Adjuvant Chemotherapy In Early-stage Research Articles

Unraveling the Benefit of Adjuvant Chemotherapy in Early Stage Combined Small-Cell Lung Cancer

Unraveling the Benefit of Adjuvant Chemotherapy in Early Stage Combined Small-Cell Lung Cancer

Can adjuvant chemotherapy improve the prognosis of adult ovarian granulosa cell tumors?: A narrative review.

Adult granulosa cell tumors (aGCTs) are rare ovarian neoplasms with a relatively favorable prognosis. They follow an indolent course, characterized by a prolonged natural history and a tendency to late recurrences, Around a quarter of patients develop recurrence and More than 70% of women with recurrence die from their disease, The percentage of patients received chemotherapy increases over time, whether adjuvant chemotherapy improve the prognosis of aGCTs is equivocal? The purpose of this review is to summarize the previously published evidence to evaluate whether adjuvant chemotherapy improve the prognosis of aGCTs to provide guidance for clinical practice. EMBASE, PubMed, Web of Science, WanFang Data and Chinese National Knowledge Infrastructure are searched up to December 2020, used the search strategy of ovar* and granulosa cell* and (tumor* or tumour* or malignan* or cancer* or carcinom* or neoplasm*) and chemotherapy. The screening process was conducted strictly based on inclusion and exclusion criteria. Clinical studies based on human including randomized controlled trial, quasi-randomised controlled trials, nonrandomised trials cohort study and case control study were included without restriction of time. The percentage of patients received chemotherapy increases over time, but the benefit of adjuvant chemotherapy is lack of high-grade evidence of prospective study, based on the current retrospective studies, we still do not have the evidence to confirm the survival benefit of adjuvant chemotherapy in early stage, advanced stage or recurrent aGCT with no residual tumor, but for inoperable disseminated disease or disease with suboptimal cytoreduction, adjuvant chemotherapy maybe an Optable options. Multinational prospective randomised controlled trials are urgently needed to validate the role of adjuvant chemotherapy. Further research on molecular mechanisms and developing novel targeted medicines may improve the survival of aGCTs.

A prognostic and predictive computational pathology image signature for added benefit of adjuvant chemotherapy in early stage non-small-cell lung cancer.

We developed and validated a prognostic and predictive computational pathology risk score (CoRiS) using H&E stained tissue images from patients with early-stage non-small cell lung cancer (ES-NSCLC). 1330 patients with ES-NSCLC were acquired from 3 independent sources and divided into four cohorts D1-4. D1 comprised 100 surgery treated patients and was used to identify prognostic features via an elastic-net Cox model to predict overall and disease-free survival. CoRiS was constructed using the Cox model coefficients for the top features. The prognostic performance of CoRiS was evaluated on D2 (N=331), D3 (N=657) and D4 (N=242). Patients from D2 and D3 which comprised surgery+chemotherapy were used to validate CoRiS as predictive of added benefit to adjuvant chemotherapy (ACT) by comparing survival between different CoRiS defined risk groups. CoRiS was found to be prognostic on univariable analysis, D2 (hazard ratio (HR)=1.41, adjusted (adj.) P=.01) and D3 (HR=1.35, adj. P < .001). Multivariable analysis showed CoRiS was independently prognostic, D2 (HR=1.41, adj. P < .001) and D3 (HR=1.35, adj. P < .001), after adjusting for clinico-pathologic factors. CoRiS was also able to identify high-risk patients who derived survival benefit from ACT D2 (HR=0.42, adj. P=.006) and D3 (HR=0.46, adj. P=.08). CoRiS is a tissue non-destructive, quantitative and low-cost tool that could potentially help guide management of ES-NSCLC patients. Data collection, anlaysis, and computation resources of the research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award numbers: 1U24CA199374-01, R01CA202752-01A1, R01CA208236-01A1, R01 CA216579-01A1, R01 CA220581-01A1, 1U01 CA239055-01. National Center for Research Resources under award number 1 C06 RR12463-01. VA Merit Review Award IBX004121A from the United States Department of Veterans Affairs Biomedical Laboratory Research and Development Service, the DOD Prostate Cancer Idea Development Award (W81XWH-15-1-0558), the DOD Lung Cancer Investigator-Initiated Translational Research Award (W81XWH-18-1-0440), the DOD Peer Reviewed Cancer Research Program (W81XWH-16-1-0329), the Ohio Third Frontier Technology Validation Fund, the Wallace H. Coulter Foundation Program in the Department of Biomedical Engineering and the Clinical and Translational Science Award Program (CTSA) at Case Western Reserve University.

Molecular Subtypes and Precision Oncology in Intrahepatic Cholangiocarcinoma.

Cholangiocarcinomas (CCAs) are the second-most common primary liver cancers. CCAs represent a group of highly heterogeneous tumors classified based on anatomical localization into intra- (iCCA) and extrahepatic CCA (eCCA). In contrast to eCCA, the incidence of iCCA is increasing worldwide. Curative treatment strategies for all CCAs involve oncological resection followed by adjuvant chemotherapy in early stages, whereas chemotherapy is administered at advanced stages of disease. Due to late diagnosis, high recurrence rates, and limited treatment options, the prognosis of patients remains poor. Comprehensive molecular characterization has further revealed considerable heterogeneity and distinct prognostic and therapeutic traits for iCCA and eCCA, indicating that specific treatment modalities are required for different subclasses. Several druggable alterations and oncogenic drivers such as fibroblast growth factor receptor 2 gene fusions and hotspot mutations in isocitrate dehydrogenase 1 and 2 mutations have been identified. Specific inhibitors have demonstrated striking antitumor activity in affected subgroups of patients in phase II and III clinical trials. Thus, improved understanding of the molecular complexity has paved the way for precision oncological approaches. Here, we outline current advances in targeted treatments and immunotherapeutic approaches. In addition, we delineate future perspectives for different molecular subclasses that will improve the clinical care of iCCA patients.

Stereotactic Body Radiation Therapy plus Induction Chemotherapy versus Stereotactic Body Radiation Therapy plus Adjuvant Chemotherapy for Early Stage but Medically Inoperable Pancreatic Cancer: A Propensity Score Matched Analysis

Although surgical resection has been confirmed as the only strategy for cure, especially for resectable pancreatic cancer, only 15-20% of the patients were amenable to this curative-intent treatment at the initial diagnose. However, there was no consensus or clinical trials about optimal multimodality treatment for patients with resectable but medically inoperable pancreatic cancer. Hence, radiotherapy and chemotherapy may be the alternatives if patients are not candidates for surgery. Stereotactic body radiation therapy (SBRT) has become a promising option due to its precise treatment delivery. Therefore, we sought to evaluate the efficacy and safety of SBRT plus chemotherapy and the treatment sequences and identify clinical factors associated with survival in a large cohort of patients with early stage but medically inoperable pancreatic cancer. All patients included in this study were biopsy-proven radiographically resectable pancreatic cancer. Only when they were intolerant of or declined operations, subsequent radiotherapy or chemotherapy was taken into considerations. All patients were required to complete a planned chemotherapy with 6 cycles. The chemotherapy regimen was gemcitabine plus S-1. The interval between induction or adjuvant chemotherapy and SBRT was 2 to 3 weeks. Patients who had completed induction chemotherapy would receive PET-CT to preclude metastasis. Those with metastasis were excluded from the study and received other treatment based on the multidisciplinary approach. CA19-9 response was defined as the level of CA19-9 decrease by 50% from baseline levels of ≥74 U/ml. Hence, three groups were formed for univariate analysis: CA19-9 levels ≥74 U/ml with response vs. CA19-9 levels ≥74 U/ml with no response (including CA19-9 levels within the normal range before SBRT while increased after SBRT) vs. CA19-9 levels <74 U/ml (before SBRT and during follow-up). Factors were investigated for their association with overall survival (OS) and progression free survival (PFS) using univariate log-rank comparisons and then COX regression model. Propensity score matched analyses were performed to further assess the efficacy of different treatment sequences. Forty-eight patients received induction chemotherapy and fifty-two with adjuvant chemotherapy from 2012 to 2016. Only radiation doses were higher in adjuvant chemotherapy group. After multivariate analysis, patients with adjuvant chemotherapy (P<0.001), CA19-9 response (P<0.001) and BED10≥60Gy (P=0.024) had a longer OS, while the former two correlated with PFS. After propensity score matched analysis, patients with adjuvant chemotherapy had OS (23.1 months vs. 15.6, P<0.001) and PFS benefits (18.0 months vs. 11.6 months, P<0.001) than those with induction chemotherapy. SBRT plus chemotherapy, especially adjuvant chemotherapy, may be an alternative for patients with early stage pancreatic cancer but not eligible for surgical resection.

Stereotactic body radiation therapy plus induction or adjuvant chemotherapy for early stage but medically inoperable pancreatic cancer: A propensity score-matched analysis of a prospectively collected database.

BackgroundTo evaluate and compare the efficacy and safety of stereotactic body radiation therapy (SBRT) plus induction chemotherapy and SBRT plus adjuvant therapy.MethodsPatients with radiographically resectable, biopsy-proven pancreatic cancer were enrolled. Data were prospectively collected from 2012 to 2016. Cox proportional hazards regression was used to identify factors predictive of survival. Propensity score matching analysis was performed to assess the efficacy of SBRT combined with different timing of chemotherapy.ResultsOne hundred patients were enrolled with 48 receiving induction chemotherapy and 52 undergoing adjuvant chemotherapy. The median overall survival (OS) and progression-free survival (PFS) were 17.5 months (95% CI: 15.8–19.2 months) and 13.7 months (95% CI: 12.3–15.1 months), respectively. Patients with adjuvant chemotherapy (P <0.001), CA19-9 response (P <0.001) and BED10 (biological effective dose, α/β = 10) ≥ 60 Gy (P = 0.024) had a longer OS, while the former two correlated with PFS. Patients with more positive factors had a superior OS and PFS. After propensity score matching analysis, there were 23 patients from each group included in the analysis. Longer OS (23.1 months versus 15.6, P <0.001) and PFS (18.0 months versus 11.6 months, P <0.001) were found in patients with adjuvant chemotherapy compared with those with induction chemotherapy.ConclusionSBRT was safe and effective in early stage pancreatic cancer. Combined with adjuvant chemotherapy, SBRT could be an alternative for patients with resectable pancreatic cancer but not eligible for surgical resection.

Impact of chemotherapy-induced amenorrhea in breast cancer patients: the evaluation of ovarian function by menstrual history and hormonal levels.

BackgroundChemotherapy-induced amenorrhea (CIA) is one of the most frequent therapy-related adverse events observed in breast cancer patients who have undergone chemotherapy. Although the characteristics of CIA have been studied in Western countries, little is known about CIA in Asian. We conducted a retrospective analysis to assess the characteristics and influencing factors of CIA and its association with menopause in Chinese women who underwent adjuvant chemotherapy for early-stage breast cancer.MethodsSeventy-three premenopausal women who underwent adjuvant chemotherapy for early stage (stages I to III) breast cancer were analyzed. Patient clinical characteristics, treatment regimes, menstrual information, and serum hormone values were collected retrospectively. Characteristic factors relevant to the onset of CIA and menopause were also estimated.ResultsApproximately 83.6% of patients developed CIA. Older patients (>40 years old) had higher CIA incidence compared with younger patients (P <0.0001). The onset of menopause was correlated with age (P <0.0001) and tamoxifen use (P = 0.0313). On the basis of the Kaplan–Meier analysis, a significant difference was observed in the time of onset of permanent amenorrhea as determined by menstrual history and hormone levels (P = 0.0028). In women aged 46 to 49 years, the beginning of permanent amenorrhea was detected earlier via the clinical method than via the hormonal method (2 months versus 23 months, P <0.0001). In the analysis of patients ≥50 years old, the median time to detection of permanent amenorrhea was 19 months in the hormonal test and 2 months in the clinical test (P = 0.0112).ConclusionsAge at diagnosis is a predictor of the onset of amenorrhea and transformation into menopause among premenopausal breast cancer patients. Adjuvant tamoxifen therapy substantially affects the onset of menopause. A delay of the onset of serum hormone postmenopausal status was observed compared with clinical symptoms. This interval was approximately 21 months in patients aged 46 to 49 years and 17 months in patients aged over 50 years. This interval is significant in the clinical estimate of the menstrual status.

Estado actual del tratamiento adyuvante a la cirugía en los estadios iniciales del cáncer de pulmón no microcítico

The results of the recently performed randomised trials support the conclusion that adjuvant chemotherapy confers survival advantage in early stage in non-small cell lung cancer, and now has become the standard of care for patients with resected stage II and IIIA. The role of adjuvant chemotherapy for stage I disease remains controversial. Only some patients benefit from systemic adjuvant therapy and we need to identify factors of patients most likely to respond to chemotherapy. The purpose of this article is to provide a general overview of adjuvant chemotherapy for early stage in non-small cell lung cancer.

Influence of Timing of Initiation of Adjuvant Chemotherapy Over Survival in Breast Cancer: A Negative Outcome Study by the Spanish Breast Cancer Research Group (GEICAM)

This retrospective trial evaluates whether the timing of initiation of the adjuvant chemotherapy has any influence over survival in early-stage breast cancer. A total of 2782 patients from El Alamo project (from 1990 to 1997; n = 15,400) were selected with stages I-III, surgery and adjuvant chemotherapy. Data were gathered about prognostic factors such as age, tumor size, vessel permeation (vascular or lymphatic), histological grade, and number of involved nodes, hormonal receptor status and administration of hormone therapy. The time interval between surgery and initiation of chemotherapy, and dates of relapse, second primary breast tumor and death were recorded. Patients were assigned in four groups according to the surgery-chemotherapy interval: <3 weeks (group A), 3-6 weeks (group B), 6-9 weeks (group C) and >9 weeks (group D). There were no differences in disease-free survival (DFS), nor in 5-year overall survival (OS), according to the timing of initiation of adjuvant chemotherapy. Cox proportional hazards model was used to adjust analysis for known prognostic factors but the effect of surgery-chemotherapy interval remained non-significant. The variable timing of initiation of adjuvant chemotherapy has also been assessed as a continuous variable and no differences have been detected. The optimum time of initiation of adjuvant chemotherapy in early stages of breast cancer is unknown. The delay in the initiation of adjuvant chemotherapy has no influence over survival in the analyzed time intervals. Retrospective analysis like this one with enough statistical power would be necessary to detect differences among groups.

O-58 Quality of life in a trial of adjuvant chemotherapy for early stage completely resected non-small cell lung cancer (NCIC CTG BR.10)

O-58 Quality of life in a trial of adjuvant chemotherapy for early stage completely resected non-small cell lung cancer (NCIC CTG BR.10)

The place of adjuvant chemotherapy in early stages

The place of adjuvant chemotherapy in early stages