Chemotherapy In Management Research Articles

The role of chemotherapy in the management of pancreatic acinar cell carcinoma

AbstractIntroductionPancreatic acinar cell carcinoma (pACC) is a rare malignancy with unique clinical and molecular features. The role of chemotherapy in pACC management is not well established.MethodsThe National Cancer Database (NCDB) for pACC was used. Cox regression was used in resected pACC patients to identify significant overall survival (OS) predictors. Patients were then divided based on these risk factors into propensity‐matched group of surgery versus surgery + chemotherapy and Kaplan–Meier analysis was performed with log‐rank tests to compare OS.ResultsThe NCDB 2004–2020 included 1592 pACC patients, 1553 were selected. Median age was 66 and 1090 (70.2%) were males. 622 (40.1%) received chemotherapy only, 257 (16.5%) had surgery only, and 365 (23.5%) had both. 189 Patients who received surgery were only matched to peers who had surgery + chemotherapy. The median OS for surgery only was 57.8 ± 6.0 versus 54.2 ± 9.9 months for surgery + chemotherapy (p = 0.836). Cox regression identified nodal and margin status as independent predictors of OS. Therefore, subgroups of patients with node‐negative, node‐positive, margin‐negative, and margin‐positive resections were similarly matched 1:1 for the receipt of surgery only versus surgery + chemotherapy. Only patients with node‐positive disease had a significant OS benefit with the addition of chemotherapy (44.2 ± 7.3 vs. 27.5 ± 10.5 months; p = 0.036).ConclusionOur analysis suggests that surgical resection remains the cornerstone of therapy for pACC. Node status and margin status are the primary prognosticators. The addition of chemotherapy provides an OS benefit only in node‐positive disease.

Combination of neoadjuvant and adjuvant chemotherapy with FOLFOX compared with adjuvant chemotherapy in management of locally advanced rectal cancers: a randomized trial of a promising therapeutic approach

BackgroundColorectal cancer (CRC) is a significant malignancy with widespread implications. Despite progress in surgical interventions for rectal cancer, improvements in overall prognosis remain disproportionate. Standard preoperative chemoradiation, while established as the standard treatment for the majority of rectal cancers, exhibits limited effectiveness in enhancing disease-free survival (DFS) and mitigating distant metastases, particularly in cases of locally advanced rectal cancer (LARC).MethodsThis randomised clinical trial assessed 286 patients with LARC in two paralleled groups. Group A underwent six courses of neoadjuvant MFOLFOX chemotherapy, chemoradiation, surgery, and six adjuvant chemotherapy cycles. Group B received concurrent chemoradiation, surgery, and twelve adjuvant chemotherapy cycles. Patient evaluations were achieved at multiple stages of treatment and follow-up.ResultsGroup A had significantly lower local recurrence (11.64%) than Group B (21.74%, P = 0.025). The distant metastasis rate in Group A (8.90%) was lower than in Group B (20.29%) but was not significant (p = 0.143). More patients in Group A experienced downstaging (80.82% vs. 60.87%, p < 0.001). Specifically, 72.60% demonstrated downstaging of tumour invasion and 54.79% downstaging of lymph node involvement, compared to 57.25% and 41.30% in Group B (p = 0.009 and p = 0.025, respectively) as well as higher pCR rate (26.03% vs. 15.25%, p = 0.030) and three-year DFS rate (82.19% vs. 71.01%, p = 0.035) in group A compare to group B.ConclusionThis innovative strategy for LARC showed promising results with lower local recurrence and higher rates of downstaging and pCR. Treatment side effects were similar in both groups but less frequent in Group A. Anaemia was the most common haematological side effect (A: 58%, B: 68%), and peripheral sensory neuropathy was the most common non-haematological complication (A: 63%, B: 64%). These findings suggest this regimen could be a valuable therapeutic approach for LARC.Trial RegistrationThis trial was registered on 2023–12-08 within the IRCT.IR database under the number IRCT20210308050628N1.

Neo-adjuvant PIPAC and Systemic Chemotherapy in Management of Synchronous Peritoneal Metastasis From Gastric Cancer

Introduction: Polycystic Ovarian Disorder (PCOD) is a prevalent endocrine illness in women of reproductive age. It has hormonal abnormalities, irregular menstrual cycles and tiny ovarian cysts. Lifestyle and food affect PCOD development and maintenance, coupled with Peritoneal metastasis from gastric cancer remains a major problem. The aim of our study is a retrospective analysis in two different groups with used PIPAC as neo-adjuvant management of synchronous peritoneal metastasis. Group A: 42 patients received as neo-adjuvant treatment 2 cycles of PIPAC (Doxorubicin 3 mgr/m2, cisplatin 10 mgr/m2) and 6 cycles of neo-adjuvant systemic chemotherapy with FLOT and we performed CRS+HIPEC (with cisplatin 80 mgr/m2, mitomycin 35 mgr/m2) for 90 min and 6 cycles of adjuvant systemic chemotherapy with FLOT. Group B: 26 patients received 4 cycles of neo-adjuvant systemic chemotherapy with FLOT, we performed CRS+HIPEC as Group A and 4 cycles of systemic chemotherapy with FLOT. For patients of Group A, the Median survival time is 46months.Group B patients had a median OS of 36 months. For patients of Group A, the Median Disease Time (DFS) was 37 months. Group B patients had a median DFS of 30 months. For each degree increase in the PCI pre score and for the same treatment group, the PCI posr score increases by 0.573 degrees. Group 2, for the same PCIpre score, have a 163% higher PCI posr score. On patients with singet ring cell adenocarcinoma there is a statistical significance difference in OS for PIPAC group. Patients of group A had a median OS of 26 months. For patients of group B, the median OS was 14 months. Morbidity and mortality in both groups are 53,4% and 4,7% for Group A and 44,5% and 5,5% for Group B respectively. The neo-adjuvant PIPAC with systemic chemotherapy might be a promising approach for patients with peritoneal metastasis from gastric cancer. PIPAC is a safe and well tolerated procedure.

Lessons learnt from 1300 consecutive gallbladder cancer surgeries: Evolving role of peri-operative chemotherapy in the treatment paradigm

BackgroundLevel I evidence for multi-modality management of gallbladder cancers (GBC) is evolving. MethodsProspectively maintained operative GBC database of 1307 patients (year 2010–2019) was analysed to study the impact of peri-operative chemotherapy (PCT) on survival outcomes. Results1040 patients had pathologically confirmed GBC. Stage distribution showed: Stage I(85,8.2%), II(247,23.8%), III(460,44.2%), IV(248, 23.8%). PCT was used as follows: in stage II, 164 patients received adjuvant chemotherapy(ACT); in stage III, ACT was given to 444 patients, either operated upfront(244 patients) or after neoadjuvant chemotherapy (NACT)(216 patients); in stage IV, 32 patients (11 received NACT) underwent radical surgery followed by ACT and 216 patients had inoperable disease (77 received NACT) upon exploration. With a median follow-up of 30 months, the 3-year OS for stage I, II and III was 94.1%, 82.6% and 48.2% respectively. Corresponding DFS was 93.8%, 67.3% and 38.3%. Upon reassessment for surgery after NACT (n = 332), patients who underwent radical surgery (n = 235) had superior OS (p = 0.000) and DFS (p = 0.000) in comparison to those who had inoperable disease (n = 97). Amongst stage III and IV patients with operable disease (n = 492), those who were operated upfront (n = 238) had equivalent survival as those operated after NACT (n = 254). This was also confirmed by a 1:1 propensity matched analysis (118 patients each), matching for T and N stage. ConclusionThe role of peri-operative chemotherapy in management of GBC is evolving. While the role of NACT for locally advanced GBC is unsettled and merits testing prospectively, it helps in selection of patients with favourable disease biology for radical surgery.

Assessment of Renal and Liver Function Tests Before and After Induction of Chemotherapy in Newly Diagnosed Acute Lymphoblastic Leukemia in Children

A prospective study was done in the Department of Paediatric Hematology &amp; Oncology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, between January and June of 2012, to observe the renal and liver function status in children suffering from acute lymphoblastic leukemia (ALL) before and after induction of chemotherapy. A total of 30 diagnosed patients of acute lymphoblastic leukemia were enrolled in the study. Renal and liver function tests were done before and after induction of chemotherapy. All the patients of the study were within 2-11 years range. Mean age was 5.12±2.53 years. Maximum 43.3% patients were within 3-6 years of age followed by 33.3% up to 3 years of age,13.3% within 6-9 year of age range and 10% above 9-year age range. 73.3% were male and 26.7% were female. Among the liver functions tests, mean bilirubin level of the patients before induction of chemotherapy was 2.31±4.71 mg/dl and after induction of chemotherapy was 1.12±2.15 mg/dl (P=0.122). Mean SGPT levels were 35.33±15.82 IU/L and 75±57.12 IU/l respectively (P=0.001). Mean total protein levels were 67.05±6.99 gm/dl and 64.47±7.51 gm/dl respectively (P=0.06). All the patients were HBsAg negative. Among the renal function tests, mean blood urea level of the respondents before induction was 28.89±7.95 mg/dl and after induction was 30.67±9.39 mg/dl (P=0.429). Mean serum uric acid levels were 4.63±1.18 mg/dl and 5.12±0.44 mg/dl respectively (P=0.044). Mean serum creatinine levels were 0.74±0.27 mg/dl and 0.67±0.22 mg/dl respectively (P=0.168). Mean GFR was 99.77±37.38 ml/1.732/min. before induction of chemotherapy and 108.57±37.29 ml/1.732/min. following chemotherapy (P=0.177). Kidney and liver functions may be affected in ALL in children. Recognition of hepatic and renal impairment at the onset of illness helps judicious chemotherapy in management of ALL.&#x0D; CBMJ 2022 January: vol. 11 no. 01 P: 21-26

The Role of Chemotherapy in Management of Inoperable, Metastatic and/or Recurrent Melanotic Neuroectodermal Tumor of Infancy-Own Experience and Systematic Review.

Simple SummaryMelanotic Neuroectodermal Tumor of Infancy (MNTI) is a very rare neoplasm that most commonly develops within maxilla in infants. It usually has a benign clinical course and is treated with only surgery. However, patients with large, inoperable, metastatic or multiply recurring MNTI may require systemic treatment. The role of pre- and post-surgery chemotherapy (CHT) in the management of MNTI is unclear. Here, we have presented the disease courses and outcomes of four infants treated with multidrug CHT due to inoperable/recurrent MNTI. Additionally, a systematic literature review was performed which revealed 38 similar cases in the last 42 years. Most children with primarily inoperable MNTI responded to CHT, which allowed physicians to perform complete, non-mutilating delayed surgery. However, it is still uncertain whether CHT administered after incomplete resection of MNTI prevents recurrence. This study aimed to contribute to the establishment of standards of management in patients with inoperable, metastatic or persistently recurring MNTIs, which are currently lacking.Melanotic Neuroectodermal Tumor of Infancy (MNTI) is a very rare pediatric neoplasm of neural crest origin. In most cases, it develops in infants as a localized tumor of the maxilla, and surgery is usually curative. In less than 10% of patients with inoperable, metastatic or persistently recurring MNTI, chemotherapy (CHT) may be considered; however, its role is still unclear. The aim of our study was to assess the efficacy of CHT in children with large, inoperable, metastatic and/or recurrent MNTI. Four such infants, treated with CHT in Polish and German centers of pediatric oncology, were presented. Additionally, a systematic literature search of the PubMed/MEDLINE, Scopus and Web of Science databases was performed, yielding 38 similar cases within the last 42 years. Neoadjuvant CHT, based mainly on the protocols for neuroblastoma, was often effective, allowing for complete delayed surgery in most cases. However, the role of adjuvant CHT in preventing recurrences after incomplete resection of MNTI remains unclear. Disseminated inoperable MNTI was almost universally associated with poor response to CHT and unfavorable outcome. Further investigations to elaborate standards of management in patients with inoperable, metastatic or persistently recurring MNTIs are necessary to improve outcomes.

Effectiveness of Learning Enrichment Programme on the Attittude Regarding Side Effects of Chemotherapy and Its Management among Caregivers of Patients Receiving Chemotherapy

The incidence of cancer has seen a remarkable increase in the recent times and chemotherapy occupiesa pivotal role in the recovery process of the patient. Several types of cancer are now considered curablewith chemotherapy even in advanced stages. The client who is at high risk for recurrence but shows noevidence of current disease may be a candidate for chemotherapy. The primary objective of the study is toassess the effectiveness of learning enrichment program on attitude regarding side effects of chemotherapyand its management among care givers of patients receiving chemotherapy. Hence the research approachselected for study was quantitative research approach. One group pretest posttest experimental researchdesign was used. 30 care givers of patients receiving chemotherapy were selected from the oncology wardand day care center by using convenience sampling technique. Attitude was assessed by using attitudescale. The group was offered a learning enrichment program regarding side effect and its management ofchemotherapy. The data collected were analyzed using descriptive and inferential statistics. The result showsthat there is significant improvement in the level of attitude of care givers of clients receiving chemotherapyregarding side effects of chemotherapy and its management after learning enrichment programme with amean difference 6.11at p&gt;O.O5 level of significance.

Early Maintenance with Tyrosine Kinase Inhibitors Post Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) Improves Survival in Ph+ Acute Lymphoblastic Leukemia (ALL) Patients

Introduction: Addition of tyrosine Kinase inhibitors (TKI) to induction chemotherapy in management of Philadelphia chromosome positive (Ph+) ALL has significantly improved remission rates prior to allogeneic HSCT compared to the pre-TKI era. Consolidation with HSCT further prolongs remission and is potentially curative in the majority of patients. However, relapse is the commonest cause of treatment failure post HSCT with the highest incidence occurring within 18 months post-transplant. One possible strategy to minimize the risk of relapse is to commence TKI maintenance early post transplantation; which is increasingly becoming a common practice in many centers. However long term efficacy of this approach has not been established.Methods: A retrospective search for Ph+ ALL patients undergoing allogeneic HSCT from March 2001 to September 2015 (n=150) at our center was performed. From this cohort to determine the impact of prophylaxis we identified a subgroup of patients (n=99) who were in complete molecular response (CMR) before day +90 post HSCT. Subsequently we performed a day +90 landmark analysis to examine the outcome for patients according to whether or not they had commenced TKI maintenance by day +90 in a univariate and multivariate model. TKI maintenance was recommended but the final decision was based on feasibility and patient/physician preference.Results: Of the 99 patients included in the landmark analysis, 58.6% were men and 41.4% were women. Median age of study participants at the time of HSCT was 40 (range 3-64) years with a median follow up duration of 5.2 (range 1.1-15.0 ) years. At time of HSCT, 74.7% patients were in CR1, 16.2% were in CR2, and 9.1% were beyond CR2 or had primary induction failure. The majority of patients (97%) received a myeloablative preparative regimen, including radiation therapy in 31.3%. The median duration of TKI maintenance was 12.1 months (range 1-74 months). Imatinib was the commonest TKI used. Patients who received TKI maintenance (n=38) had superior 10-year probability of PFS and OS compared to patients who did not receive maintenance (n=61) at 68.1% vs 44.8%, p=0.005, and 67.1% vs 47.8%, p=0.004, respectively (Figure 1). TKI maintenance (HR=0.282, CI=0.122-0.654, p=0.001) and disease status pre-HSCT (beyond CR1) (HR=2.909, CI=1.286-6.577, p=0.01) were the two independent predictors for PFS in the multivariate model. Similarly, TKI maintenance (HR=0.244, CI=0.098-0.608, p=0.001) and disease status pre-HSCT (beyond CR1) (HR=3.394, CI=1.449-7.948, p=0.03) were the two independent predictor for OS. Both groups appeared to be well matched for several transplant/disease/treatment related variables.Conclusion: Prophylactic TKI maintenance early post allo-SCT is feasible and is associated with improved PFS and OS. Future prospective studies are needed to define the optimal duration of TKI maintenance to further improve outcomes for this historically adverse group. [Display omitted] DisclosuresOran:Celgene: Research Funding; AROG: Research Funding; Astex: Research Funding. Jabbour:Bristol-Myers Squibb: Consultancy. Kantarjian:Bristol-Meyers Squibb: Research Funding; Pfizer: Research Funding; Novartis: Research Funding; Amgen: Research Funding; ARIAD: Research Funding; Delta-Fly Pharma: Research Funding.

Role of altered fractionation in radiation therapy with or without chemotherapy in management of carcinoma cervix: Time to revisit in the current COVID-19 pandemic

Severe acute respiratory syndrome coronavirus 2 as COVID-19 virus has affected the entire world and so to the cancer care and health-care facility. Cancer cervix is one of the common malignancies among women in developing and underdeveloped countries. Various challenges are being faced by patients and health-care providers to deliver optimal treatment under prescribed time frame. Faster delivery of whole treatment is desirable in the current pandemic. Overall treatment time in cancer cervix has prognostic value. Adoption of altered fractionation to delivered external beam radiation therapy could be a method for faster delivery of whole treatment. Altered fractionation such as hyperfractionation (HFX), hypofractionation, and accelerated fraction alone or with HFX has already been experimented for the past three decades. The total duration of treatment has been significantly reduced without addition of much toxicity. Few studies had also highlighted the feasibility of addition of chemotherapy to such fractionation schedule. However, prospective studies are still warranted to generate data to further support its use in the future.

Information Booklet on Self-Care Management of Chemotherapy among gynecological Cancer Survivors at Selected Hospital, Mangalore, Karnataka

Background of the study: Cancers of the female reproductive tract and breast has a high incidence amongst Indian women. Cancer registries have also highlighted that more than 70% of cancers in females occur in the age group of 35-64, and that these cancers exercise an adverse influence on the productive role of women in our society. Chemotherapy is a type of cancer treatment that uses one or more anti-cancer drugs that can have severe adverse effects on the patient both during the therapy and for some time after. Title of the study: Information Booklet on Self-Care Management of Chemotherapy among gynecological Cancer Survivors at Selected Hospital. Objectives 1) To assess the knowledge on self-care management of chemotherapy among Gynecological cancer survivors 2) To determine the effectiveness of information booklet on self-care management of chemotherapy among Gynecological cancer survivors Hypothesis: H1: The mean posttest knowledge level will be significantly higher than mean pretest knowledge level on self-care management of chemotherapy among Gynecological cancer survivors. Methodology: Quantitative research approach and the design adopted was pre experimental in this study. The investigator selected total of 60gynaecologic cancer survivors receiving chemotherapy through purposive sampling technique. The researcher collected the data from the participants with the help of validated knowledge questionnaire and demographic Performa information before administering self care management information booklet. The information booklet was comprised of side effects and management of chemotherapy with pictorial depiction. The posttest was conducted at the immediate subsequent cycle of chemotherapy. The obtained data were analyzed by using descriptive & inferential statistics. Results: The result of the present study showed that the mean post-test knowledge score (11.63) of gynecologic cancer survivors were significantly higher than their mean pre-test knowledge score (7.90). The calculated‘t’ value was (15.562) and’ p’ value is less than 0.05.Hence the research hypothesis was accepted at 5% level significance.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in management of peritoneal carcinomatosis: Single center experience in Korea

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in management of peritoneal carcinomatosis: Single center experience in Korea

P098. Audit of Neoadjuvant Chemotherapy in management of breast cancer – our unit experience

P098. Audit of Neoadjuvant Chemotherapy in management of breast cancer – our unit experience

Affect of Neo-Adjuvant Chemotherapy in Management of Locally Advanced Breast Carcinoma

Affect of Neo-Adjuvant Chemotherapy in Management of Locally Advanced Breast Carcinoma

Papulopustular lesions of the face caused by panitumumab: case report and literature review

Introduction:Panitumumab (VECTIBIX®) is a monoclonal antibody used alone or in combination with a chemotherapy for management of metastatic colorectal cancer.Observation:A patient treated with this protocol manifested skin lesions; the etiological diagnosis was difficult. The lesions, namely a papulopustular rash at the lower third of the face, and the medical history allowed to diagnose an acute skin toxicity case due to this monoclonal antibody.Commentary:Many side effects are related to the panitumumab, among which dermatologic adverse events having already been the subject of some publications. Nevertheless, several studies conclude that the therapeutic benefit of this epidermal growth factor receptor inhibitor makes acceptable these complications.Conclusion:Stop treatment and corticosteroids allowed a whole and quick disappearance of skin lesions. Alongside dermatologists and infectious diseases specialists, the opinion of an oral surgeon was useful to provide an answer to these symptoms.

Comprehensive evaluation of clinical efficacy and safety of celecoxib combined with chemotherapy in management of gastric cancer.

Background:To evaluate the clinical efficacy and safety of celecoxib combined with chemotherapy in the treatment of gastric cancer.Methods:In total, 240 gastric cancer patients undergoing radical gastrectomy followed by adjuvant chemotherapy were randomly assigned into 2 groups. In the experimental group (n = 120), patients were administered with celecoxib-based chemotherapy, and chemotherapy alone was performed in the control group. Disease-free survival (DFS) and progression-free survival (PFS) were considered as the primary efficacy parameters, and objective response rate (ORR), overall survival (OS), quality of life (QOL), and safety as the secondary efficacy parameters.Results:The 3-year OS did not significantly differ between the experimental (72%) and control groups (68%, P = .67). The 3-year DFS in the experimental group was 64%, which did not significantly differ from 51% in the control group (P = .41). In patients with positive cyclooxygenase-2 (COX-2) from the experimental group, the 3-year OS was 78%, significantly higher compared with 66% in the control group (P = .02), and the 3-year DFS was 70%, considerably >50% in the control group (P = .01). No statistical significance was identified in the incidence of nausea, neutropenia, anorexia, peripheral neurotoxicity, diarrhea, vomiting, asthenia, and thrombocytopenia, etc. The EORTC quality of life questionnaire (QLQ)-C30 questionnaire revealed that the global QOL in the experimental group was significantly higher than that in the control group (P < .05). No statistical significance was noted in the scores of functioning scale between 2 groups, whereas the scores of the symptom scale, especially pain and fatigue in the experimental group were remarkably higher than that in the control group (P < .05). The global score of EORTC QLQ-STO22 in the experimental group was considerably higher compared with that in the control group (P < .05). No statistical significance was identified in term of the domains of restrictions on feeding, dysphagia, anxiety, reflux, sense of taste, dry mouth, hair loss, and body shape between groups (all P > .05).Conclusion:Celecoxib combined with chemotherapy yields clinical benefits for gastric cancer patients with positive COX-2, which not only enhances the OS, DFS, PFS, QOL, and short-term clinical efficacy, but also does not increase the risk of adverse events.

445P - Phase II study of efficacy of bevacizumab plus chemotherapy in management of malignant pleural effusion in non-squamous non-small cell lung cancer patients with malignant pleural effusion (MPE) unsuccessfully controlled by tube drainage or pleurodesis (NEJ-13-2 trial)

Background: Prospective and retrospective studies on intrapleural therapy of malignant pleural effusion (MPE) have reported that the success rate for controlling pleural effusion is 50% at 2.5 months. When pleurodesis is unsuccessful, the lung is not fully expanded after drainage before receiving effective chemotherapy. Vascular endothelial growth factor (VEGF) plays a pivotal role in the pathogenesis of MPE. Here, a multicenter phase II trial was conducted to evaluate bevacizumab therapy in non-squamous NSCLC patients with unsuccessful management of MPE. Methods: Non-squamous NSCLC patients with MPE who had received unsuccessful tube drainage or pleurodesis received chemotherapy with bevacizumab (15 mg/kg) every 3 weeks. The primary endpoint was pleural effusion control rate (PECR), defined as the percentage of patients without reaccumulation of MPE for 8 weeks. The secondary endpoint was pleural Progression-free survival (PPFS), defined as PFS without reaccumulation of MPE. Results: Fifteen of 20 patients entered received a median of 4 cycles of carboplatin plus paclitaxel or pemetrexed including maintenance therapy with bevacizumab. The PECR was 80% of treated patients. PPFS was 16.6 months. The response rate and disease control rate were 45% and 80%, respectively, and the median PFS and overall survival (OS) were 9.8 months and 19.6 months, respectively. The patients with high VEGF (<1000pg/ml) in MPE had shorter PPFS (P = 0.01) and OS (P < 0.01). Toxicities of grade ≥3 included neutropenia (50.0%), thrombocytopenia (10.0%), proteinuria (10.0%) and hypertension (2.0%). Global QOL score investigated by EORTC QLQ-C30 favored in the patients without reaccumulation of MPE. Conclusions: The combination of bevacizumab with chemotherapy demonstrated efficacy with acceptable toxicities as a standard therapy in controlling MPE in patients with non-squamous NSCLC whose MPE was unsuccessfully controlled by tube drainage or pleurodesis. Clinical trial indentification: trial protocol number (NIH or European equivalent) is UMIN000006868. The release data is 10/12/2011. Legal entity responsible for the study: North East Japan Study Group Funding: None Disclosure: Y. Hosomi: Research funding from Chugai, MSD, Boheringer and Astrazeneca, H. Okamoto: Reserch funding from Chugai MSD Taiho AstraZeneca, Merck, Eli Lilly, Bristol and Astellas. K. Hagiwara: Patents, Royalties from LSI Medience, K. Kubota: Research funding from Chugai, Astrazeneca, Bheringer and Lilly. A. Gemma: Research fundung from Astrazeneca, Taiho, Chugai, MSD, Lilly and Bheringer. All other authors have declared no conflicts of interest.

Phase II study of efficacy of bevacizumab plus chemotherapy in management of malignant pleural effusion (MPE) in non-squamous non-small cell lung cancer (NSCLC) patients with MPE unsuccessfully controlled by tube drainage or pleurodesis (North East Japan Study Group Trial NEJ-013B-2).

e21660 Background: Prospective and retrospective studies on intrapleural therapy of malignant pleural effusion (MPE) have reported that the success rate for controlling pleural effusion was 50–70% at 2.5 months, and that the median post-pleurodesis survival time was 6-9 months. When pleurodesis is unsuccessful, and the lung is not fully expanded after drainage, the patients cannot receive effective chemotherapy. Vascular endothelial growth factor (VEGF) plays a pivotal role in the pathogenesis of MPE. Here, a multicenter phase II trial was conducted to evaluate bevacizumab therapy in non-squamous non-small cell lung carcinoma patients with unsuccessful management of MPE. Methods: Non-squamous NSCLC patients with MPE who had received unsuccessful tube drainage or pleurodesis received chemotherapy with bevacizumab (15 mg/kg) every 3 weeks. The primary endpoint was Pleural effusion control rate (PECR), defined as the percentage of patients without reaccumulation of MPE for 8 weeks. The secondary endpoint was pleural Progression-free survival (PPFS), defined as PFS without reaccumulation of MPE. Results: Fifteen of 20 patients entered received a median of 4 cycles of carboplatin plus paclitaxel or pemetrexed including maintenance therapy with bevacizumab. The PECR was 80% of treated patients (95% CI: 78-82%). PPFS was 16.6 months (95% CI: 11.46-21.80 months). The response rate (RR) and disease control rate (DCR) were 45% (95% CI: 39.6-50.4%), and 80% (95% CI: 78.0-82.0 %), respectively, and the median PFS and overall survival (OS) were 9.8 months (95% CI: 4.38-15.28 months) and 19.6 months (95% CI: 4.38-15.28 months), respectively. Toxicities of grade ≥3 included neutropenia (50.0%), thrombocytopenia (10.0%), proteinuria (10.0%), hypertension (2.0%), pulmonary embolism (5%). Conclusions: The combination of bevacizumab with chemotherapy demonstrated efficacy with acceptable toxicities in controlling MPE in patients with non-squamous NSCLC whose MPE was unsuccessfully controlled by tube drainage or pleurodesis.

Variation in the Use of Splenectomy for Splenic Lymphomas: Analysis of the National Cancer Data Base

Introduction: Splenectomy has been a historically important diagnostic and therapeutic modality for splenic lymphomas, but with the advent of sensitive diagnostic tools and efficacious immunochemotherapy, its role has diminished. Our objective was to describe trends in the use of splenectomy for management of splenic lymphomas, and to determine the association of practice setting with choice of surgical treatment. Methods: Using the National Cancer Data Base (NCDB), a nationwide registry capturing &gt;80% of lymphomas in the United States, we selected non-Hodgkin lymphoma cases diagnosed in 2004-2013, with spleen recorded as the primary site. We identified the use of splenectomy and chemotherapy as part of the initial treatment. Splenectomy was assumed to be diagnostic when it was coincident with lymphoma diagnosis (0 days from diagnosis to surgery). Treatment facilities were designated by the NCDB as community, comprehensive community, academic/research, or integrated network cancer programs, depending on case volume and available services. We studied factors associated with the use of splenectomy in a multilevel mixed-effects logistic model (with random intercepts for each geographic region and each facility within it), reporting odds ratios (OR) and intraclass correlation (ICC) with 95% confidence intervals (CI). Linearized trends from log-binomial regression were expressed as average annual percent change (APC) in the proportion of patients (pts) undergoing splenectomy. Results: Among 6,504 of pts with splenic lymphomas, 48% were classified as splenic marginal zone (SMZL), 28% as diffuse large B-cell (DLBCL), 4% as mantle cell (MCL), 5% as follicular (FL), 4% as T-cell lymphoma (TCL, 52% being hepatosplenic γd-TCL), and 11% were other or unspecified histologies. Overall, 58% of pts underwent any splenectomy, and 33% a diagnostic splenectomy, but these proportions significantly varied by histology (χ2P&lt;.0001, Table). After a diagnostic splenectomy, 31% of DLBCL and 47% of MCL pts did not receive chemotherapy. Between 2004 and 2013, the proportion undergoing splenectomy significantly decreased for most histologies (Figure). This trend was most pronounced in SMZL (APC, -7.7%; Table), and MCL (APC, -8.4%), and it was paralleled by a significant increase in the use of chemotherapy for management of SMZL and TCL. Mortality at 30 days after splenectomy was 4% overall, varying from &lt;2% in SMZL/MCL/FL, 6% in DLBCL, to 10% in TCL (χ2P&lt;.0001). The proportion of pts undergoing splenectomy differed significantly according to type of treating hospital only in SMZL, where it was 39% for pts treated in "community", 52% in "comprehensive community", 50% in "academic/research", and 44% in "integrated network" centers (χ2P=.0004). In contrast, facility type was not associated with splenectomy use in DLBCL (P=.47), MCL (P=.55), FL (P=.75), or TCL (P=.15). The proportion of splenectomies performed for diagnosis was significantly lower in academic (51%) than in community (62%), comprehensive community (59%), or integrated network centers (60%, χ2P&lt;.0001) In a multivariable model in treated SMZL pts, those who had advanced-stage lymphoma or B symptoms, and those who were older, male, without comorbidities, with Medicaid, or with no insurance were significantly less likely to undergo splenectomy. There was evidence of significant clustering of treatment selection in each hospital (ICC, 24%; CI, 17-32%), but not in geographical regions (ICC, 2%; CI, 0.2-9.5%). Compared with academic/research centers, splenectomy was performed less frequently in smaller community centers (adjusted OR, 0.59; CI, 0.38-0.93, P=.022), but not in larger comprehensive community centers (OR, 0.97; CI, 0.72-1.32, P=.86). Conclusions: Although the use of splenectomy for management of splenic lymphomas has declined, nearly half of pts with splenic DLBCL, FL, or TCL still undergo surgery for diagnosis, highlighting the ongoing need for reliable, non-invasive diagnostic modalities. A substantial proportion of pts with DLBCL and MCL do not receive chemotherapy after surgery. Further research should elucidate the reasons for it, and associated outcomes in those groups. In SMZL, the use of splenectomy is facility-dependent after adjusting for patient- and lymphoma-related characteristics, with lower rate of splenectomy in smaller community centers, possibly reflecting availability of surgical expertise. Disclosures Olszewski: TG Therapeutics: Research Funding; Genentech: Research Funding; Bristol-Myers Squibb: Consultancy.

Role of Cpis And Crp In Determination The Efficacy of Chemotherapy In Management of Enterobacter Nosocomia Pneumonia

Patients in intensive care unit (ICU) are at risk for death not only from their critical illness but also from secondary processes such as nosocomial infection. Pneumonia is the second most common nosocomial infection in critically ill patients. The present study was conducted to evaluate the role of the clinical pulmonary infection score (CPIS) and C-reactive protein (CRP) in measurement the efficacy of antibiotic therapy against nosocomial enterobacter pneumonia. After approval of the study by the Research Ethics Committee, 200 patients with manifestation of pneumonia as assessed at the onset of ICU administration by calculation the CPIS and daily by CRP detection during the first 8 days of intubation. According to the culture and sensitivity, 48 patients were positive for enterobacteraerogens, 34 patients from the 48 were sensitive to amikacin and levofloxacin. So, firstly we began with amikacin and noticed that only sixteen patients were respond. On the other hand addition of levofloxacin to amikacin on the fourth day to treat the remaining patients showed complete recovery of the patients as reported by CPIS and CRP. There is a significant change in both CPIS and CRP in first day versus fourth day in 16 patients that responded to single antibiotics amikacin, however, the remaining 18 patients not response to single antibiotic. On the other hand, adding other antibiotic (levofloxacin) for the remaining eighteen patients showed a significant changes in both CPIS and CRP in fifth day versus ninth day It can be concluded that CPIS and CRP play an important role in determination the efficacy of antibiotics that used in treatment in nosocomial Pneumonia.

The impact of patient centered communication in managing Gardner′s syndrome

Effective patient communication and comprehension are fundamental toward empowering the patient to make optimal health decisions. Barriers in patient health literacy extend beyond cultural and language differences and can significantly impede this process. This case report illustrates a major communication gap that resulted in contradictory perceptions between a treating oncologist and a patient. The patient's dentist was able to resolve this miscommunication and facilitate the patient's acceptance of the recommended intravenous chemotherapy for management of malignant desmoid tumors occurring secondary to Gardner's syndrome (GS). This report also documents classic craniofacial manifestations of GS including multiple unerupted supernumerary teeth, compound odontomas associated with a dentigerous cyst, as well as multiple osteomas in both arches and in the ethmoid and irregularly shaped radioopacities in both arches. In summary, effective patient-centered communication is a prerequisite for the optimal delivery of healthcare. Both interdisciplinary care and one-on-one patient-provider relationship center on coherent bidirectional communication.