scholarly journals First- Third generation EGFR inhibitor combined with cytotoxic chemotherapy in elderly Patients with advanced lung adenocarcinom in routine clinical practice-results from A Subgroup Analysis

2021 ◽  
Author(s):  
Chen ◽  
An-Tai He . ◽  
Yi Pei .
Keyword(s):  
Clinical Practice ◽  
Lung Adenocarcinoma ◽  
Survival Time ◽  
First Generation ◽  
Response Rate ◽  
Cytotoxic Chemotherapy ◽  
Routine Clinical Practice ◽  
Third Generation ◽  
Egfr Inhibitor ◽  
Mean Survival Time

Abstract BackgroundThe third generation Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitor (TKI) osimertinib has been initially approved for T790M positive lung adenocarcinoma patients and more recently for first-line treatment of EGFR-mutant T790M negative lung adenocarcinoma, Similarly to previous generation TKIs, despite the high response rate, disease progression eventually occurs and current clinical research is focused on novel strategies to delay the emergence of osimertinib resistance.In this study,we investigated a the combination of osimertinib/ gefitinib/ erlotinib with cytotoxic chemotherapy for EGFR-mutated positive lung adenocarcinoma patients in long-term survival outcomes. Method We enrolled Ⅲb-IV stage lung adenocarcinoma patients with an EGFR mutation，Patients receiving standard Osimertinib,Gefitinib,Erlotinip alone treatment and Osimertinib,Gefitinib and Erlotinip with cytotoxic chemotherapy treatment were retrospectively reviewed.The performance status were collected,The response rate, progression-free survival (PFS) and overall survival (OS) and toxicity profile were analyzed.ResultBetween January 2014 to Dec 2020,240 patients with Ⅲb-Ⅳstages lung adenocarcinoma were enrolled from a institution.All patients who received different standard treatment respectively,were divided into four groups,64 who received（gefitinib or Erlotinb)with cytotoxic chemotherapy, 60 who received single gefitinib or erlotinib.58 who received (Osimertinib) with cytotoxic chemotherapy,58 who received single (Osimertinib) were eligible for this study.First generation Chemical-TKItherapy group PFS vs First generation TKI therapy alone PFS.P<0.05. Mean Survival Time 22.00 month,95%CI[16.29,27.70] VS 16.00 month.95%CI[11.98,20.01].First generation Chemical-TKItherapy group OS vs First generation TKI therapy alone OS. P<0.05. Mean Survival Time 32.00 month,95%CI[25.29,3871] VS 28.00 month, 95%CI[14.58,41.41].Third generation Chemical-TKItherapy group PFS vs Third generation TKI therapy PFS. P<0.001.Mean Survival Time 40.00,95%CI[28.12,51.87] VS 26.66 95%CI[24.77,29.22].Third generation Chemical-TKItherapy group OS vs Third generation TKI therapy OS.P<0.05. Mean Survival Time 48.00.95%CI[42.81,53.18] VS 36.00. 95%CI[34.71,38.28].First-Third generation Chemical-TKItherapy group PFS vs.First-Third generation TKI therapy alone PFS.P<0.001.Mean Survival Time 28.00,95%CI[24.86,31.11] VS 17.00 95%CI[13.83,20.16].First-Third generation Chemical-TKItherapy group OS vs First-Third generation TKI therapy alone OS.P<0.001. Mean Survival Time 41.00.95%CI[31.70,50.30] VS 29.00. 95%CI[17.68,38.31].Cox regression models showed a significant prognostic factors for OS were old age (55-69 years) (HR = 0.49 [0.28–0.89], p < 0.02) and gene mutation (Positive) (HR = 0.15 [0.07–0.29], p < 0.05),First add third generationTKI with chemicaltherapy (HR = 0.56 [0.35–0.89], p < 0.02). ConclusionFirst-Third generation EGFR inhibitor combined with cytotoxic chemotherapy represents a suitable palliative treatment option in further therapy lines for elderly patients with advanced lung adenocarcinoma.The results obtained under real-life conditions add to our understanding of the benefits and risks of First-Third generation EGFR inhibitor combined with cytotoxic chemotherapy in routine clinical practice.

scholarly journals Efficacy of First-Third generation EGFR inhibitor combined with chemotherapy as first-line treatment for advanced lung adenocarcinoma in a real-world setting

2021 ◽  
Author(s):  
Ming-Wei Chen Ming-Wei Chen ◽  
An-Tai He . ◽  
Yi Pei .
Keyword(s):  
Lung Adenocarcinoma ◽  
Survival Time ◽  
Progression Free Survival ◽  
Egfr Mutations ◽  
Combination Group ◽  
First Line ◽  
Free Survival ◽  
Mean Survival Time ◽  
First Line Therapy ◽  
To Receive

Abstract BackgroundTo explore the optimal treatment strategy for patients who harbor sensitive EGFR mutations, a head-to-head study was performed to compare chemotherapy and gefitinib-erlotinip, osimertinib treatment in combination or with either agent alone as first-line therapy, in terms of efficacy and safety.MethodsA total of 200 untreated patients with advanced lung adenocarcinoma who harbored sensitive EGFR mutations were randomly assigned to receive gefitinib-erlotinip combined with pemetrexed and carboplatin group, gefitinib-erlotinip osimertinib combined with pemetrexed and carboplatin group, pemetrexed plus carboplatin alone group, or gefitinib-erlotinip alone group, osimertinib alone group.ResultsThe progression-free survival (PFS) of patients in the gefitinib-erlotinip combination group Mean Survival Time PFS 22.00 month,95%CI[16.29,27.70] and osimertinib gefitinib-erlotinip combination group Mean Survival Time PFS 40.00 month,95%CI[28.12,51.87]was longer than that of patients in the chemotherapy alone group PFS10,81 months, 95% CI,[ 8.99–12.64],gefitinib-erlotinip alone group PFS14.00 month.95%CI[11.98-20.01], osimertinib alone group PFS 26.66 month 95%CI[24.77-29.22].The gefitinib-erlotinip osimertinib combinational resulted in longer overall survival (OS) than chemotherapy alone (HR = 0.46, p = 0.016) or gefitinib-erlotinip alone (HR = 0.36, p = 0.01). osimertinib alone (HR = 0.26, p = 0.01).ConclusionsOur finding suggested that treatment with pemetrexed plus carboplatin combined with gefitinib-erlotinip and pemetrexed plus carboplatin combined with gefitinib-erlotinip osimertinib group could provide better survival benefits for patients with lung adenocarcinoma harboring sensitive EGFR mutations.

Primary mediastinal large B-cell lymphoma: Treatment outcomes in 43 patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17556-17556
Author(s):  
C. L. Mello ◽  
O. Feher ◽  
V. C. Lima ◽  
C. Valadares ◽  
F. A. Soares ◽  
...  
Keyword(s):  
B Cell ◽  
First Generation ◽  
Response Rate ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Third Generation ◽  
First Line ◽  
Large B Cell Lymphoma ◽  
Large B Cell

17556 Objectives: Primary mediastinal B-cell Lymphoma (PMBL) is recognized as a separate entity in the WHO classification. Treatment for PMBL is based on a combination of conventional dose chemotherapy, high dose chemotherapy and radiation therapy. The best strategy is still undefined. We conducted a retrospective analysis of patients with PBML to identify clinical prognostic factors. Methods: A retrospective analysis of 43 patients treated at Hospital do Cancer AC Camargo, Sao Paulo, Brazil, between 1989 and 2004. All patients had previous diagnosis of diffuse large B-cell lymphoma, with positive CD20 on neoplastic cells. A predominant anterior mediastinal lesion should be present. Induction chemotherapy regimens were grouped in first generation (CHOP/CHOP-like), third generation (PromaceCytabon/MACOP) and other (pediatric regimens, COP). Results: Age ranged from 16 to 82 years-old, 30 females and 13 male. Age < 35 yo was associated with a better prognosis (5 years OS - 56% × 34%, p = 0.048). Among clinical variables, female gender, stage IA-IIB, IPI 0–1, normal LDH, absence of mediastinal bulky disease were associated with better prognosis, although not statistically significant. Response rate to first generation regimens was: 37% CR (11/29), 24% PR (7/29) and 24% PD (7/29). Four patients were treated with Third generation regimens with 2 CR and 2 PR. 20 out of 25 patients with PR or CR to first line chemotherapy received mediastinal radiation therapy. More than 65% of patients had a follow up of 5 years or more. With a median follow up of 22.3 months, projected 5 year OS was 47% and for the responders the median PFS was 8,4 months. No difference in OS and PFS was observed among the three chemotherapy groups. Conclusion: Our analysis showed that response rate to first line regimens was around 60% and 25% of patients were primarily refractory to CHOP regimen. Age younger than 35 years old was associated with a better prognosis. 5 years overall survival was 45% and is in accordance with the literature. Although recent studies have demonstrated biological similarities between PMBL and Hodgkin’s Lymphoma, the prognosis of PMBL is less favorable than HL. Better understanding of the disease will help in developing more appropriate therapeutic strategies for PMBL. No significant financial relationships to disclose.

The use of Sertraline in Psychiatric Practice

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
N. Zivlak - Radulovic ◽  
M. Miskovic ◽  
D. Zoric ◽  
T. Maglov ◽  
D. Ilic
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Adverse Effects ◽  
Prospective Study ◽  
Serotonin Reuptake ◽  
Routine Clinical Practice ◽  
Third Generation ◽  
The Third ◽  
A Prospective Study ◽  
First Time

Sertraline is an antidepressant of the third generation of the selective serotonin reuptake inhibitor (SSRI) class. It is simple to use and has a wide application in treating various psychiatric disorders, but with much less pronounced side effects.The aim of this study is to establish the frequency and adverse effects in users of sertraline during clinical treatment.The method of work was a prospective study which comprised 30 participants who came for a medical examination for the first time and who had a valid indication for drug suitability. The patients were observed during the following two control check-ups. The findings thus gathered were statistically analysed and shown on the graphs.Conclusion:The examination has shown that the possible side effects of sertraline are rare and mainly of temporary nature, and confirm the effectiveness and safety of sertraline in routine clinical practice.

scholarly journals Survival Benefit of Ixazomib, Lenalidomide and Dexamethasone (IRD) over Lenalidomide and Dexamethasone (Rd) in Relapsed and Refractory Multiple Myeloma Patients in Routine Clinical Practice

2021 ◽  
Author(s):  
Jiri Minarik ◽  
Tomas Pika ◽  
Jakub Radocha ◽  
Alexandra Jungova ◽  
Jan Straub ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clinical Practice ◽  
Confidence Interval ◽  
Proportional Hazards ◽  
Response Rate ◽  
Statistical Tests ◽  
Cox Proportional Hazards ◽  
Routine Clinical Practice ◽  
Refractory Multiple Myeloma ◽  
Survival Endpoints

Abstract Background: We have performed a head to head comparison of all-oral triplet combination of ixazomib, lenalidomide and dexamethasone (IRD) versus lenalidomide and dexamethasone (RD) in patients with relapsed and refractory multiple myeloma (RRMM) in the routine clinical practice. Methods: A total of 344 patients treated with IRD (N=127) or RD (N=217) were selected for analysis from the Czech Registry of Monoclonal Gammopathies (RMG). Descriptive statistics were used to assess patient’s characteristics associated with the respective therapy. The primary endpoint was progression free survival (PFS), secondary end points included response rates and overall survival (OS). Survival endpoints were plotted using Kaplan-Meier methodology at 95% Greenwood confidence interval. Univariable and multivariable Cox proportional hazards models were used to evaluate the effect of treatment regimens and the significance of uneven variables. Statistical tests were performed at significance level 0.05.Results: In the whole cohort, median PFS for IRD was 17.5 and for RD was 11.5 months favoring the all-oral triplet, p = 0.005; in patients within relapse 1-3, the median PFS was 23.1 vs 11.6 months, p = 0.001. The hazard ratio for PFS was 0.67 (95% confidence interval [CI] 0.51 – 0.89, p = 0.006). The PFS advantage translated into improved OS for patients treated with IRD, median 36.6 months vs 26.0 months (p = 0.008). The overall response rate (ORR) was 73.0 % in the IRD group vs 66.2 % in the RD group with a complete response rate (CR) of 11.1 % vs 8.8 %, and very good partial response (VGPR) 22.2 % vs 13.9 %, IRD vs RD respectively. The IRD regimen was most beneficial in patients ≤75 years with ISS I, II, and in the first and second relapse. Patients with the presence of extramedullary disease did not benefit from IRD treatment (median PFS 6.5 months). Both regimens were well tolerated, and the incidence of total as well as grade 3/4 toxicities was comparable. Conclusions: Our analysis confirms the results of the TOURMALINE-MM1 study and shows benefit of all-oral triplet IRD treatment versus RD doublet. It demonstrates that the addition of ixazomib to RD improves key survival endpoints in patients with RRMM in a routine clinical setting.

scholarly journals Feasibility of Tobacco Interventions in Anesthesiology Practices

2009 ◽  
Vol 110 (6) ◽  
pp. 1223-1228 ◽  
Author(s):  
David O. Warner ◽  
Keyword(s):  
Clinical Practice ◽  
Response Rate ◽  
Smoking Behavior ◽  
Pilot Project ◽  
Routine Clinical Practice ◽  
Surgical Patients ◽  
Routine Practice ◽  
Web Based ◽  
Quit Smoking ◽  
Written Materials

Background Abstinence from smoking can improve postoperative outcomes, and surgery is also an excellent opportunity for smokers to permanently quit. One strategy for perioperative tobacco interventions is that anesthesiologists Ask, Advise, and Refer (AAR) -- Ask their patients about tobacco use, Advise them to abstain, and Refer them to resources such as telephone quit-lines. This pilot project determined the feasibility and acceptability of the AAR strategy in anesthesiology practices. Methods An educational program, including presentations, written materials, and Web-based resources, was developed and disseminated to 14 U.S. anesthesiology practices, representing both academic and private practices, who agreed to implement the AAR strategy as a part of their routine clinical practice. Three months after implementation, a survey was administered to those members of these practices who were instructed in the AAR strategy. Results There were 97 respondents (75% response rate). Since the pilot project began, 91%, 79%, and 58% of respondents reported that they frequently or almost always asked, advised, and referred their patients who smoke, respectively. The majority of respondents (56%) agreed that they were responsible for helping patients get the help they need to quit smoking. Most (74%) also agreed that they planned to incorporate the AAR strategy into their routine practice. Conclusion These results suggest that the AAR strategy is potentially feasible and well-accepted in anesthesiology clinical practice. Further work will be needed to define whether these practices and attitudes can be sustained and whether they are ultimately effective in modifying perioperative smoking behavior in surgical patients.

scholarly journals Survival Benefit of Ixazomib, Lenalidomide and Dexamethasone (IRD) Over Lenalidomide and Dexamethasone (Rd) in Relapsed and Refractory Multiple Myeloma Patients in Routine Clinical Practice

2020 ◽  
Author(s):  
Jiri Minarik ◽  
Tomas Pika ◽  
Jakub Radocha ◽  
Alexandra Jungova ◽  
Jan Straub ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clinical Practice ◽  
Confidence Interval ◽  
Proportional Hazards ◽  
Response Rate ◽  
Statistical Tests ◽  
Cox Proportional Hazards ◽  
Routine Clinical Practice ◽  
Refractory Multiple Myeloma ◽  
Survival Endpoints

Abstract Background: We have performed a head to head comparison of all-oral triplet combination of ixazomib, lenalidomide and dexamethasone (IRD) versus lenalidomide and dexamethasone (RD) in patients with relapsed and refractory multiple myeloma (RRMM) in the routine clinical practice. Methods: A total of 344 patients treated with IRD (N=127) or RD (N=217) were selected for analysis from the Czech Registry of Monoclonal Gammopathies (RMG). Descriptive statistics were used to assess patient’s characteristics associated with the respective therapy. The primary endpoint was progression free survival (PFS), secondary end points included response rates and overall survival (OS). Survival endpoints were plotted using Kaplan-Meier methodology at 95% Greenwood confidence interval. Univariable Cox proportional hazards models were used to evaluate the effect of treatment regimen. Statistical tests were performed at significance level 0.05.Results: In the whole cohort, PFS for IRD was 17.5 and for RD was 11.5 months favoring the all-oral triplet, p = 0.005; in patients within relapse 1-3, the median PFS was 23.1 vs 11.6 months, p = 0.001. The hazard ratio for PFS was 0.67 (95% confidence interval [CI] 0.51 – 0.89, p = 0.006). The PFS advantage translated into improved OS for patients treated with IRD, median 36.6 months vs 26.0 months (p = 0.008). The overall response rate (ORR) was 73.0 % in the IRD group vs 66.2 % in the RD group with a complete response rate (CR) of 11.1 % vs 8.8 %, and very good partial response (VGPR) 22.2 % vs 13.9 %, IRD vs RD respectively. The IRD regimen was most beneficial in patients ≤75 years with ISS I, II, and in the first and second relapse. Patients with the presence of extramedullary disease did not benefit from IRD treatment (median PFS 6.5 months). Both regimens were well tolerated, and the incidence of total as well as grade 3/4 toxicities was comparable. Conclusions: Our analysis confirms the results of the TOURMALINE-MM1 study and shows benefit of all-oral triplet IRD treatment versus RD doublet. It demonstrates that the addition of ixazomib to RD improves key survival endpoints in patients with RRMM in a routine clinical setting.

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