scholarly journals Non-High-Risk Neuroblastoma: Classification and Achievements in Therapy

Children ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. 5 ◽  
Author(s):  
Holly J. Meany
Keyword(s):  
High Risk ◽  
Prognostic Significance ◽  
Disease Recurrence ◽  
Disease Stage ◽  
Current Therapy ◽  
Mycn Gene ◽  
Risk Of Disease ◽  
Short And Long Term ◽  
Risk Categories

Neuroblastoma, a tumor of the sympathetic nervous system, is the most common extra-cranial neoplasm of childhood. Variables with prognostic significance in patients with neuroblastoma, including age at diagnosis, disease stage, tumor histology, MYCN gene amplification, tumor cell ploidy, and the presence of segmental chromosomal aberrations are utilized to classify patients based on risk of disease recurrence. Patients with non-high-risk neuroblastoma, low- and intermediate-risk categories, represent nearly half of all newly diagnosed cases. This group has an excellent event-free and overall survival with current therapy. Over time, the objective in treatment of non-high-risk neuroblastoma has been reduction of therapy intensity to minimize short- and long-term adverse events all the while maintaining excellent outcomes.

scholarly journals Establishing a nurse-led thyroid cancer follow-up clinic

2021 ◽  
Vol 30 (4) ◽  
pp. S28-S35
Author(s):  
Andrew Fishburn ◽  
Nicola Fishburn
Keyword(s):  
Thyroid Cancer ◽  
Complex Disease ◽  
Disease Recurrence ◽  
Patient Survey ◽  
Safe Patient Care ◽  
Face To Face ◽  
Number Of Patients ◽  
Risk Of Disease

Thyroid cancer is a complex disease requiring management by a large multidisciplinary team. The number of patients with a diagnosis of thyroid cancer is significantly increasing year-on-year, and traditional models of consultant-led follow up are no longer sustainable. Although nurse-led cancer follow-up clinics are becomining increasingly common, thyroid cancer nurse-led follow-up clinics are rare. An excellent understanding of the disease, treatment and management of risk of disease recurrence is essential for safe patient care, and is discussed in this article. The clinic discussed uses the skill set of head and neck nurse specialists, including psychological support, coping strategies for long-term side effects of treatment and non-medical prescribing. A patient survey of the service revealed high levels of patient satisfaction and a desire to continue face-to-face consultations rather than telephone clinics.

scholarly journals Clinically defining and managing high-risk pediatric patients with acute lymphoblastic leukemia

Hematology ◽  
2014 ◽  
Vol 2014 (1) ◽  
pp. 181-189 ◽  
Author(s):  
Sarah Alexander
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
High Risk ◽  
Lymphoblastic Leukemia ◽  
Disease Recurrence ◽  
Cooperative Groups ◽  
Optimal Care ◽  
Disease Response ◽  
Improved Outcomes ◽  
Risk Of Disease ◽  
Outcomes For Children

Abstract For children with acute lymphoblastic leukemia, the identification of those at higher risk of disease recurrence and modifying therapy based on this risk is a critical component to the provision of optimal care. The specific definitions of high-risk ALL vary across cooperative groups, but the themes are consistent, being largely based on leukemia biology and disease response. Intensification of conventional chemotherapy for those with high-risk disease has led to improved outcomes. It is anticipated that the development of rational targeted therapy for specific biologically unique subsets of children with leukemia will contribute to ongoing progress in improving the outcomes for children with acute lymphoblastic anemia.

Risk of disease recurrence and mortality in gastrointestinal stromal tumor (GIST) patients receiving short-term versus long-term imatinib adjuvant therapy: A chart review analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e20511-e20511
Author(s):  
Anthony Paul Conley ◽  
Annie Guerin ◽  
Medha Sasane ◽  
Genevieve Gauthier ◽  
Frances Schwiep ◽  
...  
Keyword(s):  
Extended Period ◽  
Disease Recurrence ◽  
Mortality Rates ◽  
Short Term ◽  
Online Data ◽  
Risk Of Recurrence ◽  
Adjusted Risk ◽  
Risk Of Disease ◽  
Collection Form

e20511 Background: The benefits of long-term (36 months) use of adjuvant imatinib (IM) in high risk GIST patients (pts) have been demonstrated in a recent multicenter, prospective clinical trial that compared efficacy and safety of 3 years vs 1 year IM treatment. However, in clinical practice, there is no consensus on the optimal IM treatment duration after surgery. The objective of this retrospective observational study was to compare the risk of recurrence and survival among primary resectable Kit positive GIST pts treated with adjuvant IM for a short vs an extended period of time in a real-world setting. Methods: Information on adult pts with primary resectable Kit positive GIST initiating imatinib ≤84 days after surgery was collected from 248 U.S. oncologists using an online data collection form. Detailed pt information following first GIST diagnosis, including demographic, GIST-related characteristics (e.g., risk profile), comorbidity profile, IM treatment characteristics, disease recurrence and mortality was collected for pts with short-term (6-12 months) and long-term IM use (≥24 months). Disease recurrence and mortality rates were estimated from the 1st surgery date to the 1st evidence of recurrence, mortality, or end of observation period. Multivariate Cox proportional hazard models were used to compare recurrence and mortality rates between short vs long term IM use pts. Results: Among the 246 short-term and 395 long-term IM pts, the median follow up was 884 and 963 days, respectively. The average age was similar [59.0 (10.4) vs 58.1 (9.5); p=.23] but short-term pts had less males [57.7% vs 69.6% (p<.01)] and a lower Miettinen risk score [0.3 vs 0.4, p< .01)] than long-term pts. Disease recurrence [7.3 vs 1.8%, (p< .01)] and mortality rates [6.9% vs 2.3%, (p < .01)] were also higher in short- vs long-term pts. The adjusted risk of recurrence was 4.77 times [95% CI: 1.98 – 11.48, (p<.01)] higher and mortality risk was 3.44 times [CI: 1.53 – 7.75, (p<.01)] higher in short- vs long-term pts. Conclusions: Use of IM over an extended period of time is associated with a reduction in long-term risk of disease recurrence and mortality.

Long-term analysis of the WHO-defined molecular subgroups of high-risk grade II gliomas treated with radiation and temozolomide on NRG Oncology/RTOG 0424.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2518-2518
Author(s):  
Erica Hlavin Bell ◽  
Stephanie L. Pugh ◽  
Barbara Jean Fisher ◽  
Glenn Jay Lesser ◽  
David R. Macdonald ◽  
...  
Keyword(s):  
High Risk ◽  
Survival Data ◽  
Multivariate Analyses ◽  
Prognostic Significance ◽  
Low Grade ◽  
Term Survival ◽  
Grade Ii ◽  
Risk Grade ◽  
Post Hoc

2518 Background: This study sought to evaluate the prognostic significance of the three WHO-defined molecular glioma subgroups ( IDHwt, IDHmt/non-codel, and IDHmt/codel) in NRG Oncology/RTOG 0424, a phase II trial of high-risk low-grade gliomas treated with radiation (RT) and concurrent and adjuvant temozolomide (TMZ) after biopsy/surgical resection. Notably, this is the first clinical study to evaluate the prognostic value of the WHO subgroups in RT + TMZ-treated high-risk grade II (G2) gliomas using prospectively-collected long-term survival data. Methods: IDH1/2 mutation status was determined by next-generation sequencing. 1p/19q co-deletion status was determined by Oncoscan and/or 450K methylation data. Overall survival (OS) and progression-free survival (PFS) by marker status were determined by the Cox proportional hazard model and tested using the log-rank test in a post-hoc analysis. Patient pre-treatment characteristics were included as covariates in multivariate analyses. Results: Of all the eligible patients (N=129), 80 (62%) had sufficient quality DNA for both IDH and 1p/19q analyses. Of these 80, 54 (67.5%) were IDHmt, and 26 (32.5%) were IDHwt. Of the 54 IDHmt patients, 26 (32.5% of total, 48% of IDHmt) were IDHmt/codel, and 28 (35% of total, 52% of IDHmt) were IDHmt/non-codel. Both IDHmt subgroups were significantly correlated with longer PFS ( IDHmt/co-del = 8.1yrs (5.2-not reached (NR)); IDHmt/non-codel = 7.5yrs (3.9-11.8); IDHwt = 1.0yr (0.6-1.7), p<0.001) and OS ( IDHmt/co-del = 9.4yrs (8.2-NR); IDHmt/non-codel = 8.8yrs (5.9-NR); IDHwt = 2.3yrs (1.4-3.4), p<0.001) relative to the IDHwt subgroup. Upon univariate and multivariate analyses, both molecular IDHmt subgroup comparisons relative to IDHwt remained significant (p<0.001) even after incorporation of known clinical variables. Conclusions: These analyses suggest that G2 glioma patients harboring IDH1/2 mutations, regardless of co-deletion status, demonstrated longer survival with RT + TMZ relative to IDHwt tumors, although sample size is limited and analyses were post-hoc. These results also support the notion that outcomes for IDHwt high-risk G2 gliomas remain dismal (median = 2.3yrs, similar to G3 anaplastic astrocytoma); these patients should be separated from IDHmt patients in future G2 glioma trials, and warrant novel treatment strategies. Funding: U10CA180868, U10CA180822, U24CA196067, CURE, PA Dept. of Health, and Merck. Also, R01CA108633, R01CA169368, RC2CA148190, U10CA180850, BTFC, OSUCCC (all to AC). Clinical trial information: NCT00114140 .

A phase III, randomized, double-blind study of adjuvant cemiplimab versus placebo post-surgery and radiation therapy (RT) in patients (pts) with high-risk cutaneous squamous cell carcinoma (CSCC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. TPS10084-TPS10084
Author(s):  
Danny Rischin ◽  
Matthew G. Fury ◽  
Israel Lowy ◽  
Elizabeth Stankevich ◽  
Hyunsil Han ◽  
...  
Keyword(s):  
High Risk ◽  
Disease Recurrence ◽  
Phase Iii ◽  
Asia Pacific ◽  
Disease Stage ◽  
Double Blind Study ◽  
Extracapsular Extension ◽  
Double Blind ◽  
Post Surgery ◽  
To Receive

TPS10084 Background: CSCC is the second most common skin cancer. While the surgical cure rate for CSCC is > 95%, a proportion of pts are considered to have high risk for recurrence as assessed by immune status, primary disease stage, extent of nodal involvement, presence of extracapsular extension, and prior treatment. Post-operative RT is recommended for pts with high-risk features, but relapse with locoregional recurrence or distant metastases may still occur. This study evaluates the efficacy of cemiplimab, a human anti‒PD-1 monoclonal antibody, as an adjuvant therapy for pts with CSCC with high-risk features, after surgery and RT. Methods: This randomized, placebo-controlled, double-blind, multicenter, Phase 3 study will evaluate cemiplimab as an adjuvant treatment for pts with high-risk CSCC, based on surgical and clinicopathologic findings, who have completed surgery and post-operative RT (NCT03969004). Immunocompromised pts were excluded. The trial will enrol 412 pts from about 100 sites in North America, Europe, and Asia-Pacific regions. Pts with at least one of the following high-risk features are eligible: a) nodal disease with extracapsular extension b) in-transit metastases c) T4 lesion d) perineural invasion, and e) recurrent CSCC with at least one other risk factor. In Part 1 (blinded), pts will be randomized 1:1 to receive cemiplimab 350 mg or placebo intravenously every 3 weeks (Q3W) for up to 48 weeks. In optional Part 2 (unblinded), pts in the placebo arm who experience disease recurrence or pts in the cemiplimab arm who experience disease recurrence ≥3 months after completion of 48-week treatment in Part 1 will be eligible to receive open-label cemiplimab 350 mg Q3W for up to 96 weeks. Key objectives are to compare disease-free survival (primary) as well as overall survival, freedom from locoregional relapse, and distant relapse (secondary) of adjuvant cemiplimab vs placebo in pts with high-risk CSCC. This study is currently open for enrollment. Clinical trial information: NCT03969004.

Troponin T in patients with low grade or atypical angina. Identification of a high risk group for short- and long-term cardiovascular events

1998 ◽  
Vol 19 (12) ◽  
pp. 1802-1807 ◽  
Author(s):  
M. Möckel ◽  
T. Störk ◽  
G. Heller ◽  
L. Röcker ◽  
O. Danne ◽  
...  
Keyword(s):  
High Risk ◽  
Cardiovascular Events ◽  
Risk Group ◽  
Troponin T ◽  
High Risk Group ◽  
Low Grade ◽  
Short And Long Term

scholarly journals BEACOPP chemotherapy is a highly effective regimen in children and adolescents with high-risk Hodgkin lymphoma: a report from the Children's Oncology Group

Blood ◽  
2011 ◽  
Vol 117 (9) ◽  
pp. 2596-2603 ◽  
Author(s):  
Kara M. Kelly ◽  
Richard Sposto ◽  
Raymond Hutchinson ◽  
Vickie Massey ◽  
Kathleen McCarten ◽  
...  
Keyword(s):  
High Risk ◽  
Hodgkin Lymphoma ◽  
Treatment Strategies ◽  
Stage Iv ◽  
Disease Stage ◽  
Oncology Group ◽  
Event Free Survival ◽  
Free Survival ◽  
Field Radiation

AbstractDose-intensified treatment strategies for Hodgkin lymphoma (HL) have demonstrated improvements in cure but may increase risk for acute and long-term toxicities, particularly in children. The Children's Oncology Group assessed the feasibility of a dose-intensive regimen, BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) in children with high-risk HL (stage IIB or IIIB with bulk disease, stage IV). Rapidity of response was assessed after 4 cycles of BEACOPP. Rapid responders received consolidation therapy with guidelines to reduce the risk of sex-specific long-term toxicities of therapy. Females received 4 cycles of COPP/ABV (cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, vinblastine) without involved field radiation therapy (IFRT). Males received 2 cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) with IFRT. Slow responders received 4 cycles of BEACOPP and IFRT. Ninety-nine patients were enrolled. Myelosuppression was frequent. Rapid response was achieved by 74% of patients. Five-year event-free-survival is 94%, IFRT with median follow-up of 6.3 years. There were no disease progressions on study therapy. Secondary leukemias occurred in 2 patients. Overall survival is 97%. Early intensification followed by less intense response-based therapy for rapidly responding patients is an effective strategy for achieving high event-free survival in children with high-risk HL. This trial is registered at http://www.clinicaltrials.gov as #NCT00004010.

scholarly journals Imatinib as adjuvant therapy for high risk GIST: a case report

2015 ◽  
Vol 5 (4S) ◽  
pp. 7-12
Author(s):  
Patrizia Lista ◽  
Agostino Ponzetti
Keyword(s):  
High Risk ◽  
Adjuvant Therapy ◽  
Standard Dose ◽  
Abdominal Mass ◽  
Disease Recurrence ◽  
First Year ◽  
Radical Excision ◽  
Risk Of Disease ◽  
Exon 11 ◽  
Ct Finding

We here report a case of 42 years old man who experienced sudden abdominal cramps and then underwent explorative laparotomy because of the CT-finding of a 23 cm abdominal mass at the stomach. Frozen specimen analysis indicated a probable gastrointestinal stromal tumor (GIST). Radical excision was performed. Definitive pathological analysis revealed a CD34 and CD 117(c-KIT) positive GIST with a mitotic count of 15/50 HPF. These features indicate a disease with an high risk of recurrence within few years. Molecular analysis found a WK557-558 deletion of c-KIT exon 11, that indicates a poor prognosis in patients with completely resected GIST. In april 2010 he started adjuvant therapy with imatinib at standard dose of 400 mg/day that was well tolerated: he reported only G1 periocular edema and conjunctivitis. Considering the risk of disease recurrence he continued adjuvant therapy beyond the first year.

Sign in / Sign up

Export Citation Format

Share Document