Current Issue : July - September Volume : 2020 Issue Number : 3 Articles : 7 Articles
Background: We assessed breast cancer mortality in older versus younger women according to race/ethnicity,\nneighborhood socioeconomic status (nSES), and health insurance status.\nMethods: The study included female breast cancer cases 18 years of age and older, diagnosed between 2005 and\n2015 in the California Cancer Registry. Multivariable Cox proportional hazards modeling was used to generate\nhazard ratios (HR) of breast cancer specific deaths and 95% confidence intervals (CI) for older (60+ years) versus\nyounger (< 60 years) patients separately by race/ethnicity, nSES, and health insurance status.\nResults: Risk of dying from breast cancer was higher in older than younger patients after multivariable adjustment,\nwhich varied in magnitude by race/ethnicity (P-interaction< 0.0001). Comparing older to younger patients, higher\nmortality differences were shown for non-Hispanic White (HR = 1.43; 95% CI, 1.36â??1.51) and Hispanic women (HR =\n1.37; 95% CI, 1.26â??1.50) and lower differences for non-Hispanic Blacks (HR = 1.17; 95% CI, 1.04â??1.31) and Asians/\nPacific Islanders (HR = 1.15; 95% CI, 1.02â??1.31). HRs comparing older to younger patients varied by insurance status\n(P-interaction< 0.0001), with largest mortality differences observed for privately insured women (HR = 1.51; 95% CI,\n1.43â??1.59) and lowest in Medicaid/military/other public insurance (HR = 1.18; 95% CI, 1.10â??1.26). No age differences\nwere shown for uninsured women. HRs comparing older to younger patients were similar across nSES strata.\nConclusion: Our results provide evidence for the continued disparity in Black-White breast cancer mortality, which\nis magnified in younger women. Moreover, insurance status continues to play a role in breast cancer mortality, with\nuninsured women having the highest risk for breast cancer death, regardless of age....
Background: Although checkpoint blockades have become widely used, the immunological impact in cancer\npatients, especially those with oral cavity squamous cell carcinoma (OCSCC), has not been well studied.\nMethods: The present study assessed the immunological impact of anti-PD-1 (nivolumab) treatment in 10 patients\nwith OCSCC. This involved phenotypic analyses of peripheral blood T-cell subpopulations and their expression of\nimmune mediators prior to and following nivolumab treatment. The focus was on immunological effects of\ntreatment without regard to possible clinical responses.\nResults: Nivolumab caused a decline in the frequency of blood CD4+ cells but did not affect their expression of\nIFN-������.....
Background: The identification of neck lymph node (LN) metastases represents a very important issue in the\nmanagement of patients with differentiated thyroid carcinoma (DTC). To this purpose, in the present study, we\nused 131I-SPECT/CT as a diagnostic imaging procedure.\nMethods: A consecutive series of 224 DTC patients with ascertained neck radioiodine-avid foci at 131I-SPECT/CT\nduring long-term follow-up was evaluated. All patients had already undergone total thyroidectomy and radioiodine\ntherapy and had been classified as follows: 62 at high risk (H), 64 at low risk (L) and 98 at very low risk (VL). 131IWhole\nbody scan (WBS) followed by SPECT/CT was performed in all cases.\nResults: In the 224 patients, 449 neck iodine avid foci were ascertained at SPECT/CT, while 322 were evidenced at\nWBS in 165/224 patients. WBS classified as residues 263/322 foci and as unclear 59/322 foci; among the former foci\nSPECT/CT correctly characterized 8 LN metastases and 3 physiologic uptakes and among the latter, it pinpointed 26\nLN metastases, 18 residues, and 15 physiologic uptakes. SPECT/CT also classified 127 foci occult at WBS as 59 LN\nmetastases and 68 residues. Globally, SPECT/CT identified 93 LN metastases in 59 patients (26 H, 20 L, 13 VL), while\nWBS evidenced 34 in 25 cases. All 13 VL patients, T1aN0M0, 5 of whom with LN near sub-mandibular glands, had\nthyroglobulin undetectable or < 2.5 ng/ml. Globally, SPECT/CT obtained an incremental value than WBS in 45.5% of\npatients, a more correct patient classification changing therapeutic approach in 30.3% of cases and identified WBS\nfalse-positive findings in 8% of cases.\nConclusions: 131I-SPECT/CT proved to correctly detect and characterize neck LN metastases in DTC patients in\nlong-term follow-up, improving the performance of planar WBS. SPECT/CT routine use is thus suggested; its role is\nparticularly relevant in patients with WBS inconclusive, VL, T1aN0M0 and with undetectable or very low\nthyroglobulin levels....
Background: NEPA is an oral fixed-dose combination of netupitant, a new highly selective neurokinin-1 receptor\nantagonist, and palonosetron. This study was conducted to evaluate whether the efficacy of NEPA against\nchemotherapy-induced nausea and vomiting (CINV) in cycle 1 would be maintained over subsequent\nchemotherapy cycles in breast cancer patients receiving adjuvant anthracycline plus cyclophosphamide (AC). The\nstudy also describes the relationship between efficacy on day 1 through 5 (overall period) and control of CINV on\nday 6 through 21 (very late period) in each cycle.\nMethods: In this multicentre, phase II study, patients received both NEPA and dexamethasone (12 mg\nintravenously) just before chemotherapy. The primary efficacy endpoint was overall complete response (CR; no\nemesis and no rescue medication use) in cycle 1. Sustained efficacy was evaluated during the subsequent cycles by\ncalculating the rate of CR in cycles 2â??4 and by assessing the probability of sustained CR over multiple cycles. The\nimpact of both overall CR and risk factors for CINV on the control of very late events (vomiting and moderate-tosevere\nnausea) were also examined.\nResults: Of the 149 patients enrolled in the study, 139 were evaluable for a total of 552 cycles; 97.8% completed all\n4 cycles. The proportion of patients with an overall CR was 70.5% (90% CI, 64.1 to 76.9) in cycle 1, and this was\nmaintained in subsequent cycles. The cumulative percentage of patients with a sustained CR over 4 cycles was\n53%. NEPA was well tolerated across cycles. In each cycle, patients with CR experienced a significantly better\ncontrol of very late CINV events than those who experienced no CR. Among the patients with CR, the only\npredictor for increased likelihood of developing very late CINV was pre-chemotherapy (anticipatory) nausea\n(adjusted odds ratio = 0.65â??0.50 for no CINV events on cycles 3 and 4).\nConclusion: The high anti-emetic efficacy seen with the NEPA regimen in the first cycle was maintained over\nmultiple cycles of adjuvant AC for breast cancer. Preliminary evidence also suggests that patients achieving a CR\nduring the overall period gain high protection even against very late CINV events in each chemotherapy cycle.\nTrial registration: This trial was retrospectively registered at Clinicaltrials.gov identifier (NCT03862144) on 05/Mar/\n2019....
Many studies have reported the prognostic significance of the bone scan index (BSI) for metastatic\ncastration-resistant prostate cancer (mCRPC); however, these reports are controversial. This study investigated the\nBSI in mCRPC and its relationship with prognosis.\nMethods: The PubMed, Cochrane, and Embase databases were searched systematically for relevant articles\npublished before September 1, 2019. Hazard ratios (HRs) were used to investigate the prognostic value................
Background: Prophylactic cranial irradiation (PCI) is a current standard of care after confirmed response to radical\nchemoradiotherapy for limited disease small cell lung cancer (LD-SCLC). This standard is mostly based on results of\nold randomized studies when brain imaging with magnetic resonance (MRI) was not available. Survival benefit of\nPCI in extended disease SCLC was recently challenged by the results of randomized phase III study from Japan.\nMethods: Eighty patients with LD-SCLC after response to chest chemoradiotherapy will be enrolled. Patients will be\nfollowed up by brain MRI every 3 to 6 months up to 3 years. Neurocognitive function tests will be performed at\nbaseline and after 12 and 24 months. Patients who develop brain metastases will be irradiated with stereotactic\n(SRT) or whole brain RT (WBRT). The primary endpoint is overall survival. The secondary endpoints are: response rate\nto radiotherapy of early detected brain metastases, analysis of efficacy of SRT and WBRT; assessment and analysis of\nneurocognitive functions and QoL in the studied cohorts: QLQ-C30 questionnaire and the California Verbal Learning\nTest, Color connection test, Benton visual retention test, and verbal fluency test will be carried out.\nDiscussion: The results of this trial may contribute to changing of LD-SCLC clinical management by deescalating\nthe treatment. There is a lack of prospective, recent studies in LD-SCLC patients with omission of PCI and modern\nradiation therapy technologies for developed brain metastases. The comprehensive neurocognitive function testing\nwill help to assess the impact of modern radiotherapy (SRT) compared with WBRT and no-PCI in SCLC patients. A\nsubgroup of long-term survivors, who will not develop brain metastases, will not be exposed to unnecessary brain\nirradiation with its deleterious consequences. The limitation of our study is a lack of parallel randomized control\narm. This is a potential source of bias; however, randomized study will be difficult to complete for two major\nreasons: (1) limited population of LD-SCLC eligible for the study and (2) opinions of our patients, who after\ninformation and discussion about benefits and potential harms of PCI, often choose to omit PCI in our practice.\nTrial registration: ClinicalTrials.gov Identifier: NCT04168281, 19 Nov. 2019....
Background: Immune checkpoint inhibitors (ICI) are an integral part of bladder cancer therapy, however, the\nrelevance of ICI treatment for mixed and pure squamous cell carcinoma of the bladder remains poorly studied.\nTherefore, we analysed the expression of programmed death-ligand 1 (PD-L1) in urothelial carcinomas with\nsquamous differentiation (UC/SCC) and pure squamous cell carcinoma (SCC) of the bladder and studied a UC/SCC\npatient with ICI therapy.\nMethods: Tissue microarrays of 45 UC/SCC and 63 SCC samples were immunohistochemically stained with four\nanti-PD-L1 antibodies (28â??8, 22C3, SP142 and SP263). PD-L1 expression was determined for tumour cells (TP-Score),\nimmune cells (IC-Score) and combined (CPS, combined positive score). In addition, we present clinical and\nhistological data of an UC/SCC patient with nivolumab therapy.\nResults: Overall, positive PD-L1 staining ranged between 4.8 and 61.9% for IC and 0 and 51.2% for TC depending\non the used antibody. There were no significant differences between UC/SCC and SCC. According to current FDA\nguidelines for example for first line therapy of urothelial cancer with pembrolizumab.........................
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