First Line Treatment
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2021 ◽  
Vol 11 ◽  
Hélène Carinato ◽  
Mickaël Burgy ◽  
Régine Ferry ◽  
Cathie Fischbach ◽  
Michal Kalish ◽  

ObjectiveFor most patients suffering from recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC), chemotherapy is the main option after considering surgery and reirradiation. Cetuximab combined with a platinum-fluorouracil regimen (EXTREME) has been the standard of care for over a decade. Nevertheless, a significant number of patients remain unfit for this regimen because of age, severe comorbidities, or poor performance status. The aim of this study is to investigate an alternative regimen with sufficient efficacy and safety.MethodsWe reviewed retrospectively the medical charts of all patients treated with paclitaxel, carboplatin, and cetuximab (PCC) at our institution. Eligibility criteria were as follows: first-line R/M-HNSCC of the oral cavity, oropharynx, hypopharynx, or larynx not suitable for local therapy, cisplatin, and/or 5-FU ineligibility, ECOG-PS: 0–2. PCC consisted of paclitaxel 80 mg/m2, carboplatin AUC 2, and cetuximab at an initial dose of 400 mg/m2 then 250 mg/m2, for 16 weekly administrations followed by cetuximab maintenance for patients for whom a disease control was obtained. The primary endpoint was overall survival (OS), and secondary endpoints were overall response rate (ORR), progression free survival (PFS), and safety.ResultsWe identified 60 consecutive patients treated with PCC between 2010 and 2016 at our institution. Thirty-one patients (52%) were ECOG-PS 2. Fifty-five patients (92%) were cisplatin ineligible. ORR was 43.3% (95% CI, 30.8–55.8), and disease control rate was 65% (95% CI, 52.9–77.1). With a median follow-up of 35.7 months (IQR 28.6–48.8), median PFS was 5.8 months (95% CI, 4.5–7.2), and median OS was 11.7 months (95% CI, 7.5-14.8). For ECOG-PS 0–1 patients, median OS was 14.8 months (95% CI, 12.2–21.7) while it was only 7.5 months (95%CI: 5.5-12.7) for ECOG-PS 2 patients (p < 0.04). Grades III–IV toxicities occurred in 30 patients (50%). Most toxicities were hematologic. Six patients (10%) had febrile neutropenia. Nonhematologic toxicities were reported such as cutaneous toxicities, neuropathy, infusion-related reactions, or electrolyte disorders.ConclusionThe weekly PCC regimen seems to be an interesting option in cisplatin-unfit patients. This study shows favorable PFS and OS when compared with what is achieved with the EXTREME regimen and a high controlled disease rate with predictable and manageable toxicities even in the more fragile population.

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Zhenghui Ge ◽  
Mengyun Wang ◽  
Qun Liu

To analyze the evaluation of artificial intelligence algorithm combined with gastric computed tomography (CT) image in clinical chemotherapy for advanced gastric cancer, 112 patients with advanced gastric cancer were selected as the research object. Among which, 56 patients in the experimental group received paclitaxel (PTX) combined with decitabine sequential decitabine maintenance therapy. Fifty-six patients in the control group received first-line treatment with decitabine combined with cisplatin. The image segmentation algorithm based on fast interactive dictionary selection was used to process gastric CT images. Complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), response rate (RR), disease control rate (DCR), and overall survival (OS) after treatment were recorded. The true-positive rate (TPR) and coincidence ratio (CR) of the proposed algorithm for image segmentation were significantly higher than those of the mean shift algorithm and the iCoseg algorithm. The mean edge distance (MED) and edge distance variance (EDV) were significantly lower than the mean shift algorithm and the iCoseg algorithm, and the differences were considerable ( P < 0.05 ). The number of CR (5 cases), PR (13 cases), RR (18 cases), and DCR (44 cases) in the experimental group was significantly higher than that in the control group, while the number of PD (12 cases) was significantly lower than that in the control group ( P < 0.05 ). The number of patients complicated with hematological toxicity, leucopenia, thrombocytopenia, and digestive tract reaction in the experimental group was less than that in the control group ( P < 0.05 ). From the comparison of long-term efficacy, the survival rate of patients in both groups showed a decreasing trend within 24 months, but the decreasing trend of survival rate of patients in the experimental group was better than that in the control group. In short, the proposed algorithm had better segmentation performance than traditional algorithms. Compared with first-line treatment with decitabine and cisplatin, PTX in combination with decitabine sequential citabine maintenance regimens had better disease control rates, lower toxicity, and more effective improvements in patient quality of life and longer survival in patients with advanced gastric cancer.

2021 ◽  
Vol 14 (1) ◽  
Irma Olarte Carrillo ◽  
Anel Irais García Laguna ◽  
Adrián De la Cruz Rosas ◽  
Christian Omar Ramos Peñafiel ◽  
Juan Collazo Jaloma ◽  

Abstract Background Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy characterized by different genetic alterations that cause changes in the normal mechanisms of differentiation, which are associated with chemoresistance. The ABCB1 gene is part of a family of ATP-binding cassette (ABC) transporter genes involved in the progression of various types of cancer. The following work aimed to evaluate the expression levels of the ABCB1 gene and the C3435T SNP with the response to first-line treatment and survival in patients with AML. Methods In total 135 samples were taken to isolate total RNA and DNA at the beginning of the treatment. Expression analysis by RT-qPCR and SNP C3435T assessment method were performed for real-time Polymerase chain reaction (qPCR). Results The expression levels impact on the survival of patients with AML compared to low or absent levels; the CC genotype was found in 22.9%, the CT genotype was found in 47.4%, and the TT genotype was found in 29.6%, the presence of the C3435T SNP, the TT genotype also impacts with a lower survival compared to CT and CC genotypes. In addition, it was shown that the dominant model significantly impacts survival. Conclusion In conclusion, we have found that the overexpression of the ABCB1 gene, as well as the presence of the TT genotype of the C3435T SNP, contributes to a worse prognosis in AML.

2021 ◽  
pp. 030089162110492
Stefania Pipitone ◽  
Maria Giuseppa Vitale ◽  
Cinzia Baldessari ◽  
Massimo Dominici ◽  
Roberto Sabbatini

Introduction: Xp11.2 translocation is a rare subtype of renal cell carcinoma (RCC), identified as a single entity only from 2004 by World Health Organization (WHO). These tumors involve pediatric age group and rarely patients over 40 years old. Children show indolent disease; adult population has invasive tumor at diagnosis with rapid progression. Case report: We describe a case report of a young woman affected by metastatic clear cell renal carcinoma with Xp11.2 translocation. She achieved a longer stable disease (SD) to first line treatment with atezolizumab plus bevacizumab, obtaining a progression free survival (PFS) of 21 months. After she received cabozantinib, sunitinib and then sorafenib. Conclusions: The patient had an overall survival (OS) of 51 months, which is much higher than that reported in literature data. Unfortunately, the biology of Xp11.2 translocation RCC and its therapeutic management are still unclear.

2021 ◽  
Xinqing Lin ◽  
Haiyi Deng ◽  
Suyang Li ◽  
Xiaohong Xie ◽  
Chao Chen ◽  

Abstract Purpose:The ORIENT-12 study demonstrated the promising results of sintilimab combined with gemcitabine and platinum (GP) therapy in squamous non-small-cell lung cancer (sqNSCLC) patients. However, the efficacy of sintilimab plus paclitaxel/nab-paclitaxel and platinum (TP) in sqNSCLC is not yet known. Methods: Real-life data were collected from patients with untreated locally advanced or metastatic sqNSCLC who were treated with sintilimab plus TP (arm A) or sintilimab plus GP (arm B) between January 2019 and January 2021. Results:A total of 52 patients were included (arm A, n=32 and arm B, n=20). After a median follow-up of 12.1 months, the median PFS was 10.9 months (95% confidence interval [CI], 5.0 to 16.7) in arm A and 7.5 months (95% CI, 4.0–10.9) in arm B (hazard ratio [HR], 0.64; 95% CI, 0.30 to 1.4; P = 0.24). The median overall survival was 20.1 months (95% CI, 13.6 to 26.6) in arm A and 16.3 months (95% CI, 2.9 to 29.6) in arm B (HR, 0.69; 95% CI, 0.26–1.84; P = 0.46). The overall response rate was 59.4% in arm A and 40.0% in arm B. Adverse events of grade 3 or higher occurred in 37.5% of the patients in arm A and 55.0% of the patients in arm B. Conclusions: Sintilimab-TP exhibits similar clinical benefits compared with sintilimab-GP in patients with untreated advanced or metastatic sqNSCLC.

2021 ◽  
Marian Warsame ◽  
Ali Abdulrahman Osman ◽  
Abdikarim Hussein Hassan ◽  
Abdi Abdulle ◽  
Abdikarim Muse ◽  

Case management – rapid diagnosis and prompt administration of artemisinin-based combination therapy (ACT) – is a fundamental pillar of recommended malaria interventions in Somalia. Unfortunately, the emergence and spread of drug resistant falciparum parasites continues to pose a considerable threat to effective case management. With technical and financial support from WHO, the efficacy of recommended ACTs has been regularly monitored in sentinel sites since 2003. These studies provided evidence that supported the adoption of artesunate-sulfadoxine/pyrimethamine as first-line treatment in 2005 and artemether-lumefantrine as second-line treatment in 2011. Efficacy studies conducted between 2011 and 2015 showed high artesunate-sulfadoxine/pyrimethamine treatment failure rates of 12.3% - 22.2%, above the threshold (10%) for a change of treatment policy as recommended by WHO. This was also associated with high prevalence of quadruple and quintuple mutations in the dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) genes, which are associated with sulfadoxine/pyrimethamine resistance. Based on these findings, national malaria treatment guidelines were updated in 2016, with artesunate-sulfadoxine/pyrimethamine replaced by artemether-lumefantrine as first-line treatment and dihydroartemisinin-piperaquine recommended as second-line treatment. Subsequent efficacy studies in 2016 and 2017 confirmed that both the current first- and second-line treatments remain highly efficacious (cure rate above 97%). Technical and financial support from WHO has been instrumental in generating evidence that informs malaria treatment policy and should therefore continue to ensure that effective treatments are available to malaria patients in the country.

2021 ◽  
Vol 8 (11) ◽  
pp. 152
Martina Caruso ◽  
Carlo Ricciardi ◽  
Gregorio Delli Paoli ◽  
Fabiola Di Dato ◽  
Leandro Donisi ◽  

Kasai portoenterostomy (KP) represents the first-line treatment for biliary atresia (BA). The purpose was to compare the accuracy of quantitative parameters extracted from laboratory tests, US imaging, and MR imaging studies using machine learning (ML) algorithms to predict the long-term medical outcome in native liver survivor BA patients after KP. Twenty-four patients were evaluated according to clinical and laboratory data at initial evaluation (median follow-up = 9.7 years) after KP as having ideal (n = 15) or non-ideal (n = 9) medical outcomes. Patients were re-evaluated after an additional 4 years and classified in group 1 (n = 12) as stable and group 2 (n = 12) as non-stable in the disease course. Laboratory and quantitative imaging parameters were merged to test ML algorithms. Total and direct bilirubin (TB and DB), as laboratory parameters, and US stiffness, as an imaging parameter, were the only statistically significant parameters between the groups. The best algorithm in terms of accuracy, sensitivity, specificity, and AUCROC was naive Bayes algorithm, selecting only laboratory parameters (TB and DB). This preliminary ML analysis confirms the fundamental role of TB and DB values in predicting the long-term medical outcome for BA patients after KP, even though their values may be within the normal range. Physicians should be alert when TB and DB values change slightly.

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