scholarly journals ASO Author Reflections: Neoadjuvant Chemotherapy Switch: Optimizing Neoadjuvant Treatment Sequencing in Pancreas Cancer

2021 ◽  
Author(s):  
Roberto Alva-Ruiz ◽  
Mark J. Truty
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Pancreas Cancer ◽  
Neoadjuvant Treatment ◽  
Treatment Sequencing

scholarly journals Morbidity and mortality of lobectomy or pneumonectomy after neoadjuvant treatment: an analysis from the ESTS database

2019 ◽  
Author(s):  
Alessandro Brunelli ◽  
Gaetano Rocco ◽  
Zalan Szanto ◽  
Pascal Thomas ◽  
Pierre Emmanuel Falcoz
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Propensity Score ◽  
Propensity Score Analysis ◽  
Bronchopleural Fistula ◽  
Neoadjuvant Treatment ◽  
Mortality Rates ◽  
Induction Treatment ◽  
Score Analysis ◽  
Cardiopulmonary Complications ◽  
Lung Resections

Abstract OBJECTIVES To evaluate the postoperative complications and 30-day mortality rates associated with neoadjuvant chemotherapy before major anatomic lung resections registered in the European Society of Thoracic Surgeons (ESTS) database. METHODS Retrospective analysis on 52 982 anatomic lung resections registered in the ESTS database (July 2007–31 December 2017) (6587 pneumonectomies and 46 395 lobectomies); 5143 patients received neoadjuvant treatment (9.7%) (3993 chemotherapy alone and 1150 chemoradiotherapy). To adjust for possible confounders, a propensity case-matched analysis was performed. The postoperative outcomes (morbidity and 30-day mortality) of matched patients with and without induction treatment were compared. RESULTS 8.2% of all patients undergoing lobectomies and 20% of all patients undergoing pneumonectomies received induction treatment. Lobectomy analysis: propensity score analysis yielded 3824 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the neoadjuvant group (626 patients, 16% vs 446 patients, 12%, P < 0.001), but 30-day mortality rates were similar (71 patients, 1.9% vs 75 patients, 2.0%, P = 0.73). The incidence of bronchopleural fistula and prolonged air leak >5 days were similar between the 2 groups (neoadjuvant: 0.5% vs 0.4%, P = 0.87; 9.2% vs 9.9%, P = 0.27). Pneumonectomy analysis: propensity score analysis yielded 1312 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the treated patients compared to those without neoadjuvant treatment (neoadjuvant 275 cases, 21% vs 18%, P = 0.030). However, the 30-day mortality was similar between the matched groups (neoadjuvant 68 cases, 5.2% vs 5.3%, P = 0.86). Finally, the incidence of bronchopleural fistula was also similar between the 2 groups (neoadjuvant 1.8% vs 1.4%, P = 0.44). CONCLUSIONS Neoadjuvant chemotherapy is not associated with an increased perioperative risk after either lobectomy or pneumonectomy, warranting a more liberal use of this approach for patients with locally advanced operable lung cancer.

scholarly journals Efficacy and Safety of Albumin-Bound Paclitaxel Compared to Docetaxel as Neoadjuvant Chemotherapy for HER2-Negative Breast Cancer

2022 ◽  
Vol 11 ◽  
Author(s):  
Zhi-Dong Lv ◽  
Hong-Ming Song ◽  
Zhao-He Niu ◽  
Gang Nie ◽  
Shuai Zheng ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
Neoadjuvant Treatment ◽  
Disease Free Survival ◽  
Lymph Node Status ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Paclitaxel Group ◽  
Docetaxel Group

BackgroundNanoparticle albumin-bound paclitaxel (nab-paclitaxel) as neoadjuvant chemotherapy (NAC) for breast cancer remains controversial. We conducted a retrospective study to compare the efficacy and safety of nab-paclitaxel with those of docetaxel as neoadjuvant regimens for HER2-negative breast cancer.MethodsIn this retrospective analysis, a total of 159 HER2-negative breast cancer patients who had undergone operation after NAC were consecutively analyzed from May 2016 to April 2018. Patients were classified into the nab-paclitaxel group (n = 79, nab-paclitaxel 260 mg/m2, epirubicin 75 mg/m2, and cyclophosphamide 500 mg/m2) and the docetaxel group (n = 80, docetaxel 75 mg/m2, epirubicin 75 mg/m2, and cyclophosphamide 500 mg/m2) according to the drug they received for neoadjuvant treatment. The efficacy and adverse events were evaluated in the two groups.ResultsThe pathological complete response (pCR)(ypT0/isN0) rate was significantly higher in the nab-paclitaxel group than in the docetaxel group (36.71% vs 20.00%; P = 0.031). The multivariate analysis revealed that therapeutic drugs, lymph node status, and tumor subtype were the most significant factor influencing treatment outcome. At a median follow-up of 47 months, disease-free survival (DFS) was not significantly different in those assigned to nab-paclitaxel compared with docetaxel (82.28% vs 76.25%; P = 0.331). The incidence of peripheral sensory neuropathy in the nab-paclitaxel group was higher than that in the docetaxel group (60.76% vs 36.25%; P = 0.008), while the incidence of arthralgia was observed more frequently in the docetaxel group (57.50% vs 39.97%; P = 0.047).ConclusionsCompared with docetaxel, nab-paclitaxel achieved a higher pCR rate, especially those patients with triple-negative breast cancer or lymph node negative breast cancer. However, there was no significant difference in DFS between the two groups. This study provides a valuable reference for the management of patients with HER2-negative breast cancer.

scholarly journals Neoadjuvant Ifosfamide and Epirubicin in the Treatment of Malignant Peripheral Nerve Sheath Tumors

Sarcoma ◽  
2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Angela C. Hirbe ◽  
Pippa F. Cosper ◽  
Sonika Dahiya ◽  
Brian A. Van Tine
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Peripheral Nerve ◽  
Clinical Benefit ◽  
Metabolic Response ◽  
Neoadjuvant Treatment ◽  
Soft Tissue Sarcomas ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
Response To Chemotherapy

Background and Objectives. Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft tissue sarcomas with poor overall survival. Response to chemotherapy has been debated for these tumors. Methods. We performed a retrospective analysis of the patients at our institution with a biopsy-proven diagnosis of MPNST that underwent neoadjuvant chemotherapy prior to surgery. Results. We retrospectively identified five patients who received neoadjuvant chemotherapy with epirubicin and ifosfamide that demonstrated a 30% reduction in tumor growth and a 60% response rate by RECIST criteria. Additionally, a metabolic response was observed in all three patients who received serial PET scans during neoadjuvant treatment. The clinical benefit rate, which includes stable disease, was 100%. Conclusions. Our data suggest that MPNSTs do respond to epirubicin and ifosfamide based chemotherapy and prospective studies are warranted to further define the clinical benefit.

A phase 1 study of neoadjuvant chemotherapy followed by concurrent chemoradiation with gemcitabine, sorafenib, and vorinostat in pancreatic cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16268-e16268
Author(s):  
Andrew Stewart Poklepovic ◽  
Emma Charlotte Fields ◽  
Dipankar Bandyopadhyay ◽  
Mary Beth Tombes ◽  
Maciej Kmieciak ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Antitumor Activity ◽  
Drug Exposure ◽  
Phase 1 ◽  
Neoadjuvant Treatment ◽  
R0 Resection ◽  
Resection Rate ◽  
Correlative Studies ◽  
Dose Levels

e16268 Background: The multi-kinase inhibitor sorafenib (S) and HDAC inhibitor vorinostat (V) demonstrated synergism against preclinincal pancreatic cancer (PaCa) models. The combination of S & V also potently radiosensitized pancreatic cancer cells and enhanced the activity of gemcitabine (G). This led to a phase 1 trial to determine the doses and schedule appropriate for phase 2 study of S & V with weekly G and intensity modulated radiotherapy (IMRT) as neoadjuvant treatment of PaCa following chemotherapy. Methods: Using a 3+3 dose-escalation design, adult patients with resectable, borderline resectable, unresectable, and lymph node positive PaCa were enrolled to 6 dose levels. Enrolled patients had completed at least 8w of neoadjuvant chemotherapy prior to IMRT. The schedule of administration was weekly 200mg/m2 G weekly during IMRT, S & V were dosed either 3x or 5x weekly during IMRT. Primary endpoint was to identify the dose and schedule for S & V with G based chemoradiation. Key secondary endpoints included antitumor activity, R0 resection rate, OS. Correlative studies to evaluate a variety of biomarkers and Nanostring expression analysis on pre- and post-therapy tumor specimens were also performed. Results: 22 patients were enrolled and 21 treated at 6 dose levels. Due to thrombocytopenia limiting drug exposure, the trial was modified to reduce G to 200mg/m2/wk and S & V to 3 d/wk instead of 5 d/wk. 13 patients were eligible for surgery, and 9 had R0 resections. Conclusions: Our findings indicate that the study regimen was well tolerated, typical toxicities of S (hand foot syndrome) were not observed with intermittent dosing. Uncomplicated cytopenias limited drug exposure, which was improved with intermittent S&V dosing. The RP2D of the combination is S (400mg po BID 3d/wk), V (200mg po qd 3d/wk), G 200mg/m2 IV weekly, with IMRT (50.4 Gy over 28 fractions, 5d/wk). Antitumor activity was observed across dose levels, with an encouraging R0 resection rate. These results warrant further investigation of combining S and V with G and IMRT as neoadjuvant treatment of PaCa following chemotherapy. Analyses of correlative studies and OS are underway. Clinical trial information: NCT02349867. [Table: see text]

Lymph node yield during surgery after neoadjuvant therapy compared to surgery without neoadjuvant therapy in patients with esophageal, gastric, pancreatic, or rectal carcinoma: systematic review and meta-analysis (Preprint)

2021 ◽  
Author(s):  
Ulrich Ronellenfitsch ◽  
Nika Maximov ◽  
Juliane Friedrichs ◽  
Jorg Kleeff
Keyword(s):  
Systematic Review ◽  
Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
Neoadjuvant Therapy ◽  
Meta Analysis ◽  
Neoadjuvant Treatment ◽  
Surrogate Marker ◽  
Lymph Node Yield ◽  
Gastrointestinal Carcinomas ◽  
Node Yield

BACKGROUND The lymph node yield is an important surrogate parameter for assessing the oncological radicality of the resection of gastrointestinal carcinomas and a prognostic factor in these diseases. It remains unclear if and to what extent neoadjuvant chemotherapy, radiotherapy or chemoradiotherapy, which have become established treatments for carcinoma of the esophagus, stomach, and rectum and are increasingly used in pancreatic carcinoma, affect the lymph node yield. OBJECTIVE This systematic review with meta-analysis is conducted with the aim of summarizing the available evidence regarding the oncological surrogate marker lymph node yield in patients with gastrointestinal carcinomas undergoing surgery after neoadjuvant treatment compared to those operated without neoadjuvant therapy. METHODS Studies comparing oncological resection of esophageal, stomach, pancreatic and rectal carcinoma with and without prior neoadjuvant therapy are eligible for inclusion regardless of study design. Publications will be identified with a defined search strategy in the electronic databases PubMed and Cochrane Library. The primary endpoint of the analysis is the number of lymph nodes identified in the resected specimen. Secondary endpoints include number of harvested metastatic lymph nodes, operation time, postoperative complications, pTNM staging, and overall and recurrence-free survival time. Using suitable statistical methods, the endpoints between patients with and without neoadjuvant therapy as well as in defined subgroups (neoadjuvant chemotherapy, neoadjuvant radiotherapy, neoadjuvant chemoradiotherapy, and esophageal, gastric, pancreatic, and rectal cancer) will be compared. RESULTS As of October 2021, we started with the data collection. CONCLUSIONS This systematic review with meta-analysis is conducted with the aim of summarizing the available evidence regarding the oncological surrogate marker lymph node yield in patients with gastrointestinal carcinomas undergoing surgery after neoadjuvant treatment compared to those operated without neoadjuvant therapy. CLINICALTRIAL This systematic review is registered at PROSPERO, ID: 218459.

Analysis of two consecutive series of unresectable high-grade glioma (HGG) patients (pts) treated with or without neoadjuvant chemotherapy before estandar radiochemotherapy (CRT) and adjuvant temozolamide (TMZ).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e12504-e12504
Author(s):  
Laia Capdevila ◽  
Sara Cros ◽  
Nuria Pardo ◽  
Jose Luis Cuadra ◽  
Olatz Etxaniz ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Neoadjuvant Therapy ◽  
Barthel Index ◽  
Standard Treatment ◽  
Negative Impact ◽  
Neoadjuvant Treatment ◽  
Group Versus ◽  
Consecutive Series ◽  
Multifocal Lesions ◽  
Small Series

e12504 Background: Standard treatment of HGG is based in CRT with TMZ. Neoadjuvant treatment before radiotherapy has been studied in small series. Methods: We retrospectively analyzed 2 consecutive series of non-resectable HGG pts treated with neoadjuvant chemotherapy (TMZ & cisplatin) before the 2005 with those treated with TMZ and concurrent and adjuvant TMZ & radiotherapy (after 2005). Results: 46pts diagnosed between August 2003 and October 2010 were selected. 23 received neoadjuvant therapy with TMZ (200mg/m2/d x 5d) and cisplatin (75mg/m2) followed by radiotherapy -60Gy 6w- (NA group), and the remaining 23pts received standard treatment with concomitant TMZ and radiotherapy -60Gy 6w- and adjuvant TMZ (CRT group). In the NA group, 87% of pts were ≥50 years, 43.5% were men, 65.2% had performance status (PS) <2, 38.4% Barthel index <70. Histology: 78.3% were glioblastoma (GB). 30.4% of pts had multifocal lesions and 43.5% had seizures at the diagnosis. 95.7% of pts required dexamethasone. In the CRT group, 91.3% of pts were ≥50 years, 78.3% were men, PS was <2 in 60.9% and Barthel index <70 in 21.7% of cases. Histology: 69.6% were GB, 26.1% pts had multifocal lesions and 26.1% had seizures at diagnosis. 87% of pts required dexamethasone. All factors were uniformly distributed in the two groups. 82.6% of pts completed scheduled radiotherapy in NA group in front 91.3% in the CRT group (P= 0.66). PFS was 2.9 months (m) (CI 95%: 0.5 – 5.5) in NA group versus 5.1m (CI 95%: 3.1 – 7.1) in the CRT group (p=0.62), OS was 8.5m (CI 95%: 4.0 – 12.9) vs 8.2m (CI 95%: 1.2 – 15.2) respectively (p=0.45). Conclusions: No differences were found in either PFS or OS between the two treatment groups. The administration of neoadjuvant therapy does no have a negative impact on the ability to receive radiotherapy. These results provide a basis to justify clinical trials in this setting with promising drugs before radiotherapy treatment.

Pathologic response and disease-free survival (DFS) after neoadjuvant trastuzumab (T) for HER2+ breast cancer (BC): Results from the National Cancer Institute (NCI) of Mexico.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11533-e11533
Author(s):  
Cynthia Mayte Villarreal-Garza ◽  
Enrique Soto-Perez-de-Celis ◽  
Erika Sifuentes ◽  
Yanin Chavarri Guerra ◽  
Santiago Ruano ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Neoadjuvant Chemotherapy ◽  
Ductal Carcinoma ◽  
Residual Disease ◽  
Pathologic Complete Response ◽  
Neoadjuvant Treatment ◽  
Disease Free Survival ◽  
Rank Test ◽  
Her2 Breast Cancer

e11533 Background: The most accurate definition of pathologic complete response (pCR) in HER2+ BC patients (pts) receiving T-based neoadjuvant chemotherapy associated with improved DFS is controversial, particularly regarding the role of residual ductal carcinoma in situ (ypTis) and focal invasive residuals (ypT1mic). The effect of pCR on DFS in various subgroups of HER2+ BC is also uncertain. Methods: Pts with localized HER2+ BC that received T-based neoadjuvant chemotherapy at NCI between January 2007 and May 2012 were identified. We conducted an exploratory analysis of DFS in pts according to their tumor response. DFS curves were derived from Kaplan-Meier estimates and compared by log-rank test. Multivariate analysis was performed using Cox’s regression model. Results: 243 pts were included for analysis. Median follow-up was 39 months (mo). 49% of pts had no invasive and no in situ residuals at surgery (ypT0), 14.4% had ypTis/ypT1mic residuals and 36.6% had gross residual BC. DFS was significantly superior in pts with both ypT0 and ypTis/ypT1mic (no gross invasive residual BC) compared with those with gross residual disease (60.6 and 62.7 mo respectively vs. 51.6 mo, p=0.011 and 0.017). There was no difference in DFS between ypT0 and ypTis/ypT1mic pts (p=0.402). The rate of no gross invasive residual BC was significantly superior in pts with ER-PR- tumors compared with patients with ER+/PR+ tumors (69.9% vs. 56.7%, p=0.034). No gross invasive residual BC was associated with improved DFS in pts with HER2+ ER-/PR- (60.3 vs. 49.0 mo; p=0.005), as opposed to HER2+ ER+/PR+ tumors (61.0 vs. 51.6 mo; p=0.100). Multivariate analysis showed that tumor size (p=0.013) and no gross invasive residual BC (p=0.13) were associated with improved DFS in all subgroups. Conclusions: The absence of gross invasive residual BC was associated with improved DFS in pts with HER2+ BC treated with T-based neoadjuvant chemotherapy, particularly in those with HER2+ ER-/PR- BC. Our data suggest a comparable DFS in HER2+ BC patients with no gross invasive residual BC regardless of the presence or absence of both ypTis and ypT1mic disease after neoadjuvant treatment.

Outcome of BC2001 patients (CRUK/01/004) who received neoadjuvant chemotherapy prior to randomization to chemo-radiotherapy (cRT) versus radiotherapy (RT).

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 298-298 ◽  
Author(s):  
Syed A. Hussain ◽  
Emma Hall ◽  
Nuria Porta ◽  
Malcolm Crundwell ◽  
Peter Jenkins ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Performance Status ◽  
Neoadjuvant Treatment ◽  
Late Toxicity ◽  
Invasive Bladder Cancer ◽  
P Value ◽  
Muscle Invasive Bladder Cancer ◽  
Cox Models ◽  
Muscle Invasive

298 Background: Neoadjuvant chemotherapy is considered standard of care for patients with muscle invasive bladder cancer (MIBC). Gemcitabine plus cisplatin or carboplatin (GC) has been adopted as a standard neoadjuvant regimen for MIBC. BC2001 showed that adding chemotherapy (5FU+MMC) to radiotherapy (55Gy/20f or 64Gy/32f) significantly improved rates of muscle invasive bladder cancer (MIBC) locoregional control (LRC) [James 2012]. We report outcome of patients (pts) receiving neoadjuvant chemotherapy prior to starting BC2001 trial treatment (cRT or RT alone). Methods: Between August 2001 and April 2008, 360 pts were randomised to RT (178) or cRT (182); 117 (32.5%) received neoadjuvant chemotherapy (61 RT, 56 cRT). Primary endpoint was LRC, secondary endpoints included toxicity, overall survival (OS) and metastasis free survival (MFS). Cox models adjusted by known prognostic factors were used to estimate randomised treatment effect in this subgroup of pts. Toxicities were compared by Chi squared tests. Results: Median age of the 117 pts was 66 (interquartile range: 60-73) years, 86% were male, 73% had baseline 0 WHO performance status. 81% had T2 and 87% G3 tumours. Neoadjuvant treatment received was GC (73.5%), MVAC (13.6%), CMV (11.1%) or other (<2%). 92.3% cRT and 91.8% RT pts completed radiotherapy as planned. Grade 3 or above adverse events during treatment occurred in 27.4% pts (32.2% cRT vs 22.9 RT, p-value(p)=0.27), and in 9.5% during follow-up (13.4% cRT vs 5.3% RT, p=0.21). There was a trend for improved LRC in the cRT group (hazard ratio HR=0.64, 95CI% 0.33-1.23, p=0.18), while no differences in OS (HR=0.95, 95CI% 0.57-1.57, p=0.83) or MFS (HR=0.93, 95CI% 0.52-1.65, p=0.80) were observed. Median OS was 46.7 months ,cRT: 50.4 months vs RT: 46.7 months. MFS: Median: 68.5 months, cRT: 118.5 months vs RT: 54.2 months. Conclusions: The benefit in improved LRC of synchronous chemotherapy with 5FU/MMC was also found in the subgroup of BC2001 pts receiving neoadjuvant chemotherapy, with no significant increase in late toxicity. Neoadjuvant chemotherapy did not compromise the delivery of radical curative treatment with RT or cRT. Clinical trial information: ISRCTN68324339.

Sign in / Sign up

Export Citation Format

Share Document