Cancer treatment communications最新文献

Metastatic breast cancer (MBC) is quite sensitive to chemotherapy, with patients often benefiting from multiple lines of treatment. Continuation of chemotherapy until disease progression, if tolerable, prolongs disease control and improves patient outcomes. Compared to combination regimens, sequential single-agent chemotherapy provides similar efficacy and improved tolerability and may represent the preferred option for most patients. Numerous agents are available, but there are few data to advise optimal sequencing. Oral chemotherapeutic agents, including capecitabine and vinorelbine, have demonstrated significant efficacy in patients with MBC. These drugs prolong disease control with good tolerability, especially when used as single agents. In addition, oral chemotherapy reduces the time and cost associated with treatment and usually is preferred by patients if compared with intravenous delivery. Metronomic administration of oral chemotherapy also represents a promising therapeutic approach for select patients with MBC, inhibiting tumor progression through multiple mechanisms of action. Ongoing clinical trials are exploring metronomic regimens as a strategy to prolong disease control with favorable tolerability. Key data on the role for oral chemotherapy in the therapeutic landscape for MBC will be reviewed and accompanied by expert perspectives on important considerations for the integration of oral chemotherapeutic agents into the treatment of patients with MBC.

Treatment with lapatinib results in many toxicities. Described here is a novel toxicity, mucosal discoloration that developed after lapatinib was initiated in a breast cancer patient.

Background

Controversy continues regarding the optimal therapy for stage IIIA non-small cell lung cancer (NSCLC). Improved survival has been shown in patients undergoing multimodality therapy that includes surgical intervention.

Methods

Stage IIIA NSCLC demographics, post-treatment survival, complications and survival rates were compared with stage I and stage II NSCLC.

Results

Mean age for patients from all groups was over 60 years (p=0.66). They had similar BMI (p=0.35) and the majority of the patients in all groups were females (p=0.51). Lobectomy was the most used procedure in all three groups; 93% in patients with stage I NSCLC, 73% and 76% in patients with stage II and IIIA, respectively (p<0.001). Video-assisted thoracoscopic surgery (VATS) was used in 69% of lobectomies in patients with stage I NSCLC, 37% in stage II and 65% of lobectomies in patients with IIIA NSCLC (p<0.001). More stage IIIA patients had prolonged ventilation (>24 h; 3%) than patients in stage I (<1%) and stage II (0%; p=0.032). Median hospital length of stay was 3 days for stage II and IIIA patients and 2 days for patients with stage I (p<0.001). Overall survival rate for stage IIIA patients at 1-, 3- and 5-years was 85%, 55% and 48%, respectively.

Conclusions

Pulmonary resection as an initial therapy or following neoadjuvant radiation and chemotherapy is safe for patients with stage IIIA NSCLC. Locally advanced disease does not confer increased risk of perioperative morbidity or mortality in our study population.

The Publisher regrets that this article is an accidental duplication of an article that has already been published in 〈Abbreviated Journal Title, volume (year) first page - last page〉, 10.19187/abc.201523100-103. The duplicate article has therefore been withdrawn.

The full Elsevier Policy on Article Withdrawal can be found at (http://www.elsevier.com/locate/withdrawalpolicy).

Introduction

Optimization of surgical outcomes after colectomy continues to be actively studied, but most studies group right-sided and left-sided colectomies together. The aim of our study was to determine whether the complication rate differs between right-sided and left-sided colectomies for cancer.

Methods

We identified patients who underwent laparoscopic colectomy for colon cancer between 2005 and 2010 in the American College of Surgeons National Surgical Quality Improvement Program database and stratified cases by right and left side. The two groups were matched using propensity score matching for demographics, previous abdominal surgery, pre-operative chemotherapy and radiotherapy, and pre-operative laboratory data. Outcome measures were: 30-day mortality and morbidity.

Results

We identified 2512 patients who underwent elective laparoscopic colectomy for right-sided or left-sided colon cancer. The two groups were similar in demographics, and pre-operative characteristics. There was no difference in overall morbidity (15% vs. 17.7%; p value<0.08) or 30-day mortality (1.5% vs. 1.5%; p value<0.9) between the two groups. Sub-analysis revealed higher surgical site infection rates (9% vs. 6%; p value<0.04), higher incidence of ureteral injury (0.6% vs. 0.4%; p value<0.04), higher conversion rate to open colectomy (51% vs. 30%; p value<0.01) and a longer hospital length of stay (10.5±4 vs. 7.1±1.3 days; p value<0.02) in patients undergoing laparoscopic left colectomy.

Conclusion

Our study highlights the difference in complications between right-sided and left-sided colectomies for cancer. Further research on outcomes after colectomy should incorporate right vs. left side colon resection as a potential pre-operative risk factor.

Background

Stereotactic body radiotherapy (SBRT) has emerged as an effective treatment for localized prostate cancer. However, prostate-specific antigen (PSA) kinetics after SBRT has not been well characterized. The objective of the current study is to analyze the rate of PSA decline and PSA nadir following hypofractonated SBRT in low- and intermediate-risk prostate cancer.

Methods

From 2008 to 2014, 36 patients newly diagnosed, low- and intermediate-risk (NCCN definition) prostate cancer were treated with SBRT using Cyberknife. Total dose of 36.25 Gy in 5 fractions of 7.25 Gy were administered. No one received androgen deprivation therapy (ADT). PSA nadir and rate of change in PSA (slope) were calculated and compared.

Results

With a median follow-up of 52 months (range, 13–71), the median rates of decline of PSA were −0.359, −0.199 and −0.127 ng/mL/month, respectively, for durations of 1, 2 and 3 years after radiotherapy, respectively. The decline of PSA was maximal in the first year and continuously decreased for durations of 2 and 3 year. The median PSA nadir was 0.27 ng/mL after a median 33 months. 5-year biochemical failure (BCF)-free survival was 100% for low- and intermediate-risk patients.

Conclusions

In this report of low- and intermediate-risk prostate cancer, continuous decrease of PSA level for duration 1, 2 and 3 year following SBRT using Cyberknife resulted in lower PSA nadir. Also, SBRT leaded to long-term favorable BCF-free survival in low- and intermediate-risk prostate cancer.

Myxofibrosarcoma is a connective tissue malignancy that classically presents as a subcutaneous mass and metastasizes in 20–35% of cases, most typically to the lymph nodes, lungs, and bone. Here we document the first reported case of high grade myxofibrosarcoma metastasizing to the colon. An 81-year old man presented with a 5 cm tumor in the right forearm; the tumor was excised and found to be high grade myxofibrosarcoma. Over the next 4 years, the disease metastasized to multiple distant sites, and the metastases were treated with surgery and radiation. At 4.5 years after the initial presentation, the patient complained of melena. Colonoscopy revealed a firm, ball-like polypoid lesion in the proximal transverse colon, measuring 3.5×3×1.3 cm³, found on pathologic analysis to be metastatic high grade myxofibrosarcoma. This report underscores the metastatic and aggressive potential of myxofibrosarcoma. Therefore, when myxofibrosarcoma is diagnosed, aggressive treatment and follow-up should be implemented to prevent its spread. New onset gastrointestinal symptoms in patients with myxofibrosarcoma may indicate metastasis, and a gastrointestinal workup should be implemented in such cases.

Background

Oncologists use Eastern Cooperative Oncology Group (ECOG) performance score to assess patients' performance status (PS) and guide treatment decisions, but patients may not necessarily agree on their scores. We compared PS scores assessed by patients with non-small-cell lung cancer (NSCLC) to those of their medical oncologists to explore concordance and whether any discrepancy may have implications on treatment and survival prediction.

Methods

NSCLC patients self-assessed their PS scores using the Patient-Generated Subjective Global Assessment tool prior to chemotherapy. Kappa was used to assess agreement of ECOG scores between patients and oncologists. Survival was calculated from date of chemotherapy using Kaplan Meier method.

Results

A total of 79 patients (median age 63 years, 87% stages IIIB/IV) were included. PS scores differed in 34 (43%) cases. The inter-rater reliability between patients and their oncologists was Kappa=0.35 (p<0.001). In 31/34 (91%) of cases where the physicians and patients did not agree, physicians were more optimistic in their PS rating. If only patient PS scores were used, 11 patients (14%) would be deemed unfit for chemotherapy (ECOG≥3) and 21 patients (27%) would be excluded from most chemotherapy trials (ECOG≥2). ECOG (0 versus >0) irrespective of assessor was predictive of survival (p=0.017–0.023).

Conclusions

There was only fair agreement in PS scores assessed by NSCLC patients and oncologists, with patient scores usually poorer. A number of patients would have excluded themselves from therapeutic interventions including clinical trials based on their PS rating.

Introduction

Nivolumab is a programmed death 1 (PD-1) immune-checkpoint inhibitor antibody currently approved for second-line therapy of metastatic non-small-cell lung cancer (NSCLC). PD-1 inhibitors including nivolumab are associated with a unique spectrum of immune-related adverse events (irAEs), though hematologic irAEs are rare and have not been previously reported in patients with NSCLC.

Presentation of case

Here we report a patient who experienced an exacerbation of underlying immune thrombocytopenia (ITP) while receiving nivolumab for NSCLC. The patient's ITP was successfully managed with romiplostim during nivolumab therapy, allowing for 7 months of clinical benefit and a partial tumor response.

Discussion

Using this case as an example, we provide a brief review of irAEs associated with PD-1 blockade, with particular attention to hematologic events. We also describe our approach to the use of nivolumab in this patient with underlying autoimmune disease.

Conclusion

Patients with NSCLC and underlying autoimmune disease may experience a flare of the autoimmune condition while receiving immune checkpoint inhibition. As illustrated by this case of ITP exacerbated by nivolumab, careful management of the autoimmune disease may allow for the safe administration of PD-1 directed agents in these patients.