Medical Oncology Clinic Research Articles

Incidence of hypomagnesemia in patients with HER2+ breast cancer treated with pertuzumab.

e12569 Background: Breast cancer is the most common cancer diagnosed in women. HER2 gene amplification/protein overexpression is seen in about 20% of breast cancer cases. Pertuzumab (P), an EGFR inhibitor, is a monoclonal antibody administered with Trastuzumab in the treatment of HER2-positive breast cancer. Breast oncologists across multiple institutions have noted hypomagnesemia in patients receiving P-containing regimens. Retrospective data from Memorial Sloan Kettering Cancer Center and University of Florida Health have reported the incidence of hypomagnesemia in patients treated with P neoadjuvantly (8/90 and 7/25, respectively). Cetuximab and Panitumumab, also EGFR inhibitors, are well known to cause hypomagnesemia. Hypomagnesemia can be clinically associated with convulsions, atrial tachycardias, hypocalcemia and hypokalemia. This prospective study details the incidence, severity, and timeline of hypomagnesemia in HER2-positive breast cancer patients treated with P. Methods: 27 eligible patients were identified at two institutions through medical oncology clinic visits and weekly tumor board screenings. Inclusion criteria was HER2+ breast cancer patients initiating treatment with P. Patients receiving platinum agents were excluded (8/27). Following informed consent, magnesium levels were obtained along with standard of care comprehensive metabolic panels at the first four P infusions (19/27). Results: A one-sample binomial test was used to compare the proportion of hypomagnesemia at 3 months among subjects who receive P with 2% (historical control). Results demonstrated that only one patient developed a magnesium level below normal range, resulting in no significant difference with historical control (P = 0.291) This patient’s magnesium level was low at baseline and did not significantly improve or worsen throughout treatment with P. Conclusions: There was no significant incidence of hypomagnesemia noted in HER2+ breast cancer patients treated with P. This emphasizes the safety of P in patient populations prone to developing hypomagnesemia such as those receiving concurrent Carboplatin. Our results do not indicate clinical monitoring of hypomagnesemia is necessary for patients receiving P. [Table: see text]

Characteristics and clinical outcome of BRCA germline mutation carriers with advanced breast cancer treated with PARP (poly ADP-ribose polymerase) inhibitors: A single institution experience.

10587 Background: About 5-10% of breast cancers (BC) are related to germline BRCA 1/2 pathogenic variants (PV). Several studies have demonstrated the effectiveness of PARP inhibitors (PARPi) in this population. However, BC patients with BRCA PVs remain a challenge to treat. In this report, we aim to characterize the clinical characteristics and outcome of a single institution cohort of advanced BC patients with a BRCA PV and who received PARPi therapy. Methods: Patients with BRCA 1/2 germline PVs who presented to the University of Texas MD Anderson Cancer Center Breast Medical Oncology clinics and were treated with PARPi between 2008-2022 as part of their treatment for metastatic or recurrent disease were included in the analysis. Variables included in this analysis included age at diagnosis, family history of BC and ovarian cancer, treatment details, tumor characteristics including histological type, receptor status and clinical outcome. Descriptive statistics, the Kaplan-Meier method, and The Cox proportional hazards regression model were used to report patient characteristics and outcomes. Progression free survival (PFS) was defined as the time from treatment initiation of PARPi to disease progression or death. Overall survival (OS) was defined as the time from treatment initiation of PARPi to death of any cause. Results: One hundred and seven patients were treated with PARPi. Median age at diagnosis was 38 years (23-73). Forty-eight (44.9%) and 59 (55.1%) patients had BRCA1 and BRCA2 mutations, respectively. Ninety-seven (90.7%) had invasive ductal carcinoma and 42 (39.3%) had triple negative BC. Nineteen (17.8%) patients were de novo metastatic BC (Stage IV). Sixty-two (57.9%) patients received one or more prior lines of chemotherapy before being treated with PARPi; 24 (22.4%) patients received prior platinum. In 91 patients evaluable for clinical response, the overall response rate (ORR) was 59.4% and the duration of response (DoR) was 7 months (2.1-96.2). In platinum-naïve patients ORR was 70.4% and DoR 7.4 months (2.1-96.2). Median PFS was 8.9 months (95% CI 6.3-10.3) and median OS 25.8 mo (95% CI 18.3-30.9). In univariate analysis, first-line PARPi use (p = 0.0274) and no previous use of platinum (p = 0.0121) were statistically significant for better PFS. Hormone receptor positive BC (p = 0.0105) was statistically significant for better OS. Conclusions: In this real-world single institution cohort of advanced BC patients with BRCA germline PVs who were treated with PARPi, the ORR and outcome of patients is similar to those reported in the previous clinical trials. Platinum naïve and patients who received PARPi as 1st line therapy had a better ORR. Further studies of predictive markers of response and resistance as well as sequencing with platinums are needed to optimize the use of PARPi in this patient population.

Disparities in medical oncology visit adherence among African American (AA) men with prostate cancer (pCa).

e18671 Background: AA patients (pts) with pCa tend to have worse outcomes when compared to Caucasians. Disparities in access to healthcare among AA pts with pCa is a significant barrier to improvement in outcomes. Medical oncology visit attendance among this population has not been thoroughly investigated. Methods: Pts with a diagnosis (dx) of pCa scheduled to see a provider (MD or advanced practice provider) at a single academic institution medical oncology clinic between January 2022 and December 2022 were retrospectively identified. Pts were categorized by self-identified race. The total number of scheduled clinic visits was recorded, and each visit was categorized by visit status; completed, cancelled, no-show, or left clinic. The reason for visit cancellation was assessed and cancelled visits for non-pt driven reasons (ie. scheduling error) were removed. The data were summarized using descriptive statistics. Z-test and Chi-square analysis were utilized to compare proportions of visits between AA and Caucasian pts and the association of race with visit status. Results: A total of 992 pts were selected, 80% (n = 792) were Caucasian and 16% (n = 162) were AA, representing 4231 clinic visits during the study period. AA pts accounted 18% (n = 763) of the total scheduled visits. 94% of visits (n = 3962) were follow up and 6% (n = 269) were new pt visits. 86% of all scheduled visits were completed and 10 % (n = 436) were cancelled for pt driven reasons. Roughly 3% (n = 135) of visits were no-show. AA pts had fewer completed visits compared to Caucasian pts, 78% vs 88% (p < 0.001) and a higher no-show rate of 10% vs 1.5% (p < 0.001). The cancellation rate was similar between AA and Caucasian pts, 11% vs 10% (p = 0.33). The combined no-show and cancellation rate for AA pts was 22% vs 12% for Caucasian pts (p < 0.001). There was a significant association between AA race and no-show visit status (p < 0.001). Conclusions: AA men with pCa have much poorer visit adherence to scheduled medical oncology visits compared to their Caucasian counterparts. Identifying reasons for no-show and visit cancellations and targeted interventions to improve access to care are needed to improve outcomes. [Table: see text]

Ask Questions (ASQ): Implementation of a question prompt list communication intervention in a network of outpatient medical oncology clinics.

e24185 Background: High-quality, patient-centered communication is not experienced equitably across patient populations, likely contributing to healthcare disparities. Question Prompt Lists (QPL) improve patient active participation and other aspects of patient-physician communication in diverse populations and settings. This descriptive, single-arm study assessed the implementation and patient perceptions of a previously-developed, evidence-based QPL, the ASQ brochure, across a network of oncology clinics providing care in a diverse population across Michigan. Methods: The QPL was revised in collaboration with community and physician stakeholders. Implementation was assessed through the reach, adoption, and efficacy domains of the RE-AIM framework. Eligible patients had a cancer diagnosis and were scheduled for a first appointment with an oncologist at any of eight participating clinics. All participants received the ASQ brochure and completed three surveys: one at baseline, one immediately before their appointment, and one following their appointment. Surveys assessed sociodemographic characteristics; communication-related outcomes (knowledge, self-efficacy in interacting with physicians, trust in physicians, distress); and perceptions of the ASQ brochure. Analyses included descriptive statistics and univariable and multivariable linear mixed-effects models. Results: Reach: A total of 81 patients participated with a consent rate of 68.3%. Self-identified racial/ethnic groups were representative of the population served by the clinic network (72.4% white, 21.0% black, 3.7% American Indian/Native Alaskan, and 1.2% Mexican/Hispanic). Adoption: All eight invited clinics participated and recruited patients. Efficacy: All outcomes improved significantly, with no significant differences by clinic site or patient race. Patient perceptions of the ASQ brochure were overwhelmingly positive. Conclusions: The implementation of the ASQ brochure was successful in this oncology clinic network providing care to a diverse patient population. Findings suggest this simple, evidence-based communication intervention should be implemented widely in similar clinical contexts.

Abstract 87: Time From Symptom Development to Care Milestones at the Only Public Oncology Clinic in Belize

Abstract Purpose: Belize is a middle-income Caribbean country with a fragmented healthcare system. In 2018, the first and only public medical oncology clinic was opened through a capacity building partnership with the Ministry of Health. Little is known about the country’s referral infrastructure for cancer. Here we report on the stage at presentation to the clinic, and the time from symptom development to various care milestones (biopsy, oncology clinic visit, chemo, upfront surgery), referred to as time-to-care, to establish a base timeline. Methods: We performed a retrospective review of available data at the Karl Heusner Memorial Hospital (KHMH) oncology clinic from 2018 - 2022, gathering cancer type, stage, and the dates of care milestones (biopsy, initial clinic visit, chemo, upfront surgery). Date of symptom development was consistently documented by the treating physician (RY). Results: The most common presenting malignancies (n=465) were breast (28%), cervical (12%), hematologic (8%), and colorectal (7%). For staged patients (n=352), the most common presentations were stage III (28%) and IV (40%). For time-to-care, patients with available data (n=208) were seen for an initial oncology clinic visit a median of 180 days (IQR 87-382) after self-reported symptom development. For time-to-chemo at any site (ex. Belize, Mexico, Guatemala), the median was 189 days (IQR 108-404). For upfront surgery at any site the median was 188 days (IQR 60-352). In contrast to these long lead times, once established at the KHMH clinic, the time from the initial oncology clinic visit to a biopsy (if not done previously) was 22 days (IQR 11-47, n=42), 18 days (IQR 5-60, n=115) to begin chemo, and 40 days (IQR 24-72, n=22) to surgery. Conclusion: Patients were seen at the KHMH oncology clinic with predominantly late stage disease around six months after symptoms started. This is a higher fraction of stage III/IV disease than previously reported in Central America. Understanding drivers of these delays will allow for the creation of targeted public health interventions. As a marker that building infrastructure in Belize is possible, the partnership between the Belizean government and hospital administration has netted time-to-care intervals comparable to high-income nations. Citation Format: Wayne Wong, James Dickerson, Martha Habet, Margaret Bernard, Lorna Kelly, John Lattin, Philip Garrity, Franklin Huang, Ramon Yacab. Time From Symptom Development to Care Milestones at the Only Public Oncology Clinic in Belize [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 87.

Outcomes for immuno-chemotherapy based treatment in patients with poorly differentiated extrapulmonary neuroendocrine carcinoma.

e14619 Background: Extrapulmonary neuroendocrine carcinoma (EP-NEC) represents a rare collection of neuroendocrine cancers characterized with a poor prognosis and modest treatment benefit similar to small cell lung carcinoma (SCLC). Platinum-based chemotherapy (cisplatin or carboplatin) and etoposide is the preferred 1st line therapy for patients (pts) with metastatic EP-NEC who are not eligible for curative surgery (Frizziero et al. 2019). Studies in pts with advanced SCLC have shown improved progression free survival (PFS) and overall survival (OS) with the addition of atezolizumab, an anti-PD-L1 monoclonal antibody, to induction chemotherapy (4 cycles) versus chemotherapy alone (Horn et al. 2018). Prospective trials investigating immune checkpoint inhibitors such as atezolizumab plus chemotherapy have yet to be published in EP-NEC. Methods: We retrospectively reviewed all registered pts at the Gastrointestinal Medical Oncology Clinic at Banner-University of Arizona Cancer Center who received at least 1 dose of atezolizumab from 1/2017 through 3/2022 (UAIRB00001593). Criteria for pt selection for analysis was based on the following: pts diagnosed with grade III, Ki 67>20%, poorly differentiated, metastatic EP-NEC and treated with ≥ 1 dose of atezolizumab plus chemotherapy as 1st line treatment. Results: Ten pts received atezolizumab based therapy during this timeframe. 6 pts met criteria for analysis and 4 pts were excluded for alternative diagnoses. 4 pts were female, 2 pts were male, and the average age at diagnosis was 63.8 years. The median number of chemotherapy cycles was 7.0 [4-17]. The median number of atezolizumab doses was 7.5 [6-28]. The median PFS was 7 months (95% CI 5-*). The median overall survival (mOS) was 13 months (95% CI 8-*). The mOS since starting atezolizumab was 12 months (95% CI 8-*). [*Upper bound of 95% CI cannot be determined.] Five pts (83%) demonstrated a partial response per RECISTv1.1. All pt tumors were MMR-proficient/MSI-stable and PD-L1 expression was negative in 3 pts (PD-L1 status unavailable for 3 pts). No hospitalizations related to immunotherapy or chemotherapy were observed. The most common adverse events included nausea, diarrhea and fatigue. One immune-mediated adverse event of thyroid dysfunction was observed and successfully medically managed. Conclusions: Our experience with atezolizumab plus chemotherapy for 1st line EP-NEC pts demonstrated efficacy via high response rate and survival rates above historical experience. Continuing chemotherapy beyond the induction phase until maximum clinical response demonstrated tolerability with manageable side effects. Although the scope is limited due to sample size, this data supports further investigation of this combination. There is an ongoing large, randomized, prospective trial investigating this regimen in frontline, metastatic EP-NEC pts ( NCT05058651 ).

Longitudinal variability in symptom burden for patients with prostate cancer (PC).

e17019 Background: Patients with PC often live for many years and can experience burdensome symptoms associated with PC and its treatment. The longitudinal fluctuations in symptom burden for a given individual with PC, or for groups with different PC disease states, are not well-described. We assessed self-rated performance status (PS), pain interference with daily activities, bother from sexual dysfunction, depression, and anxiety symptoms longitudinally for a cohort of patients with PC. Methods: For one year, patients with PC and ≥1 Urology or Medical Oncology clinic visit in the prior 6 months were emailed surveys every 60 days containing the ECOG PS instrument (range 0-4, higher scores = worse PS), PROMIS Pain Interference Short Form 4a (normalized range 1-5, higher scores = greater pain interference), PROMIS Sexual Bother (Male) items SFBOT 204, 205, and 206 (normalized range 1-5, higher scores = greater bother), PHQ-9 depression scale (range 0-27, score ≥10 considered positive for moderate symptoms), and GAD-7 anxiety scale (range 0-21, score ≥10 considered positive for moderate symptoms). We used chart review to obtain baseline characteristics and one-way ANOVA for comparisons. Results: For 201 enrolled patients, mean (SD) number of surveys completed was 5.8 (1.8) over a mean (SD) of 10.6 (3.1) months. At baseline, 50.7% had localized PC (LPC), 18.9% biochemically recurrent PC (BCR-PC), and 30.3% metastatic PC (MPC). 40.8% of patients were on androgen deprivation therapy, which was not associated with greater sexual bother (p = 0.17). Mean (SD) values for ECOG PS, pain interference, sexual bother, the PHQ-9, and the GAD-7 are shown by PC disease state (Table). For patients who completed ≥2 surveys (N = 192), mean (SD) ranges for these scales were 0.4 (0.6), 0.8 (0.9), 1.2 (0.8), 3.7 (3.3), and 2.6 (2.6), respectively. Mean range differed by PC disease state for ECOG PS (0.31 LPC vs 0.63 BCR-PC vs 0.59 MPC, p = 0.003) and pain interference (0.63 LPC vs 1.02 BCR-PC vs 0.95 MPC, p = 0.03). For patients with ≥1 positive PHQ-9 (N = 36) or GAD-7 (N = 11) screen over ≥2 surveys, a mean (SD) of 41% (30%) and 39% (33%), respectively, of their total screens were positive. Mean (SD) ranges for these patients were 8.4 (3.6) for the PHQ-9 and 8.5 (3.4) for the GAD-7 (both p < 0.001 compared with those who never screened positive). Conclusions: Patients with more advanced PC had worse PS, pain, and depression, but those with BCR-PC reported greater longitudinal fluctuations in PS and pain. Patients who screened positive for depression or anxiety only did so in ~40% of their surveys, and had greater longitudinal variability in their PHQ-9/GAD-7 scores than those who never screened positive. [Table: see text]

Ask questions (ASQ): Implementation of a question prompt list communication intervention in a network of outpatient medical oncology clinics

ObjectiveThis descriptive, single-arm study assessed the implementation and patient perceptions of an evidence-based Question Prompt List (QPL), the ASQ brochure, across a network of oncology clinics in a diverse patient population. MethodThe QPL was revised in collaboration with stakeholders. Implementation was assessed using the RE-AIM framework. Eligible patients were scheduled for a first appointment with an oncologist at any of eight participating clinics. All participants received the ASQ brochure and completed three surveys: one at baseline, one immediately before, and one following their appointment. Surveys assessed sociodemographic characteristics; communication-related outcomes (perceived knowledge, self-efficacy in interacting with physicians, trust in physicians, distress); and perceptions of the ASQ brochure. Analyses included descriptive statistics and linear mixed-effects models. ResultsReach: Participants (n = 81) represented the diverse population served by the clinic network. Efficacy: All outcomes improved significantly, with no significant differences by clinic site or patient race. Adoption: All eight invited clinics participated and recruited patients. Patient perceptions of the ASQ brochure were overwhelmingly positive. ConclusionImplementation of the ASQ brochure was successful in this oncology clinic network providing care to a diverse patient population. Practical ImplicationsThis evidence-based communication intervention can be implemented widely in similar medical contexts and populations.

Private Equity Acquisition of Oncology Clinics in the US From 2003 to 2022

This cross-sectional study examines private equity–backed acquisitions of medical and radiation oncology clinics in the US from 2003 to 2022 using financial databases and publicly available data.

Major and minor salivary gland cancers: A multicenter retrospective study.

Most of the studies on salivary gland cancers are limited for various reasons such as being single-center, small number of patients, including only major or minor SGCs, or only including epidemiological data. A total of 37 medical oncology clinics from different regions of Turkey participated in this retrospective-multicenter study. The analyzed data included clinical and demographical features, primary treatment, metastasis localizations, and treatments and includes certain pathologic features. The study included data from a total of 443 SGCs. 56.7% was in major salivary glands and 43.3% was in minor salivary glands. Distant metastasis in the major SGCs was statistically significantly more common than in the minor SGCs, locoregional recurrence was statistically significantly more common in the minor SGCs than in the major SGCs (p = 0.003). Epidemiological information, metastasis and recurrence patterns, treatment modalities, and survival analysis of the patients over 20 years of follow-up are presented.

Real-Life Data of Neoadjuvant Chemotherapy in Breast Cancer: Aegean Region Experience

Objective: The use of neoadjuvant chemotherapy (NACT) in breast cancer is increasing. The management of locally advanced breast cancer differs due to the approach of the center to which the patient applied and the approach of the following physician. From this point of view, we aimed to evaluate the real life data of our region. Methods: The study included 106 patients treated with neoadjuvant chemotherapy in the medical oncology clinic of two different university hospitals. Association between clinicopathological features and pathological complete response (pCR) were analyzed. Results: The pCR rate was higher in patients with negative hormone receptors and this difference was statistically significant (p:0.000). The rate of obtaining pCR increased as the NACT duration increased, and this increase was statistically significant. The mean NACT duration applied to the patients with pCR was 5.48 ± 0.22 months, and the mean NACT duration for those who could not obtain pCR was 5.01 ± 0.1 months (p:0.041). The recurrence rate of patients with pCR was 11.1%, while the recurrence rate of patients who could not obtain pCR was 31.6% (p:0.04). Conclusions: Pathological response to chemotherapy is an important factor in determining prognosis. There appears to be a need for new biomarkers that allow the prediction of pCR and long-term outcomes.

The Frequency Of Refeeding Hypophosphatemia Patients With Solid Organ Tumors In Medical Oncology Clinics

The Frequency Of Refeeding Hypophosphatemia Patients With Solid Organ Tumors In Medical Oncology Clinics

Local interventions for colorectal cancer metastases to liver and lung.

Colorectal cancer is a common cause of cancer-related deaths. About 1/3 of all cases present with distant metastasis, with the liver as the leading site and the lung as the most common extra-abdominal site. It was aimed to evaluate the clinical characteristics and the outcomes of colorectal cancer patients with liver or lung metastasis who had received local treatments. This is a retrospective, cross-sectional, and descriptive study. The study was performed with colorectal cancer patients that referred to the medical oncology clinic of a university hospital between December 2013 and August 2021. A total number of 122 patients who have received local treatments were included. Radiofrequency ablation was applied in 32 patients (26.2%), metastasis was surgically resected in 84 patients (68.9%), and stereotactic body radiotherapy was preferred in six patients (4.9%). At the first follow-up control after completion of local or multimodal treatment, no residual tumor was determined with radiological assessment in 88 patients (72.1%). The median progression-free survival (16.7months vs 9.7months) (p = .000) and the median overall survival (37.3months vs 25.5months) (p = .004) of these patients were significantly better than the patients with residual disease. Local interventions that are applied to highly selected patients may improve the survival of metastatic colorectal cancer patients. A close follow-up after local therapies is important to diagnose recurrent disease because repeated local interventions may be possible to achieve better outcomes.

Pilot Study Evaluating Cross-Disciplinary Educational Material to Improve Patients' Knowledge of Palliative Radiation Therapy.

Palliative radiation therapy (PRT) is underutilized, partially due to misconceptions about its risks, benefits, and indications. The objective of this pilot study was to determine if patients with metastatic cancer would gain knowledge from educational material describing PRT and perceive it as useful in their care. A one-page handout conveying information about the purpose, logistics, benefits, risks, and common indications for PRT was offered to patients undergoing treatment for incurable, metastatic solid tumors in one palliative care clinic and four medical oncology clinics. Participants read the handout, then completed a questionnaire assessing its perceived value. Seventy patients participated between June and December 2021. Sixty-five patients (93%) felt they learned from the handout (40% learned "lots"), and 69 (99%) felt the information was useful (53% "very useful"). Twenty-one patients (30%) were previously unaware that PRT can relieve symptoms, 55 (79%) were unaware that PRT can be delivered in five treatments or less, and 43 (61%) were unaware that PRT usually has few side effects. Sixteen patients (23%) felt they currently had symptoms not being treated well enough, and 34 (49%) felt they had symptoms that radiation might help with. Afterwards, most patients felt more comfortable bringing symptoms to a medical oncologist's (n = 57, 78%) or radiation oncologist's (n = 51, 70%) attention. Patient-directed educational material about PRT, provided outside of a radiation oncology department, was perceived by patients as improving their knowledge and adding value in their care, independent of prior exposure to a radiation oncologist.

127P Outcomes of advanced chordoma from dedicated sarcoma medical oncology clinic from a tertiary care center in North India

127P Outcomes of advanced chordoma from dedicated sarcoma medical oncology clinic from a tertiary care center in North India

Canada’s First Joint Oncology-Allergy Clinic: Successful Desensitization to Trastuzumab Following Severe Anaphylactic Reaction in Which Epinephrine Was Inappropriately Withheld

Recognition of anaphylaxis and differentiation from other infusion reactions in an oncology setting is imperative; epinephrine is the recommended treatment for anaphylaxis and should be administered immediately to patients in whom anaphylaxis is suspected. Trastuzumab has a potentially tremendous oncological benefit, and when hypersensitivity reactions occur, rechallenge with desensitization protocols has become more common. Oncology presents a unique situation in which repeat drug exposure after a serious adverse reaction is often warranted due to the mortality risk of untreated cancer-allergists can assist with both symptom assessment and risk mitigation. This case showcases successful desensitization in a 43-year-old female with locally advanced HER2-positive breast cancer following a severe anaphylactic reaction to trastuzumab, in which epinephrine was not administered. We report the establishment of the Medical Oncology and Allergy Clinic: Canada's first multidisciplinary clinic aimed at expediting the assessment and management of oncology patients with adverse drug reactions (including chemotherapy, contrast media, antimicrobials) and those with primary and acquired immunodeficiency. We propose this multidisciplinary clinic model as a treatment framework moving forward, with the goal of continuing first-line therapies in cancer patients who develop drug-hypersensitivity (i.e., through desensitization). This case highlights the unmet need for a multidisciplinary approach to the management of oncology patients who experience hypersensitivity reactions.

Neoadjuvant Chemotherapy Followed by Cytoreductive Surgery and HIPEC Improves Survival in Peritoneal Metastatic Gastric Cancer

Introduction: This study examined the difference in overall survival (OS) between peritoneal metastatic gastric cancer (PMGC) patients who underwent neoadjuvant chemotherapy followed by cytoreductive surgery ± hyperthermic intraperitoneal chemotherapy (CRS ± HIPEC) and those who did not have surgery but instead received palliative chemotherapy. Methods: This retrospective study included 80 patients who were followed up with the diagnosis of PMGC, those undergoing neoadjuvant chemotherapy followed by CRS ± HIPEC (CRS ± HIPEC group) and those receiving chemotherapy only (non-surgical group), in the medical oncology clinic between April 2011 and December 2021. Clinicopathological features, treatments, and OS of the patients were compared. Results: There were 32 patients in the SRC CRS ± HIPEC group and 48 in the non-surgical group. In the CRS ± HIPEC group, CRS + HIPEC was performed on 20 patients, and only CRS was performed on 12 patients. All of the patients who underwent CRS + HIPEC, and 5 of the patients who underwent only CRS received neoadjuvant chemotherapy. While the median OS was 19.7 (15.5–23.8) months in the CRS ± HIPEC group, the median OS was 6.8 (3.5–10.2) months in the non-surgical group (p < 0.001). Conclusion: As a result, CRS + HIPEC significantly improves survival in PMGC patients. With experienced surgical centres and appropriate patient selection, the life expectancy of patients with PM can be extended.

The role of claudin 18.2 and HER-2 in pancreatic cancer outcomes.

To examine the prognostic value of claudin 18.2 (CLDN18.2) and human epidermal growth factor receptor-2 (HER-2) expression in patients with resected pancreatic ductal adenocarcinoma (PDAC). This study enrolled patients who underwent surgery and were diagnosed with PDAC at Suleyman Demirel University Hospital, Turkey between 2015 and 2019. Sixty-eight patients with resected PDAC treated at a medical oncology clinic were assessed. All patients were over the age of 18 years, underwent follow-up and treatment in our unit, and had pathology slides that we could access. Clinicopathological data were obtained from medical files, including the patients' age, sex, pathological parameters, and clinical stage according to the Eighth International Union against Cancer/American Joint Committee on Cancer. Patient survival and the period from the date of diagnosis to death were assessed in the follow-up data. There was no statistically significant difference between CLDN18.2 and HER-2 expression scores for samples and patient clinicopathological characteristics. No HER-2 expression scores of ≥2 were found in the samples. Only 25% (n = 17) of the samples had HER-2 expression scores of +1. CLDN18.2 expression was detected in 54.4% (n = 37) of the patient samples. CLDN18.2 expression scores were +1 in 30.8% (n = 21) of the patient samples, +2 in 16.2% (n = 11), and +3 in 7.4% (n = 5). When CLDN18.2 and HER-2 expression were compared, a statistically significant difference and moderate positive correlation were observed. No significant relationship between HER-2 expression and survival was observed in the survival analysis of PDAC patients; however, high CLDN18.2 expression was related to longer overall survival. Our study is the third to research CLDN18.2 expression in PDAC. HER-2 expression is low and CLDN18.2 expression is high in patients with PDAC. HER-2 expression is not related to overall survival but CLDN18.2 is related and may be used as a prognostic marker in patients with PDAC.

Psychosocial well-being among patients with malignant pleural mesothelioma.

The investigators conducted a psychosocial needs assessment of mesothelioma patients through self-report measures of quality of life (QOL), coping, depression, and social support. Patients with malignant pleural mesothelioma (MPM) (N=67) completed a battery of assessments at a single timepoint after being approached during routine medical oncology clinic appointments or by letter. Participants were predominately male (70.0%; n=47) and ranged in age from 35 to 83years old (M=65.61, SD=9.71). Most participants were white (88.0%; n=59), and 10.0% (n=7) were identified as Hispanic. The majority were married or living with a partner (93.0%; n=62) and had some college or more education (64.0%; n=43). Fourteen percent of participants (n=11) endorsed significantly elevated depression symptoms. No significant demographic or clinical differences in depressed compared to nondepressed participants were observed, with a trend toward those identifying as Hispanic and those who were divorced as being more likely to be depressed. For the total sample, the most frequently endorsed coping strategies were active coping, emotional support, and acceptance. The present study did not identify any clear correlates of depression or QOL among patients with MPM. This research contributes to the small literature on psychosocial functioning in patients with MPM and provides putative directions for future larger studies and the development of interventions to provide appropriate support to diverse patients with MPM.

Neoadjuvant Therapy and Factors Influencing Survival in Locally Advanced Non-Small Cell Lung Cancer.

We aimed to investigatethe effectiveness of neoadjuvant therapy (NAT) and clinicopathological characteristics in locally advanced non-small cell lung cancer (NSCLC) (IIIA-IIIB), as well as the influence of the post-NATtreatment modalities on survival. This study included patients who presented to the Dicle University Medical Oncology Clinic and received NAT for a diagnosis of locally advanced NSCLC between 2004 and 2020. Clinicopathological and radiological data of the 57 patients whose data could be retrieved from the hospital archive system were retrospectively reviewed. Patients' overall survival (OS) and failure-free survival (FFS) times and the factors influencing these times were evaluated. This study included a total of 57 patients consisting of five (8.8%) females and 52 (91.2%) males. The median patient age at diagnosis was 58 (30-75) years. All patients had received four courses of chemotherapy during the neoadjuvant period. When the factors influencing OS were evaluated, the post-NAT modality was found to have a statistically significant effect on survival. FFS times were 12, 13, and 16 months in the chemotherapy, chemoradiotherapy, and surgery arms, respectively (log-rank p=0.035). FFS was longer in those who underwent surgery (Hazard ratio (HR): 0.33, 95 % CI: 0.14-0.77, (p=0.01)). OS times were 20, 21, and 55 months in the chemotherapy, chemoradiotherapy, and surgery arms, respectively (log-rank p=0.05). OS was longer in the arm undergoing surgery compared to the other arms (HR: 0.36, 95% CI: 0.14-0.87, (p=0.02)). Five-year survival rates for the chemotherapy, chemoradiotherapy, and surgery arms were 14.3%, 21.4%, and 40%, respectively. This study shows that achieving an operable status is the most important indicator of survival and that patients undergoing surgery have a marked advantage in OS and FFS compared with patients receiving chemoradiotherapy or palliative chemotherapy.