Number Of Chemotherapy Cycles Research Articles

Treatment Toxicities, Response to Treatment and Overall Survival of Cervical Cancer in Women with and without HIV in Botswana: Ipabalele Study U54 CA190158-01

<h3>Purpose/Objective(s)</h3> Cervical cancer is the leading cause of cancer death among women in Botswana. It is well established that persistent human papillomavirus (HPV) infection is the primary risk factor for cervical cancer and that co-infection with human immunodeficiency virus (HIV) further increases the risk for cancer development. Standard of care for locally advanced disease is treatment with chemoradiation (CRT). This study aimed to characterize toxicities, response to treatment, and survival in patients with cervical cancer in Botswana. <h3>Materials/Methods</h3> Patients with histologically confirmed locally advanced cervical cancer eligible for CRT were prospectively enrolled between Jan 2015 and June 2019 to the <i>Ipabalele</i> study in Gaborone, Botswana. Clinical and treatment characteristics, on-treatment toxicities, and treatment response of patients were recorded. Biochemical response to treatment was characterized using SCC-Ag level <2.2ng/ml at the end of treatment and 3 months post treatment. Toxicities were measured during on treatment visits (OTVs) and evaluated using CTCAE 4.0 grading. All patients were followed every 3 months for 2 years. <h3>Results</h3> Of 293 women diagnosed with cervical cancer, 73.7% (n=216) were women living with HIV (WLWH). The mean age of diagnosis for cervical cancer was younger in WLWH vs those without HIV (44.9 vs. 47.5, p<0.001). There was no difference in stage at presentation by HIV status, with the most common stage at presentation among both populations as Stage II (46.3% WLWH, 58.84% without HIV, p=0.349). Median CD4 count among WLWH was 467 cells/μL. WLWH had a lower external beam radiation dose (45.76 Gy) compared to women living without HIV (47.09 Gy), p=0.002; however, HIV status did not impact total EQD2 (median 85.7 Gy). HIV status did not impact number of chemotherapy cycles received (median 4 cycles). Seventy three percent (n=106) of all patients had a complete response to treatment by clinical exam and imaging, 65% (n=82) of all patients had a complete response to treatment by SCC-Ag. HIV status did not impact response to treatment by either SCC-Ag or clinical evidence (p=0.718). Two-year overall survival (OS) probability for the cohort was 77.7%. There was no difference in survival by HIV status (OS 75.8% in WLWH; 82.05% in those without HIV, p=0.31). Treatment response by SCC-Ag was associated with OS. Factors associated with OS in a multivariate analysis included cycles of chemotherapy given and stage at presentation. HIV was not significantly related to overall survival. The most common Grade2+ toxicities included anemia (42.8%, n=125), leukopenia (34.6%, n=101), and radiation dermatitis (39.9%, n=101). Importantly, HIV did not impact prevalence of any of the toxicities measured. <h3>Conclusion</h3> HIV status impacted age of diagnosis of cervical cancer; however, did not impact stage, treatment received for cervical cancer, or OS. There was no difference seen in chemoradiation associated toxicities of treatment for locally advanced cervical cancer by HIV status.

Racial Disparities in Patients with Stage IIIC Endometrial Cancer

<h3>Purpose/Objective(s)</h3> To report the impact of race on clinical outcomes in patients with stage IIIC endometrial carcinoma (EC). <h3>Materials/Methods</h3> A retrospective multi-institutional cohort study was conducted across 13 Northern American academic centers and included patients with stage IIIC endometrial carcinoma (EC) who received both chemotherapy and radiation in an adjuvant setting. Overall survival (OS) and recurrence-free survival (RFS) were calculated by Kaplan-Meier method. Univariable and multivariable analysis were performed by Cox proportional hazard models for RFS/OS. Propensity score matching was used to estimate the effect of race on survival outcomes. Statistical analyses were conducted using statistical software. <h3>Results</h3> A total of 90 Black and 568 non-Black patients (83%) were identified with a median age at diagnosis of 62 (Interquartile Range (IQR) 55-70). Median follow-up was 45.3 months (IQR 24-71 months). Black patients were significantly older (p<0.0001), had significantly more non-endometrioid histology (p<0.0001), grade 3 tumors (p<0.0001) and were more likely to have >1 positive paraaortic lymph nodes (PALN) compared to non-black patients. The presence of lymphovascular space invasion (LVSI), depth of myometrial involvement, number of total nodes involved, adnexal and cervical involvement and stage were not correlated with race (all p>0.1). As for treatment type, chemoradiotherapy sequencing approach was not correlated with race and no difference in number of chemotherapy cycles between Black and non-Black patients (p=0.32) was observed. Black patients were more often treated with external beam radiation therapy (EBRT) (43.3% and 24%, respectively) while a higher proportion of non-black patients received both EBRT and vaginal cuff brachytherapy (VBT) (65% vs. 38 %) (P<0.0001) despite similar cervical involvement. The 5-year estimated OS and RFS rates were 45% and 47% compared to 77% and 68% for Black patients vs. non-black patients, respectively (p<0.001). After propensity score matching, the 2 groups were well balanced for most of the covariates (age, histology, stage, grade, number of positive PALN, adnexal and cervical involvement) except for depth of myometrial invasion and radiation type. The estimated hazard ratios (HRs) of Black vs. non-Black patients were 1.613 (95% CI = (1.01, 2.575), p-value = 0.045) for OS and 1.487 (95% CI = (0.906, 2.440), p-value = 0.116) for RFS, indicating that Black patients have significantly worse OS. RFS differences did not reach statistical significance. <h3>Conclusion</h3> Compared to non-Black patients, Black patients have higher rates of non-endometrioid histology, grade 3 tumors and number of PALNs. After propensity score matching, Black patients had worse OS but no statistically significant difference in RFS. Racial disparities could be mitigated by better access to care, equitable inclusion on randomized trials, and identification of genomic/molecular differences to better tailor adjuvant treatment.

Treatment Strategies for Limited-Stage Primary Small Cell Carcinoma of the Esophagus: A Multicenter Retrospective Trial from China

<h3>Purpose/Objective(s)</h3> Primary small cell carcinoma of the esophagus (PSCCE) is a rare and highly malignant disease that carries a poor prognosis. The optimal treatment strategies for limited-stage PSCCE have not been established. <h3>Materials/Methods</h3> We retrospectively reviewed the clinical records of limited-stage PSCCE patients who received chemotherapy (CT) or chemotherapy-based combined modality therapy (CMT) between December 2000 and December 2020 from the 15 hospitals in China. Patients were divided into the following two groups according to the treatment strategies: the CT group and the CMT group. A 1:3 propensity score matching (PSM) approach was applied to balance observable potential confounding factors between the two groups. The primary endpoint was overall survival (OS). <h3>Results</h3> A total of 544 patients were enrolled in our study, including 84 patients in the CT group and 460 patients in the CMT group. Univariate analysis and multivariate analysis found that Eastern Cooperative Oncology Group classification, primary tumor length, TNM stage, number of chemotherapy cycles, and treatment strategies were the independent predictors of OS. The 3-year rate of brain metastasis was 11.1% in the CMT group. After PSM, the patients' characteristics between the CT group (n=82) and the CMT group (n=218) were well balanced. The median OS in the CT and CMT group was 17.34 and 24.60 months, respectively, and the difference was statistically significant (<i>P</i> < 0.001). Moreover, progression-free survival (PFS), locoregional PFS, and distant PFS were also significantly different between the two groups (<i>P</i> < 0.05). <h3>Conclusion</h3> Compared with CT, chemotherapy-based CMT may improve OS and PFS and was the optimal treatment strategy for limited-stage PSCCE. On the other hand, prophylactic brain irradiation is not recommended.

Myocardial edema during chemotherapy for gynecologic malignancies: A cardiac magnetic resonance T2 mapping study.

ObjectiveMyocardial edema is an early manifestation of chemotherapy-related myocardial injury. In this study, we used cardiac magnetic resonance (CMR) T2 mapping to assess myocardial edema and its changes during chemotherapy for gynecologic malignancies.MethodsWe enrolled 73 patients receiving chemotherapy for gynecologic malignancies, whose the latest cycle was within one month before the beginning of this study, and 41 healthy volunteers. All participants underwent CMR imaging. Of the 73 patients, 35 completed CMR follow-up after a median interval of 6 (3.3 to 9.6) months. The CMR sequences included cardiac cine, T2 mapping, and late gadolinium enhancement.ResultsMyocardial T2 was elevated in patients who were treated with chemotherapy compared with healthy volunteers [41ms (40ms to 43ms) vs. 41ms (39ms to 41ms), P = 0.030]. During follow-up, myocardial T2 rose further [40ms (39ms to 42ms) vs. 42.70 ± 2.92ms, P < 0.001]. Multivariate analysis showed that the number of chemotherapy cycles was associated with myocardial T2 elevation (β = 0.204, P = 0.029). After adjustment for other confounders, myocardial T2 elevation was independently associated with a decrease in left ventricular mass (β = −0.186; P = 0.024).ConclusionIn patients with gynecologic malignancies, myocardial edema developed with chemotherapy cycles increase, and was associated with left ventricular mass decrease. T2 mapping allows the assessment of myocardial edema and monitoring of its change during chemotherapy.

ABCL-398 Primary Breast Diffuse Large B-Cell Lymphoma: An Indian Experience

Primary breast diffuse large B-cell lymphoma (PB-DLBCL) is a rare site of localized extranodal DLBCL. It represents 0.5% of all primary malignant neoplasms of the breast and around 2% of extranodal lymphomas. There is a paucity of data regarding the clinicopathologic characteristics, cell of origin, response, and outcome of treatment with uniform treatment protocol in patients from India diagnosed with PB-DLBCL. This was a retrospective study of 18 consecutive cases of PB-DLBCL registered at All India Institute of Medical Sciences between 2006 and 2021 treated with uniform 3x weekly cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) ±rituximab (R) with involved-field radiotherapy. The patients were classified as germinal center B-cell-like or activated B-cell (ABC) type using the Hans classification. The median age was 43 (21-67) years with a male:female ratio of 1:17. All the patients presented with a breast lump with a median tumor size of 5 cm. The right side was involved in 11 (61.1%) cases. Eight patients were diagnosed with lumpectomy, 9 patients with biopsy, and one patient with mastectomy specimen. Out of 18 patients, Ann Arbor: Stage I was seen in 6 (33.3%) patients, Stage IIE in 11 (61.1%) patients, and Stage 1V in 1 (5.5%) patient. B-symptoms and bulky disease were seen in 6 (33.3%) and 7 (38.8%) patients, respectively. Cell of origin data were available in 14 patients, and 11 (71.4%) were ABC in origin. Low- and intermediate-risk International Prognostic Index was seen in 42% and 48% of patients, respectively. The median number of chemotherapy cycles was 4 (3-6), rituximab was used in 10 (55.5%) cases, and CNS prophylaxis with intrathecal methotrexate was used in 10 (55.5%) cases. The complete response rate was 83.3%. After a median follow-up of 42 months, the 3-year progression-free survival and overall survival were 75% and 88%, respectively. The most common site of relapse (n=3) was parenchymal brain disease. Multimodality combination therapy (chemotherapy, immunotherapy, and radiation) can give good survival with PB-DLBCL but adding high-dose methotrexate to existing protocol needs further exploration.

Effect of structured interventional programme on knowledge regarding post effect of parenteral chemotherapy and its management among patients admitted in oncology units

Patients who are treated for cancer may experience difficult emotional responses, in addition to physical discomfort. Chemotherapy is associated with a number of side effects, such as nausea and vomiting, loss of appetite, mucositis, diarrhoea, infections, fatigue and emotional distress. Receiving chemotherapy treatment was perceived as difficult, and the experienced side effects negatively influenced patient’s bodies and moods. The research process for this study was guided by conceptual framework based on Kings Goal Attainment theory. A pre-experimental, One-group pre-test post-test design was undertaken for the study. The independent variable for the study was the structured interventional programme on post effect of chemotherapy and its management and the dependent variable was knowledge of patients admitted in oncology unit. The study was conducted in oncology unit of S.G.P.T. government cancer hospital, Indore. The samples for the study were the patients admitted in oncology unit and the sample size for the study were 300. Non- probability convenient sampling technique was utilized to select the sample from the population. Patients were assessed using the structured knowledge questionnaire for knowledge regarding post effect of parenteral chemotherapy and its management. After assessing knowledge Structured Interventional Programme was implemented. After intervention on 7 day the post-test knowledge was assessed. The analysis revealed that in the pre-test, 195 (65.0%) patients had obtained inadequate knowledge score, 91 (30.3%) patients had obtained moderate knowledge score and 14 (4.7%) patients had obtained adequate knowledge score. In the post-test, majority 192 (64.0%) patients had obtained adequate knowledge score, 58 (19.3%) patients had obtained moderate knowledge score and 50 (16.7%) patients had obtained inadequate knowledge score. Findings revealed that the mean pre-test knowledge score was 14.74 ± 6.03, while the post-test knowledge score was 24.69 ± 7.12.The student paired ‘t’ test value of the group was t = 33.063. The difference was found to be statistically significant (p&amp;#60;0.05), showing a significantly higher post-test knowledge in comparison to the pre-test knowledge score. It infers that the structured interventional programme on knowledge regarding post effect of parenteral chemotherapy and its management among patients were effective in improving the knowledge level of patients. Findings in present study also reveal that pre-test knowledge score statistically associated with the age, sex, marital status, educational status, occupation area, history of cancer in family of the patients, habit of the patients, number of chemotherapy cycle receiving, body system affected with cancer and the previous information about parenteral chemotherapy and its management.The study concluded that Structured Interventional Programme was effective in improving the knowledge of patients on post effect of parenteral chemotherapy and its management. The study recommended the utilization of structured interventional programme by community health nurses, nurse researchers, nurse administrators, nurse educators and health care professionals to improve knowledge of cancer patients receiving chemotherapy.

The Effectiveness of an Oral Fixed-Dose Combination of Netupitant and Palonosetron (NEPA) in Patients With Multiple Risk Factors for Chemotherapy-Induced Nausea and Vomiting: A Multicenter, Observational Indian Study.

BackgroundFemale gender, young age, first chemotherapy cycle, and low alcohol intake have all been linked to an increased risk of nausea and vomiting from chemotherapy. We intended to see if netupitant and palonosetron (NEPA) could prevent chemotherapy-induced nausea and vomiting (CINV) in patients with risk factors such as age, gender, chemotherapy cycle number, and alcohol consumption history.MethodsIn this retrospective study, chemotherapy-naïve patients who were prescribed netupitant (300 mg) and palonosetron (0.50 mg) (NEPA) before the first cycle of chemotherapy were analyzed for overall, acute, and delayed phases of complete response (CR), complete protection (CP), and control.ResultsIn the acute phase (AP), delayed phase (DP), and overall phase (OP), complete response was 88.23%, 86.27%, and 86.27%, respectively; complete protection was 80.39%, 78.43%, and 76.47%, respectively; and complete control was 76.47%, 72.54%, and 70.58%, respectively, in the whole population (i.e., 51 patients). Complete response, protection, and control in the overall phase were achieved by 86.27%, 72.72%, and 68.18% of patients who received the highly emetogenic chemotherapy (HEC) regimen (i.e., 44 patients), respectively.ConclusionNEPA provided a consistent magnitude of benefit for patients who are at high risk, receiving HEC and moderately emetogenic chemotherapy (MEC), and having good control in the acute, delayed, and overall phases of CINV.

Survival prognostic factors in unresectable/advanced primary thoracic sarcomas.

BackgroundPrimary thoracic sarcomas (PTS) including primary pulmonary and chest wall sarcomas (CWS), are aggressive lung malignancies with limited information specially in an advanced/unresectable setting. Unfortunately, prognostic factors for these malignancies are not well identified.MethodsRetrospective cohort analysis of patients diagnosed with unresectable/advanced soft tissue PTS from a third level reference institute. Univariate and multivariate analysis performed via Cox-regression model. Progression-free survival (PFS) and overall survival (OS) analysis via Kaplan-Meier method.ResultsA total of 157 patients were identified, 55.4% female, mean age 51.8 years (range, 18–90 years), 19.1% tobacco exposure and 10.8% asbestos exposure. The most common performance status was Eastern Cooperative Oncology Group (ECOG) 1 (38.9%), most common clinical presentation cough (58.4%) and thoracic pain (55.4%). Undifferentiated sarcoma (37.6%) followed by synovial sarcoma (34.4%) were the most common histologies. Most patients received five chemotherapeutic cycles (37.6%), 57.3% of patients obtained a partial response and 61.1% an overall response rate (ORR). Median PFS was 9 months [95% confidence interval (CI): 8.717–9.283 months]. The multivariable analysis identified ECOG ≥2, a poorer response to chemotherapy (less number of chemotherapy cycles) and an increase Response Evaluation Criteria in Solid Tumors (RECIST) to be associated with a shorter progression-free period. Median OS was 11 months (95% CI: 10.402–11.958 months) with an ECOG ≥2 and a poorer response to chemotherapy (less number of chemotherapy cycles) associated with a shorter survival.ConclusionsAge, gender, comorbidities, tobacco and asbestos exposure, clinical presentation and histopathological diagnosis are not useful prognostic factors in unresectable/advanced PTS, however, an adequate initial ECOG, RECIST and a better response to chemotherapy should be used as prognostic factors in the management of these tumors.

Prognostic variables and 4-year survival outcomes in CD20 Positive AIDS-Related Lymphoma in the Anti-retroviral treatment era: A Retrospective Review from a Single Centre in KwaZulu-Natal, South Africa.

To describe 4-year survival outcomes and assess the value of established and additional relevant variables to predict complete response (CR), four-year progression-free survival (PFS) and overall survival (OS) of CD20 positive AIDS-Related Lymphoma (ARL) treated with standard combination chemotherapy. We performed a retrospective review of patients diagnosed with CD20 positive ARL between 2006 and 2016. All patients over 12 years of age who received at least one cycle of combination chemotherapy with curative intent were included in the analysis. Variables assessed included the International Prognostic Index (IPI), age-adjusted-IPI, age, gender, B symptoms, extent of disease, functional performance status, CD4 cell count, viral load, concurrent ART with chemotherapy, rituximab inclusion, and number of chemotherapy cycles used. Kaplan-Meier survival curves for OS and PFS at 4 years were compared for IPI and aaIPI using the log-rank test. A Cox proportional hazards model was used to investigate the effects of prognostic variables for patients achieving OS and PFS at 4 years and logistic regression for patients achieving CR. A total of 102 patients were included in the analysis. At year four of follow-up, the OS was 50% (n = 51) and PFS was 43% (n = 44). Attaining a CR and male gender were significantly associated with improved 4-year OS (p<0.001 and p = 0.028 respectively) and PFS (p<0.001 and 0.048 respectively). A viral load of < 50 copies/ml was associated with a higher complete response rate (aOR 6.10 [95% CI 1.15, 24.04], p = 0.01). Six or more cycles of chemotherapy was superior to fewer cycles for both PFS (aHR 0.17 [95% CI 0.10, 0.29]) and OS (aHR 0.12 [95% CI 0.07, 0.22]) with p-value < 0.001 for both PFS and OS. The Kaplan-Meier survival estimates demonstrated the prognostic utility of the IPI and aaIP for OS (p = 0.002 and 0.030 respectively) and the IPI for PFS (p = 0.002). This study is a first from a high prevalence HIV area in KwaZulu-Natal, South Africa, and confirms the utility of the internationally accepted prognostic scoring systems in predicting survival in CD20 positive ARL in the local population.

Comparison of involved-field intensity-modulated radiotherapy combined with S-1 vs radiotherapy alone for elderly patients with esophageal cancer.

BACKGROUNDIt is estimated that about 30% of esophageal cancer (EC) patients are over 70 years old. Therefore, there is less evidence on the diagnosis and management of elderly EC patients. It is important to explore how elderly EC patients benefit from radical radiochemotherapy regimens, including the target area of radiotherapy (RT), radiation dose and fraction, and choice of chemotherapy drugs.AIMTo compare the efficacy of involved-field intensity-modulated RT (IF-IMRT) combined with S-1 vs RT alone in the treatment of elderly EC patients in terms of safety, short-term response, and survival.METHODSThirty-four EC patients aged > 70 years were prospectively enrolled between December 2017 and December 2019. Based on the random number table, they were divided into an IF-IMRT + S-1 group and an IF-IMRT alone group, with 17 patients in each group. All patients were treated with IF-IMRT at a dose of 50.4-56 Gy in 28-30 fractions (1.8-2 Gy/fraction, 5 fractions/wk). Oral S-1 was administered concomitantly in the IF-IMRT + S-1 group for 14 consecutive days, and a second cycle was started 7 d after drug withdrawal. After RT, 4 cycles of S-1 treatment were offered as the consolidation chemotherapy. The safety, short-term response, and survival were observed after the treatment.RESULTSAs of April 2022, these 34 patients had been followed up for 15.2-32.5 mo, with a median follow-up period of 24.5 mo. Complete efficacy indicators were obtained from all the patients. The objective response rate was 88.2% vs 76.5%, respectively, in the IF-IMRT + S-1 group and the RT alone group, where as the disease control rate was 100% vs 82.4%, respectively. The incidence of adverse events including grade 1-2 fatigue, granulocytopenia, thrombocytopenia, anemia, radiation esophagitis, radiation-induced skin injury, and radiation-induced lung injury was not significantly different between these two groups, so was the incidence of the grade 3 radiation esophagitis (0% vs 5.7%). The rate of progressive disease (PD) was 52.9% (n = 9) in the IF-IMRT + S-1 group and 64.7% (n = 11) in the RT alone group. The median progression-free survival (PFS) was 23.4 mo vs 16.3 mo, and the 2-year PFS rate was 42% vs 41.2%. The median overall survival (OS) was 27.0 mo vs 23.0 mo, and the 2-year OS rate was 58.8% vs 47.1%. Multivariate analysis showed that age was a significant prognostic factor (P = 0.0019); patients aged < 75 years had a significant survival advantage over patients aged ≥ 75 years. The locations of EC also affected the prognosis. In the IF-IMRT + S-1 group, the number of chemotherapy cycles was a significant prognostic factor (P = 0.0125), and the risk of PD was significantly lower in EC patients who had received 6 cycles of chemotherapy than those who had received 2-5 cycles of chemotherapy.CONCLUSIONCompared with IF-IMRT alone, IF-IMRT + S-1 shows the benefits of preventing PD and prolonging survival without increasing adverse reactions. Therefore, this concurrent radiochemotherapy deserves clinical application.

Investigating the effect of optimal cytoreduction in the context of platinum sensitivity in high-grade serous ovarian cancer.

The survival benefits of surgical cytoreduction in ovarian cancer are well-established. However, the surgical outcome has never been assessed while controlling for the efficacy of chemotherapy. This leaves the possibility that cytoreduction may not be beneficial for patients whose cancer does not respond well to adjuvant treatment. We sought to answer whether surgical cytoreduction independently improves overall survival when controlling for chemotherapy outcome. We performed a retrospective case-control study using our institution's ovarian cancer database to evaluate the effect of optimal cytoreduction on advanced stage, high-grade serous ovarian cancer. Patients' characteristics were compared using both univariate and multivariate regression modeling to assess for independent predictors of overall survival. A total of 470 patients were assessed for inclusion; 234 responders to chemotherapy and 98 nonresponders. Significant survival characteristics were identified and included in the multivariate analysis. Independent predictors of survival in the multivariate analysis were age, responder status, optimal cytoreduction, neoadjuvant chemotherapy, and number of chemotherapy cycles. Kaplan-Meier survival curves showed improved survival for both patients who responded to chemotherapy and for those undergoing optimal cytoreduction (p < 0.001). We also demonstrated improved survival for patients receiving optimal cytoreduction among both nonresponders and responders (p < 0.001). Our analysis shows that patients who undergo optimal cytoreduction have an overall survival benefit regardless of their response to chemotherapy. Therefore, cytoreduction should be considered in all patients, even in those with advanced disease, if an optimal result can be achieved. This study was underpowered to assess patients who received neoadjuvant chemotherapy as a separate subgroup, but the order of treatment was controlled for in the overall analysis.

A comparative study of gemcitabine and cisplatin versus oral capecitabine alone in metastatic gallbladder cancer.

There is no consensus for palliative chemotherapy regimen in metastatic gallbladder cancer. We did a retrospective study to compare the treatment outcome in patients of metastatic gallbladder cancer treated with either gemcitabine + cisplatin (regimen A) or oral capecitabine (regimen B) alone. A total of 67 patients between January 2015 and September 15 treated with either regimen A or regimen B were retrospectively evaluated. Statistical analysis was done in June 2019. Kaplan-Meir and Log rank test were used to compare survival between two arms. Out of 67 patients, 31/67 (46%) received regimen A, and 36/67 (54%) received regimen B. Male to female ratio was 1:3. About 42% patients in regimen A and 20% in regimen B required palliative stenting. Median number of chemotherapy cycles was 4 in both regimen A (range 1->6) and regimen B (range 1->6). Patients receiving 3 cycles and 6 cycles of chemotherapy in regimen A and regimen B was 68% and 31% versus 70% and 63%, respectively (P = 0.86). Response assessment as any response (complete response + partial response + disease was stable) after 3 cycles and 6 cycles was 71% and 57% (P = 0.20), 44% and 39% (P = 0.29), in regimen A and B, respectively. Median survival was 23 weeks (range 2-106 weeks) in regimen A and 15 weeks (range 4-83 weeks) in regimen B (P = 0.40). The present study shows gemcitabine and cisplatin has nonsignificant better survival compared to oral capecitabine. However, oral capecitabine is more convenient and easy to administer. Studies with larger sample size are needed to further establish the standard chemotherapy guidelines.

Küçük hücreli akciğer kanserinde tedavi sonuçları ve etki eden prognostik faktörler

Giriş ve Amaç: Küçük hücreli akciğer kanseri (KHAK) tüm akciğer kanserlerinin yaklaşık %15’ini oluşturmaktadır. Küçük hücreli akciğer kanserinde prognoz; yeni kemoterapotik ajanların kullanılması, radyoterapi (RT) tekniklerinin gelişmesi ve profilaktik kraniyal ışınlamanın (PKI) eklenmesi ile tedavi sonuçları iyileşmesine rağmen halen kötüdür. Akciğer kanserinde prognostik faktörlerin önceden belirlenmesi tedavi ve takip açısından çok önemlidir. Bu tür çalışmaların çoğu küçük hücreli dışı akciğer kanserli hastalarla yapıldığı için çalışmamızda küçük hücreli akciğer kanserli olgularımızda tedavi sonuçlarını ve prognostik faktörleri değerlendirdik. &#x0D; Gereç ve Yöntemler: Hastanemizde 2002–2017 yılları arasında tedavi edilen 123 küçük hücreli akciğer kanserli olgu değerlendirmeye alındı. Retrospektif olarak hasta dosyaları tarandı.&#x0D; Bulgular: Hastaların 102’si erkek olup, medyan yaş 61 (29-81) olarak saptandı. Başlangıçta 59 hastada kilo kaybı vardı, en sık şikayet öksürüktü. 72’si (58.5) sınırlı, 51’i (%41,5) yaygın evreydi. Tümör 68 hastada sağ taraf yerleşimliydi. 24 hastada aile öyküsü vardı. 48 hastada ek hastalık ve119’unda sigara öyküsü vardı. Radyoterapi 63 (%51,2) hastada küratif, 60 hastada palyatif olarak uygulandı. 55 hasta radyokemoterapi aldı.79 hastada kemoterapi kür sayısı 5 ve üzerinde olup,44 hastada 4 ve daha az sayıda kür uygulandı.68 hasta PKI aldı. Ortalama izlem süresi 19.2 aydı. Bir yıllık genel sağ kalım%62,2, 2 yıllık sağkalım%30,1 ve genel sağ kalım 15 ay ve progresyonsuz sağkalım %15 olarak bulunmuştur. 59 hastada lokal nüks, 47 hastada uzak metastaz gelişti. Evre, yaş, ECOG, kilo kaybı, kraniyal metastaz gelişmesi, başlangıçta başağrısı, dispne ve kemoterapi kür sayısı; genel sağ kalımda istatistiksel olarak anlamlı bulunmuştur. ECOG, kilo kaybı, cinsiyet ve KT kür sayısı progresyonsuz sağ kalımda anlamlı bulunmuştur. &#x0D; Sonuç: KHAK’nin tedavisinde önemli mesafeler alınmasına karşılık, sağ kalım oranlarında beklenen artış henüz sağlanamamaktadır. Çalışmamızda sağ kalım oranları literatürle uyumludur. PKI’nın sınırlı evrede tedaviye eklenmesi belirgin şekilde beyin metastazını azaltmaktadır. Beyin metastazsız yaygın evre hastalıkta PKI’nın tedaviye eklenmesi genel sağ kalım üzerine etkili bulunmamakla birlikte beyin metastazı gelişme süresinin uzadığı görülmüştür. Küçük hücreli akciğer kanserinde torasik radyoterapi ve PKI uygulamasıyla bir çok çalışmada sağ kalımda artış görülmüş olup, radyoterapinin rolü giderek artmaktadır. Her hasta için potansiyel fayda ve riskler başlangıç tedavisinden önce belirlenmeli ve kişiye özel tedavi planlanmalıdır.

Effect of chemotherapy induced hair-loss on distress levels among cancer patients visiting public and private hospitals of Punjab

Chemotherapy is an essential part of a multimodal strategy in the treatment of many cancers. Chemotherapy-induced hair loss is believed to affect 65 percent of people. According to the study, chemotherapy-induced hair loss has been associated to anxiety, depression, a poor body image, low self-esteem, and a decreased sense of health. Objectives: To find out chemotherapy-induced alopecia distress levels among cancer patients' in Punjab's public and private hospitals. To find out the relationship between demographic variables and chemotherapy induced alopecia distress. Methods: A cross sectional study was conducted in public and private hospitals of Punjab, over the duration of 6 months, from October 2021 to March 2022. A sample of 323 respondents with the age range 19-54 was obtained. Data collection tool was adapted version of chemotherapy-induced alopecia distress scale (CASD). Frequencies and percentages of categorical variables were reported and Chi-square test was used to find out associations. Results: High distress level was 61% (n=196) while low distress level was 39% (n=127). Majority of the sample population consisted of participants belonging to age group 18-34 (n=146, 45.2%). Most of them were male 53% (n=173). Respondents diagnosed at stage2 had low distress level (54%) as compare to respondents who were diagnosed at stage3 and stage 4. Significant association (p-value ≤0.05) was found between Gender, family income, employment status, disease stage at diagnosis, number of chemotherapy cycles received and current active treatment. Conclusion: Chemotherapy-induced alopecia distress was associated with all of five domains i.e. physical, emotional, daily activities, relationships and treatment. To reduce the suffering caused by alopecia in cancer patients, appropriate therapies must be developed.

Vitamin D status in breast cancer cases following chemotherapy: A pre and post observational study in a tertiary hospital in Yogyakarta, Indonesia.

To observe pre- and post-treatment vitamin D level and its association with treatment and concomitant factors in breast cancer patients treated with chemotherapy. We performed a pre-post observational analysis that nested in an ongoing prospective cohort study of breast cancer patients at Dr. Sardjito General Hospital, Yogyakarta, Indonesia. 136 subjects were recruited from the main study. Information on subjects' socio-demographic characteristics clinical status, and tumour profile was assessed at baseline. Number of chemotherapy cycles and chemotherapy-induced nausea vomiting (CINV) were also recorded. Vitamin D concentration was measured using ELISA methods at baseline and post-treatment. Vitamin D level of <20 ng/ml and <12 ng/ml were defined as deficiency and severe deficiency. Correlation between socio-demographic and clinical profile with baseline vitamin D was tested using Spearman correlation. Paired t-test was used to evaluate changes in post-treatment vitamin D concentration. The odds ratio for a subject to experience post-treatment vitamin D decrease was assessed based on number of chemotherapy cycles and CINV severity. The mean vitamin D level before chemotherapy was very low (8.80±3.64 ng/ml) in the whole panel. Higher AST level were associated with lower vitamin D level at baseline (r = -0.188, p = 0.028). Severe deficiency was found in 82.4% subjects at baseline and the rate increased to 89.0% after chemotherapy. Eighty-five cases showed a decrease level whereas 51 showed a slight improvement. Overall, a significant decrease of the vitamin D level was observed after chemotherapy (median change 3.13±4.03 ng/ml, p <0.001). Subjects who received >6 cycles of chemotherapy were less likely to experience a decreased level of post-treatment vitamin D (OR = 0.436, 95% CI = 0.196-0.968, p = 0.039). Indonesian breast cancer patients showed pre-existing severe vitamin D deficiency and deterioration of vitamin D after chemotherapy. Future research is needed to explore its implication towards patients' survival in the local setting. Evidence-based approach also needs to be taken to address this modifiable condition, including increasing awareness of the importance of maintaining vitamin D sufficiency both in patients and the general population.

Altered Regional Brain Glucose Metabolism in Diffuse Large B-Cell Lymphoma Patients Treated With Cyclophosphamide, Epirubicin, Vincristine, and Prednisone: An Fluorodeoxyglucose Positron Emission Tomography Study of 205 Cases

BackgroundA growing number of neuroimaging studies reported that chemotherapy might impair brain functions, leading to persistent cognitive alterations in a subset of cancer patients. The present study aimed to investigate the regional brain glucose metabolism differences between diffuse large B cell lymphoma (DLBCL) patients treated with cyclophosphamide, epirubicin, vincristine, and prednisone and controls using positron emission tomography with 18F-labeled fluoro-2-deoxyglucose integrated with computed tomography (18F-FDG PET/CT) scanning.MethodsWe analyzed 18F-FDG PET data from 205 right-handed subjects (for avoiding the influence of handedness factors on brain function), including 105 post-chemotherapy DLBCL patients and 100 controls. The two groups had similar average age, gender ratio, and years of education. First, we compared the regional brain glucose metabolism using a voxel-based two-sample t-test. Second, we compared the interregional correlation. Finally, we investigated the correlations between the regional brain glucose metabolism and the number of chemotherapy cycles.ResultsCompared with the controls, the post-chemotherapy group showed higher metabolism in the right hippocampus and parahippocampal gyrus (region of interest (ROI) 1) and the left hippocampus (ROI 2), and lower metabolism in the left medial orbitofrontal gyrus (ROI 3), the left medial superior frontal gyrus (ROI 4), and the left superior frontal gyrus (ROI 5). The two groups had different interregional correlations between ROI 3 and ROI 5. In some brain regions—mainly located in the bilateral frontal gyrus—the number of chemotherapy cycles was positively correlated with the regional brain glucose metabolism. Meanwhile, in some bilateral hippocampus regions, these two parameters were negatively correlated.ConclusionThe present study provides solid data on the regional brain glucose metabolism differences between post-chemotherapy DLBCL patients and controls. These results should improve our understanding of human brain functions alterations in post-chemotherapy DLBCL patients and suggest that 18F-FDG PET/CT scanning is a valuable neuroimaging technology for studying chemotherapy-induced brain function changes.

Gross Tumor Volume Predicts Survival and Pathological Complete Response of Locally Advanced Esophageal Cancer After Neoadjuvant Chemoradiotherapy

BackgroundNeoadjuvant chemoradiotherapy (neo-CRT) plus surgery has greatly improved the prognosis of locally advanced esophageal cancer (EC) patients. But which factors may influence the pathological tumor response and long-term survival remains unclear. The purpose of this study was to identify the prognostic biomarkers of locally advanced EC patients receiving neo-CRT.MethodsWe reviewed the data of 72 patients with cT2-4N0-3M0 EC who underwent neo-CRT at our hospital. The patients received intensity-modulated radiation therapy with a total radiation dose of 41.4–60.0 Gy. Most patients received platinum + paclitaxel-based combination regimens every three weeks for 2–4 cycles. The recorded data included age, sex, smoking history, alcohol use, histology, tumor location, clinical TNM stage, tumor length, gross tumor volume (GTV), GTV of primary tumor (GTVp), GTV of lymph nodes (GTVn), radiation dose, and number of chemotherapy cycles. Overall survival (OS), progression-free survival (PFS), and pathological complete response (pCR) were analyzed.ResultsThe 3-year OS and PFS rates of these patients who underwent neo-CRT were 51.14% and 43.28%, respectively. In the univariate analyses, smoking history, clinical stage, GTV, GTVp, and GTVn were significantly associated with OS, whereas alcohol use, GTV, GTVp, and GTVn were significantly associated with PFS. Furthermore, in the multivariate analysis, GTV was an independent prognostic predictor of OS (hazard ratio (HR): 14.14, 95% confidence interval (CI): 3.747–53.33, P < 0.0001) and PFS (HR: 6.090, 95% CI: 2.398–15.47, P < 0.0001). In addition, GTV < 60.50 cm3 compared to > 60.50 cm3 was significantly associated with higher pCR rate (59.3% and 27.8%, respectively, P = 0.038). High dose (> 50 Gy) and increased number of chemotherapy cycles (≥ 3) didn’t improve the OS or PFS in patients with GTV > 60.50 cm3.ConclusionGTV was an independent prognostic factor of long-term survival in EC patients, which may be because GTV is associated with histological response to neo-CRT. Additionally, patients with GTV > 60.50 cm3 didn’t benefit from increased radiation dose or increased number of chemotherapy cycles.

Risk factors for oxaliplatin-induced peripheral neuropathy: a systematic review and meta-analysis.

Oxaliplatin-induced neuropathy is a significant complication of cancer therapy. We aimed at investigating the risk factors of oxaliplatin-induced neuropathy (OIPN) and providing evidence to enhance its prevention. PubMed, Medline, Web of Science, Embase, China Knowledge Resource Integrated Database, and the Wanfang Database were searched comprehensively for observational studies investigating the prevalence and risk factors of OIPN from inception to November 30, 2021. The Newcastle-Ottawa Scale was used by two independent reviewers to assess methodological quality. When applicable, we used meta-analysis to determine mean differences and odds ratios for continuous and nominal scaled data. We included 20 studies involving 10,900 participants for analysis. Factors associated with OIPN risk identified by meta-analysis were age, gender, diabetes, anemia, hypomagnesaemia, alcohol consumption, body mass index, body surface area, cumulative oxaliplatin dose and the number of chemotherapy cycles. Factors not associated with OIPN risk included smoking history and chemotherapy regimen. This meta-analysis identified multiple variables associated with OIPN. The recognition of modifiable risk factors is an urgent priority to improve prevention and treatment outcomes.

HER2-targeted immunoconjugates for breast cancer: Ancestry and dose adjustment for thrombocytopenia.

1048 Background: Thrombocytopenia (TCP) is a common toxicity of HER2-targeted agents, trastuzumab emtansine (TDM1) and trastuzumab deruxtecan (TDXd). A high incidence of this toxicity was observed in pivotal trials that led to approval of these agents. We investigated whether Asian ancestry increases risk of dose adjustment for TCP on TDM1/TDXd and its impact on dosing in the real-world setting. Methods: Females with HER2+ breast cancer who initiated TDM1/TDXd between 1/16/17-10/26/21 were identified by retrospective review. Primary endpoint was number of chemotherapy cycles until adjustment of TDM1/TDXd dose for TCP; competing endpoints included discontinuation for other toxicity, disease progression, and completion of treatment. Individuals who were switched from TDM1 to TDXd contributed an additional observation post-switch. Recurrent events analysis evaluated Asian ancestry (p&lt;0.05) using a proportional means model, with robust sandwich estimate recognizing correlation between repeated observations per individual. Covariates (age, metastatic disease, drug, prior adjustment) were retained if they improved the model. Results: The study excluded individuals who declined to self-identify (n=23), self-identified as other than Asian or White (n=28), and/or dissented to research (n=24). The study included n=181 individuals (mean age 55.1+12.8 years), of whom n=48 (26.5%) identified as Asian and n=124 (68.5%) had metastatic disease. Overall, 33 individuals received TDXd exclusively, leaving 148 (81.8%) individuals who received TDM1, including 45 individuals who later switched to TDXd after development of TCP while on TDM1 (n=9) or other toxicity (n=36) on TDM1. For n=226 observations (total 2551 cycles), the endpoint was dose adjustment for TCP (n=32), discontinuation for other toxicity or disease progression (n=112), completion of treatment (n=27), or censoring (n=55). Taking into account history of switching drug for TCP, Asian ancestry was associated with increased risk of dose adjustment for TCP (Table). Neither age, metastatic disease, nor specific drug improved the model (data not shown). Conclusions: Among individuals taking TDM1 and/or TDXd for HER2+ breast cancer, we observed that those with Asian ancestry are at greater risk of dose reduction for TCP than their non-Asian counterparts. Upon confirmation in additional individuals with HER2+ cancers of the breast and other sites, this heightened susceptibility to TCP among Asian individuals should be further investigated to elucidate the underlying mechanism and optimize clinical guidelines for prevention and management. [Table: see text]

Dose intensity and outcomes of VDC/IE chemotherapy for adolescent and adult patients with Ewing’s family sarcoma.

11570 Background: Ewing’s family sarcoma (EFS) is a rare and aggressive malignancy with peak incidence in the second decade of life. Treatment is multimodal, involving local surgery and/or radiotherapy, and chemotherapy, typically with VDC/IE (Vincristine, Doxorubicin, Cyclophosphamide alternating with Ifosfamide, Etoposide). There is paucity of data in the adult setting, with treatment protocols extrapolated mainly from the paediatric setting. We assessed chemotherapy dose intensity and outcomes across four Australian sarcoma centres (three adult and one paediatric centre). Methods: Using the Australia New Zealand Sarcoma Association national database (ACCORD) and medical records, we identified patients aged ≥10 years diagnosed with EFS between 2010-2020. Clinical characteristics, treatment and survival information were collected for those receiving Ewing protocol with VDC/IE backbone. Received Dose Intensity (RDI) of chemotherapy was calculated using planned and actual doses received and time taken. RDI ≥85% was considered acceptable, consistent with published literature. We compared survival outcomes based on RDI. Clinical predictors of achieving an acceptable RDI were explored using logistic regression. Results: Of 146 patients with EFS identified, 76 received VDC/IE (59% male). The median age was 25 years, with age distribution 24% aged 10-19, 58% aged 20-39, and 18% aged 40-59. Majority had extraskeletal Ewing’s (57%), non-extremity primary site (64%) and localised disease (stage, II 37%; III 28%; IV 28%). Treatment received included surgery (74%), radiotherapy (66%) and chemotherapy (100%). Over two-thirds (70%) completed their scheduled chemotherapy and 57% achieved an acceptable RDI (67% aged 10-19, 61% aged 20-39, 29% aged 40-59). Compared to those aged 10-19, the odds ratio (OR) of an acceptable RDI for patients aged 20-39 was 0.79 (95% CI 0.24-2.46, p = 0.70) and for patients aged 40-59 was 0.20 (95% CI 0.04-0.86, p = 0.04). The median number of chemotherapy cycles was 14 (range, 2-17). Dose reductions were mostly within 20% cumulative target dose (91%), and were predominantly for neutropenia (47%), thrombocytopenia (30%) and/or anaemia (28%), and less frequently for cardiotoxicity (7%). Median follow-up was 37.3 months. Two-year progression-free survival (PFS) rates were 56% for acceptable RDI, compared to 30% for low RDI (p = 0.001), with two-year overall survival (OS) rates respectively 88% versus 49% (p &lt; 0.001). After adjustment for age, gender, Ewing’s type, primary site and stage, RDI remained an important prognostic factor (PFS HR 0.39, 95% CI 0.18-0.82; OS HR 0.25, 95% CI 0.10-0.63). Conclusions: Survival outcomes in EFS were contingent on achieving an acceptable RDI. It was more difficult to maintain VDC/IE chemotherapy dose intensity in adults aged over 40 years, due to myelosuppression. Optimal treatment strategy for older adults remains to be defined.