Pub Date : 2024-11-18DOI: 10.1016/s1470-2045(24)00633-8
Eric A Mellon
No Abstract
无摘要
{"title":"The power of three: hypofractionation, protons, and molecular imaging in glioblastoma radiotherapy","authors":"Eric A Mellon","doi":"10.1016/s1470-2045(24)00633-8","DOIUrl":"https://doi.org/10.1016/s1470-2045(24)00633-8","url":null,"abstract":"No Abstract","PeriodicalId":22865,"journal":{"name":"The Lancet Oncology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-18DOI: 10.1016/s1470-2045(24)00585-0
Sujay Vora, Deanna Pafundi, Molly Voss, Matthew Buras, Jonathan Ashman, Bernard Bendok, William Breen, Leland Hu, Sani Kizilbash, Nadia Laack, Wei Liu, Anita Mahajan, Maciej Mrugala, Alyx Porter, Michael Ruff, Terence Sio, Joon Uhm, Ming Yang, Debra Brinkmann, Paul Brown
<h3>Background</h3>Older patients (aged ≥65 years) with glioblastoma have a worse prognosis than younger patients and a median overall survival of 6–9 months. 3,4-Dihydroxy-6-[<sup>18</sup>F]fluoro-L-phenylalanine (<sup>18</sup>F-DOPA) PET sensitively and specifically identifies metabolically active glioblastoma for preferential targeting. Proton beam therapy potentially improves quality of life (QOL) by sparing more healthy brain tissue than photon radiotherapy. With improved targeting and the dosimetric advantages of proton beam therapy, we aimed to test whether hypofractionated proton beam therapy could improve survival and QOL in older patients with glioblastoma.<h3>Methods</h3>In this single-arm phase 2 trial, we enrolled patients aged 65 years and older with an Eastern Cooperative Oncology Group performance status score of 0–2 and newly diagnosed WHO grade 4, malignant glioblastoma from two Mayo Clinic campuses (Phoenix, AZ, and Rochester, MN, USA). Radiotherapy target volumes were defined by <sup>18</sup>F-DOPA PET and MRI regions of contrast enhancement. Patients were given dose-escalated hypofractionated proton beam therapy (35–40 Gy equivalents in five or ten treatments) plus oral concurrent temozolomide (75 mg/m<sup>2</sup> daily on days 1–7 for the five-treatment regimen or on days 1–14 for the ten-treatment regimen), and 1 month after completing radiotherapy patients were given adjuvant temozolomide (150–200 mg/m<sup>2</sup> on days 1–5 for six 28-day cycles). The primary endpoint was overall survival at 12 months after enrolment. The primary endpoint and safety were assessed in the intention-to-treat population (defined as all eligible patients who started radiotherapy). This study is registered with <span><span>ClinicalTrials.gov</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, <span><span>NCT03778294</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, and is now complete.<h3>Findings</h3>Between May 22, 2019, and May 25, 2021, 43 patients were enrolled, of whom four did not receive treatment because of progression (n=2), death (n=1), or insurance denial (n=1), such that 39 patients received treatment (median age 70·2 years [IQR 67·4–74·3]; 11 [28%] of 39 patients were female, 28 [72%] were male, 37 [95%] were White, one [3%] was Black or African American, and one chose not to disclose their race). As of data cutoff (Jan 30, 2024), median follow-up was 25·4 months (IQR 22·1–29·7). 22 (56% [95% CI 39–72]) of 39 patients were alive at 12 months. Median overall survival was 13·1 months (95% CI 11·1–19·1). Grade 3 baseline-adjusted, treatment-associated adverse events were CNS necrosis (four [10%] of 39) and thromboc
{"title":"Short-course hypofractionated proton beam therapy, incorporating 18F-DOPA PET and contrast-enhanced MRI targeting, for patients aged 65 years and older with newly diagnosed glioblastoma: a single-arm phase 2 trial","authors":"Sujay Vora, Deanna Pafundi, Molly Voss, Matthew Buras, Jonathan Ashman, Bernard Bendok, William Breen, Leland Hu, Sani Kizilbash, Nadia Laack, Wei Liu, Anita Mahajan, Maciej Mrugala, Alyx Porter, Michael Ruff, Terence Sio, Joon Uhm, Ming Yang, Debra Brinkmann, Paul Brown","doi":"10.1016/s1470-2045(24)00585-0","DOIUrl":"https://doi.org/10.1016/s1470-2045(24)00585-0","url":null,"abstract":"<h3>Background</h3>Older patients (aged ≥65 years) with glioblastoma have a worse prognosis than younger patients and a median overall survival of 6–9 months. 3,4-Dihydroxy-6-[<sup>18</sup>F]fluoro-L-phenylalanine (<sup>18</sup>F-DOPA) PET sensitively and specifically identifies metabolically active glioblastoma for preferential targeting. Proton beam therapy potentially improves quality of life (QOL) by sparing more healthy brain tissue than photon radiotherapy. With improved targeting and the dosimetric advantages of proton beam therapy, we aimed to test whether hypofractionated proton beam therapy could improve survival and QOL in older patients with glioblastoma.<h3>Methods</h3>In this single-arm phase 2 trial, we enrolled patients aged 65 years and older with an Eastern Cooperative Oncology Group performance status score of 0–2 and newly diagnosed WHO grade 4, malignant glioblastoma from two Mayo Clinic campuses (Phoenix, AZ, and Rochester, MN, USA). Radiotherapy target volumes were defined by <sup>18</sup>F-DOPA PET and MRI regions of contrast enhancement. Patients were given dose-escalated hypofractionated proton beam therapy (35–40 Gy equivalents in five or ten treatments) plus oral concurrent temozolomide (75 mg/m<sup>2</sup> daily on days 1–7 for the five-treatment regimen or on days 1–14 for the ten-treatment regimen), and 1 month after completing radiotherapy patients were given adjuvant temozolomide (150–200 mg/m<sup>2</sup> on days 1–5 for six 28-day cycles). The primary endpoint was overall survival at 12 months after enrolment. The primary endpoint and safety were assessed in the intention-to-treat population (defined as all eligible patients who started radiotherapy). This study is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT03778294</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, and is now complete.<h3>Findings</h3>Between May 22, 2019, and May 25, 2021, 43 patients were enrolled, of whom four did not receive treatment because of progression (n=2), death (n=1), or insurance denial (n=1), such that 39 patients received treatment (median age 70·2 years [IQR 67·4–74·3]; 11 [28%] of 39 patients were female, 28 [72%] were male, 37 [95%] were White, one [3%] was Black or African American, and one chose not to disclose their race). As of data cutoff (Jan 30, 2024), median follow-up was 25·4 months (IQR 22·1–29·7). 22 (56% [95% CI 39–72]) of 39 patients were alive at 12 months. Median overall survival was 13·1 months (95% CI 11·1–19·1). Grade 3 baseline-adjusted, treatment-associated adverse events were CNS necrosis (four [10%] of 39) and thromboc","PeriodicalId":22865,"journal":{"name":"The Lancet Oncology","volume":"240 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-18DOI: 10.1016/s1470-2045(24)00654-5
Dario Trapani, Nirmala Bhoo-Pathy
No Abstract
无摘要
{"title":"The trade-off between accelerated cancer drug approvals and patient preferences","authors":"Dario Trapani, Nirmala Bhoo-Pathy","doi":"10.1016/s1470-2045(24)00654-5","DOIUrl":"https://doi.org/10.1016/s1470-2045(24)00654-5","url":null,"abstract":"No Abstract","PeriodicalId":22865,"journal":{"name":"The Lancet Oncology","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.1016/s1470-2045(24)00523-0
Taylor Hughes, Andrew Harper, Sumit Gupta, A Lindsay Frazier, Winette T A van der Graaf, Florencia Moreno, Adedayo Joseph, Miranda M Fidler-Benaoudia
Background
Compared with children and older adults, the burden of cancer in adolescents and young adults (ages 15–39) is understudied. We aimed to quantify the global burden of adolescent and young adult cancer in 2022 and 2050, and explore patterns in incidence, mortality, and case fatality.
Methods
In this population-based study, we used the GLOBOCAN database to quantify the number of new cases and cancer-related deaths, and corresponding age-standardised incidence and mortality rates (ASRs; per 100 000 people aged 15–39 years), in adolescents and young adults. Estimates were quantified for all cancers combined, excluding non-melanoma skin cancer, and 33 specific cancer types. Case fatality was estimated using mortality-to-incidence ratios. Overall and sex-specific estimates were calculated at the world, regional, human development index (HDI), and income level. We estimated the future cancer burden by applying the GLOBOCAN 2022 rates to sex-specific demographic projections for the year 2050 using the UN World Population Prospects 2019 revision.
Findings
An estimated 1 300 196 cases and 377 621 cancer-related deaths occurred in adolescents and young adults in 2022. Incidence ASRs were 1·9-times higher and mortality ASRs were 1·2-times higher in females than in males (incidence ASR 52·9 vs 28·3; mortality ASR 13·1 vs 10·6). Although the incidence ASR was highest in the high-income countries, the mortality ASR was highest in the low-income countries; as a result, case fatality ranged from 12% in high-income settings to 57% in low-income settings. Of the 33 cancer types included in our analyses, breast or cervical cancer was the most frequently diagnosed cancer and cause of cancer-related death in 163 and 93 countries, respectively; incidence and mortality also varied the most by region for these cancers. Finally, the adolescent and young adult cancer burden globally is projected to increase by about 12% from 2022 to 2050, albeit with declines of 10·7% projected in very high HDI countries. The increase is expected to overwhelmingly impact low HDI settings, where the burden of both cancer cases and deaths is projected to double (a 102·3% increase).
Interpretation
Although the adolescent and young adult cancer burden incidence is highest in the most developed settings, transitioning countries have the poorest outcomes and will face the greatest increases in burden by 2050. These findings act as a reference to the global adolescent and young adult cancer community to inform cancer control priorities and decrease global inequities.
{"title":"The current and future global burden of cancer among adolescents and young adults: a population-based study","authors":"Taylor Hughes, Andrew Harper, Sumit Gupta, A Lindsay Frazier, Winette T A van der Graaf, Florencia Moreno, Adedayo Joseph, Miranda M Fidler-Benaoudia","doi":"10.1016/s1470-2045(24)00523-0","DOIUrl":"https://doi.org/10.1016/s1470-2045(24)00523-0","url":null,"abstract":"<h3>Background</h3>Compared with children and older adults, the burden of cancer in adolescents and young adults (ages 15–39) is understudied. We aimed to quantify the global burden of adolescent and young adult cancer in 2022 and 2050, and explore patterns in incidence, mortality, and case fatality.<h3>Methods</h3>In this population-based study, we used the GLOBOCAN database to quantify the number of new cases and cancer-related deaths, and corresponding age-standardised incidence and mortality rates (ASRs; per 100 000 people aged 15–39 years), in adolescents and young adults. Estimates were quantified for all cancers combined, excluding non-melanoma skin cancer, and 33 specific cancer types. Case fatality was estimated using mortality-to-incidence ratios. Overall and sex-specific estimates were calculated at the world, regional, human development index (HDI), and income level. We estimated the future cancer burden by applying the GLOBOCAN 2022 rates to sex-specific demographic projections for the year 2050 using the UN World Population Prospects 2019 revision.<h3>Findings</h3>An estimated 1 300 196 cases and 377 621 cancer-related deaths occurred in adolescents and young adults in 2022. Incidence ASRs were 1·9-times higher and mortality ASRs were 1·2-times higher in females than in males (incidence ASR 52·9 <em>vs</em> 28·3; mortality ASR 13·1 <em>vs</em> 10·6). Although the incidence ASR was highest in the high-income countries, the mortality ASR was highest in the low-income countries; as a result, case fatality ranged from 12% in high-income settings to 57% in low-income settings. Of the 33 cancer types included in our analyses, breast or cervical cancer was the most frequently diagnosed cancer and cause of cancer-related death in 163 and 93 countries, respectively; incidence and mortality also varied the most by region for these cancers. Finally, the adolescent and young adult cancer burden globally is projected to increase by about 12% from 2022 to 2050, albeit with declines of 10·7% projected in very high HDI countries. The increase is expected to overwhelmingly impact low HDI settings, where the burden of both cancer cases and deaths is projected to double (a 102·3% increase).<h3>Interpretation</h3>Although the adolescent and young adult cancer burden incidence is highest in the most developed settings, transitioning countries have the poorest outcomes and will face the greatest increases in burden by 2050. These findings act as a reference to the global adolescent and young adult cancer community to inform cancer control priorities and decrease global inequities.<h3>Funding</h3>None.","PeriodicalId":22865,"journal":{"name":"The Lancet Oncology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142642565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.1016/s1470-2045(24)00580-1
Giovanni Randon, Sara Lonardi, Matteo Fassan, Federica Palermo, Stefano Tamberi, Elisa Giommoni, Carlotta Ceccon, Samantha Di Donato, Lorenzo Fornaro, Oronzo Brunetti, Ferdinando De Vita, Alessandro Bittoni, Claudio Chini, Andrea Spallanzani, Floriana Nappo, Valerie Bethaz, Antonia Strippoli, Tiziana Latiano, Giovanni Gerardo Cardellino, Francesco Giuliani, Filippo Pietrantonio
<h3>Background</h3>Paclitaxel plus ramucirumab is recommended as a second-line treatment regimen in patients with advanced HER2-negative gastric or gastro-oesophageal junction cancer. We aimed to assess whether switch maintenance or early second-line therapy with paclitaxel plus ramucirumab improved outcomes compared with continuation of oxaliplatin and fluoropyrimidine doublet chemotherapy as a first-line strategy.<h3>Methods</h3>ARMANI was a multicentre, open-label, randomised, phase 3 trial done in 31 hospitals in Italy. We enrolled patients aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0 or 1 and locally advanced unresectable or metastatic HER2-negative gastric or gastro-oesophageal junction cancer, who had disease control after 3 months of FOLFOX (leucovorin, fluorouracil, and oxaliplatin) or CAPOX (capecitabine and oxaliplatin). Patients were randomly assigned (1:1) to either paclitaxel 80 mg/m<sup>2</sup> on days 1, 8, and 15 plus ramucirumab at 8 mg/kg on days 1 and 15 every 28 days intravenously (switch maintenance group) or continuation of oxaliplatin-based doublet chemotherapy (FOLFOX or CAPOX) for an additional 12 weeks, followed by fluoropyrimidine monotherapy maintenance (control group). Randomisation was stratified by previous gastrectomy (no <em>vs</em> yes), peritoneal carcinomatosis (yes <em>vs</em> no), and primary tumour location (gastro-oesophageal junction <em>vs</em> gastric). Treatment group allocation was done using a web-based system with a minimisation algorithm implementing a random component. The primary endpoint was progression-free survival, analysed on an intention-to-treat basis. The safety population included patients who received at least one dose of the study treatment. This study is registered with <span><span>ClinicalTrials.gov</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, <span><span>NCT02934464</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, and is complete.<h3>Findings</h3>Between Jan 1, 2017, and Oct 2, 2023, 280 patients were randomly assigned to receive paclitaxel plus ramucirumab (switch maintenance group; n=144) or to continue FOLFOX or CAPOX (control group; n=136). All patients were White. 180 (64%) of 280 patients were male and 100 (36%) were female. At a median follow-up of 43·7 months (IQR 24·0–57·9), 253 (90%) of 280 patients had a progression-free survival event: 131 (91%) of 144 patients in the switch maintenance group and 122 (90%) of 136 patients in the control group. Median progression-free survival was 6·6 months (95% CI 5·9–7·8) in the switch maintenance group and 3·5 months (2·8–4·2) in the control group (HR 0·61, 95% CI
背景紫杉醇加雷莫芦单抗被推荐为晚期HER2阴性胃癌或胃食管交界处癌患者的二线治疗方案。我们的目的是评估与继续使用奥沙利铂和氟嘧啶双联化疗作为一线治疗策略相比，紫杉醇加雷莫芦单抗的二线治疗转换维持或早期治疗是否能改善疗效。我们招募了年龄在18岁或18岁以上、东部合作肿瘤学组表现状态为0或1、局部晚期不可切除或转移性HER2阴性胃癌或胃食管交界处癌患者，这些患者在接受FOLFOX（亮菌素、氟尿嘧啶和奥沙利铂）或CAPOX（卡培他滨和奥沙利铂）治疗3个月后疾病得到控制。患者被随机分配（1:1）至紫杉醇 80 毫克/平方米（第 1、8 和 15 天），外加拉穆单抗 8 毫克/公斤（第 1 和 15 天，每 28 天静脉注射一次）（切换维持组），或继续接受以奥沙利铂为基础的双联化疗（FOLFOX 或 CAPOX）12 周，然后接受氟嘧啶单药维持治疗（对照组）。随机分组按既往胃切除术（否 vs 是）、腹膜癌（是 vs 否）和原发肿瘤位置（胃食管交界处 vs 胃）进行。治疗组的分配是通过一个基于网络的系统完成的，该系统采用了随机成分的最小化算法。主要终点是无进展生存期，以意向治疗为基础进行分析。安全人群包括至少接受过一次研究治疗的患者。该研究已在ClinicalTrials.gov注册，编号为NCT02934464，目前已完成。研究结果在2017年1月1日至2023年10月2日期间，280名患者被随机分配接受紫杉醇加ramucirumab治疗（转换维持组；n=144）或继续接受FOLFOX或CAPOX治疗（对照组；n=136）。所有患者均为白人。280名患者中有180名（64%）男性，100名（36%）女性。中位随访时间为43-7个月（IQR 24-0-57-9），280名患者中有253名（90%）出现无进展生存事件：在转换维持组的 144 名患者中，131 人（91%）获得了无进展生存，在对照组的 136 名患者中，122 人（90%）获得了无进展生存。转换维持组的无进展生存期中位数为 6-6 个月（95% CI 5-9-7-8），对照组为 3-5 个月（2-8-4-2）（HR 0-61，95% CI 0-48-0-79；P=0-0002）。违反了比例危险假设；在对24个月限制性平均生存时间的分析中，转换维持组的限制性平均无进展生存期为8-8个月（95% CI 7-7-9-9），对照组为6-1个月（5-0-7-2）（P=0-0010）。最常见的 3-4 级治疗相关不良事件是中性粒细胞减少症（转换维持组 37 [26%] 例 vs 对照组 13 [10%] 例）、周围神经病变（8 [6%] 例 vs 9 [7%] 例）和动脉高血压（9 [6%] 例 vs 无）。实验组 141 名患者中有 28 人（20%）发生了严重不良事件，对照组 135 名患者中有 15 人（11%）发生了严重不良事件；这些事件与治疗有关，其中转换维持组有 2 人（1%）（肺栓塞），对照组有 2 人（1%）（粘膜炎和贫血）。没有发生与治疗相关的死亡。解释紫杉醇和雷莫芦单抗换药维持治疗可能是一种潜在的治疗策略，适用于不符合免疫疗法或靶向药物治疗条件的晚期HER2阴性胃癌或胃食管交界癌患者。
{"title":"Ramucirumab plus paclitaxel as switch maintenance versus continuation of first-line oxaliplatin-based chemotherapy in patients with advanced HER2-negative gastric or gastro-oesophageal junction cancer (ARMANI): a randomised, open-label, multicentre, phase 3 trial","authors":"Giovanni Randon, Sara Lonardi, Matteo Fassan, Federica Palermo, Stefano Tamberi, Elisa Giommoni, Carlotta Ceccon, Samantha Di Donato, Lorenzo Fornaro, Oronzo Brunetti, Ferdinando De Vita, Alessandro Bittoni, Claudio Chini, Andrea Spallanzani, Floriana Nappo, Valerie Bethaz, Antonia Strippoli, Tiziana Latiano, Giovanni Gerardo Cardellino, Francesco Giuliani, Filippo Pietrantonio","doi":"10.1016/s1470-2045(24)00580-1","DOIUrl":"https://doi.org/10.1016/s1470-2045(24)00580-1","url":null,"abstract":"<h3>Background</h3>Paclitaxel plus ramucirumab is recommended as a second-line treatment regimen in patients with advanced HER2-negative gastric or gastro-oesophageal junction cancer. We aimed to assess whether switch maintenance or early second-line therapy with paclitaxel plus ramucirumab improved outcomes compared with continuation of oxaliplatin and fluoropyrimidine doublet chemotherapy as a first-line strategy.<h3>Methods</h3>ARMANI was a multicentre, open-label, randomised, phase 3 trial done in 31 hospitals in Italy. We enrolled patients aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0 or 1 and locally advanced unresectable or metastatic HER2-negative gastric or gastro-oesophageal junction cancer, who had disease control after 3 months of FOLFOX (leucovorin, fluorouracil, and oxaliplatin) or CAPOX (capecitabine and oxaliplatin). Patients were randomly assigned (1:1) to either paclitaxel 80 mg/m<sup>2</sup> on days 1, 8, and 15 plus ramucirumab at 8 mg/kg on days 1 and 15 every 28 days intravenously (switch maintenance group) or continuation of oxaliplatin-based doublet chemotherapy (FOLFOX or CAPOX) for an additional 12 weeks, followed by fluoropyrimidine monotherapy maintenance (control group). Randomisation was stratified by previous gastrectomy (no <em>vs</em> yes), peritoneal carcinomatosis (yes <em>vs</em> no), and primary tumour location (gastro-oesophageal junction <em>vs</em> gastric). Treatment group allocation was done using a web-based system with a minimisation algorithm implementing a random component. The primary endpoint was progression-free survival, analysed on an intention-to-treat basis. The safety population included patients who received at least one dose of the study treatment. This study is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT02934464</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, and is complete.<h3>Findings</h3>Between Jan 1, 2017, and Oct 2, 2023, 280 patients were randomly assigned to receive paclitaxel plus ramucirumab (switch maintenance group; n=144) or to continue FOLFOX or CAPOX (control group; n=136). All patients were White. 180 (64%) of 280 patients were male and 100 (36%) were female. At a median follow-up of 43·7 months (IQR 24·0–57·9), 253 (90%) of 280 patients had a progression-free survival event: 131 (91%) of 144 patients in the switch maintenance group and 122 (90%) of 136 patients in the control group. Median progression-free survival was 6·6 months (95% CI 5·9–7·8) in the switch maintenance group and 3·5 months (2·8–4·2) in the control group (HR 0·61, 95% CI ","PeriodicalId":22865,"journal":{"name":"The Lancet Oncology","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142642569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-14DOI: 10.1016/s1470-2045(24)00528-x
Sean Miller, Ralph Jiang, Matthew Schipper, Lars G Fritsche, Garth Strohbehn, Beth Wallace, Daria Brinzevich, Virginia Falvello, Benjamin H McMahon, Rafael Zamora-Resendiz, Nithya Ramnath, Xin Dai, Kamya Sankar, Donna M Edwards, Steven G Allen, Shinjae Yoo, Silvia Crivelli, Michael D Green, Alex K Bryant
<h3>Background</h3>Black patients were severely under-represented in the clinical trials that led to the approval of immune checkpoint inhibitors (ICIs) for all cancers. The aim of this study was to characterise the effectiveness and safety of ICIs in Black patients.<h3>Methods</h3>We did a retrospective cohort study of patients in the US Veterans Health Administration (VHA) system's Corporate Data Warehouse containing electronic medical records for all patients who self-identified as non-Hispanic Black or African American (referred to as Black) or non-Hispanic White (referred to as White) and received PD-1, PD-L1, CTLA-4, or LAG-3 inhibitors between Jan 1, 2010, and Dec 31, 2023. Effectiveness outcomes were overall survival, time to treatment discontinuation, and time to next treatment. The safety outcome was the frequency of immune-related adverse events; assessed among a random sample of 1000 Black patients and 1000 White patients, 892 pairs were matched on the basis of baseline characteristics using 1:1 exact matching without replacement. After manual chart review, patients who did not receive ICI therapy or who had inadequate follow-up were excluded. The adjusted effect of race on each effectiveness outcome was assessed in the whole ICI-treated cohort with propensity-weighted Cox regression with robust standard errors. Immune-related adverse events outcomes were analysed in the random matched sample with multivariable Cox regression, adjusting for baseline characteristics.<h3>Findings</h3>We identified 26 398 patients, of whom 4943 (18·7%) patients were Black, 21 455 (81·3%) were White, 895 (3·4%) were female, 25 503 (96·6%) were male, 11 859 (45%) had non-small-cell lung cancer, and 26 045 (98·7%) received PD-1 or PD-L1 inhibitors. As of data cutoff (Aug 28, 2024), median follow-up was 40·3 months (95% CI 38·3–42·3) for Black patients and 43·9 months (43·0–45·1) for White patients. Compared with White patients, Black patients had longer time to treatment discontinuation (2-year unadjusted rates 10·7% [95% CI 9·8–11·7] for Black patients <em>vs</em> 8·6% [8·2–9·0] for White patients; adjusted hazard ratio [HR] 0·91, 95% CI 0·87–0·95, p<0·0001), similar time to next treatment (23·5% [22·3–24·8] for Black patients <em>vs</em> 25·6% [25·0–26·2] for White patients; 1·00, 0·95–1·05, p=0·96), and slightly improved overall survival (36·5% [35·2–38·1] for Black patients <em>vs</em> 36·5% [35·8–37·1]; 0·95, 0·90–0·99, p=0·036). 1710 patients (n=862 Black and n=848 White) were analysed for safety outcomes. Compared with White patients, Black patients had a reduced risk of all-grade immune-related adverse events (unadjusted 2-year rate 33·1% [95% CI 28·9–37·1] <em>vs</em> 44·1% [95% CI 39·1–48·7]; adjusted HR 0·75, 95% CI 0·62–0·90, p=0·0026), immune-related adverse events requiring treatment with systemic steroids (0·61, 0·46–0·81, p=0·00051), and immune-related adverse events resulting in permanent ICI discontinuation (0·58, 0·44–0·78, p=0·00024).
背景黑人患者在导致免疫检查点抑制剂（ICIs）获准用于所有癌症的临床试验中代表性严重不足。我们对美国退伍军人健康管理局（VHA）系统企业数据仓库中的患者进行了一项回顾性队列研究，该数据库包含所有自称为非西班牙裔黑人或非裔美国人（简称黑人）或非西班牙裔白人（简称白人），并在2010年1月1日至2023年12月31日期间接受过PD-1、PD-L1、CTLA-4或LAG-3抑制剂治疗的患者的电子病历。疗效指标为总生存期、终止治疗时间和下次治疗时间。安全性结果是免疫相关不良事件的发生频率；在随机抽取的 1000 名黑人患者和 1000 名白人患者中进行评估，根据基线特征采用 1:1 精确配对法对 892 对患者进行配对，不进行替换。经过人工病历审查，未接受 ICI 治疗或随访不足的患者被排除在外。采用带有稳健标准误差的倾向加权 Cox 回归法评估了整个 ICI 治疗队列中种族对每种疗效结果的调整效应。我们发现了26 398名患者，其中4943人（18-7%）为黑人，21 455人（81-3%）为白人，895人（3-4%）为女性，25 503人（96-6%）为男性，11 859人（45%）患有非小细胞肺癌，26 045人（98-7%）接受了PD-1或PD-L1抑制剂治疗。截至数据截止日（2024年8月28日），黑人患者的中位随访时间为40-3个月（95% CI 38-3-42-3），白人患者的中位随访时间为43-9个月（43-0-45-1）。与白人患者相比，黑人患者中断治疗的时间更长（2 年未调整率黑人患者为 10-7% [95% CI 9-8-11-7] ，白人患者为 8-6% [8-2-9-0]；调整后危险比 [HR] 0-91，95% CI 0-87-0-95，p<；0-0001），下次治疗时间相似（黑人患者为23-5% [22-3-24-8] vs 白人患者为25-6% [25-0-26-2]; 1-00, 0-95-1-05, p=0-96），总生存期略有改善（黑人患者为36-5% [35-2-38-1] vs 36-5% [35-8-37-1]; 0-95, 0-90-0-99, p=0-036）。对1710名患者（黑人患者862人，白人患者848人）进行了安全性结果分析。与白人患者相比，黑人患者发生所有等级免疫相关不良事件的风险较低（未经调整的 2 年不良事件发生率为 33-1% [95% CI 28-9-37-1] vs 44-1% [95% CI 39-1-48-7]；调整后 HR 0-75，95% CI 0-62-0-90，p=0-0026）、需要使用全身类固醇治疗的免疫相关不良事件（0-61，0-46-0-81，p=0-00051）和导致永久停用 ICI 的免疫相关不良事件（0-58，0-44-0-78，p=0-00024）。在对免疫相关不良事件亚型的探索性分析中发现，黑人患者发生结肠炎（0-46，0-27-0-76，p=0-0026）和甲状腺功能亢进或甲状腺功能减退（0-63，0-44-0-90，p=0-011）的风险显著降低，而在分析的其他免疫相关不良事件亚型中未发现显著差异。在使用基于类固醇的免疫相关不良事件定义对整个ICI治疗队列进行分析时，也发现了类似的结果。与白人患者相比，黑人患者的ICI疗效相似，而在全国VHA系统中接受治疗的患者的毒性较低，这可能反映出ICI的治疗比（获益与伤害之比）存在重要差异。我们关于黑人患者毒性降低的研究结果需要进一步调查，以评估其普遍性。
{"title":"Effectiveness and safety of immune checkpoint inhibitors in Black patients versus White patients in a US national health system: a retrospective cohort study","authors":"Sean Miller, Ralph Jiang, Matthew Schipper, Lars G Fritsche, Garth Strohbehn, Beth Wallace, Daria Brinzevich, Virginia Falvello, Benjamin H McMahon, Rafael Zamora-Resendiz, Nithya Ramnath, Xin Dai, Kamya Sankar, Donna M Edwards, Steven G Allen, Shinjae Yoo, Silvia Crivelli, Michael D Green, Alex K Bryant","doi":"10.1016/s1470-2045(24)00528-x","DOIUrl":"https://doi.org/10.1016/s1470-2045(24)00528-x","url":null,"abstract":"<h3>Background</h3>Black patients were severely under-represented in the clinical trials that led to the approval of immune checkpoint inhibitors (ICIs) for all cancers. The aim of this study was to characterise the effectiveness and safety of ICIs in Black patients.<h3>Methods</h3>We did a retrospective cohort study of patients in the US Veterans Health Administration (VHA) system's Corporate Data Warehouse containing electronic medical records for all patients who self-identified as non-Hispanic Black or African American (referred to as Black) or non-Hispanic White (referred to as White) and received PD-1, PD-L1, CTLA-4, or LAG-3 inhibitors between Jan 1, 2010, and Dec 31, 2023. Effectiveness outcomes were overall survival, time to treatment discontinuation, and time to next treatment. The safety outcome was the frequency of immune-related adverse events; assessed among a random sample of 1000 Black patients and 1000 White patients, 892 pairs were matched on the basis of baseline characteristics using 1:1 exact matching without replacement. After manual chart review, patients who did not receive ICI therapy or who had inadequate follow-up were excluded. The adjusted effect of race on each effectiveness outcome was assessed in the whole ICI-treated cohort with propensity-weighted Cox regression with robust standard errors. Immune-related adverse events outcomes were analysed in the random matched sample with multivariable Cox regression, adjusting for baseline characteristics.<h3>Findings</h3>We identified 26 398 patients, of whom 4943 (18·7%) patients were Black, 21 455 (81·3%) were White, 895 (3·4%) were female, 25 503 (96·6%) were male, 11 859 (45%) had non-small-cell lung cancer, and 26 045 (98·7%) received PD-1 or PD-L1 inhibitors. As of data cutoff (Aug 28, 2024), median follow-up was 40·3 months (95% CI 38·3–42·3) for Black patients and 43·9 months (43·0–45·1) for White patients. Compared with White patients, Black patients had longer time to treatment discontinuation (2-year unadjusted rates 10·7% [95% CI 9·8–11·7] for Black patients <em>vs</em> 8·6% [8·2–9·0] for White patients; adjusted hazard ratio [HR] 0·91, 95% CI 0·87–0·95, p<0·0001), similar time to next treatment (23·5% [22·3–24·8] for Black patients <em>vs</em> 25·6% [25·0–26·2] for White patients; 1·00, 0·95–1·05, p=0·96), and slightly improved overall survival (36·5% [35·2–38·1] for Black patients <em>vs</em> 36·5% [35·8–37·1]; 0·95, 0·90–0·99, p=0·036). 1710 patients (n=862 Black and n=848 White) were analysed for safety outcomes. Compared with White patients, Black patients had a reduced risk of all-grade immune-related adverse events (unadjusted 2-year rate 33·1% [95% CI 28·9–37·1] <em>vs</em> 44·1% [95% CI 39·1–48·7]; adjusted HR 0·75, 95% CI 0·62–0·90, p=0·0026), immune-related adverse events requiring treatment with systemic steroids (0·61, 0·46–0·81, p=0·00051), and immune-related adverse events resulting in permanent ICI discontinuation (0·58, 0·44–0·78, p=0·00024).","PeriodicalId":22865,"journal":{"name":"The Lancet Oncology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-14DOI: 10.1016/s1470-2045(24)00531-x
Jean-Marc Classe, Pierre Meeus, Delphine Hudry, Romuald Wernert, François Quenet, Frédéric Marchal, Gilles Houvenaeghel, Anne-Sophie Bats, Fabrice Lecuru, Gwenaël Ferron, Cécile Brigand, Dominique Berton, Laurence Gladieff, Florence Joly, Isabelle Ray-Coquard, Sylvaine Durand-Fontanier, Gabriel Liberale, Marc Pocard, Constantin Georgeac, Sébastien Gouy, Olivier Glehen
<h3>Background</h3>Hyperthermic intraperitoneal chemotherapy (HIPEC) at interval cytoreductive surgery for ovarian cancer improves overall survival but its role in recurrent disease is uncertain. We aimed to compare outcomes in patients treated with or without HIPEC during surgery for recurrent ovarian cancer.<h3>Methods</h3>The multicentre, open-label, randomised, phase 3 CHIPOR trial was conducted at 31 sites in France, Belgium, Spain, and Canada, and enrolled patients with first relapse of epithelial ovarian cancer at least 6 months after completing platinum-based chemotherapy. Eligible patients were aged 18 years or older with WHO performance status of less than 2. After six cycles of platinum-based chemotherapy (and optional bevacizumab), patients amenable to complete cytoreductive surgery were randomly assigned centrally in a 1:1 ratio, using a web-based system and a minimisation procedure, during surgery to receive HIPEC (cisplatin 75 mg/m<sup>2</sup> in 2 L/m<sup>2</sup> of serum at 41±1°C for 60 min) or not, stratified by centre, completeness of cytoreduction score, platinum-free interval, and latterly, planned poly(ADP-ribose) polymerase inhibitor use. The primary endpoint was overall survival, analysed on an intention-to-treat basis in all randomly assigned patients. This ongoing trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, <span><span>NCT01376752</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>.<h3>Findings</h3>Between May 11, 2011, and May 14, 2021, 415 female patients were randomly assigned (207 HIPEC, 208 no HIPEC). At the primary analysis (median follow-up 6·2 years, IQR 4·1–8·1), 268 (65%) patients had died (126 [61%] of 207 in the HIPEC group; 142 [68%] of 208 in the no-HIPEC group). Overall survival was significantly improved with HIPEC (stratified hazard ratio 0·73, 95% CI 0·56–0·96; p=0·024). Median overall survival was 54·3 months (95% CI 41·9–61·7) with HIPEC versus 45·8 months (38·9–54·2) without. Grade 3 or worse adverse events within 60 days after surgery occurred in 102 (49%) of 207 patients receiving HIPEC versus 56 (27%) of 208 receiving no HIPEC, the most common being anaemia (47 [23%] <em>vs</em> 30 [14%]), hepatotoxicity (23 [11%] <em>vs</em> 18 [9%]), electrolyte disturbance (28 [14%] <em>vs</em> two [1%]), and renal failure (20 [10%] <em>vs</em> three [1%]). There were three deaths within 60 days of surgery, all in the no-HIPEC group.<h3>Interpretation</h3>Adding HIPEC to cytoreductive surgery after response to platinum-based chemotherapy at first epithelial ovarian cancer recurrence significantly improved overall survival. When trea
背景卵巢癌细胞减灭术间隔期腹腔内热化疗（HIPEC）可提高总生存率，但其对复发疾病的作用尚不确定。我们的目的是比较复发性卵巢癌手术期间接受或不接受 HIPEC 治疗的患者的疗效。方法 多中心、开放标签、随机、3 期 CHIPOR 试验在法国、比利时、西班牙和加拿大的 31 个地点进行，入选者为完成铂类化疗至少 6 个月后首次复发的上皮性卵巢癌患者。符合条件的患者年龄在 18 岁或以上，WHO 体征表现小于 2 级。在进行了六个周期的铂类化疗（可选择贝伐单抗）后，可进行完全细胞减灭术的患者在手术过程中通过网络系统和最小化程序，按1:1的比例被随机分配接受或不接受HIPEC治疗（顺铂75毫克/平方米，溶于2升/平方米的血清中，温度为41±1°C，时间为60分钟），分层因素包括中心、细胞减灭术评分完成度、无铂间隔时间，以及后来计划使用的多（ADP-核糖）聚合酶抑制剂。主要终点是总生存期，对所有随机分配的患者进行意向治疗分析。2011年5月11日至2021年5月14日期间，415名女性患者被随机分配（207人接受HIPEC治疗，208人未接受HIPEC治疗）。在主要分析中（中位数随访 6-2 年，IQR 4-1-8-1），有 268 名（65%）患者死亡（HIPEC 组 207 人中有 126 人[61%]死亡；无 HIPEC 组 208 人中有 142 人[68%]死亡）。HIPEC可明显提高总生存率（分层危险比为0-73，95% CI为0-56-0-96；P=0-024）。采用HIPEC治疗的中位总生存期为54-3个月（95% CI 41-9-61-7），而不采用HIPEC治疗的中位总生存期为45-8个月（38-9-54-2）。术后60天内，接受HIPEC治疗的207例患者中有102例（49%）发生了3级或更严重的不良事件，而未接受HIPEC治疗的208例患者中有56例（27%）发生了3级或更严重的不良事件，最常见的不良事件是贫血（47例[23%] vs 30例[14%]）、肝毒性（23例[11%] vs 18例[9%]）、电解质紊乱（28例[14%] vs 2例[1%]）和肾功能衰竭（20例[10%] vs 3例[1%]）。首次上皮性卵巢癌复发时，对铂类化疗有反应后，在细胞剥脱手术中加入 HIPEC 可显著提高总生存率。在治疗晚期首次复发的高分化浆液性或高分化子宫内膜样卵巢癌患者时，如果患者可以在专科中心接受完全的细胞减灭术，则应考虑使用铂类HIPEC来延长患者的总生存期。
{"title":"Hyperthermic intraperitoneal chemotherapy for recurrent ovarian cancer (CHIPOR): a randomised, open-label, phase 3 trial","authors":"Jean-Marc Classe, Pierre Meeus, Delphine Hudry, Romuald Wernert, François Quenet, Frédéric Marchal, Gilles Houvenaeghel, Anne-Sophie Bats, Fabrice Lecuru, Gwenaël Ferron, Cécile Brigand, Dominique Berton, Laurence Gladieff, Florence Joly, Isabelle Ray-Coquard, Sylvaine Durand-Fontanier, Gabriel Liberale, Marc Pocard, Constantin Georgeac, Sébastien Gouy, Olivier Glehen","doi":"10.1016/s1470-2045(24)00531-x","DOIUrl":"https://doi.org/10.1016/s1470-2045(24)00531-x","url":null,"abstract":"<h3>Background</h3>Hyperthermic intraperitoneal chemotherapy (HIPEC) at interval cytoreductive surgery for ovarian cancer improves overall survival but its role in recurrent disease is uncertain. We aimed to compare outcomes in patients treated with or without HIPEC during surgery for recurrent ovarian cancer.<h3>Methods</h3>The multicentre, open-label, randomised, phase 3 CHIPOR trial was conducted at 31 sites in France, Belgium, Spain, and Canada, and enrolled patients with first relapse of epithelial ovarian cancer at least 6 months after completing platinum-based chemotherapy. Eligible patients were aged 18 years or older with WHO performance status of less than 2. After six cycles of platinum-based chemotherapy (and optional bevacizumab), patients amenable to complete cytoreductive surgery were randomly assigned centrally in a 1:1 ratio, using a web-based system and a minimisation procedure, during surgery to receive HIPEC (cisplatin 75 mg/m<sup>2</sup> in 2 L/m<sup>2</sup> of serum at 41±1°C for 60 min) or not, stratified by centre, completeness of cytoreduction score, platinum-free interval, and latterly, planned poly(ADP-ribose) polymerase inhibitor use. The primary endpoint was overall survival, analysed on an intention-to-treat basis in all randomly assigned patients. This ongoing trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT01376752</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>.<h3>Findings</h3>Between May 11, 2011, and May 14, 2021, 415 female patients were randomly assigned (207 HIPEC, 208 no HIPEC). At the primary analysis (median follow-up 6·2 years, IQR 4·1–8·1), 268 (65%) patients had died (126 [61%] of 207 in the HIPEC group; 142 [68%] of 208 in the no-HIPEC group). Overall survival was significantly improved with HIPEC (stratified hazard ratio 0·73, 95% CI 0·56–0·96; p=0·024). Median overall survival was 54·3 months (95% CI 41·9–61·7) with HIPEC versus 45·8 months (38·9–54·2) without. Grade 3 or worse adverse events within 60 days after surgery occurred in 102 (49%) of 207 patients receiving HIPEC versus 56 (27%) of 208 receiving no HIPEC, the most common being anaemia (47 [23%] <em>vs</em> 30 [14%]), hepatotoxicity (23 [11%] <em>vs</em> 18 [9%]), electrolyte disturbance (28 [14%] <em>vs</em> two [1%]), and renal failure (20 [10%] <em>vs</em> three [1%]). There were three deaths within 60 days of surgery, all in the no-HIPEC group.<h3>Interpretation</h3>Adding HIPEC to cytoreductive surgery after response to platinum-based chemotherapy at first epithelial ovarian cancer recurrence significantly improved overall survival. When trea","PeriodicalId":22865,"journal":{"name":"The Lancet Oncology","volume":"158 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142609764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-14DOI: 10.1016/s1470-2045(24)00597-7
Naomi Kiyota
No Abstract
无摘要
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