk to approximately 1%. Standard adjuvant chemotherapy regimens consist of 2 cycles of EP or 2 cycles of bleomycin plus EP (BEP). Methods: From March 1989 to April 2016, 156 pts with PS II NSGCT seen at Memorial Sloan Kettering Cancer Center and assigned to two cycles of EP chemotherapy following RPLND were included. Pts from a prior analysis (Kondagunta, JCO, 2004) were included with updated survival outcomes and expanded histopathologic parameters. Each cycle consisted of cisplatin 20mg/m2 and etoposide 100mg/m2 administered on days 1 to 5 at 21-day intervals. Demographics, histopathologic features, therapeutic and survival outcomes were recorded. Results: Median age was 28 years (range 15-52). 30 pts (19%) had pN1 disease, 122 (78%) pN2 disease and 4 (3%) pN3 disease. Median number of positive lymph nodes was 3 (range 1-37) and median size of the largest positive node was 2.0cm (range 0.4-7.0cm). 69 pts (45%) had extranodal tumor extension. Embryonal carcinoma, seminoma, mature teratoma and yolk sac were the predominant histological subtypes in the RPLND pathology in 115 (90%), 8 (6%), 4 (3%) and 1 (1%) pts respectively. 150 pts (96%) received 2 cycles of EP, 5 (3%) received 1 cycle of EP and one received 4 cycles of EP due to a transient marker increase following his first cycle. Dose delays occurred in 54 (38%) pts, mostly due to neutropenia (44/54 delays). With a median follow-up of 9 years, 2 pts (1 pN2 and 1 pN3) relapsed; both achieved a complete response to paclitaxel, ifosfamide and cisplatin (TIP), remaining disease-free at 65 and 143 months respectively. 3 pts died, all unrelated to GCT or treatment, for 10-year relapse-free and overall survival rates of 98% and 99%, respectively. Conclusions: This is the largest series reported to date on adjuvant chemotherapy with EP for PS II NSGCT. With 100% disease-specific survival and acceptable toxicity, these data confirm the efficacy of 2 cycles of EP and suggest that inclusion of bleomycin (e.g. BEP) in this setting is not necessary.

scholarly journals SARS-CoV-2 seropositivity and seroconversion in patients undergoing active cancer-directed therapy

2021 ◽  
Author(s):  
Lova Sun ◽  
Sanjna Surya ◽  
Noah G. Goodman ◽  
Anh N. Le ◽  
Gregory Kelly ◽  
...  
Keyword(s):  
Cancer Care ◽  
Negative Impact ◽  
Care Delivery ◽  
Seroconversion Rate ◽  
University Of Pennsylvania ◽  
Blood Draw ◽  
The University ◽  
Initial Blood ◽  
Active Cancer

AbstractMultiple studies have demonstrated the negative impact of cancer care delays during the COVID-19 pandemic, and transmission mitigation techniques are imperative for continued cancer care delivery. To gauge the effectiveness of these measures at the University of Pennsylvania, we conducted a longitudinal study of SARS-CoV-2 antibody seropositivity and seroconversion in patients presenting to infusion centers for cancer-directed therapy between 5/21/2020 and 10/8/2020. Participants completed questionnaires and had up to five serial blood collections. Of 124 enrolled patients, only two (1.6%) had detectable SARS-CoV-2 antibodies on initial blood draw, and no initially seronegative patients developed newly detectable antibodies on subsequent blood draw(s), corresponding to a seroconversion rate of 0% (95%CI 0.0-4.1%) over 14.8 person-years of follow up, with a median of 13 healthcare visits per patient. These results suggest that cancer patients receiving in-person care at a facility with aggressive mitigation efforts have an extremely low likelihood of COVID-19 infection.

scholarly journals Low-Dose Radiotherapy Versus Moderate-Dose Radiotherapy for the Treatment of Indolent Orbital Adnexal Lymphomas

2021 ◽  
Vol 11 ◽  
Author(s):  
Jonathan Baron ◽  
Christopher M. Wright ◽  
Daniel Y. Lee ◽  
Maribel Carpenter ◽  
Shwetha H. Manjunath ◽  
...  
Keyword(s):  
Low Dose ◽  
Response Rates ◽  
Complete Response ◽  
Moderate Dose ◽  
Exact Test ◽  
Overall Response ◽  
Low Dose Radiotherapy ◽  
Kaplan Meier ◽  
Grade 3

PurposeRadiation therapy (RT) with doses ranging from 24 Gray (Gy) to 40 Gy is a proven treatment modality for indolent orbital adnexal lymphoma (IOAL), but recently the use of low dose RT (LDRT, defined as 2 Gy x 2 fractions) has become a notable alternative. However, limited data exists comparing outcomes following LDRT to moderate-dose RT (MDRT, RT dose 4 – 36 Gy). We present a single institution retrospective analysis comparing outcomes of patients with IOALs following LDRT or MDRT.MethodsA total of 36 patients treated with 38 consecutive courses of RT were identified; LDRT was delivered for 14 courses and MDRT for 24 courses. Overall response rates (ORR) were recorded according to Deauville or RECIST criteria with a response characterized as a complete response (CR) or partial response. Local control (LC), orbital control (OC), and overall survival (OS) rates were estimated with the Kaplan-Meier method. RT toxicity was graded per CTCAEv5 and compared with the Fisher’s exact test.ResultsMedian follow-up time was 29 months (m) (range, 4-129m), and median MDRT dose used was 24 Gy (range 21-36 Gy). Overall response rates (ORR) were 100% (CR 50%) and 87.5% (CR 58.3%) following LDRT and MDRT, respectively. OS at 2 years was 100% and 95% for the LDRT and MDRT groups, respectively (p=0.36). LC rates at 2 years was 100% for both LDRT and MDRT groups and at 4 years was 100% and 89% for the LDRT and MDRT groups, respectively (p=0.56). The 4-year OC rate (including both ipsilateral and contralateral relapses) was 80% and 85% for the LDRT and MDRT groups, respectively (p=0.79). No patient required treatment with RT to a previously irradiated orbit. Acute toxicities were reported following 6 LDRT courses compared to 20 MDRT courses (p=.014). No Grade 3 or higher acute toxicities occurred in either group. Late toxicities were reported following 2 LDRT courses compared to 10 MDRT courses (p=0.147).ConclusionsLDRT produced similar ORR, LC, OC, and OS rates compared to MDRT with fewer acute and minimal late toxicities reported. Future multi-center studies with larger patient numbers are warranted to show significant associations.

Salvage therapies in women who fail to respond to first-line treatment with fluorouracil, epirubicin, and cyclophosphamide for advanced breast cancer.

1994 ◽  
Vol 12 (8) ◽  
pp. 1639-1647 ◽  
Author(s):  
K Porkka ◽  
C Blomqvist ◽  
P Rissanen ◽  
I Elomaa ◽  
S Pyrhönen
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Salvage Therapy ◽  
Performance Status ◽  
Metastatic Breast ◽  
Complete Response ◽  
Salvage Chemotherapy ◽  
Study Cohort ◽  
First Line

PURPOSE We studied all salvage therapies given until death or the end of follow-up evaluation in women who failed to respond to the same first-line cytotoxic therapy for metastatic breast cancer. PATIENTS AND METHODS The study cohort consisted of 140 women who had received the fluorouracil, epirubicin, and cyclophosphamide (FEC) regimen for metastatic breast cancer. Eight patients were excluded. No exclusions with respect to disease site, performance status, or biochemical abnormalities were made. The median follow-up time was 29 months for surviving patients. RESULTS Most patients (88%) died during the follow-up period. Patients received a median of three salvage therapies (range, zero to eight) during the course of disease. Most courses (52%) were not assessable for response. Fifty-percent of courses consisted of chemotherapy: 35% of hormonal and 15% of combination of cytotoxic and hormonal therapies. The median duration of therapy (DT) ranged from 4 to 1 months, and decreased with advancing stages of therapy. Similarly, median time to treatment failure (TTF) ranged from 3 to 0.5 months. For unknown causes, patients who received second-line hormonal therapy fared better than those who received other forms of therapy. Of 366 analyzed courses, only one complete response (CR) and 18 partial responses (PRs) were observed (response rate, 11% for assessable and 5% for all courses). Stable disease for at least 3 months was found in 20% to 25% of courses. Most responses (n = 10) occurred during first salvage therapy, and no responses were observed after third salvage therapy. CONCLUSIONS Response rates for salvage therapies were low, and median treatment times short. The value of offering more than two salvage chemotherapy regimens to an unselected group of patients is questionable.

Durability of complete response (CR) with atezolizumab (atezo) in locally advanced/metastatic urothelial carcinoma (mUC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 4527-4527
Author(s):  
Yohann Loriot ◽  
Arjun Vasant Balar ◽  
Robert Dreicer ◽  
Jean H. Hoffman-Censits ◽  
Jose Luis Perez-Gracia ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Complete Response ◽  
First Response ◽  
Long Term Follow Up ◽  
Metastatic Urothelial Carcinoma ◽  
Post Hoc ◽  
Clinical Trial Information ◽  
Disposition Time

4527 Background: Atezo (anti–PD-L1) has been shown to elicit CRs in a number of mUC patients (pts) in clinical trials. We sought to describe the kinetics, durability and outcomes associated with these CRs in Ph I (PCD) and II (IMvigor210) atezo studies, each with long-term follow-up. Methods: In PCD (pre-treated mUC) and IMvigor210 (Cohort 1, cisplatin-ineligible untreated mUC; Cohort 2, platinum-treated mUC), pts received atezo per protocol (Petrylak JAMA Oncol 2018; Balar Lancet 2017; Rosenberg Lancet 2016). This post hoc analysis descriptively assessed pt disposition, time to and duration of RECIST 1.1 response and overall survival in pts with CR. Results: CR rates were 13%, 8% and 7% in PCD, IMvigor210 Cohort 1 and Cohort 2, respectively. First response was PR in most pts with CR. Median CR duration was > 3 y in PCD, not estimable (NE) in IMvigor210 Cohort 1 and > 2 y in Cohort 2 (Table). At data cutoff, all but 2, 0 and 1 pts were alive, respectively; across studies, ≥ 40% of pts with CR were on treatment. CR pts had a first response (PR/CR) by a median of 3.5 cycles. Further pt characteristics and survival outcomes will be reported. Conclusions: Across Ph I/II atezo mUC studies, CRs appeared durable (median duration > 2 y) despite small pt numbers. Most pts with CR were alive, with responses ongoing after long-term follow-up (median follow-up > 30 mo). Clinical trial information: NCT01375842, NCT02951767, NCT02108652. [Table: see text]

Head-to-head comparison between decipher and prolaris tests: Two commercially available post-prostatectomy genomic tests.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 348-348
Author(s):  
Mohammed Shahait ◽  
Mohammed Alshalalfa ◽  
Edward M. Schaeffer ◽  
Huei-Chung Huang ◽  
Andrea Cronican ◽  
...  
Keyword(s):  
High Risk ◽  
Pearson Correlation ◽  
Additional Treatment ◽  
University Of Pennsylvania ◽  
Johns Hopkins University ◽  
Risk Of Progression ◽  
Small Cohort ◽  
Highly Correlated ◽  
The University

348 Background: Several post-prostatectomy genomic tests are available; which are used to improve prognostication and to guide additional treatment after radical prostatectomy (RP). There has been no head to head comparison between these tests. The objective of this study is to compare the performance of two genomic tests in predicting oncological outcomes. Methods: 16 patients who underwent RP at the University of Pennsylvania (UPenn) (2013-2018), had adverse pathology (margin, and/or pT3a/b) and had each been tested with both Decipher (D) and Prolaris (P). Pearson correlation was used to compare scores from D and P as well as CCP scores and microarray derived CCP (mCCP). The associations of D and P with biochemical recurrence (BCR) and metastasis (M) was evaluated in survival analysis in a large cohort of RP patients treated at Johns Hopkins University (1992-2010) (JHU). Results: The median follow-up of the UPenn cohort was 24 months. 6 patients developed BCR and two distant M. There was a significant correlation between the D and P score (r=0.67,p=0.004), and between the 10-year BCR risk reported by P and the 5-year M risk reported by D (r=0.69, p=0.003). Each test called 7 patients to be high risk; 5 were in common. Both tests correctly called the 2 M cases as high risk and 4/6 BCR patients to be high risk. A microarray-derived CCP (mCCP) was highly correlated to the CCP scores reported from P (r=0.88, p=6.7e-6) in the UPenn cohort. To compare the prognostic performance of mCCP to D for predicting BCR and M, we used Post-RP cohort from JHU (N=355). Both scores were correlated (r=0.36, p2e-12). D and mCCP were stratified into 5 groups of incremental 20%. When including mCCP groups, D groups, Gleason score, SVI, EPE, LNI, and PSA; D remained independent prognostic variable of BCR (HR 1.16, 95%CI [1.05-1.3], p=0.005) and M (HR 1.3, 95%CI [1.12-1.52], p=0.0005). However, mCCP was not prognostic of BCR (p=0.59) nor M (p=0.62). Conclusions: The findings from this study show that P and D scores post-RP were highly correlated and help in identifying patients who at high risk of progression in this small cohort with short follow up. However, D outperformed mCCP for predicting BCR and M in larger cohorts with longer follow up.

Adoptive Transfer of Autologous CD25-Depleted, CD3/CD28-Costimulated T Cells After Cyclophosphamide - Fludarabine Chemotherapy in Patients with Low-Grade Follicular Lymphoma: Long-Term Follow up

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1631-1631
Author(s):  
Stephen J. Schuster ◽  
Nicole A. Aqui ◽  
Benjamin Musher ◽  
Bruce L. Levine ◽  
Charalambos Andreadis ◽  
...  
Keyword(s):  
T Cells ◽  
Follicular Lymphoma ◽  
Adoptive Transfer ◽  
Complete Response ◽  
University Of Pennsylvania ◽  
Low Grade ◽  
Financial Interest ◽  
Cell And Gene Therapy ◽  
Culture Technology

Abstract Abstract 1631 Introduction: Fludarabine-based chemotherapy combinations are highly effective in patients with low-grade follicular lymphoma but cause severe and long-lasting immunosuppression related to depletion of normal T cells, especially CD4 T cells. Aside from increasing the risk of serious infections, this toxicity may limit the ability of the immune system to eliminate minimal residual disease. To determine whether adoptive transfer of autologous CD25-depleted, CD3/CD28-costimulated T cells expanded ex vivo (ACTC) improves immune reconstitution following cyclophosphamide - fludarabine chemotherapy, we conducted a phase I study in patients with relapsed/refractory follicular lymphoma. Patients and Methods: Eligible patients had previously treated, purine analog naïve, relapsed or refractory follicular lymphoma (grade 1 or 2). After leukapheresis, patients received 4 cycles of fludarabine (25 mg/m2) and cyclophosphamide (250 mg/m2) on days 1 – 3 of a 28 – 42 day cycle. Four weeks after last chemotherapy, responding patients [complete response (CR), complete response unconfirmed (CRu), and partial response (PR)] received escalating doses of ACTC prepared from autologous T cells collected prior to chemotherapy. Results: Fifteen patients were enrolled. Median age was 49 years (range: 32 – 68), median number of prior therapies was 2 (range: 1 – 3), and 14 patients (93%) were rituximab-refractory. Five patients were withdrawn from the study, 2 due to chemotherapy-related hematologic toxicity and 3 for progressive disease during chemotherapy. For 10 evaluable patients completing chemotherapy and ACTC infusion, 8 patients were in CR and 2 patients in PR at the time of ACTC infusion; 5 patients received 1 – 5 × 109 ACTC and 5 patients received 5 – 10 × 109 ACTC. There were no adverse events related to T cell infusions. Following chemotherapy and before ACTC infusion, median CD4 and CD8 counts were 91/μL (range: 15 –169) and 64/μL (range: 19 – 273), respectively; four weeks after ACTC, median CD4 and CD8 counts were 502/μL (range: 156 – 1053) and 509/μL (range: 158 – 1860). Median %CD4+FOXP3+ blood cells before chemotherapy was 15.8% (n = 8; range: 5.07 – 37.1); after chemotherapy / before ACTC, 21.4% (n = 7; range: 6.15 – 56.3); on day 60 after ACTC, 3.3% (n = 8; range: 1.5 – 20.4) (p = 0.01 for both pre ACTC and post ACTC comparisons). Before receiving chemotherapy and ACTC, all 10 patients were anergic to candida antigen by DTH skin testing; 60 days after ACTC, 5 patients developed a positive DTH response to candida antigen (p = 0.03). From the day of ACTC infusion, median progression-free survival (PFS) is 14.1 months. Most significantly, no patient relapsed or had progression of lymphoma after 14.1 months with follow-up from 16.5 – 101.5 months. In addition, PFS is significantly longer than time to progression from prior therapy (p = 0.01; see figure below). Overall survival after ACTC was 60% with median follow-up of 68 months. Conclusions: Adoptive transfer of ACTC after fludarabine - cyclophosphamide chemotherapy enhances recovery of CD4 and CD8 lymphocyte counts compared to historical observations, results in a relative reduction in peripheral blood FOXP3+ regulatory T cells, enhances recovery of lymphocyte function, and can result in prolonged remission. Our findings suggest that reversal of immunosuppression by adoptive transfer of autologous co-stimulated T-cells may significantly improve therapeutic outcome after cytotoxic therapy for patients with follicular lymphoma. Disclosures: Levine: US Patent: Financial interest due to intellectual property and patents in the field of cell and gene therapy. Conflict of interest is managed in accordance with University of Pennsylvania policy and oversight., Financial interest due to intellectual property and patents in the field of cell and gene therapy. Conflict of interest is managed in accordance with University of Pennsylvania policy and oversight. Patents & Royalties. June:Life Technologies / Invitrogen: cell culture technology patents owned by U.S. Government and licensed to Life Technology / Invitrogen, cell culture technology patents owned by U.S. Government and licensed to Life Technology / Invitrogen Patents & Royalties.

Pathologic complete response (pCR) following weekly (wkly) paclitaxel (cremophor or albumin-bound) and carboplatin (TC) ± trastuzumab (H), ± bevacizumab (B) in patients (pts) with doxorubicin/cyclophosphamide-resistant (AC-Res) and AC-sensitive (AC-S) large and inflammatory breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 591-591 ◽  
Author(s):  
R. S. Mehta ◽  
T. Schubbert ◽  
K. Kong ◽  
D. Hsiang ◽  
J. Butler ◽  
...  
Keyword(s):  
Pathologic Complete Response ◽  
Stage Iv ◽  
Complete Response ◽  
High Rate ◽  
Exact Test ◽  
Short Course ◽  
Resistance Reversal ◽  
Dose Dense

591 Introduction: Historically, pCR is rare in AC-Res in contrast to AC-S BC except following TCH in HER2+ BC in preliminary analysis (SABCS-2004, #1110). Moreover, robust predictors of pCR are needed. Methods: 106 consecutive BC pts on neoadjuvant studies were treated with GM/G-CSF supported dose-dense AC (except 7**- Table ), 2 cycles if AC-Res and 4 if AC-S. Pts then received 9–12 wkly TC (3 wks on, 1 off) ± 6–8 bi-wkly B if HER2- or +12–16 wkly H if HER2+, followed by surgery. Fisher’s exact test was performed to compare pCR percentages by various characteristics. Results: pCR in breast and lymph nodes in 38 of 84 assessable tumors in the first 82 pts were documented. 67% (56/84) tumors were reduced to ≤5 mm. Overall, no difference in pCR rates were found between AC-S and AC-Res BC, but pCR rates were 2- to 4-fold higher in HER2+, AC-S (79%) and AC-Res (65%) subsets compared to HER2-, AC-S (32%) and AC-Res (16%) subsets. Higher pCR rates were associated with HER2+/hormone receptor- (HR-) > HER2+/HR+, HER2-/HR- (triple-) > HER2-/HR+, and within the HER2+ subset-IHC 3+/FISH+ or unknown > IHC 3+/FISH- or IHC 1–2+/FISH+, and ductal > other histology. No patient had clinical cardiac dysfunction or EF <50, except 1 on AC/TC. 13/106 (12%) progression or death at a median follow-up of 22 months (range 2–46) is mostly due to stage IV and CNS progression. Conclusion: Short course of TCH achieves a high rate of pCR in AC-Res and AC-S, HER2+ BC in contrast to TC ± B in AC-Res and AC-S, HER2- BC. This is the first demonstration of high rate of complete AC resistance reversal across stage II-IV, inflammatory and recurrent HER2+ BC. In vivo response adjusted 2–4 cycles of dose-dense AC limited clinical cardiac toxicity. HER2+ (IHC 3+/FISH+ or unknown), HR- and ductal histology are significant predictors of high pCR. HER2 and HR confer 4 predictive subtypes of BC. [Table: see text] No significant financial relationships to disclose.

Sign in / Sign up

Export Citation Format

Share Document