Pilot evaluation of PD-1 inhibition in metastatic cancer patients with a history of liver transplantation: the Mayo Clinic experience

e20614 Background: Zoledronic acid (ZA) is one of the important biphosphanate which is widely used in bone metastatic cancer patients and osteoporotic patients. In a few studies it has been reported that treatment with biphosphonate was associated with an increased risk for atrial fibrillation. We aim to evaluate the arrhythmias that developed during infusion and immediately after infusion of the ZA. Methods: Bone metastatic 52 patients were included in study group. All of patients had totally 24 hour holter motorization during the first dose ZA infusion day. All of patients had 4 hours basal cardiac rhythm records before ZA infusion and about 19 hours after infusion. A short survey including demographic data and past medical history was completed. None of patients had clinically important arrhythmias before ZA infusion. We divided arrhythmias as supraventricular and ventricular. We evaluated arrhythmias pre, during and after ZA infusion. ZA were administered 4 mg IV in 15 minutes. Results: Thirty three of patients (63,5%) were male and 19 (36,5%) female. Median age of the patients was 52 (27-73). Most frequent cancers were breast (25%) and lung cancer (15,3%).Twelve (23%) patients had history of mediastinal radiotherapy. Three patients had history of myocardial infarction. In basal records we detected that twenty four of patients had supraventricular tachycardia (SVT) or ventricular premature systole (VPS). Fifteen of patients had SVT and fourteen had VPS during infusion period. After infusion period 48 of patients had SVT and 41 had VPS. Only 3 patients had none of arrhythmia after infusion. Three of the patients had sinusoidal arrhythmia and two had Mobitz type 2 bloc after infusion and also one of our patient who had no history of co morbidities and had SVT basal records, developed atrial fibrillation that refractory to medical cardioversion after 10 days of seventh dose ZA infusion. Conclusions: In this study we found that both SVT and VPS increased in cancer patients treated with ZA. Furthermore ZA may induce clinically important arrhythmias.

Download Full-text

Assessing clinical outcomes following liver transplantation in intrahepatic cholangiocarcinoma and mixed hepatocellular carcinoma-cholangiocarcinoma patients: The Mayo Clinic experience.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.e16114 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. e16114-e16114

Author(s):

Thomas DeLeon ◽

David D. Lee ◽

Marcela Salomao ◽

Marlene E. Girardo ◽

Charles Burke Rosen ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Clinical Outcomes ◽

Intrahepatic Cholangiocarcinoma ◽

Mayo Clinic ◽

Clinic Experience

Download Full-text

Effect of discharge to subacute rehabilitation (SAR) on hospitalized patients with progressive gastrointestinal (GI) cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.41 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 41-41

Author(s):

Andrew S. Epstein ◽

Anjali V. Desai ◽

Leonard Saltz

Keyword(s):

Cancer Patients ◽

Metastatic Cancer ◽

Cancer Center ◽

Low Grade ◽

First Line ◽

First Line Therapy ◽

Gi Cancer ◽

History Of ◽

Chemotherapy Patients

41 Background: SAR may be an alternative when hospice is declined. However, the outcomes of discharges to SAR in cancer patients with progressive (chemotherapy-refractory) disease are not known. We examined the characteristics and outcomes of patients with debility from progressive metastatic GI cancer who were discharged to SAR after an admission to our center. Methods: An institutional electronic database was queried to identify patients of the GI medical oncology service of Memorial Sloan Kettering Cancer Center who had been discharged to a SAR facility. Patient exclusion criteria were: incomplete follow-up, non-metastatic cancer, low grade neuroendocrine tumors, patients receiving first-line chemotherapy or with newly diagnosed cancer awaiting planned chemotherapy, patients off treatment with a remote history of metastatic cancer, and a primary admitting diagnosis representing an acute complication of cancer treatment. Results: From 2008-2014, 22 patients meeting criteria were identified. Median overall survival from the time of discharge to SAR was 0.8 months (range 0.2-5.2 months). Of the 22 patients, 7 (32%) died at the SAR. Twelve (55%) and 19 (86%) died within 1 and 3 months of discharge to SAR, respectively. For 7 patients (32%), documentation indicated that hospice, instead of SAR, had been recommended by clinicians but declined by family. Nine patients (41%) ultimately were transitioned to hospice within 3 months of discharge to SAR. Eight (36%) were readmitted to hospital within 1 month of discharge to SAR. Two (9%) were able to follow up with their medical oncologist for an outpatient appointment after discharge to SAR. None of the 22 patients received further chemotherapy after discharge to SAR. Conclusions: SAR is not a productive alternative to hospice in hospice-eligible patients with GI malignancies.In patients with metastatic GI cancers whose diseases had progressed beyond first-line therapy and who were hospitalized for reasons other than acute reversible toxicity, discharges to SAR were not associated with either prolonged survival or resumption of chemotherapy. These data can help inform decisions and establish goals of care in advanced GI cancer patients.

Download Full-text

Pilot evaluation of PD-1 inhibition in metastatic cancer patients with liver transplantations (LT): The Mayo Clinic experience.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.328 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 328-328 ◽

Cited By ~ 1

Author(s):

Thomas DeLeon ◽

Marcela Salomao ◽

Bashar A. Aqel ◽

Mohamad B. Sonbol ◽

Alan Haruo Bryce ◽

...

Keyword(s):

Cancer Patients ◽

Allograft Rejection ◽

Mtor Inhibitor ◽

Checkpoint Inhibitors ◽

Case Reports ◽

Metastatic Cancer ◽

Progression Free Survival ◽

Immunosuppressive Regimen ◽

Solid Organ ◽

History Of

328 Background: Patients with a history of solid organ transplants have been excluded from PD-1/PD-L1 inhibitor clinical trials due to concern for graft rejection. Only 2 case reports of PD-1 inhibitor use in patients with liver transplantation (LT) have been reported thus far. Here, we report our experience with using checkpoint inhibitors in metastatic cancer patients with LT. Methods: A single center pilot evaluation was conducted to evaluate the safety and efficacy of PD-1/PD-L1 inhibitors in patients with LT. PD-L1 staining on both the tumor and allograft were assessed if there was available tissue. The primary endpoint was evaluation of the risk for allograft rejection. Secondary endpoints included RECIST v1.1 and Immune-Related Response criteria (iRC) response rates, progression free survival (PFS) and overall survival (OS). Translational objectives included the relationship of PD-L1/PD-1 staining of tumor/allograft with response and rejection. Results: Six metastatic cancer patients with a history of LT received PD-1 inhibitor therapy (hepatocellular n=5, melanoma n=1). 3 patients were on mTOR inhibitor as immunosuppressive regimen and 3 on calcineurin inhibitor. Overall, allograft rejection was observed in 1/6 patients (on mTOR inhibitor). One patient achieved a CR (melanoma), 3 patients had PD and 2 patients discontinued therapy prior to restaging assessments. A single response (by both RECIST v1.1 and iRC) and rejection were reported in patients who received mTOR inhibitors (1 of 3). Three patients were tested for PD-L1 staining in the allograft tissue and all of them were negative (0% staining) with no graft rejections observed. Four patients had tumor PD-L1 evaluated (2 patients tested positive with 1 patient obtained a CR). The median OS, PFS and duration of therapy were 1.2, 1.8 and 1.2 months respectively. Conclusions: In this pilot evaluation of PD-1/PD-L1 inhibitors in LT patients both preliminary efficacy (1 of 4) and allograft rejection (1 of 6) was exhibited. Larger, prospective trials are needed to elucidate optimal patient and immunosuppressive regimen selection in these patients.

Download Full-text

How Valid are Patient Reports of Family History of Illness?

Methods of Information in Medicine ◽

10.1055/s-0038-1635275 ◽

1980 ◽

Vol 19 (03) ◽

pp. 162-164 ◽

Cited By ~ 1

Author(s):

Rachel Harris ◽

W. Margaret ◽

Kathleen Hunter

Keyword(s):

Family History ◽

Medical History ◽

Cancer Patients ◽

Cause Of Death ◽

Death Certificate ◽

Recall Rate ◽

Patient Reports ◽

Small Subgroup ◽

History Of ◽

Medical Histories

The recall rate of patients’ family medical histories was studied in 200 cancer and non-cancer patients. Data on age and cause of death for parents and grandparents were collected. Although most patients knew the age and cause of death of parents, less than half knew for grandparents. Cancer patients had significantly greater recall for maternally related relatives. A subsample of patients’ family medical histories was compared to death certificate data. Patients’ reports were found to be highly inaccurate. Since only a small subgroup could provide medical history data for grandparents, the generaliz-ability for history of family illness is questioned.

Download Full-text

ROLE OF LIPID PROFILE IN OVARIAN CARCINOMA PATIENTS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i8.501 ◽

2019 ◽

Vol 3 (8) ◽

Author(s):

Dr. Manisha ◽

Dr. Ruchi Jindal

Keyword(s):

Ovarian Cancer ◽

Lipid Profile ◽

Cancer Patients ◽

Ovarian Tumor ◽

Ovarian Cancer Risk ◽

Low Level ◽

Medical College ◽

Group I ◽

History Of

Background: The term "ovarian cancer" includes several different types of cancer that arise from cells of the ovary, most commonly, tumors arise from the epithelium or lining cells of the ovary. Ovarian cancer risk is positively associated with higher consumption of dietary cholesterol and eggs, and inversely associated with a higher intake of vegetables. High consumption of fats may increase circulating estrogen levels, thus increasing the possibility of cell damage and proliferation that is responsible for cancerous growth. Material & Methods: The present study was conducted at Geetanjali Medical College and Hospital, Udaipur (Rajasthan). Total 100 cases (females) attending the obstetrics and gynecology department for some gynecological and other problem were selected for this study between the age of 40-60 years, who were attending cancer centre at GEETANJALI MEDICAL COLLEGE AND HOSPITAL, Udaipur (Rajasthan). GROUP I: - It consisted of healthy females control subjects (n=50) .By routine examination and tests, we ensured that all the subjects were healthy and there were no signs and symptoms or history of ovarian tumor and diseases GROUP II: - It consisted of ovarian cancer females subjects (n=50) with a history of ovarian tumor. Results: Higher level of cholesterol, LDL, VLDL and low level of HDL are found in ovarian cancer patients. Conclusion: The present study we highlights the importance and role of serum lipid profile in diagnosis, prognosis and recurrence of the disease. The study shows that serum level of cholesterol, LDL, VLDL was elevated in patients of ovarian cancer while low level of HDL are found in ovarian cancer patients. Key words: lipid profile, ovarian cancer.

Download Full-text