Impact of COVID19 pandemic on treatment outcome of locally-advanced head and neck squamous cell carcinoma (LA-HNSCC): IMPACCT study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6061-6061
Author(s):  
Pau Guillen Sentis ◽  
Carmen Castillo Manzano ◽  
Beatriz Quirós ◽  
Francisca Morey Cortes ◽  
Sara Tous ◽  
...  
Keyword(s):  
Negative Impact ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Stage Iii ◽  
Rank Test ◽  
Historical Cohort ◽  
First Semester ◽  
Kaplan Meier ◽  
Chi Squared ◽  
One Year

6061 Background: Treatment (ttm) of cancer patients (pts) was compromised during the first wave of COVID19 pandemic due to collapse of healthcare systems. Standard of care (SOC) for LA-HNSCC pts had to be adapted as operating rooms were temporarily unavailable, and to reduce risk of COVID19 exposure. The IMPACCT study evaluated the outcome of LA-HNSCC pts treated at the Catalan Institute of Oncology during the first semester of 2020 and compared it to a control cohort previously treated in the same institution. Methods: Retrospective single institution analysis of two consecutively-treated cohorts of newly-diagnosed HNSCC pts: from January to June of 2020 (CT20) and same period of 2018 and 2019 (CT18-19). Pt demographics and disease characteristics were obtained from our in-site prospective database. Ttm modifications from SOC as per COVID19-contingency protocol in CT20 for LA-HNSCC were collected. Chi-squared was used to compare variables and ttm response between cohorts. One-year recurrence-free survival (1yRFS) and overall survival (1yOS) of LA-HNSCC pts were estimated by Kaplan-Meier method and compared by Log-rank test. Results: A total of 306 pts were included: CT20=99; CT18-19=207. Baseline characteristics were balanced between cohorts (Table1). In pts treated with conservative ttm (non-surgical approach), persistence disease was higher in CT20 vs CT18-19 (26 vs. 10% p=0.02). Median follow-up of CT20 and CT18-19 was 6.8 months (IQR 5.1-7.9) and 12.3 (6.7-18.4), respectively. A trend towards lower 1yRFS and 1yOS was observed in CT20 vs CT18-19 (72 vs 83% p=0.06; 80 vs 84% p=0.07), respectively. Within CT20, 37 pts (37%) had one or more ttm modifications: switch from surgery to conservative ttm (n=13); altered radiotherapy fractionation (n=14); reduced cisplatin cumulative dose to 200mg/m2 (n=19); no adjuvant ttm (n=1). Pts who received modified ttm had no differences in 1yRFS vs those who did not (80 vs 66% p=0.31), but higher 1yOS was observed (97 vs 67% p<0.01). When stratified by stage, 1yOS difference remained significant in stage III/IVA (100 vs 61% p<0.01) but not in I/II (100 vs 77% p=0.28) or IVB (67 vs 50% p=0.54). Conclusions: COVID19 pandemic had a negative impact on ttm outcomes and survival in LA-HNSCC pts when compared to our historical cohort. Ttm modifications based on COVID19-contingency protocol did not compromise ttm efficacy in terms of RFS and was associated with better OS in Stage III/IVA.[Table: see text]

scholarly journals Glioblastoma and Increased Survival with Longer Chemotherapy Duration

2019 ◽  
Vol 12 (3) ◽  
pp. 65-69 ◽  
Author(s):  
Dory Abou Jaoude ◽  
Joseph A Moore ◽  
Matthew B Moore ◽  
Philip Twumasi-Ankrah ◽  
Elizabeth Ablah ◽  
...  
Keyword(s):  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Rank Test ◽  
Free Survival ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Optimal Duration ◽  
Multicenter Prospective Study ◽  
One Year

Introduction The five-year survival rate for patients with glioblastoma (GBM) is low at approximately 4.7%. Radiotherapy plus concomitant and adjuvant temozolomide (TMZ) remains the standard of care. The optimal duration of therapy with TMZ is unknown. This study sought to evaluate the survival benefit of two years of treatment. Methods This was a retrospective chart review of all patients diagnosed with GBM and treated with TMZ for up to two years between January 1, 2002 and December 31, 2011. The Kaplan-Meier method with log-rank test was used to estimate the progression-free survival (PFS) and the overall survival (OS). The results were compared to historical controls and data from previous clinical trials of patients treated up to one year. Results Data from 56 patients with confirmed GBM were evaluated. The OS probability was 54% (SE = 0.068) at one year, 28.3% (SE = 0.064) at two years, 17.8% (SE = 0.059) at three years, and 4% (SE = 0.041) at five years. Seven patients (12.5%) were treated with TMZ for two years. Their median time-to-progression was 28 months (95% CI = 5.0 - 28.0), and they had an increased survival probability at three years compared to other patients (log-rank test χ2 (1, N = 56) = 19.2, p < 0.0001). Conclusions There may be an advantage for a longer duration of TMZ therapy among patients with GBM, but the sample size was too small for generalization. A multicenter prospective study is needed to dentify optimal duration of TMZ therapy.

Association of the establishment of multidisciplinary (MDC) hepatocellular carcinoma (HCC) clinic with clinical outcome.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 332-332 ◽  
Author(s):  
Adam C. Yopp ◽  
Katherine T Ostapoff ◽  
Amit G Singal ◽  
John C. Mansour ◽  
Glen C. Balch ◽  
...  
Keyword(s):  
Tumor Stage ◽  
Rank Test ◽  
Time To Treatment ◽  
Treatment Regimens ◽  
Kaplan Meier ◽  
Tumor Stages ◽  
Chi Squared ◽  
One Year ◽  
Lost To Follow Up ◽  
The Impact

332 Background: Multidisciplinary clinics are prevalent in the management of cancer. However, there is a lack of data demonstrating improved outcomes. The variability of liver- and tumor-specific factors in HCC mandates multimodal therapy. The aim of this study was to evaluate the impact of establishing a MDC HCC clinic. Methods: A MDC HCC clinic consisting of surgeons, hepatologists, oncologists, and radiologists was established October 2010. After this date, any patient with HCC or suspected HCC (any liver mass on radiology or elevated AFP) was evaluated in the MDC clinic. We conducted a retrospective review of a prospective HCC database to identify patients diagnosed in the year following and three years prior to initiation of the MDC clinic. Demographics, tumor characteristics, treatment regimens, and survival were compared between the two groups of patients with one-way ANOVA and Chi-squared tests. Survival curves were generated using Kaplan-Meier with log rank test. Results: 105 patients were identified in the year prior to the MDC clinic and 209 patients in the 3 previous years. There was no difference in gender, race/ethnicity, etiology of cirrhosis, or Child-Pugh stage between the groups. Patients diagnosed after the MDC clinic were found at earlier tumor stages by AJCC and BCLC classification (p=0.001 and p=0.003, respectively). More post-clinic patients received treatment (56% vs. 44%, p=0.04), and time-to-treatment was shorter (2.2 vs. 4.6 months, p=0.001) than those diagnosed prior to the MDC clinic. Median survival of patients diagnosed after the MDC clinic was significantly longer than those seen during the 3 prior years (15.2 vs. 4.7 months, p=0.002). This difference in survival persisted when patients who were lost to follow-up or died within one month of HCC diagnosis were excluded (17.7 vs. 7.0 months, p=0.004). Survival after excluding BCLC D patients was also longer in the post-clinic period (one year survival, 64% vs. 47%, p=0.001). Conclusions: Formation of a MDC HCC clinic is associated with improved survival, most likely due to more streamlined care resulting in HCC diagnosis at earlier tumor stage and shorter time to treatment.

Five-year survival outcomes with durvalumab after chemoradiotherapy in unresectable stage III NSCLC: An update from the PACIFIC trial.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 8511-8511
Author(s):  
David R. Spigel ◽  
Corinne Faivre-Finn ◽  
Jhanelle Elaine Gray ◽  
David Vicente ◽  
David Planchard ◽  
...  
Keyword(s):  
Progression Free Survival ◽  
Standard Of Care ◽  
Phase Iii ◽  
Stage Iii ◽  
Smoking History ◽  
Kaplan Meier ◽  
Unresectable Stage ◽  
The Pacific ◽  
Patient Reported ◽  
Stage Iii Nsclc

8511 Background: In the placebo-controlled Phase III PACIFIC trial of patients with unresectable Stage III NSCLC whose disease had not progressed after platinum-based concurrent chemoradiotherapy (cCRT), durvalumab improved overall survival (OS) (stratified hazard ratio [HR] 0.68; 95% confidence interval [CI] 0.53–0.87; p=0.0025; data cutoff [DCO] Mar 22, 2018) and progression-free survival (PFS) (stratified HR 0.52, 95% CI 0.42–0.65; p<0.0001; DCO Feb 13, 2017) based on the DCOs used for the primary analyses, and the degree of benefit remained consistent in subsequent updates. Durvalumab was associated with a manageable safety profile, and did not detrimentally affect patient-reported outcomes, compared with placebo. These findings established consolidation durvalumab after CRT (the ‘PACIFIC regimen’) as the standard of care in this setting. We report updated, exploratory analyses of OS and PFS, assessed approximately 5 years after the last patient was randomized. Methods: Patients with WHO PS 0/1 (and any tumor PD-L1 status) whose disease did not progress after cCRT (≥2 overlapping cycles) were randomized (2:1) 1–42 days following cCRT (total prescription radiotherapy dose typically 60–66 Gy in 30–33 fractions) to receive 12 months’ durvalumab (10 mg/kg IV every 2 weeks) or placebo, stratified by age (<65 vs ≥65 years), sex, and smoking history (current/former smoker vs never smoked). The primary endpoints were OS and PFS (blinded independent central review; RECIST v1.1) in the intent-to-treat (ITT) population. HRs and 95% CIs were estimated using stratified log-rank tests in the ITT population. Medians and OS/PFS rates at 60 months were estimated with the Kaplan–Meier method. Results: Overall, 709/713 randomized patients received treatment in either the durvalumab (n/N=473/476) or placebo (n/N=236/237) arms. The last patient had completed study treatment in May 2017. As of Jan 11, 2021 (median follow-up duration of 34.2 months in all patients; range, 0.2–74.7 months), updated OS (stratified HR 0.72, 95% CI 0.59–0.89; median 47.5 vs 29.1 months) and PFS (stratified HR 0.55, 95% CI 0.45–0.68; median 16.9 vs 5.6 months) remained consistent with the results from the primary analyses. The 60-month OS rates were 42.9% and 33.4% with durvalumab and placebo, respectively, and 60-month PFS rates were 33.1% and 19.0%, respectively. Updated treatment effect estimates for patient subgroups will be presented. Conclusions: These updated survival analyses, based on 5-year data from PACIFIC, demonstrate robust and sustained OS plus durable PFS benefit with the PACIFIC regimen. An estimated 42.9% of patients randomized to durvalumab remain alive at 5 years and approximately a third remain both alive and free of disease progression. Clinical trial information: NCT02125461.

scholarly journals Risk of colonic diverticular rebleeding according to endoscopic appearance

2018 ◽  
Vol 06 (01) ◽  
pp. E36-E42 ◽  
Author(s):  
Koki Kawanishi ◽  
Jun Kato ◽  
Tetsuhiro Kakimoto ◽  
Takeshi Hara ◽  
Takeichi Yoshida ◽  
...  
Keyword(s):  
Clinical Problem ◽  
Endoscopic Hemostasis ◽  
Rank Test ◽  
Diverticular Bleeding ◽  
Kaplan Meier ◽  
Colonic Diverticular Bleeding ◽  
One Year ◽  
Colonic Diverticula

Abstract Background and study aims Re-commencement of bleeding (rebleeding) of colonic diverticula after endoscopic hemostasis is a clinical problem. This study aimed to examine whether endoscopic visibility of colonic diverticular bleeding affects the risk of rebleeding after endoscopic hemostasis. Patients and methods We performed a retrospective review of endoscopic images and medical charts of patients with colonic diverticular bleeding who underwent endoscopic hemostasis. Endoscopic visibility was classified into two types according to visibility of the source of bleeding; source invisibility due to bleeding or attached hematin (type 1), or endoscopically visible responsive vessels (type 2). Rebleeding rates within one year after initial hemostasis were examined. Results Of 93 patients with successful endoscopic hemostasis, 38 (41 %) showed type 1 visibility, while the remaining presented type 2. All patients received hemostasis with clipping, rebleeding developed in 20 patients (22 %). Type 1 visibility was more likely to be observed in patients with rebleeding (65 % vs. 34 %, P = 0.013). Multivariate analysis revealed that after endoscopic hemostasis, type 1 visibility (invisible source) was the only independent risk factor for colonic diverticular rebleeding (odds ratio, 3.05; 95 % confidence interval, 1.03 – 9.59, P = 0.044). Kaplan-Meier curve showed the cumulative incidence of rebleeding was significantly higher in patients with type 1 visibility than those with type 2 visibility (P = 0.0033, log-rank test) Conclusion Hemostasis by clipping for colonic diverticular bleeding without definite observation of the source of bleeding may not be sufficiently effective. Other hemostatic methods, including band ligation, should be considered when the source of bleeding is unclear.

Cisplatin(P)-including triplets versus P-free doublets in the treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC): SICOG 0101 randomized trial

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7103-7103 ◽  
Author(s):  
P. Comella ◽  
S. Palmeri ◽  
G. De Cataldis ◽  
G. Filippelli ◽  
R. Cioffi ◽  
...  
Keyword(s):  
Advanced Nsclc ◽  
Locally Advanced ◽  
Stage Iv ◽  
Standard Of Care ◽  
Rank Test ◽  
Stage Iiia ◽  
Log Rank Test ◽  
Grade 3 ◽  
Metastatic Sites ◽  
Nsclc Patients

7103 Background: We previously reported that triplets with P-gemcitabine (G) plus vinorelbine (V) (PGV) or paclitaxel (T) (PGT) prolonged the survival (S) of advanced NSCLC patients (pts) in comparison with P-based doublets (PG or PV). Aims of the present study were: (1) to compare (log-rank test) the S of P-based triplets vs P-free doublets, and (2) to compare (Fisher test) safety and response rate (RR) of T- and V-regimens. Methods: A 2x2 factorial design was adopted. Pts aged ≤ 70 years, with PS (ECOG) < 2, inoperable stage IIIA, IIIB, or IV NSCLC were randomly treated with: GV = G 1,000 mg/m2 + V 25 mg/m2 on day (D) 1 and 8; GT = G 1,000 mg/m2 + T 125 mg/m2 on D 1 and 8; PGV = P 50 mg/m2 on D 1 and 8 + GV; PGT = P 50 mg/m2 on D 1 and 8 + GT. In all arms, cycles were repeated Q 3 weeks. Only responder pts after 3 cycles received further chemotherapy (CT). Thoracic RT was delivered after CT to pts with intra-thoracic disease. 330 events were required to have a 90% power to demonstrate (two-sided P < 0.05) a 30% reduction of hazard of death. Results: From April 2001 to December 2005, 431 pts were recruited in the 4 arms. Characteristics in % were well balanced in P-based triplets and P-free doublets: males, 84/91; PS 0, 25/23; squamous cell carcinoma, 38/42; weight loss, 22/29; stage IV, 66/65; CNS metastases, 5/8; ≥ 2 metastatic sites, 29/30. So far, 411 pts were assessed for response: RR of triplets vs doublets was 88/204 (43%) vs 68/207 (33%) (P = 0.020), and of T-based vs V-based regimens was 40% vs 36% (P = 0.218). To date, 313 deaths were registered: median and 1-year S were 10.6 mo. and 41% for pts treated with triplets, and 10.4 mo. and 39% for pts treated with doublets (P = 0.786). Over initial 3 courses, occurrence of grade ≥ 3 toxicity (T vs V, % pts) was: neutropenia, 18% vs 30% (P < 0.004); febrile neutropenia, 4% vs 7%; platelets, 7% vs 12% (P = 0.056); anemia, 5% vs 7%; vomiting, 1% vs 2%; diarrhea, 6% vs 3%; stomatitis, 3% vs 0.5%. Grade ≥ 2 neurotoxicity occurred in 1% of both groups. Conclusions: Activity was significantly higher with P-based triplets, but they did not affect the OS. T-based regimens were equally active and less toxic than V-based regimens. Therefore, the GT regimen may represent a new standard of care for advanced NSCLC pts. No significant financial relationships to disclose.

Complete 18FDG positron emission tomography (PET) response after induction chemotherapy (IC) is correlated with long survival in patients (pts) with locally advanced non-small cell lung cancer (LA NSCLC)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17004-17004
Author(s):  
D. Schallier ◽  
H. Everaert ◽  
B. Neyns ◽  
N. Baelde ◽  
M. Meysman ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Standardized Uptake Value ◽  
Complete Response ◽  
Stage Iii ◽  
Rank Test ◽  
Axial Tomography ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Positron Emission

17004 Background: PET and computerized axial tomography scan (CT) are complimentary tools in the diagnosis and treatment of pts with LA NSCLC. Recent data have shown that response to IC as determined with PET has a better prognostic relevance for long term outcome than CT (Hoekstra et al JCO 2005;23:33:8362–70). Methods: PET and chest CT were performed before and after 3 cycles of IC in pts with LA NSCLC (D. Schallier et al, Suppl JCO 2005;23:165:7285, 6915). Response was defined according to WHO and EORTC criteria for CT and PET respectively (complete response: CR; partial response: PR; stable disease: SD; progressive disease: PD). PET images corrected for attenuation were acquired in 3D on a Siemens Accel camera starting 60 minutes after administration of 307–606 MBq 18FDG. The maximal standardized uptake value (SUVmax) within the tumor was measured and a SUVmax value ≥2.5 was used as a cut off. PET responses were classified either as complete (resolution of the enhanced uptake within the tumor) or non-complete. For each subgroup, classified according to CT and PET response, time to progression (TTP) and survival (S) was calculated and analysed statistically according to Kaplan-Meier and log rank test. Results: 21 pts were eligible for the PET and CT confrontation. Characteristics: 14 male, 7 female; median age 70 y (39–78); median KS: 90 (80–100); stage III A: 9; stage III B: 12; T1,2,3,4: 4/3/7/7; N0,1,2,3: 4/1/11/5. Response: CT: 12 PR; 9 SD; PET: 6 CR, 9 PR, 5SD, 1PD. Nine/12 PR on CT were also CR (5) and PR (4) on PET. Median TTP was correlated significantly with PR and CR (versus SD and non-CR) on CT and PET respectively (288 versus 606 days, p = 0.045 for CT and 299 versus median not reached p = 0.024 for PET); with a median follow up of 19+ month, median S was not significantly correlated with PR on CT but was highly significantly correlated with CR on PET (439 days versus median not reached p = 0.005). Conclusions: Assessment of response to IC using CT or PET largely overlaps. PET appears to be a more ‘sensitive‘ tool to measure response. CR on PET provides a better accuracy for determination of long term outcome than CT. The present results corroborate previously published results. No significant financial relationships to disclose.

Outcome of surgical resection for pathologic Nx and N0 non-small cell lung cancer (NSCLC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 7513-7513
Author(s):  
R. U. Osarogiagbon ◽  
J. W. Allen ◽  
A. Farooq ◽  
M. Ninan ◽  
T. W. Ratliff
Keyword(s):  
Surgical Resection ◽  
Lung Resection ◽  
Small Cell ◽  
Rank Test ◽  
Small Cell Lung ◽  
Survival Estimate ◽  
Kaplan Meier ◽  
Radio Therapy ◽  
Chi Squared ◽  
Analysis Survival

7513 Background: Metastasis to lymph nodes (LN) connotes poor prognosis in NSCLC. Sufficient LN must be examined to accurately determine LN negativity. Patients with no LN examined (pNx) may be incompletely staged and erroneously assigned to a low risk group. To evaluate this possibility, we compared the survival of patients with node negative disease and at least 1 LN examined (pN0) to those with pNx. Methods: Retrospective analysis of all resections for NSCLC from January 1, 2004 to December 31, 2007 identified through a search of pathology databases at hospitals in the Memphis Metropolitan Area. Benign and metastatic disease, pre-operative chemo/radio therapy, bronchoalveolar cell, small cell lung, carcinoid tumors and repeat lung resection were excluded. Date of death was obtained from a National Death Index search. Variables were compared by chi-squared test, survival estimates calculated by Kaplan Meier analysis, survival estimates compared by log-rank test. Results: 746 of 809 resections met inclusion criteria. 86 (11.5%) were pNx and 510 (68.4%) pN0. Demographic and histologic characteristics were similar ( Table 1 ). 55.8% of the pNx group had sublobar resection, compared to 5.7% of pN0 (p<0.0001). 179 pN0 patients (35.1%) had only hilar-intrapulmonary LN (stations 10–14), median 3 (range 1–18) examined. 46 patients (9.02%) had only mediastinal LN (stations 1–9), median 2 (1–13); 281 patients (55.1%) had both stations 10–14 and 1–9, median 7 (2–45). 85% of pN0 patients had <10 LNs examined. 3-year survival estimate for the T1NxM0 vs T1N0M0 patients was 69% vs 70% (p= 0.14); for T2NxM0 vs T2N0M0 it was 25% vs 65% (p <0.01). Conclusions: A high percentage of patients (11.5%) undergoing surgical resection for NSCLC had pNx. These patients were more likely to have sublobar resections. Most (85%) patients with pN0 had <10 nodes examined and a large proportion (35.1%) had no mediastinal LNs, raising the possibility of understaging. Patients with pT2NxM0 did significantly worse than those with pT2N0M0. [Table: see text] [Table: see text]

Three fluoropyrimidine-based regimens in second-line therapy following nab-paclitaxel plus gemcitabine in metastatic pancreatic cancer: Efficacy and tolerance in clinical practice.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 370-370
Author(s):  
Anne Laure Pointet ◽  
David Tougeron ◽  
Simon Pernot ◽  
Astrid Pozet ◽  
Dominique Bechade ◽  
...  
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Statistical Significance ◽  
Performance Status ◽  
Locally Advanced ◽  
Rank Test ◽  
Line Treatment ◽  
Second Line ◽  
Secondary Resection ◽  
Kaplan Meier ◽  
Metastatic Sites

370 Background: Combination of nab-paclitaxel plus gemcitabine (N+G) has recently become a valid first-line treatment (1L) in metastatic pancreatic adenocarcinoma (MPA) in patients (pts) with performance status (PS) of 0,1 or 2, but there is currently no standard second-line treatment (2L) after this new 1L option. We evaluated survival outcomes and tolerability of three usual fluoropyrimidine-based regimens: FOLFOX, FOLFIRI or FOLFIRI.3 (FOLFIRI1/3), and FOLFIRINOX after N+G failure in MPA pts. Methods: We prospectively identified 138 pts from 11 French centers who received 1L N+G for unresectable pancreatic adenocarcinoma. After disease progression or unacceptable toxicity, we excluded pts with locally advanced cancer, or who underwent secondary resection/chemoradiotherapy. Three subgroups of 2L chemotherapy were identified: FOLFOX, FOLFIRI1/3 and FOLFIRINOX regimens. Response was evaluated by RECIST criteria, progression-free survivals (PFS1, PFS2), and overall survival (OS1, OS2) were calculated using Kaplan-Meier method and compared with the Log-rank test. Results: 61 pts with MPA received a 2L. Persistent neuropathy was present in 27% of pts. Median age was 71.7 years [41-83]. PS was 0, 1 or 2. Median 1L duration, number of metastatic sites, PS, CA19.9, albumin, and bilirubin levels, and persistent neuropathy grade were statistically comparable between the 3 subgroups. Median OS for all 2L pts was 6.0 months [4-8]. Third line regimen was used in 32.8% of 2L pts without statistical significance between the subgroups. Main grade 3/4 adverse events reported were thrombocytopenia (18%), anemia (7.7%), neutropenia (21.4%) and nausea (5.4%). No toxic deaths occurred. Conclusions: This study suggests a clinical benefit and a manageable toxicity profile of 2L fluoropyrimidine-based regimens after N+G failure in patients with MPA, in particularly combined with irinotecan.[Table: see text]

First line gemcitabine and nab-paclitaxel chemotherapy for localized pancreatic ductal adenocarcinoma.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 369-369
Author(s):  
Pat Gulhati ◽  
Laura Prakash ◽  
Matthew H. G. Katz ◽  
Xuemei Wang ◽  
Milind M. Javle ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Metastatic Disease ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Clinical Staging ◽  
Ductal Adenocarcinoma ◽  
First Line ◽  
First Line Therapy ◽  
Kaplan Meier ◽  
Ecog Ps

369 Background: Chemotherapy is widely used as a component of treatment of localized pancreatic ductal adenocarcinoma (PDAC). Pre-operative chemotherapy is associated with early treatment of micro-metastases and guaranteed delivery of all components of multimodality therapy. For locally advanced (LA) PDAC, induction chemotherapy is standard of care. We evaluated the use of gemcitabine and nab-paclitaxel (Gem/nab-P) as first-line therapy in localized PDAC. Methods: Records of pts with localized PDAC who initiated Gem/nab-P at a single institution from 2013-2015 were retrospectively reviewed. Clinicopathologic features, dose and outcomes were evaluated. Pts were staged using our previously published criteria: potentially resectable (PR), borderline type A (BR-A) (anatomy amenable to vascular resection), BR-B (biology suspicious for metastatic disease including high CA19-9), BR-C (co-morbidities requiring medical optimization), and LA. Co-morbidities were classified using adult comorbidity evaluation-27 score. Overall survival (OS) was analyzed using Kaplan Meier method. Results:99 pts [M/F: 50/49; median age: 70 yrs (range 30-85); PR/BR/LA: 45/14/40] were treated with Gem/nab-P. Clinical staging showed PR+BR-A/BR-B+C: 20/39. BR-B+C included one or more of the following factors: age ≥80 yrs [13%], ECOG PS ≥2 [13%], moderate/severe co-morbidities [55%], CA19-9≥1000 [28%], suspicion for metastatic disease [21%]. Majority of pts received biweekly Gem/nab-P dosing [standard/biweekly/other: 10/80/9] with minimal grade 4 toxicity. 45/99 pts received chemoradiation after Gem/nab-P [30Gy/50.4Gy: 15/30]. 12/20 (60%) PR+BR-A, 2/39 (5%) BR-B+C and 1/40 (3%) LA pts underwent pancreatectomy. 13/15 resected pts received adjuvant chemotherapy. At median follow-up of 26 mo, median OS was 18 (95% CI: 15.6-20.5) mo for all, 17 (95% CI: 14.6-19.5) mo for unresected and not reached for resected pts (p = 0.03). Conclusions: A significant number of pts with resectable PDAC albeit aggressive biology (BR-B) and/or medically inoperable disease (BR-C) received first-line Gem/nab-P; resection rates were lower compared to PR/BR-A pts. Biweekly dosing is being used in localized PDAC and is well tolerated.

Clinical and prognostic implications of sarcopenia in patients affected by locally advanced NSCLC.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20046-e20046
Author(s):  
Sabrina Rossi ◽  
Luca Disconzi ◽  
Luca Toschi ◽  
Giovanna Finocchiaro ◽  
Laura Giordano ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Induction Chemotherapy ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Stage Iii ◽  
Rank Test ◽  
Skeletal Muscle Index ◽  
Computed Tomography Images ◽  
Locally Advanced Nsclc ◽  
The Impact

e20046 Background: Sarcopenia is a loss of skeletal muscle mass that has been studied as prognostic factor in several cancers. Retrospective studies have suggested that sarcopenia is associated with poorer survival outcomes and with an increase of major chemotherapy toxicities resulting in dose reduction and delay. This study examined the value of sarcopenia in patients with stage III non-small cell lung cancer (NSCLC). Methods: This retrospective analysis includes 68 patients affected by stage III NSCLC treated with induction chemotherapy followed by surgery or radical radiation therapy in our cancer center. Weight and height were obtained from medical records at diagnosis. Skeletal muscle index (SMI) was measured by the analysis of electronically stored computed tomography images obtained before the start of chemotherapy; sarcopenia was defined by international consensus as a SMI≤39 cm2/m2 for women and ≤55 cm2/m2 for men. Kaplan-Meier method and Log-Rank test were used to determine the impact of sarcopenia on overall survival (OS) and progression-free survival (PFS). Exact Fisher test and Chi-squared test were used to establish the association between the presence of sarcopenia and other variables. Results: A total of 68 patients (stage 3A = 39; stage 3B = 29) with performance status 0-1 and median age 67 yrs were analyzed. Forty-five patients (66%) were sarcopenic: 100% of underweight patients (BMI ≤18.5), 83% of patients with normal weight (BMI 18.5-24.9), 56% of overweight patients (BMI 25-29.9) and 30% of obese (BMI≥30). Sarcopenia was not associated with age≥70 yrs (p = 0.67), Charlson Comorbidity Index (p = 1.00), stage (p = 0.53), response rate to chemotherapy (p = 0.78) or toxicities of grade≥3 (p = 0.83). Median OS in sarcopenic patients was 18.2 months compared with 33.2 months in nonsarcopenic patients (p = 0.03); the difference in terms of PFS was not statistically significant (10.7 vs 14.9 months; p = 0.19). Conclusions: Sarcopenia is associated with shorter OS in patients with locally advanced NSCLC but it seems not related with worse response to induction chemotherapy or higher toxicities. These data should be validated in larger prospective clinical studies.

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