scholarly journals Impact of ARDS Etiology on the Failure of Noninvasive Ventilation and 28-Day Mortality: A Multicenter Prospective Observational Study

2021 ◽  
Author(s):  
Weiwei Shu ◽  
Shuliang Guo ◽  
Fuxun Yang ◽  
Bicui Liu ◽  
Zhongxing Zhang ◽  
...  
Keyword(s):  
Observational Study ◽  
Noninvasive Ventilation ◽  
Prospective Observational Study ◽  
Distress Syndrome ◽  
Cox Regression ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Propensity Matching ◽  
Multicenter Prospective Observational Study

Abstract Background: The failure rate of noninvasive ventilation (NIV) remains high in patients with acute respiratory distress syndrome (ARDS). The etiology of ARDS may play an important role in NIV failure.Methods: A multicenter prospective observational study was performed in 17 ICUs in China from September 2017 to December 2019. ARDS patients who used NIV as a first-line therapy were enrolled. The etiology of ARDS was recorded at study entry. Results: A total of 306 patients were enrolled. Of the patients, 146 were classified as having pulmonary ARDS (ARDSp) and 160 were classified as having extrapulmonary ARDS (ARDSexp). NIV improved PaO2/FiO2 from initiation to 24 h of NIV in both groups. However, it improved more slowly in patients with ARDSp than in those with ARDSexp (interaction effect: p < 0.01). ARDSp patients experienced more NIV failure (55% vs. 28%; p < 0.01) and higher 28-day mortality (47% vs. 14%; p < 0.01). The multivariate Cox regression also showed that ARDSp was independently associated with NIV failure (hazard ratio [HR] = 2.81, 95% confidence interval [CI]: 1.89-4.18) and 28-day mortality (HR = 7.49, 95% CI: 4.32-13.01). After propensity matching, 62 patients remained in each group. The baseline data were comparable between the two groups. ARDSp was still independently associated with NIV failure and 28-day mortality (HR = 2.62, 95%CI: 1.49-4.61; and 5.70, 2.59-12.55, respectively). Sensitivity analysis also confirmed these results. Conclusions: Among ARDS patients who used NIV as a first-line therapy, ARDSp was associated with slower improvement in oxygenation, more NIV failure, and higher 28-day mortality than ARDSexp.

scholarly journals Nsclc Patients with Brain Metastases Treated with Platinum-Based Doublets As First-Line Therapy: Analyses from the European Frame Observational Study

2014 ◽  
Vol 25 ◽  
pp. iv439
Author(s):  
D. Moro-Sibilot ◽  
E.F. Smit ◽  
J.Castro De Carpeño ◽  
K. Lesniewski-Kmak ◽  
J.G. Aerts ◽  
...  
Keyword(s):  
Observational Study ◽  
Brain Metastases ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Nsclc Patients

scholarly journals Choosing the Right Treatment Option for the Right R/M HNSCC Patient: Should We Adhere to PFE for First-Line Therapy?

2021 ◽  
Vol 11 ◽  
Author(s):  
Katharina Lübbers ◽  
Mykola Pavlychenko ◽  
Theresa Wald ◽  
Susanne Wiegand ◽  
Andreas Dietz ◽  
...  
Keyword(s):  
Cox Regression ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Kaplan Meier ◽  
Real World Evidence ◽  
Consumption Benefit ◽  
Outcome Differences ◽  
The Right ◽  
High Level

BackgroundThe landmark EXTREME trial established cisplatin, 5-fluorouracil and cetuximab (PFE) as first-line chemotherapy (1L-ChT) for recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). We were interested in outcome differences of R/M HNSCC in 1L-ChT and factors influencing outcome in certain subgroups, especially patients receiving PFE, and the value of PFE compared to other 1L-ChT regimens to provide real world evidence (RWE).MethodsFor this retrospective monocentric study, 124 R/M HNSCC patients without curative surgical or radiotherapy options receiving at least one cycle of 1L-ChT were eligible. We analyzed their outcome using Kaplan-Meier plot and Cox regression to identify predictors for prolonged survival.ResultsSubgroups benefiting significantly from PFE were patients suffering from an index HNSCC outside the oropharynx. The PFE regimen proved to be superior to all other 1L-ChT regimens in clinical routine. Significant outcome differences between PFE treatment within or outside controlled trials were not seen.ConclusionThis retrospective analysis provides RWE for factors linked to improved outcome. Subgroup analyses highlight the lasting value of PFE among the growing spectrum of 1L-ChT. Importantly, fit smokers with high level alcohol consumption benefit from PFE; considering the patient’s lifestyle factors, PFE should not be ignored in decision-making.

Next Generation Sequencing (NGS) to reveal mutations in IDH1 and its effect on patient (pt) outcomes in advanced biliary tract cancer (aBTC) who received gemcitabine and cisplatin (GC).

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 287-287
Author(s):  
Daniel H. Ahn ◽  
Chul Ahn ◽  
Apurva Jain ◽  
Sameh Mikhail ◽  
Christina Sing-Ying Wu ◽  
...  
Keyword(s):  
Somatic Mutations ◽  
Cox Regression ◽  
Progression Free Survival ◽  
Idh1 Mutation ◽  
Cancer Center ◽  
First Line ◽  
Free Survival ◽  
First Line Therapy ◽  
Line Therapy ◽  
Dismal Prognosis

287 Background: aBTC is uncommon and has a dismal prognosis with limited therapeutic options. First-line therapy for untreated aBTC is GC, with no approved therapies in the refractory setting. To assess for tumor-specific genetic variants that affect outcomes in patients (pts) who received GC in aBTC, we performed NGS in pts treated with who received GC as first-line therapy. Methods: Archival formalin-fixed, paraffin-embedded samples from pts with mBTC from Ohio State University and MD Anderson Cancer Center who received GC in the first-line and underwent NGS as part of routine care. 315 cancer-related genes plus select introns from 28 genes altered in solid tumors were included in the NGS panel. Univariate Cox regression model was used to determine the association between gene mutations with progression free survival (PFS) and (OS). Results: 80 evaluable pts with aBTC treated with first-line GC chemotherapy underwent successful genomic profiling. A total of 414 cancer-specific mutations were identified, where 49 (12%) genes had mutations with > 5% frequency. 17 of the 49 were known mutations. From the comprehensive analysis, somatic mutations in IDH1 (11 of 80 pts; 13%) (HR 0.31; p = 0.035) was associated with improved overall survival (OS) and progression free survival (PFS). Pts wild type for IDH1 had a median OS of 17.7 months and PFS of 4.5 months, while those with an IDH1 mutation had a median OS that was not reached and an improved PFS of 5.7 months. Conclusions: Somatic mutations in IDH1 were associated with improved clinical outcomes in pts with aBTC who received GC as first-line therapy which is consistent with other solid tumor malignancies. IDH1 is a therapeutic target of interest, where future prospective studies will be necessary to validate the predictive utility and its relevance in pt outcomes in aBTC.

Genetic Aberrations and Response to Fludarabine as First Line Treatment in a Serie of B-CLL Patients.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2131-2131
Author(s):  
Pilar Giraldo ◽  
Araceli Rubio-Martinez ◽  
Valle Recasens ◽  
Mikel Valganon ◽  
Paz Latre ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cox Regression ◽  
Genetic Alterations ◽  
Fisher Exact Test ◽  
Line Treatment ◽  
First Line ◽  
Genetic Aberrations ◽  
First Line Therapy ◽  
Line Therapy ◽  
First Line Treatment

Abstract Background: Genetic factors have been established in the recent years as the most important independent predictors of disease progression and survival in patients with B-chronic lymphocytic leukaemia (B-CLL). Fludarabine is an approved first-line treatment for B-CLL, which achieves superior remission rates than traditional therapies. The drug is equally effective in early and advanced disease and in younger and elderly patients with B-CLL but different results have been found in patients with cytogenetic aberrations as methylation in the TP53 promoter Aims: To evaluate the response to Fludarabine as first-line therapy in B-CLL patients with advanced stages. Patients and methods: In the study 55 B-CLL patients were enrolled. The diagnosis was established based on standard morphologic and immunophenotypic criteria, and classified on high clinical risk category Rai stage III/IV treated with Fludarabine (25 mg/m2 daily for 5 days IV in a 28-day cycle) as first-line therapy from January 00 to December 03. Response was evaluated after 4 cycles of therapy and in those patients which had not achieved complete remission (CR) two additional cycles were administrated. Criteria for response were established using the revised 1996 NCIWG. FISH studies were performed using the probes LSI p53 (17p13), LSI D13S25 (13q14), CEP 12 and ATM gene (11q22). The sequences of the IGVH genes were determined in cDNA of the patients. Responses to therapy, time to progression disease and overall survival were available to analyse in 41 patients. Association was studied using contingence tables followed by Fisher exact test and to evaluate survival by acturial method of Kaplan Meier and Cox regression. Results: Mean age 64 (36.9–83.9), female 53.7%. 75% of patients presented genetic aberrations associated with worse prognosis: del (17p) and/or del (11q) (45%). No-mutated IGVH genes (57%). Response: 83.5% of patients achieved response (CR 47.8%). Related to genetic aberrations the responses were: 55.5% in patients with del(17p), 75.0% del(11q), 100% +12, 88.8% del(13q) and 100% of patients without genetic alterations showed response to Fludarabine. The 48.8 % of patients developed progression of disease with mean duration of the response of 15.1 months. Related to genetic aberrations the progression was over 81% of patients with genetic aberrations versus 55.5% without genetic alterations (p=0.044). The overall survival was 68.0 months. 34.1% of patients are alive in CR, 36.6% are alive with stable disease 7.3 % are alive with disease in progression and 22.0 % have died. Conclusions: A high response to Fludarabine in first line therapy was observed, however only 55.5% of patients with del(17p) showed response. Patients with genetic aberrations had higher significant rate of progression in comparison with those containing normal genotypes.

Axitinib versus sunitinib as first-line therapies for metastatic renal cell carcinoma: A multicenter retrospective analysis.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 555-555 ◽  
Author(s):  
Shingo Hatakeyama ◽  
Toshiaki Tanaka ◽  
Yoshinori Ikehata ◽  
Naoki Fujita ◽  
Naoya Masumori ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Regression Analysis ◽  
Renal Cell ◽  
Cox Regression ◽  
First Line ◽  
Cox Regression Analysis ◽  
Oncological Outcomes ◽  
First Line Therapy ◽  
Line Therapy ◽  
Treatment Naïve

555 Background: No previous study has compared the efficacy and safety of first-line axitinib and sunitinib. We aimed to compare oncological outcomes and safety of axitinib and sunitinib in patients with treatment-naïve metastatic renal cell carcinoma (mRCC). Methods: We retrospectively evaluated 169 patients with mRCC who were treated with axitinib or sunitinib as the first-line therapy in five hospitals between October 2008 and August 2018.Oncological outcomes and safety were compared between axitinib (n = 68) and sunitinib (n = 101) groups. Inverse probability of treatment weighted (IPTW)-adjusted Cox regression analysis was performed to evaluate effects of first-line therapies on progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Results: Patients in the axitinib group were significantly older (66 vs 72 years) than those in the sunitinib group. Median relative dose intensity was significantly higher in the axitinib group (94 ± 62%) than in the sunitinib group (65 ± 20%; P = 0.001). Objective response rate was significantly higher in the axitinib group (21%) than in the sunitinib group (10%; P = 0.042). IPTW-adjusted Cox regression analysis revealed significant differences in CSS and OS but not in PFS between the two groups. Safety in terms of grade ≥3 adverse events was significantly different between the axitinib (34%) and sunitinib (55%) groups ( P = 0.006). Conclusions: Compared with sunitinib, axitinib significantly prolonged CSS and OS and showed a safer profile as the first-line therapy for treatment-naïve mRCC.

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