5-year Disease-free Survival Estimates Research Articles

Comparison of chemotherapy to radiotherapy as consolidation of complete or good partial response after six cycles of chemotherapy for patients with advanced Hodgkin’s disease: results of the Groupe d’études des Lymphomes de l’Adulte H89 trial

AbstractThe treatment of advanced Hodgkin's disease (HD) with chemotherapy (CTx) alone or combined modality treatments has been controversial. In 1989, we designed a randomized study to compare 2 cycles of CTx to (sub)total nodal irradiation (RTx) as consolidation treatments for patients with stage IIIB/IV HD in complete remission (CR) or good partial response after 6 cycles of CTx. A total of 559 patients were randomized to receive 6 cycles of MOPP/ABV (mechlorethamine, vincristine, procarbazine, prednisone/Adriamycin [doxorubicin], bleomycin, vinblastine) hybrid (n = 266) or ABVPP (n = 267). After induction treatment, 418 patients could be evaluated for the consolidation phase. With a median follow-up of 48 months, the 5-year disease-free survival estimates were 80% for 8 cycles of MOPP/ABV, 82% for 6 cycles of MOPP/ABV plus RTx, 68% for 8 cycles of ABVPP, and 75% for 6 cycles of ABVPP plus RTx (P = .01). The 5-year disease-free survival estimates did not differ between CTx and RTx, 74% and 79%, respectively (P = .07). After MOPP/ABV, the 5-year overall survival estimates did not differ between CTx and RTx, 85% and 88%, respectively (P = .2). After ABVPP, the 5-year survival estimates were 94% for CTx and 78% for RTx (P = .002). These results showed that RTx was not superior to CTx consolidation after doxorubicin-induced CR for patients with advanced HD. Because of the uncertainty of obtaining a prolonged second remission for patients relapsing after CTx and RTx and the possible long-term effects of RTx, we prefer 8 cycles of CTx as standard treatment when a CR has been achieved after 6 cycles.

Abstract P1-18-23: Evaluating the potential utility of presenting breast cancer clinical investigator estimates for numeric treatment benefit and recommendations for the use of two anti-HER2 adjuvant therapies: HER RISK

Background: The recent introductions of pertuzumab (P) and neratinib (N) have made counseling patients with HER2-positive breast cancer (BC) regarding the potential benefits of various adjuvant systemic regimens more complex and challenging. The HER RISK initiative was conceived as a novel means to support adjuvant therapy decision-making by providing input from BC clinical investigators (CIs). Methods: 30 CIs were recruited to provide numeric estimates of the potential benefit in 5-year disease-free survival (DFS) of various adjuvant therapeutic regimens and postadjuvant N for 24 HER2-positive BC scenarios along with their likely treatment recommendations. 50 community-based oncologists (CBOs) were then recruited and asked to provide the same estimates for 4 of the scenarios evaluated. They were then shown the responses from the CIs and asked to provide their perspectives on this information and its potential value as an educational resource. A modest honorarium was provided to CI and CBO participants. Results: There was a clear relationship between projected benefit of adding P or N and use of these agents in the 4 situations evaluated (Table). More than two thirds of CIs believe P improves DFS in cases with 2 positive nodes, and most generally recommend its inclusion in adjuvant therapy. However, for the 2 node-negative cases, CIs perceived the benefit of adding P to be minimal or absent and generally did not recommend this treatment. The numeric estimates and practice patterns of the CBOs were similar to those of the CIs, but P was perceived to be somewhat more beneficial by CBOs and was used more frequently in the node-negative scenarios. In terms of the decision to recommend postadjuvant N, CI responses strongly correlated with ER and nodal status. Almost all stated that N would provide benefit for a patient with ER-positive disease and 2 positive nodes and indicated that they would generally recommend N in that setting. CIs’ perceived benefit of N in the node-negative cases was minimal or absent, with few recommending it even for the ER-positive scenarios. N is commonly recommended by CBOs in the node-positive scenario — similar to the CIs — but more of these clinicians perceive a benefit to N in the node-negative cases and recommend its use. When asked whether they obtained clinical value from reviewing these types of estimates, 48 CBOs (96%) found the information useful and 34 (68%) stated that having access to it was likely to affect their practices. 45 CBOs (90%) would share the 5-year DFS estimates and treatment recommendations from the CIs with interested patients if available in an online format. Conclusions: The numeric estimates and practice patterns of CIs and CBOs were generally similar for the scenarios presented, but both P and N were perceived to be somewhat more beneficial and were used more frequently by CBOs than CIs in node-negative cases. Even in node-positive cases, CIs and CBOs estimated the benefit of P and N to be modest but in many cases sufficient to warrant their use. For both groups, there was a clear relationship between the estimated benefit of therapy and its use. CBOs found value in the graphical presentation of the CI estimates and practice patterns and would use them as part of patient counseling. The next phase of this ongoing project will evaluate whether integrating this information into shared decision-making is feasible and beneficial for CBOs. Citation Format: Neil Love, Sara A Hurvitz, Hope S Rugo, Lowell Hart, Gloria Kelly, Kirsten Miller, Trenton Cruse, Douglas Paley, Jonathan Moss, Kathryn Ziel. Evaluating the potential utility of presenting breast cancer clinical investigator estimates for numeric treatment benefit and recommendations for the use of two anti-HER2 adjuvant therapies: HER RISK [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-18-23.

Optimal time for adjuvant therapy initiation in breast cancer patients: A single center experience

Introduction. This retrospective study evaluates the association between the time of chemotherapy initiation and disease free survival in regard to breast cancer subtypes and stage at diagnosis. Material and Methods. The study included a total of 1075 breast cancer patients, stages I - III, treated at Oncology Institute of Vojvodina, Serbia (from 2010 to 2012; n = 617). The gathered data included prognostic factors used in everyday practice. Patients were divided into three groups according to the interval between surgery and chemotherapy (? 30, 31 - 60, ? 61 days). Disease free survival was calculated. Results. Among the 617 patients, the 5-year disease free survival estimate was similar: 81.5%, 81.0%, 84.6% (log-rank test, p = 0.728) regarding the time of adjuvant chemotherapy initiation: ? 30 days, 31 - 60, and ? 61 days, respectively. The study showed that 85% of our breast cancer patients started adjuvant chemotherapy within 3 months after definitive surgery. In multivariate analysis, independent prognostic factors for disease free survival were nodal status and tumor size. The 5-year disease free survival estimate was 85.8% (p = 0.001) for patients with luminal- A subtype (Estrogen +, Progesterone high, human epidermal growth factor receptor 2-, Ki-67 < 20%) with a median follow-up of 62,7 months; for patients with luminal-B (Luminal B (human epidermal growth factor receptor 2 -) Estrogen +, human epidermal growth factor receptor 2-, either Ki-67 high or Progesterone low, Luminal B (human epidermal growth factor receptor +) Estrogen +, human epidermal growth factor receptor 2 +, any Ki-67, any Progesterone) 78.3% (p = 0.534) with a median follow-up of 55.9 months; for patients with triple negative breast cancer it was 73.4% with a median follow-up of 58,1 months, and for patients with human epidermal growth factor receptor 2+ it was 77.1% (p = 0.448) with a median follow-up of 55.5 months. Conclusion. Early initiation of adjuvant chemotherapy is particularly important in patients with advanced- stage breast cancer at diagnosis, and those with trastuzumab- treated triple-negative breast cancer and human epidermal growth factor receptor 2-positive tumors.

Breast cancer after prophylactic mastectomy (bilateral or contralateral prophylactic mastectomy), a clinical entity: presentation, management, and outcomes.

Contralateral prophylactic mastectomy (CPM) and bilateral prophylactic mastectomy (BPM) markedly decrease the possibility of new breast cancer (BC) ipsilateral to the prophylactic mastectomy (PM). Given its relative infrequency, little is known about the clinical characteristics, presentation, and management of BC after PM. Between 1960 and 1993, 1065 women underwent BPM and 1643 women with unilateral BC treated with therapeutic mastectomy underwent CPM at our institution. Medical records were reviewed, and study-specific questionnaires were sent to all women. BC after PM included locoregional invasive BC or ductal carcinoma in situ ipsilateral to the PM. BC developed ipsilateral to the PM in 25 patients (13 after BPM; 12 after therapeutic mastectomy and CPM). Median follow-up after PM was 22 years (range 3-34 years). Presentations included clinically isolated local disease in 17 patients (68%); disease limited to the axilla without evidence of local primary disease in 4 (16%); synchronous local and axillary disease in 1 (4%); and synchronous local disease and distant metastases in 3 (12%). The 17 patients presenting with isolated local disease were most commonly managed with completion or redo mastectomy (65%) or local excision (29 %), followed by consideration of adjuvant therapy. The 5-year disease-free survival estimate was 69% (95% CI 52-94%) for the 22 patients who had isolated locoregional BC after PM and were treated with curative intent. Although rare, BC after PM can occur. The most common presentation, disease localized to the mastectomy site, can be managed with resection and consideration of adjuvant therapy.

Transoral laser surgery for laryngeal cancer: Outcome, complications and prognostic factors in 275 patients

Aim Curative treatment options for laryngeal carcinoma include primary radiation therapy, open surgical techniques and transoral laser surgery (TLS). In the last decade, TLS has become an important tool in the treatment of laryngeal cancer and has become the standard approach in many institutions. The aim of this study was to review the experience of a single center institution with TLS for early and advanced laryngeal cancer. Methods We retrospectively analyzed 275 patients who underwent TLS in regard to the survival outcome and surgical complications. Results The 5-year disease-free survival estimate was 90.3% and the 10-year disease-free survival estimate was 88.2%. The 5-year larynx preservation rate estimate was 88.2% and the 10-year larynx preservation rate estimate was 87.3%. The disease-free survival was significantly worsened by the variables T and N ( p = 0.0003; p < 0.001, respectively). Two percent of all patients required intraoperative tracheostomy and the rate of minor postoperative complications was 17%. There were no fatal complications. Conclusions We conclude that TLS is a valid treatment method for early laryngeal carcinoma. Selected cases of advanced carcinomas may also benefit from TLS.

Outcome of Postradiation Osteosarcoma Does Not Correlate with Chemotherapy Response

Postradiation osteosarcoma is a rare tumor with a historically poor prognosis. Recent reports concerning the prognosis of the disease have been conflicting. We ascertained the long-term outcome of patients with this disease treated in the era of contemporary chemotherapy. Twenty-seven patients diagnosed with postradiation osteosarcoma and treated with chemotherapy and surgical resection from 1980-2003 were identified. Demographics, anatomic location, stage, chemo- therapy, necrosis rate, recurrence and metastatic rates were recorded; Kaplan-Meier survival rates were estimated. The median age was 54 years (range, 12-86 years). Nineteen patients were female and eight patients were male. Median followup was 39.2 months (range, 0-218 months). Twenty-two patients received induction chemotherapy for a mean of four cycles (range, 2-6 cycles). Mean tumor necrosis was 63.5%. Seven patients had 90% necrosis; four of these patients died of their disease. The mean survival was 23 months, and the 5-year disease free survival estimate was 27.2%. Histologic response to chemotherapy did not correlate with survival. Patients who had a latency of greater than 10 years after radiation had a better prognosis. Unlike conventional osteosarcoma, response to chemotherapy (necrosis) did not have prognostic significance. Current chemotherapy regimens fail to impact survival in postradiation osteosarcoma. Therapeutic study, level IV (retrospective comparative study).

A new look at langerhans cell histiocytosis: Review of a series of 55 cases

Objective: Langerhans cell histiocytosis (LCH) has been well described only in children. We analyzed the characteristics, reactivation, and outcome of LCH in a cohort of 55 patients across all ages. Methods: We reviewed the records of all patients with LCH treated at a single institute between Jan. 1974 and May 1998. Results: The 55 patients were 2 to 67 years of age (median, 31 years) at the time of diagnosis, and 85.5% were male. Forty patients (72.7%) had single-system LCH; Fifteen (27.3%) had multisystem disease. The head and neck was the most frequent tumor site (63.6%). LCH was not found in organs at risk of involvement (liver, spleen, bone marrow, and lungs). The frequency of bony invasion (23.6% overall) differed significantly according to age ≤15 years (66.7%) vs. age >15 years (11.6%) (P=0.0005). At a median follow-up of 12 years, no patient died of LCH. The 5, 10-year survival estimates were 100%. The 5, 10-year disease-free survival estimates were 70.9% and 58.4%. The 5-year disease-free survival estimate was 58.3% for age ≤ 15 years vs. 74.4% for age >15 years (P=0.83) and 75% for single-system disease vs. 60% for multisystem disease (P=0.13). LCH was reactivated in 43.6% of patients, with a median of 14 months (range, 2–180 months). Three patients with recurrent disease experienced spontaneous remission. At the time of the most recent follow-up, 23.6% of survivors had active disease. Conclusion: LCH is not found exclusively in children and adolescents. The frequency of bone invasion is inversely related to age. Reactivation is very common regardless of the type of treatment, but the prognosis is generally good.