Use Of Systemic Chemotherapy Research Articles

Racial and social-economic inequalities in systemic chemotherapy use among adult glioblastoma patients following surgery and radiotherapy

Not all patients with glioblastoma multiforme (GBM) eligible for systemic chemotherapy after upfront surgery and radiotherapy finally receive it. The information on patients with GBM was retrieved from the surveillance, epidemiology, and end results database. Patients who underwent upfront surgery or biopsy and external beam radiotherapy between 2010 and 2019 were eligible for systemic chemotherapy. The available patient and tumor characteristics were assessed using multivariable logistic regression and chi-squared test. Out of the 16,682 patients eligible, 92.1% underwent systemic chemotherapy. The characteristics linked to the lowest systemic chemotherapy utilization included tumors of the brain stem/cerebellum (P = 0.01), former years of diagnosis (P = 0.001), ≥ 80 years of age (P < 0.001), Hispanic, Non-Hispanic Asian, Pacific Islander, or Black race (P < 0.001), non-partnered status (P < 0.001), and low median household income (P = 0.006). Primary tumor site, year of diagnosis, age, race, partnered status, and median household income correlated with the omission of systemic chemotherapy in GBM in adult patients.

Primary Malignant Melanoma of the Cervix with Rapidly Progressing Metastases

Introduction: Mucosal melanomas only account for 0.03% of newly diagnosed cancer cases. Female genital tract melanomas account for only 3% of all melanomas, with melanoma of the cervix accounting for less than 3% of all female genital tract melanomas. It is difficult to understand how mucosal melanomas arise as the pathogenesis is still unknown. The incidence of cutaneous melanoma has greatly increased over the years whereas the incidence of mucosal melanomas has stayed relatively steady. Given the rarity of melanoma of the cervix, a standard of care treatment has not been established. Based on the limited cases that have previously been treated, the first option is surgery for early stage melanomas with adjuvant radiation therapy indicated in some cases. The use of systemic chemotherapy is still controversial as it has not been shown to prevent metastases. Case Report: A 66-year-old postmenopausal female presented with heavy vaginal bleeding. A transvaginal ultrasound showed a complex cystic structure in the cervix and she was referred to gynecologic oncology. She was up to date on her pap smears, and they have always been normal. Patient was found to have a fungating 4 x 5 cm mass in the upper vagina and pathology demonstrated poorly differentiated malignant neoplasm. The patient was diagnosed with FIGO Stage IIA2 cervical cancer. Patient’s initial PET/CT demonstrated hypermetabolic area in the cervix consistent with known cervical carcinoma with no other uptake in the uterus. Weekly chemosensitization with cisplatin and external beam radiation was initiated. On clinical examination after treatment by the gynecologic oncologist, visible disease was seen confined to the cervix. An MRI of the pelvis showed response with the suspected tumor limited to the cervical stroma in the anterior and lateral portion of the cervix with no definitive parametrial tumor and no evidence of nodal metastasis. Second opinion from pathology review was received and results showed poorly differentiated malignant neoplasm immunohistochemically consistent with “melanoma”. After 25 fractions of daily radiotherapy with weekly cisplatin, patient underwent exploratory laparotomy for radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node sampling. Final pathology of the uterus and cervix showed invasive poorly differentiated melanoma with deepest invasion of melanoma measuring 8mm and negative surgical margins. All lymph nodes removed during surgery were negative for malignancy. Adjuvant Pembrolizumab was started at this time. Two months postoperatively, the patient underwent CT surveillance again due to new onset chest wall and axillary nodules varying in size from 2-4 cm. Right chest wall axilla biopsy pathology was consistent with melanoma. At this time Pembrolizumab was discontinued and the patient was transitioned to Nivolumab and Ipilimumab 19 days after discontinuing Pembrolizumab. Four months postoperatively, additional CT scans were performed showing widespread metastatic disease in the lungs, chest wall, liver, peritoneum, retroperitoneum and left eye. Patient underwent left frontal craniotomy with tumor resection, and pathology was consistent with metastatic melanoma. Subsequent to craniotomy, the patient underwent three treatments with stereotactic radiosurgery. Despite treatment, six months postoperatively, the patient’s symptoms continued to progress with slurred speech, generalized weakness and abdominal pain. Ultimately, the patient passed away nine months after the diagnosis and four months after a combination of external beam radiotherapy, surgery, and vaginal brachytherapy. Discussion: Melanoma of the cervix is a rare type of cervical cancer with poor prognosis. Globally, 5-year survival is 18.8% for stage I, 11.1% for stage II, and 0% for stages III–IV. It has been shown that median overall survival time decreases with increasing FIGO stage. Risk factors have not been identified for gynecologic melanomas or most other mucosal melanomas. Pembrolizumab is most effective for cutaneous melanomas, however, has been shown to prolong progression free survival in mucosal melanomas. The median overall survival is significantly shorter for patients with mucosal melanoma (11.3 months) as compared to patients with a cutaneous primary (23.5 months). Primary malignant melanoma of the cervix (PMMC) remains a rare tumor and the prognosis is generally poor. Radical hysterectomy, chemoradiation, and immunotherapy have all been utilized in the treatment of PMMC. Further investigation of primary melanoma of the cervix is necessary to formulate a standard of care treatment.

Primary Malignant Melanoma of the Cervix with Rapidly Progressing Metastases

Introduction: Mucosal melanomas only account for 0.03% of newly diagnosed cancer cases. Female genital tract melanomas account for only 3% of all melanomas, with melanoma of the cervix accounting for less than 3% of all female genital tract melanomas. It is difficult to understand how mucosal melanomas arise as the pathogenesis is still unknown. The incidence of cutaneous melanoma has greatly increased over the years whereas the incidence of mucosal melanomas has stayed relatively steady. Given the rarity of melanoma of the cervix, a standard of care treatment has not been established. Based on the limited cases that have previously been treated, the first option is surgery for early stage melanomas with adjuvant radiation therapy indicated in some cases. The use of systemic chemotherapy is still controversial as it has not been shown to prevent metastases. Case Report: A 66-year-old postmenopausal female presented with heavy vaginal bleeding. A transvaginal ultrasound showed a complex cystic structure in the cervix and she was referred to gynecologic oncology. She was up to date on her pap smears, and they have always been normal. Patient was found to have a fungating 4 x 5 cm mass in the upper vagina and pathology demonstrated poorly differentiated malignant neoplasm. The patient was diagnosed with FIGO Stage IIA2 cervical cancer. Patient’s initial PET/CT demonstrated hypermetabolic area in the cervix consistent with known cervical carcinoma with no other uptake in the uterus. Weekly chemosensitization with cisplatin and external beam radiation was initiated. On clinical examination after treatment by the gynecologic oncologist, visible disease was seen confined to the cervix. An MRI of the pelvis showed response with the suspected tumor limited to the cervical stroma in the anterior and lateral portion of the cervix with no definitive parametrial tumor and no evidence of nodal metastasis. Second opinion from pathology review was received and results showed poorly differentiated malignant neoplasm immunohistochemically consistent with “melanoma”. After 25 fractions of daily radiotherapy with weekly cisplatin, patient underwent exploratory laparotomy for radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node sampling. Final pathology of the uterus and cervix showed invasive poorly differentiated melanoma with deepest invasion of melanoma measuring 8mm and negative surgical margins. All lymph nodes removed during surgery were negative for malignancy. Adjuvant Pembrolizumab was started at this time. Two months postoperatively, the patient underwent CT surveillance again due to new onset chest wall and axillary nodules varying in size from 2-4 cm. Right chest wall axilla biopsy pathology was consistent with melanoma. At this time Pembrolizumab was discontinued and the patient was transitioned to Nivolumab and Ipilimumab 19 days after discontinuing Pembrolizumab. Four months postoperatively, additional CT scans were performed showing widespread metastatic disease in the lungs, chest wall, liver, peritoneum, retroperitoneum and left eye. Patient underwent left frontal craniotomy with tumor resection, and pathology was consistent with metastatic melanoma. Subsequent to craniotomy, the patient underwent three treatments with stereotactic radiosurgery. Despite treatment, six months postoperatively, the patient’s symptoms continued to progress with slurred speech, generalized weakness and abdominal pain. Ultimately, the patient passed away nine months after the diagnosis and four months after a combination of external beam radiotherapy, surgery, and vaginal brachytherapy. Discussion: Melanoma of the cervix is a rare type of cervical cancer with poor prognosis. Globally, 5-year survival is 18.8% for stage I, 11.1% for stage II, and 0% for stages III–IV. It has been shown that median overall survival time decreases with increasing FIGO stage. Risk factors have not been identified for gynecologic melanomas or most other mucosal melanomas. Pembrolizumab is most effective for cutaneous melanomas, however, has been shown to prolong progression free survival in mucosal melanomas. The median overall survival is significantly shorter for patients with mucosal melanoma (11.3 months) as compared to patients with a cutaneous primary (23.5 months). Primary malignant melanoma of the cervix (PMMC) remains a rare tumor and the prognosis is generally poor. Radical hysterectomy, chemoradiation, and immunotherapy have all been utilized in the treatment of PMMC. Further investigation of primary melanoma of the cervix is necessary to formulate a standard of care treatment.

Temporal Trends in Treatment and Outcomes of Endometrial Carcinoma in the United States, 2005-2020.

Endometrial cancer has continued to see a rising incidence in the US over the years. The main aim of this study was to assess current trends in patients' characteristics and outcomes of treatment for endometrial carcinoma over 16 years. A dataset from the National Cancer Database (NCDB) for patients diagnosed with endometrial carcinoma from 2005 to 2020 was used in this retrospective, case series study. The main outcomes and measures of interest included tumor characteristics, hospitalization, treatments, mortality, and overall survival. Then, 569,817 patients who were diagnosed with endometrial carcinoma were included in this study. The mean (SD) age at diagnosis was 62.7 (11.6) years, but 66,184 patients (11.6%) were younger than 50 years, indicating that more patients are getting diagnosed at younger ages. Of the patients studied, 37,079 (6.3%) were Hispanic, 52,801 (9.3%) were non-Hispanic Black, 432,058 (75.8%) were non-Hispanic White, and 48,879 (8.6%) were other non-Hispanic. Patients in the 4th period from 2017 to 2020 were diagnosed more with stage IV (7.1% vs. 5.2% vs. 5.4% vs. 5.9%; p < 0.001) disease compared with those in the other three periods. More patients with severe comorbidities (Charlson Comorbidity Index score of three) were seen in period 4 compared to the first three periods (3.9% vs. ≤1.9%). Systemic chemotherapy use (14.1% vs. 17.7% vs. 20.4% vs. 21.1%; p < 0.001) and immunotherapy (0.01% vs. 0.01% vs. 0.2% vs. 1.1%; p < 0.001) significantly increased from period 1 to 4. The use of laparotomy decreased significantly from 42.1% in period 2 to 16.7% in period 4, while robotic surgery usage significantly increased from 41.5% in period 2 to 64.3% in period 4. The 30-day and 90-day mortality decreased from 0.6% in period 1 to 0.2% in period 4 and 1.4% in period 1 to 0.6% in period 4, respectively. Over the period studied, we found increased use of immunotherapy, chemotherapy, and minimally invasive surgery for the management of endometrial cancer. Overall, the time interval from cancer diagnosis to final surgery increased by about 6 days. The improvements observed in the outcomes examined can probably be associated with the treatment trends observed.

HIPEC and PIPAC for gastric cancer: technique and comparison of efficacy. Literature review

Background: According to the World Health Organization (WHO) data, gastric cancer (GC) was the 5th most common cancer and the 4th leading cause of cancer death worldwide in 2020. Peritoneal metastases (PM) are associated with a poor prognosis and detected in 30 % of patients with locally advanced GC; the median overall survival in patients with PM is 3–6 months without any treatment and 6–12 months with the use of systemic chemotherapy. Delivery of appropriate chemotherapeutic drugs directly into the abdominal cavity increases the effectiveness of treatment without severe systemic side effects. Today, various forms of intra-abdominal chemotherapy of PM are used in the world.Aim: To evaluate the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) and aerosol intraperitoneal pressure chemotherapy (PIPAC) in the treatment of GC PM.Purposes: To review current domestic and foreign publications on HIPEC and PIPAC, to compare their efficacy.Materials and methods: Articles in PubMed, Scopus, Web of Science databases were studied and analyzed for the key queries: “stomach cancer”, “carcinomatosis”, “peritoneal metastases”, “HIPEC”, “PIPAC”.Conclusions: The best results were achieved when using PIPAC as preoperative chemotherapy, followed by cytoreductive surgery in combination with HIPEC. Both procedures are promising and require further study with multicenter randomized prospective trials to assess their therapeutic potential.

1187 A Study of Outcomes in Patients with Gastrointestinal Tract Lymphomas Who Require Inadvertent Surgery

Abstract Aim Patients may present with acute surgical symptoms from their lymphoma. We aimed to study postoperative outcomes and 3-year overall survival in patients who had inadvertent surgery as primary management of their gastrointestinal tract lymphomas. Method Suitable patients were identified using electronic records from January 2013 to December 2022. Demographics, clinicopathological characteristics and survival outcomes of these patients were collected retrospectively. Results A total of 25 patients were identified. The most common clinical symptom was abdominal pain (n = 18, 72%) with demonstration of an obstruction (n = 16, 64%) or perforation (n = 4, 16%) by a mass on CT scan. Small bowel was the most common site, followed by colon and stomach (55%, 24% and 21% respectively) Diffuse large B-cell lymphoma was the most common subtype (66.7%). Immunohistochemistry revealed B-lymphocyte antigen CD20 to be positive in most patients (n = 17, 68%) and Ki 67% to be high (&amp;gt;70%) in a third (n = 8, 32%). Upon discharge, two thirds of patients were well enough to have systemic chemotherapy (n = 19, 76%). Two patients died from surgical complications while the rest succumbed to disease progression (n = 10, 76%). The overall 3-year survival rate was 56%. Conclusions Patients with gastrointestinal tract lymphoma who do not die in the postoperative period after inadvertent surgery are likely to be alive at 3 years with the use of systemic chemotherapy.

Targeting the stimulator of interferon genes (STING) in breast cancer.

Breast cancer has a high occurrence rate globally and its treatment has demonstrated clinical efficacy with the use of systemic chemotherapy and immune checkpoint blockade. Insufficient cytotoxic T lymphocyte infiltration and the accumulation of immunosuppressive cells within tumours are the primary factors responsible for the inadequate clinical effectiveness of breast cancer treatment. The stimulator of interferon genes (STING) represents a pivotal protein in the innate immune response. Upon activation, STING triggers the activation and enhancement of innate and adaptive immune functions, resulting in therapeutic benefits for malignant tumours. The STING signalling pathway in breast cancer is influenced by various factors such as deoxyribonucleic acid damage response, tumour immune microenvironment, and mitochondrial function. The use of STING agonists is gaining momentum in breast cancer research. This review provides a comprehensive overview of the cyclic guanosine monophosphate-adenosine monophosphate synthase-STING pathway, its agonists, and the latest findings related to their application in breast cancer.

O122 The use of directly injectable cancer therapies: a systematic review

Abstract Introduction DIT allows for targeted delivery to a cancer. This could deescalate treatments through reduced use of systemic chemotherapy, radiotherapy dosage, and avoidance of major surgery. Palliative cancers can benefit through similar means to maintain quality of life and avoid permanent interventions (such as stomas). There is no mainstream use of DIT. Therefore, the aim of this review was to assess the role of DIT in all cancers. Methods A systematic search was performed in the Pubmed, Web of Science, Embase and Google databases. Two authors independently searched the literature and extracted data onto a dedicated proforma. Human and animal studies were included. Results 8,380 papers were identified, 49 studies were included; comprising of 1,087 patients for lung, H+N, brain, oesophagogastric and colorectal cancer. Four studies performed neoadjuvant DIT, where one showed all lung tumours down staged to an operative state. The remainder showed no advantage in survival or response. Palliative intra-tumoural cisplatin (in three studies) showed promise for malignant airway obstruction, where good responses were shown in &amp;gt; 50% of patients (single report). Cisplatin was also favourable in palliative H+N cancers (ORR=66% in one report). A minority of studies (4/49) exhibited grade 3 toxicity or higher. Conclusion DIT is safe to administer and demonstrated promise in the palliation of malignant airway obstruction and advanced/recurrent H+N cancer. Further studies are required to verify these results. Additionally, more reports are required to determine its role in neoadjuvant treatment. DIT:Direct injection of chemotherapy ORR:objective response rate H+N:head and neck

PD36-09 TIME TRENDS IN SYSTEMIC TREATMENTS AND SURVIVAL IN PATIENTS WITH METASTATIC UROTHELIAL BLADDER CANCER: OUTCOMES IN THE ERA OF IMMUNOTHERAPY

You have accessJournal of UrologyCME1 Apr 2023PD36-09 TIME TRENDS IN SYSTEMIC TREATMENTS AND SURVIVAL IN PATIENTS WITH METASTATIC UROTHELIAL BLADDER CANCER: OUTCOMES IN THE ERA OF IMMUNOTHERAPY Harshit Garg, Mukund Bhandari, Monica Sridhar, Onika Noel, Furkan Dursun, Michael Liss, Dharam Kaushik, Robert Svatek, Chethan Ramamurthy, and Ahmed Mansour Harshit GargHarshit Garg More articles by this author , Mukund BhandariMukund Bhandari More articles by this author , Monica SridharMonica Sridhar More articles by this author , Onika NoelOnika Noel More articles by this author , Furkan DursunFurkan Dursun More articles by this author , Michael LissMichael Liss More articles by this author , Dharam KaushikDharam Kaushik More articles by this author , Robert SvatekRobert Svatek More articles by this author , Chethan RamamurthyChethan Ramamurthy More articles by this author , and Ahmed MansourAhmed Mansour More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003334.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The management of metastatic urothelial carcinoma of the urinary bladder has been revolutionized with the advent of immune-checkpoint inhibitors (ICI). However, the survival outcomes in metastatic bladder cancer over the past decade with improvements in systemic therapies have not been studied. The aim of the study is to investigate the time trends in treatment strategies and overall survival (OS) in patients with metastatic urothelial cancer of the bladder. METHODS: Using the recently updated National Cancer Database, patients with newly diagnosed metastatic urothelial cancer of the urinary bladder between 2014-2019 were included. We analyzed changes in the first-line systemic treatment and the changes in the 1-year OS using cox multivariable regression and Kaplan Meier analysis. The OS analysis was censored at 1-year to account for possible bias due to shorter follow-up in most recent years. RESULTS: Overall, 10,965 patients met the inclusion criteria with 9,229 receiving systemic chemotherapy and 1,666 patients receiving systemic immunotherapy. The use of immunotherapy increased from 2.3% (9/391) in 2007 to 36.5% (484/1325) to 2019 (p<0.001) and the use of systemic chemotherapy decreased from 98.2% (270/275) in 2004 to 63.5% (841/1325) in 2019 (p<0.001). (Figure 1a). The median and 1-year OS of the entire cohort increased from 9.9 months and 38.6% in 2004 to 12.5 months and 50.8% in 2018 respectively (p<0.001) (Figure 1b). From 2009 to 2018, the 1-y OS improved gradually from 38.3% to 53.6% in systemic chemotherapy and 44.4% to 46.3% in the systemic immunotherapy group. (Figure 1c) The improvement in systemic chemotherapy arm could be potentially attributed to increased use of second line immunotherapy in this cohort. CONCLUSIONS: The use of immunotherapy as first-line therapy has substantially increased over the past years. The median OS in metastatic bladder cancer has also improved over the past 15 years, possibly because of the advent of immune-checkpoint therapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e983 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Harshit Garg More articles by this author Mukund Bhandari More articles by this author Monica Sridhar More articles by this author Onika Noel More articles by this author Furkan Dursun More articles by this author Michael Liss More articles by this author Dharam Kaushik More articles by this author Robert Svatek More articles by this author Chethan Ramamurthy More articles by this author Ahmed Mansour More articles by this author Expand All Advertisement PDF downloadLoading ...

Multi-Institutional Prospective Observational Study of Radiotherapy for Metastatic Bone Tumor

<h3>Purpose/Objective(s)</h3> To evaluate patient characteristics and radiotherapy treatments and outcomes in bone metastasis in Japan. <h3>Materials/Methods</h3> Patients for whom radiotherapy for bone metastasis was planned at 26 institutions in Japan between December 2020 and March 2021 were consecutively registered in this prospective, observational study. The number of registrations per facility was limited to 10. Study measures included patient characteristics, pain relief, skeletal-related events (SREs), overall survival, and incidence of radiation-related adverse events. Pain was evaluated by using a numerical rating scale (NRS) from 0 to 10. <h3>Results</h3> Two hundred thirty-two patients were registered; 224 patients and 302 lesions were fully analyzed. Primary sites were lung (36% of patients), breast (15%), and other (49%). ECOG-performance status (PS) was 0 in 23%, 1 in 38%, 2 in 22%, 3 in 13%, and 4 in 4%; 59% of patients had spinal metastases and 84% had painful lesions (at least NRS 2). The biologically effective dose (BED) assuming α/β=10 was <20 Gy (in 27%), 20 to <30 Gy (24%), 30 to <40 Gy (36%), and ≥40 Gy (13%); 9% of patients were treated by stereotactic body radiotherapy (SBRT). For ECOG-PS 3 or 4, 61% of patients were treated with a low BED (<30 Gy); 41% of those with ECOG-PS 0 or 1 were treated with a low BED (<30 Gy). Grade 3 adverse events occurred in 4% and no grade 4 or 5 toxicity was reported. Pain relief was achieved in 52% at 2 months and 58% at 6 months. Use of systemic chemotherapy or hormonal therapy was significantly related to good pain response at 2 months (<i>P</i> = 0.006), but no other factor was associated with pain response. Cumulative incidence of SREs was 6.5% (95% CI 3.1–9.9) at 6 months; no factor was significantly associated with SREs. Among 132 patients with spinal lesions, 10% were classified as Bilsky grade 3; 18% of patients were not ambulatory at baseline; 50% of evaluable patients in this group were able to walk at 2 months. The 6-month overall survival rate was 70.2% (95% CI 64.2–76.9). Good ECOG-PS, ambulatory status at baseline, no other bone metastases, high BED, and SBRT use were significantly related to better overall survival. <h3>Conclusion</h3> We report real-world details of radiotherapy in bone metastasis. BED is not related to pain relief or SRE incidence, but high BED or SBRT were selected for long survivors.

Physician referral patterns and use of adjuvant therapy among patients with stage IB-IIIA non–small cell lung cancer (NSCLC) (2010-2017).

114 Background: As the treatment landscape for early-stage NSCLC continues to evolve with the recent approvals of targeted and immunotherapy agents in the adjuvant setting, it is important to understand physician referral patterns and predictors of adjuvant therapy (AT). This study examined physician referral patterns at key treatment phases and assessed predictors of receiving AT in stages IB-IIIA NSCLC patients. Methods: A retrospective study using the linked SEER-Medicare database (01/01/2010-12/31/2017) included patients newly diagnosed with stages IB-IIIA NSCLC who received surgical resection. Specialties were identified by linking NSCLC claims to AMA Physician Masterfile. AT was defined as the use of systemic chemotherapy or radiation therapy within 4 months of surgery. Multivariable logistic regression was conducted to assess predictors of receiving AT. Results: A total of 7,108 patients met study criteria (53% IB; 9% IIA; 19% IIB; 20% IIIA). Primary care physician (PCP) (71%), surgical oncologist (29%), medical oncologist (36%) were the most frequently visited first specialist during pre-diagnosis, diagnosis to surgery, and post-surgery phases, respectively. The median time from diagnosis to surgery was 44 days. After surgery, 74% patients visited medical oncologist (62% IB; 87% IIA; 83% IIB; 88% IIIA). About 41% received AT (21% IB; 64% IIA; 56% IIB; 69% IIIA). Of those, the median time from surgery to adjuvant therapy was 46 days. Later stage at diagnosis and shorter referral time to medical oncologist significantly increased the odds of receiving AT (Table). Conclusions: The strongest predictors of receiving adjuvant therapy were time to medical oncologist post-surgery and stage at diagnosis. Future studies in the era of targeted therapies can use our results as a benchmark to optimize management and outcomes as well as assess changes in referral patterns in IB-IIIA NSCLC patients.[Table: see text]

Complete response in metastatic breast cancer with visceral crisis using a combination of cyclin-dependent kinase 4/6 inhibitor and aromatase inhibitor: A case report from the eastern region of India

Patients with metastatic breast cancer (MBC) in visceral crisis require systemic chemotherapy. However, a coexisting cardiac failure that contradicts the use of systemic chemotherapy often demands an alternative treatment. Here, we report a case of hormone-receptor-positive MBC with cardiological comorbidities. She was treated with a combination treatment of tablet Ribociclib (600 mg once daily for 21 days followed by 7 days gap) and tablet Letrozole (2.5 mg once daily). The patient had a complete metabolic response in 18-Fluorodeoxyglucose Positron Emission tomography-Computed Tomography (18F-FDG PET/CT), after 6 months of treatment. Combination treatment with Ribociclib and Letrozole is beneficial in postmenopausal females with hormone receptor-positive and human epidermal growth factor receptor 2 neu-negative MBC in visceral crisis who have a contraindication to chemotherapy.

Systemic therapy and perioperative management improve the prognosis of pancreatic ductal adenocarcinoma: A retrospective cohort study of 2000 consecutive cases

ObjectiveThis study aimed to explore patterns of the treatment strategies of pancreatic ductal adenocarcinoma based on 2000 consecutive cases of a prospective database since 2012 to obtain new insights for future directions. MethodsAmong 2000 patients enrolled in this study, 210 patients were excluded, and 710, 521, and 559 patients were treated between 2012 and 2015 (group 1), between 2016 and 2017 (group 2), and between 2018 and 2019 (group 3), respectively. Patient clinicopathologic and biological factors, and perioperative outcomes were used to assess the prognostic factors. ResultsThe median survival for all patients with pancreatic ductal adenocarcinoma was 21.7 months (1-year survival, 75.0%; 2-year survival, 43.7%; 5-year survival, 19.7%). Group 3 had a better survival outcome than groups 1 and 2 (median survival time: 23 versus 20.5 and 21.1 months). The proportion of patients younger than 65 gradually increased over time, as did the use of systemic chemotherapy and postoperative adjuvant radiotherapy. The tendency for early diagnosis (lower CA19-9 and CEA levels, smaller size, and earlier N stage), use of chemotherapy and radiotherapy, early recovery (lesser hospital stay and Clavien-Dindo grade <3), absence of abdominal pain, younger age, length of operation ≤3 h, and pathological factors (absence of lymphovascular invasion, peripancreatic fat infiltration and neural invasion, higher differentiation) were related to patients' survival. Multivariable analysis for prognosis revealed that tumor biological factors (increased preoperative serum CA19-9 level, tumor size, tumor differentiation, N stage, and presence of lymphovascular invasion and neural invasion), chemotherapy, radiotherapy, abdomen pain, operation period, length of stay, and length of operation correlated with patients’ survival. ConclusionsSystemic therapy, including chemotherapy and radiotherapy, has gradually improved the prognosis after operative resection for pancreatic ductal adenocarcinoma. Neoadjuvant therapy is also beneficial to improve the prognosis to a certain extent. The enhanced recovery after surgery (ERAS) policies and the specific assessment of postoperative pancreatic fistula (POPF) risk may be related to reduced hospital stays and the reduction of serious complications. These advancements show that the concept of systemic therapy has been accepted and actively applied by Chinese medical institutions.

Physician referral patterns and use of adjuvant therapy among stage IB-IIIA non-small cell lung cancer (NSCLC) patients (2010-2017).

e20509 Background: As the treatment landscape for early-stage NSCLC continues to evolve with the recent approvals of targeted and immunotherapy agents in the adjuvant setting, it is important to understand physician referral patterns and predictors of adjuvant therapy (AT). This study examined physician referral patterns at key treatment phases and assessed predictors of receiving AT in stages IB-IIIA NSCLC patients. Methods: A retrospective study using the linked SEER-Medicare database (01/01/2010-12/31/2017) included patients newly diagnosed with stages IB-IIIA NSCLC who received surgical resection. Specialties were identified by linking NSCLC claims to the AMA Physician Masterfile. AT was defined as the use of systemic chemotherapy or radiation therapy within 4 months of surgery. Multivariable logistic regression was conducted to assess predictors of receiving AT. Results: A total of 7,108 patients met the study criteria (53% IB; 9% IIA; 19% IIB; 20% IIIA). Primary care physicians (PCP) (71%), surgical oncologists (29%), and medical oncologists (36%) were the most frequently visited first specialists during pre-diagnosis, diagnosis to surgery, and post-surgery phases, respectively. The median time from diagnosis to surgery was 44 days. After surgery, 74% patients visited a medical oncologist (62% IB; 87% IIA; 83% IIB; 88% IIIA). About 41% received AT (21% IB; 64% IIA; 56% IIB; 69% IIIA). Of those, the median time from surgery to adjuvant therapy was 46 days. In the adjusted analysis, later stage at diagnosis and shorter referral time to medical oncologist had the highest odds of receiving AT (Table). Conclusions: The strongest predictors of receiving adjuvant therapy were time to medical oncologist post-surgery and stage at diagnosis. Future studies in the era of targeted therapies can use these results as a benchmark to optimize management and outcomes as well as assess changes in referral patterns in IB-IIIA NSCLC patients.[Table: see text]

Overview of histologic variants of urothelial carcinoma: current trends and narrative review on treatment outcomes.

Background and ObjectiveThe histologic variants of urothelial carcinoma (UC) are tumors arising from within the urothelium in which some component of the tumor morphology is other than urothelial. They are underdiagnosed, aggressive and have varying pathologic response rates to systemic chemotherapy. There are no consensus guidelines on the use of systemic chemotherapy in variant histology (VH) of UC. We performed a contemporary review on pathologic response rates to neoadjuvant systemic therapy and survival outcomes following radical cystectomy in order to provide a rationale for clinical practice recommendations on the management of UC with VH.MethodsA PubMed literature search was conducted for all English articles from inception reporting either pathological response rates to neoadjuvant treatment or survival outcomes after radical cystectomy in non-metastatic VH of UC.Key Content and FindingsNeoadjuvant chemotherapy (NAC) prior to radical cystectomy was shown to be a beneficial treatment strategy in UC with VH. The micropapillary, plasmacytoid, nested and sarcomatoid histologic variants were associated with worse survival outcomes compared to conventional UC and UC with squamous or glandular differentiation despite initial downstaging with chemotherapy. There is evidence of improved survival in patients with sarcomatoid differentiation receiving NAC compared to RC alone. The major prognostic factors that affect survival outcomes in VH of UC include histologic variant subtype, patient age, presence of lymphovascular invasion, hydronephrosis, nodal metastasis and advanced T stage at diagnosis. Recent studies demonstrate that VH of UC are heterogenous tumors and responsiveness to NAC may be a function of the molecular subtypes present.ConclusionsBased on these findings, NAC to achieve pathologic downstaging prior to radical cystectomy is recommended for MIBC with VH. Biomarkers identified by molecular profiling with immunohistochemistry will need to be validated as predictors of response to NAC in future trials.

Hodgkin's lymphoma in children and adolescents in Belarus Republic: 23-year survival rate of 606 pediatric patients

The article presents an analysis of treatment outcomes of pediatric patients with classical Hodgkin's lymphoma (HL) in the Republic of Belarus over more than a 20-year period. Patients aged 0 to 18 years with HL received therapy according to the DALHD-90(m) protocol. Therapy modifications involved the use of systemic chemotherapy according to the OPPA regimen (vincristine, procarbazine, prednisone and doxorubicin) for patients of both sexes and dose-reduced involved-field radiotherapy (20 Gy) for patients with early or intermediate stage HL. The aim of our study was to analyze the survival and clinical characteristics of pediatric patients with HL. The study was approved by the Independent Ethics Committee and the Scientific Council of Belarusian Research Center for Pediatric Oncology, Hematology and Immunology of the Ministry of Health of the Republic of Belarus. The analysis included 606 patients with HL, who had received treatment at the Belarusian Research Center for Pediatric Oncology, Hematology and Immunology from January 1, 1998 until December 31, 2020. The median age was 15.3 years. At 23 years, the event-free survival of the study patients was 85 ± 2%, the overall survival was 93 ± 1%, and the cumulative recurrence rate was 10 ± 1.3%. The long-term treatment results of pediatric patients with HL in the Republic of Belarus indicate that the protocol therapy is highly effective and can achieve outcomes that are equivalent to those in countries with a developed healthcare system. The applied therapeutic strategy demonstrates clinical efficacy in stage I–III HL. About 15% of patients with advanced HL (stage IV) constitute the main target group for which a search for new treatment approaches improving treatment outcomes is required.

Incidence, treatment and survival of malignant pleural and peritoneal mesothelioma: a population-based study

IntroductionMalignant mesothelioma (MM) is an aggressive cancer that primarily arises from the pleura (MPM) or peritoneum (MPeM), mostly due to asbestos exposure. This study reviewed the Dutch population-based incidence, treatment...

Statistical comparison between the physical properties of the particles on standard BhioStilo PIPAC and ultrasonic PIPAC

Background: The modality of peritoneal chemotherapy seeks to explore pharmacokinetic properties not possible with the use of systemic chemotherapy. PIPAC, in particular, seeks to better explore both the distribution and depth of penetration of therapeutic agents into the peritoneal space. This poster intent is to describe the physical properties of a new modality of aerosolization of a therapeutic substance directly into the peritoneal space using ultrasonic energy mechanism.

EVALUATION OF THE FEASIBILITY OF ULTRASONIC AEROSOLIZATION OF THERAPEUTIC SUBSTANCE IN ANIMAL MODEL

Background: The use of chemotherapy in the peritoneum seeks to explore pharmacokinetic properties not possible with the use of systemic chemotherapy. PIPAC aims to optimize the distribution and depth of penetration of therapeutic agents into the peritoneal space. This form of application uses devices that aerosolize therapeutic substances using high injection pressure atomization. This article seeks to describe the feasibility in an animal model of a new modality of aerosolization of a therapeutic substance in the peritoneum using ultrasonic energy.

Does Prophylactic Paraortic Lymph Node Irradiation Improve Outcomes in Women With Stage IIIC1 Endometrial Carcinoma?

PurposeTo evaluate the impact of prophylactic paraortic lymph node (PALN) radiation therapy (RT) on clinical outcomes in patients with International Federation of Obstetrics and Gynecology 2018 stage IIIC1 endometrial cancer (EC). Methods and MaterialsA multi-institutional retrospective study included patients with International Federation of Obstetrics and Gynecology 2018 stage IIIC1 EC lymph node assessment, status postsurgical staging, followed by adjuvant chemotherapy and RT using various sequencing regimens. Overall survival (OS) and recurrence-free survival (RFS) rates were estimated by the Kaplan-Meier method. Univariable and multivariable analysis were performed by Cox proportional hazard models for RFS/OS. In addition, propensity score matching was used to estimate the effect of the radiation field extent on survival outcomes. ResultsA total of 378 patients were included, with a median follow-up of 45.8 months. Pelvic RT was delivered to 286 patients, and 92 patients received pelvic and PALN RT. The estimated OS and RFS rates at 5 years for the entire cohort were 80% and 69%, respectively. There was no difference in the 5-year OS (77% vs 87%, P = .47) and RFS rates (67% vs 70%, P = .78) between patients treated with pelvic RT and those treated with pelvic and prophylactic PALN RT, respectively. After propensity score matching, the estimated hazard ratios (HRs) of prophylactic PALN RT versus pelvic RT were 1.50 (95% confidence interval, 0.71-3.19; P = .28) for OS and 1.24 (95% confidence interval, 0.64-2.42; P = .51) for RFS, suggesting that prophylactic PALN RT does not improve survival outcomes. Distant recurrence was the most common site of first recurrence, and the extent of RT field was not associated with the site of first recurrence (P = .79). ConclusionsProphylactic PALN RT was not significantly associated with improved survival outcomes in stage IIIC1 EC. Distant metastasis remains the most common site of failure despite routine use of systemic chemotherapy. New therapeutic approaches are necessary to optimize the outcomes for women with stage IIIC1 EC.