A comparison between Caucasian and Asian superficial venous anatomy and reflux patterns – Implications for potential precision endovenous ablation therapy

Objectives

The aim of this study is to investigate whether there are differences between predominantly Caucasians and Asians from two disparate cohorts around the globe, with regard to their pre-operative venous reflux patterns and truncal vein characteristics, which could potentially help clinicians tailor venous treatment for chronic venous insufficiency on a more individualised basis in different parts of the world.

Methods

A total of 200 lower limb chronic venous insufficiency duplex studies (127 Singaporean (predominantly Asian) patients) and 200 lower limb chronic venous insufficiency duplex scans (137 Americans predominantly Caucasians) were analysed and compared for differences in venous anatomy and reflux characteristics.

Results

Asian patients from Singapore presented with higher CEAP scores compared to the predominantly Caucasian cohort from the US (30% CEAP 4a or greater vs. 17.5%; p < 0.01). Singaporeans had more great saphenous vein reflux starting at the sapheno-femoral junction (86% vs. 73%; p < 0.01) and ending at the ankle (93% vs. 46%; p < 0.01). Vein diameters were generally larger in the US cohort of patients (median 5.7 mm vs. 2.9 mm; p < 0.01).

Conclusions

The predominantly Asian cohort from Singapore had smaller diameter truncal veins, longer segments of truncal vein reflux and present later with more advanced chronic venous insufficiency compared to their American counterparts. This information could help tailor endovenous ablation on a more individualised basis in the future.

Abstract P6-18-36: Real world treatment patterns and outcomes of patients receiving palbociclib plus aromatase inhibitor in the United States: Sub-groups analysis based on age, performance status and sites of metastases from the IRIS study

Background: Ibrance Real World Insights (IRIS) is a multi-country study aimed to describe clinical characteristics, treatment patterns and clinical outcomes of patients receiving palbociclib plus aromatase inhibitor. Previously the results on the overall population within the US have been communicated. The current analysis focuses on subgroups stratified by age, performance status and visceral status.

Materials and methods: A retrospective chart review of HR+/HER2- ABC/MBC patients who received palbociclib plus aromatase inhibitor as initial endocrine based therapy for their advanced disease was conducted between June and October 2017. Physicians completed electronic case report forms, extracting data on patient demographics, clinical characteristics, treatment history/patterns and clinical outcomes.Progression free and survival rates at 12 and 24 months were estimated via Kaplan-Meier analysis.

Results: Data for the US are reported here. In total 63 physicians completed 360 eCRFs with a mean follow up time since palbociclib initiation of 12 months. Majority of the patients were &gt;65 years (53%), and had ECOG status of 0 (30%) or 1 (56%). Overall 293 (81%) patients had metastatic disease, of which 50% had visceral metastases. Across all sub-groups, majority of patients prescribed an initial palbociclib dose of 125mg did not require a change of dose while on treatment. The 12-month and 24-month progression free and overall survival rates across subgroups are presented in Table 1. Patients with a performance status of ECOG=1 had a slightly lower progression and survival rates at 12 and 24 months compared to those with a score =0. Likewise, patients with visceral disease were observed to have slightly lower progression free and survival rates than others.

Table 1:Clinical Outcomes for the different sub-groups.Patient Sub-groups AgeECOG statusVisceral Status Up to 65 n=169Over 65 n=1910 n=1071 n=200Visceral metastases n=147Non-visceral metastases n=146Progression free survival rate at 12 months, %86.382.194.386.580.285.8Progression free survival rate at 24 months, %59.769.071.267.450.780.6Overall survival rate At 12 months, %97.992.8100.099.590.599.3Overall survival rate at 24 months, %95.185.695.796.487.290.7

Conclusions: The analysis indicates consistent trends in different clinical outcomes were observed with palbociclib plus aromatase inhibitor across patients sub-groups based on age, performance status and visceral metastases.

Citation Format: Taylor-Stokes G, Mitra D, Waller J, Gibson K, Milligan G, Zhan L, Iyer S. Real world treatment patterns and outcomes of patients receiving palbociclib plus aromatase inhibitor in the United States: Sub-groups analysis based on age, performance status and sites of metastases from the IRIS study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-36.

Abstract P6-18-21: Real world treatment patterns and outcomes of patients receiving palbociclib plus fulvestrant in the United States: Sub-groups analysis based on age, performance status and sites of metastases

Background: Ibrance Real World Insights (IRIS) is a multi-country study aimed to describe the clinical characteristics and understand treatment patterns and clinical outcomes of patients receiving palbociclib plus fulvestrant in real world clinical practice. Previously the results on the overall population within the US have been communicated. The current analyses focus on subgroups stratified by age, performance status and visceral status.

Materials and methods: A retrospective chart review of HR+/HER2- ABC/MBC patients was conducted between June and October 2017. Physicians extracted data from patient medical records for HR+/HER2- ABC patients who received palbociclib plus fulvestrant following disease progression with endocrine based therapy for their advanced disease. Electronic case report forms collected data covering patient demographics, clinical characteristics, treatment history/patterns and clinical outcomes.Progression free rates and survival rates at 6 and 12 months were estimated via Kaplan-Meier analysis.

Results: Data for the US are reported here. In total, 65 physicians extracted data for 292 patients who had a mean follow up time of 7.4 months. Majority of the patients were &gt;65 years (54%), and had ECOG status of 0 (32%) or 1 (48%). Overall 224 (77%) patients had metastatic disease, of which 93 (42%) had visceral metastases. Across all sub-groups, majority of patients prescribed an initial palbociclib dose of 125mg did not require a change of dose while on treatment. The 6-month and 12-month progression free and survival rates across subgroups are presented in Table 1. Patients with a performance status of ECOG ≥ 2 had a slightly lower progression and survival rates at 6 and 12 months compared to those with a score &lt;1. Likewise, patients with visceral disease were observed to have slightly lower progression free and survival rates than others.

Table 1:Clinical Outcomes by Patient Sub-groups.Patient Sub-groups AgeECOGstatusVisceral Status Up to 65 n=158Over 65 n=1340 n=931 n=1392+ n=60Visceral Metastases n=93Non-visceral Metastases n=131Progression free survival rate at 6 months, %95.293.297.893.490.689.694.8Progression free survival rate at 12 months, %81.277.884.683.0-73.276.5Survival rate at 6 months, %98.096.3100.098.290.692.298.9Survival rate at 12 months, %90.085.197.695.1-80.892.7

Conclusions: The analysis indicates consistent trends in different clinical outcomes were observed with palbociclib plus fulvestrant across patients sub-groups based on age, performance status and visceral metastases.

Citation Format: Waller J, Mitra D, Taylor-Stokes G, Gibson K, Milligan G, Zhan L, Iyer S. Real world treatment patterns and outcomes of patients receiving palbociclib plus fulvestrant in the United States: Sub-groups analysis based on age, performance status and sites of metastases [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-21.

Comparison of cyanoacrylate closure and radiofrequency ablation for the treatment of incompetent great saphenous veins: 36-Month outcomes of the VeClose randomized controlled trial

Objective

To evaluate the 36-month efficacy and safety of cyanoacrylate closure for the treatment of incompetent great saphenous veins in comparison with radiofrequency ablation.

Methods

In this multicenter, prospective, randomized controlled trial, 222 symptomatic subjects with incompetent great saphenous veins were assigned to either cyanoacrylate closure or radiofrequency ablation. The primary endpoint, complete closure of the target great saphenous vein, was determined using duplex ultrasound examination starting from three-month visit.

Results

At month 36, the great saphenous vein closure rates were 94.4% for the cyanoacrylate closure group and 91.9% for the radiofrequency ablation group. Stable improvement in symptoms and quality of life was observed in both groups. Adverse event rates between the 24- and 36-month visits were similar between the groups as were serious adverse events which were infrequent and judged unrelated to either the device or the procedure in both groups.

Conclusions

This trial continues to demonstrate the safety and efficacy of cyanoacrylate closure for the treatment of great saphenous vein incompetence with great saphenous vein closure rate at 36 months similar to that of radiofrequency ablation, indicating non-inferiority of cyanoacrylate closure to radiofrequency ablation. The improvement in quality of life outcomes were also sustained and similar between the two treatment groups.

Need for adjunctive procedures following cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of postprocedure compression: Three-month data from a postmarket evaluation of the VenaSeal System (the WAVES Study)

Purpose

Studies examining cyanoacrylate closure of saphenous veins with the VenaSeal™ System have not allowed concomitant procedures for tributaries at the time of the index procedure. Outside of clinical trials, however, concomitant procedures are frequently performed in conjunction with endovenous ablation. We report on the frequency of need for saphenous tributary treatment three months after cyanoacrylate closure of the treatment of great saphenous vein, small saphenous vein, and/or accessory saphenous vein.

Methods

Fifty subjects with symptomatic great saphenous vein, small saphenous vein, and/or accessory saphenous vein incompetence were treated with no postprocedure compression stockings. Concomitant procedures were not allowed. Treating physicians predicted the type and nature of any concomitant procedures that they would usually perform at the time of ablation, if not limited by the constraints of the study. Evaluations were performed at one week, one and three months and included duplex ultrasound, numeric pain rating scale, revised venous clinical severity score, the Aberdeen Varicose Vein Questionnaire, and time to return to work and normal activities. At the three-month visit, the need for and type of adjunctive procedures were recorded.

Results

Complete closure at three months was achieved in 70 (99%) of the treated veins (48 great saphenous veins, 14 accessory saphenous veins, eight small saphenous veins). Revised venous clinical severity score improved from 6.4 ± 2.2 to 1.8 ± 1.5 (P < .001) and Aberdeen Varicose Vein Questionnaire from 17.3 ± 7.9 to 6.5 ± 7.2 (P < .0001). Sixty-six percent of patients underwent tributary treatment at three months. The percentage of patients who required adjunctive treatments at three months was lower than had been predicted by the treating physicians (65% versus 96%, p=.0002).

Conclusions

Closure rates were high in the absence of the use of compression stockings or side branch treatment. Improvement in quality of life was significant, and the need for and extent of concomitant procedures was significantly less than had been predicted by the treating physicians.

Search for the Exotic Meson X(5568) with the Collider Detector at Fermilab

A search for the exotic meson X(5568) decaying into the B_{s}^{0}π^{±} final state is performed using data corresponding to 9.6  fb^{-1} from pp[over ¯] collisions at sqrt[s]=1960  GeV recorded by the Collider Detector at Fermilab. No evidence for this state is found and an upper limit of 6.7% at the 95% confidence level is set on the fraction of B_{s}^{0} produced through the X(5568)→B_{s}^{0}π^{±} process.

Combined Forward-Backward Asymmetry Measurements in Top-Antitop Quark Production at the Tevatron

The CDF and D0 experiments at the Fermilab Tevatron have measured the asymmetry between yields of forward- and backward-produced top and antitop quarks based on their rapidity difference and the asymmetry between their decay leptons. These measurements use the full data sets collected in proton-antiproton collisions at a center-of-mass energy of sqrt[s]=1.96  TeV. We report the results of combinations of the inclusive asymmetries and their differential dependencies on relevant kinematic quantities. The combined inclusive asymmetry is A_{FB}^{tt[over ¯]}=0.128±0.025. The combined inclusive and differential asymmetries are consistent with recent standard model predictions.

VeClose trial 12-month outcomes of cyanoacrylate closure versus radiofrequency ablation for incompetent great saphenous veins

OBJECTIVE

Endovenous cyanoacrylate closure (CAC) is a new U.S. Food and Drug Administration-approved therapy for treatment of clinically symptomatic venous reflux in saphenous veins. The device is indicated for the permanent closure of lower extremity superficial truncal veins, such as the great saphenous vein (GSV). Early results from a randomized trial of CAC have been reported previously. Herein we report 1-year outcomes.

METHODS

There were 222 subjects with symptomatic GSV incompetence randomly assigned to receive either CAC (n = 108) or radiofrequency ablation (RFA; n = 114). After the month 3 visit, subjects could receive adjunctive therapies aimed at treating visible varicosities and incompetent tributaries. Vein closure was assessed at day 3 and months 1, 3, 6, and 12 using duplex ultrasound. Additional study visit assessments included the Venous Clinical Severity Score; Clinical, Etiology, Anatomy, and Pathophysiology classification; EuroQol-5 Dimension; and Aberdeen Varicose Vein Questionnaire. Both time to closure and time to first reopening of the target vein were evaluated using survival curve analysis. Adverse events were evaluated at each visit.

RESULTS

Of 222 enrolled and randomized subjects, a 12-month follow-up was obtained for 192 (95 CAC and 97 RFA; total follow-up rate, 192/222 [86.5%]). By month 1, 100% of CAC subjects and 87% of RFA subjects demonstrated complete occlusion of the target vein. By month 12, the complete occlusion rate was nearly identical in both groups (97.2% in the CAC group and 97.0% in the RFA group). Twelve-month freedom from recanalization was similar in the CAC and RFA groups, although there was a trend toward greater freedom from recanalization in the CAC group (P = .08). Symptoms and quality of life improved equally in both groups. Most adverse events were mild to moderate and not related to the device or procedure.

CONCLUSIONS

In patients with incompetent GSVs, treatment with both CAC and RFA results in high occlusion rates. Time to complete occlusion was faster with CAC, and freedom from reopening was higher after CAC. Quality of life scores improved equally with both therapies.

American College of Phlebology Guidelines – Treatment of refluxing accessory saphenous veins

The American College of Phlebology Guidelines Committee performed a systematic review of the literature regarding the clinical impact and treatment of incompetent accessory saphenous veins. Using an accepted process for guideline developments, we developed a consensus opinion that patients with symptomatic incompetence of the accessory great saphenous veins (anterior and posterior accessory saphenous veins) be treated with endovenous thermal ablation (laser or radiofrequency) or ultrasound-guided foam sclerotherapy to eliminate symptomatology (Recommendation Grade 1C).

A multicenter, randomized, placebo-controlled study to evaluate the efficacy and safety of Varithena® (polidocanol endovenous microfoam 1%) for symptomatic, visible varicose veins with saphenofemoral junction incompetence

Objectives

A randomized, placebo-controlled, multicenter study was conducted to evaluate the safety and efficacy of polidocanol endovenous microfoam (1%, Varithena® [polidocanol injectable foam], BTG International Ltd.).

Methods

Patients (n = 77) with symptomatic, visible varicose veins were randomized to treatment with either Varithena 1% or placebo.

Results

Varithena provided greater mean changes from Baseline in patient-reported assessments of symptoms (e.g., heaviness, achiness, swelling, throbbing, itching [HASTI®] score 30.7 points vs 16.7 points, p = 0.0009, primary endpoint; and modified Venous Insufficiency Epidemiological and Economic Study-Quality-of-Life/Symptoms [m-VEINES-QOL/Sym; p < 0.001]), physician-assessed VCSS, and physician- and patient-assessed appearance compared with placebo.

The HASTI score correlated highly with the modified-VEINES-QOL/Sym and Chronic Venous Insufficiency Questionnaire-2 scores (r = 0.7 to > 0.9, p ≤ 0.001). Adverse events included contusion, incision-site hematoma, and limb discomfort. Venous thrombus adverse events were reported as mild and generally resolved without sequelae.

Conclusions

Varithena provided significantly greater symptom relief and improvement in leg appearance compared with placebo. Adverse events were generally mild and transient. (www.clinicaltrials.gov [NCT00758420]).

Cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of post-procedure compression: Initial outcomes of a post-market evaluation of the VenaSeal System (the WAVES Study)

Purpose Cyanoacrylate closure of the great saphenous vein with the VenaSeal™ Closure System is a relatively new modality. Studies have been limited to moderate-sized great saphenous veins and some have mandated postoperative compression stockings. We report the results of a prospective study of cyanoacrylate closure for the treatment of great saphenous vein, small saphenous veins, and/or accessory saphenous veins up to 20 mm in diameter. Methods Fifty subjects with symptomatic great saphenous vein, small saphenous veins, and/or accessory saphenous veins incompetence were each treated at a single session. Compression stockings were not used post-procedure. Subjects returned to clinic at week 1 and again at one month. Post-procedure evaluations were performed at seven days and one month and included numerical pain rating score, revised venous clinical severity score, the Aberdeen Varicose Vein Questionnaire score, and time to return to work and normal activities. Duplex ultrasound was performed at each visit. Findings Procedural pain was mild (numerical pain rating scale 2.2 ± 1.8). All treated veins (48 great saphenous vein, 14 accessory saphenous veins, and 8 small saphenous veins) had complete closure by duplex ultrasound at seven days and one month. Mean time to return to work and normal activities was 0.2 ± 1.1 and 2.4 ± 4.1 days, respectively. The revised venous clinical severity score was improved to 1.8 ± 1.4 ( p < .001) and Aberdeen Varicose Vein Questionnaire score to 8.9 ± 6.6 ( p < .001) at one month. Phlebitis in the treatment area or side branches occurred in 10 subjects (20%) and completely resolved in all but one subject (2%) by one month; 98% of subjects were "completely" or "somewhat" satisfied, and 2% "unsatisfied" with the procedure at one month, despite the protocol disallowance of concomitant side branch treatment. Conclusions Cyanoacrylate closure is safe and effective for the treatment of one or more incompetent saphenous or accessory saphenous veins. Closure rates were high even in the absence of the use of compression stockings or side branch treatment. Time back to work or normal activities was short and improvements in venous severity scores and QOL were significant, comparing favorably with alternative treatment methods.

Clinical outcome after treatment of pelvic congestion syndrome: sense and nonsense

Chronic pelvic pain accounts for approximately 10% of outpatient gynecologic visits and among the varied causes, pelvic congestion syndrome is second only to endometriosis in frequency. Manifestations may include pelvic pain, dyspareunia, dysuria, and dysmenorrhea as well as external varices and a number of psychosocial symptoms. Although a variety of treatments have been proposed-including pharmacologic ovarian suppression, hysterectomy with or without oophorectomy, and ovarian vein resection-transcatheter embolization is the least invasive and most efficacious management option. Complete or partial symptom improvement has been reported in 68.2-100% of patients and there has been a consistent reduction in visual analog pain scores after treatment. Based upon these results, recommendation of either pharmacotherapy or other surgical procedures is difficult to justify. However, it is also clear that 6-31.8% of patients do not get substantial relief from pelvic venous embolization. Potential explanations for an inadequate response to treatment include patient variability, procedural variability, and inadequate outcome measures. The latter are particularly important and future investigation should focus on the development of disease-specific quality of life measures as well as identifying those aspects of the procedure, such as choice of embolic agents and extent of embolization, associated with the best clinical outcomes.

Tevatron Combination of Single-Top-Quark Cross Sections and Determination of the Magnitude of the Cabibbo-Kobayashi-Maskawa Matrix Element V_{tb}

We present the final combination of CDF and D0 measurements of cross sections for single-top-quark production in proton-antiproton collisions at a center-of-mass energy of 1.96 TeV. The data correspond to total integrated luminosities of up to 9.7 fb^{-1} per experiment. The t-channel cross section is measured to be σ_{t}=2.25_{-0.31}^{+0.29} pb. We also present the combinations of the two-dimensional measurements of the s- vs t-channel cross section. In addition, we give the combination of the s+t channel cross section measurement resulting in σ_{s+t}=3.30_{-0.40}^{+0.52} pb, without assuming the standard model value for the ratio σ_{s}/σ_{t}. The resulting value of the magnitude of the top-to-bottom quark coupling is |V_{tb}|=1.02_{-0.05}^{+0.06}, corresponding to |V_{tb}|>0.92 at the 95% C.L.

Search for Resonances Decaying to Top and Bottom Quarks with the CDF Experiment

We report on a search for charged massive resonances decaying to top (t) and bottom (b) quarks in the full data set of proton-antiproton collisions at a center-of-mass energy of √[s]=1.96  TeV collected by the CDF II detector at the Tevatron, corresponding to an integrated luminosity of 9.5  fb(-1). No significant excess above the standard model background prediction is observed. We set 95% Bayesian credibility mass-dependent upper limits on the heavy charged-particle production cross section times branching ratio to tb. Using a standard model extension with a W'→tb and left-right-symmetric couplings as a benchmark model, we constrain the W' mass and couplings in the 300-900  GeV/c(2) range. The limits presented here are the most stringent for a charged resonance with mass in the range 300-600  GeV/c(2) decaying to top and bottom quarks.