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Palenzuela G, Schiffler C, Frappaz D, Peyrl A, Gerber NU, Kortmann RD, Philippe M, Zimmermann M, Murray MJ, Nicholson JC, Calaminus G, Faure-Conter C. Acute toxicity of chemotherapy in central nervous system germ cell tumour patients according to age. Front Oncol 2024; 14:1421418. [PMID: 39077474 PMCID: PMC11284053 DOI: 10.3389/fonc.2024.1421418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/17/2024] [Indexed: 07/31/2024] Open
Abstract
Background SIOP-CNS-GCT-II European trial was opened for the treatment of patients of any age with central nervous system germ cell tumour (CNS-GCT). Four courses of pre-irradiation chemotherapy were delivered. The influence of patient age on chemotherapy related acute toxicity (CRAT) was assessed. Methods CRAT was analysed according to age-groups: children (aged ≤11 years), adolescents (aged 12-17 years), adults (aged ≥18 years) and to chemotherapy type: CarboPEI (alternating etoposide-carboplatin/etoposide-ifosfamide) for non-metastatic germinoma; PEI (cisplatin-etoposide-ifosfamide) for standard-risk non-germinomatous GCT (NGGCT); PEI and high-dose PEI (HD-PEI), for high-risk or poorly responsive NGGCTs. Results 296 patients were assessable for CRAT: 105 children, 121 adolescents, 70 adults (max age: 41 years). Median cumulative doses/m² of chemotherapy were similar among age-groups. The proportion of germinoma over NGGCT (and accordingly use of CarboPEI chemotherapy) was higher in the adult groups (79%) versus the other two groups (62%). Delay in chemotherapy ≥7 days was noticed in 27%, 38%, and 19% of children, adolescents, and adults, respectively. Grade ≥3 haematological and non-haematological adverse events (AEs) were observed in 94%/31%, 97%/36%, and 77%/21% of children, adolescents, and adults, respectively. No toxic death was reported. Grade ≥3 AEs and delayed chemotherapies were significantly rarer in adults when compared with adolescents, even when adjusted on chemotherapy type: odds ratio: 0.1 [95%CI 0.02-0.4], and 0.2 [95%CI 0.1-0.4] in the group treated with CarboPEI. Conclusion Adult patients can be treated safely with a chemotherapy intensive protocol, with even less toxicity than that observed in adolescents. Further work is required to understand age-related differences regarding toxicity.
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Affiliation(s)
- Gilles Palenzuela
- University Hospital, Department of Paediatric Haematology and Oncology, Montpellier, France
| | | | - Didier Frappaz
- Department of Pediatric Oncology, Institut d’Hémato‐oncologie Pédiatrique, Lyon, France
| | - Andreas Peyrl
- Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Nicolas U. Gerber
- Department of Oncology, University Children’s Hospital, Zürich, Switzerland
| | | | - Michael Philippe
- Department of Clinical Pharmacy and Oncology, Centre Léon Bérard, Lyon, France
| | - Martin Zimmermann
- Department of Paediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Matthew J. Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals, Cambridge, United Kingdom
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - James C. Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Gabriele Calaminus
- Department of Paediatric Haematology and Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Cécile Faure-Conter
- Department of Pediatric Oncology, Institut d’Hémato‐oncologie Pédiatrique, Lyon, France
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2
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Stafford LK, Tang X, Brandt A, Ma J, Banchs J, Livingston JA, Roth ME, Morrison AC, Hildebrandt MAT. Risk of anthracycline-induced cardiac dysfunction in adolescent and young adult (AYA) cancer survivors: role of genetic susceptibility loci. THE PHARMACOGENOMICS JOURNAL 2024; 24:21. [PMID: 38951505 DOI: 10.1038/s41397-024-00343-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 06/05/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024]
Abstract
There is a known genetic susceptibility to anthracycline-induced cardiac dysfunction in childhood cancer survivors, but this has not been adequately shown in adolescent and young adult (AYA) patients. Our aim was to determine if the previously identified variants associated with cardiac dysfunction in childhood cancer patients affect AYA cancer patients similarly. Forty-five variants were selected for analysis in 253 AYAs previously treated with anthracyclines. We identified four variants that were associated with cardiac dysfunction: SLC10A2:rs7319981 (p = 0.017), SLC22A17:rs4982753 (p = 0.019), HAS3:rs2232228 (p = 0.023), and RARG:rs2229774 (p = 0.050). HAS3:rs2232228 and SLC10A2:rs7319981 displayed significant effects in our AYA cancer survivor population that were in the opposite direction than that reported in childhood cancer survivors. Genetic variants in the host genes were further analyzed for additional associations with cardiotoxicity in AYA cancer survivors. The host genes were then evaluated in a panel of induced pluripotent stem cell-derived cardiomyocytes to assess changes in levels of expression when treated with doxorubicin. Significant upregulation of HAS3 and SLC22A17 expression was observed (p < 0.05), with non-significant anthracycline-responsivity observed for RARG. Our study demonstrates that there is a genetic influence on cardiac dysfunction in AYA cancer patients, but there may be a difference in the role of genetics between childhood and AYA cancer survivors.
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Affiliation(s)
- Lily K Stafford
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiaohui Tang
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda Brandt
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianzhong Ma
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jose Banchs
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J Andrew Livingston
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael E Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michelle A T Hildebrandt
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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3
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Metts JL, Aye JM, Crane JN, Oberoi S, Balis FM, Bhatia S, Bona K, Carleton B, Dasgupta R, Dela Cruz FS, Greenzang KA, Kaufman JL, Linardic CM, Parsons SK, Robertson-Tessi M, Rudzinski ER, Soragni A, Stewart E, Weigel BJ, Wolden SL, Weiss AR, Venkatramani R, Heske CM. Roadmap for the next generation of Children's Oncology Group rhabdomyosarcoma trials. Cancer 2024. [PMID: 38941509 DOI: 10.1002/cncr.35457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Clinical trials conducted by the Intergroup Rhabdomyosarcoma (RMS) Study Group and the Children's Oncology Group have been pivotal to establishing current standards for diagnosis and therapy for RMS. Recent advancements in understanding the biology and clinical behavior of RMS have led to more nuanced approaches to diagnosis, risk stratification, and treatment. The complexities introduced by these advancements, coupled with the rarity of RMS, pose challenges to conducting large-scale phase 3 clinical trials to evaluate new treatment strategies for RMS. Given these challenges, systematic planning of future clinical trials in RMS is paramount to address pertinent questions regarding the therapeutic efficacy of drugs, biomarkers of response, treatment-related toxicity, and patient quality of life. Herein, the authors outline the proposed strategic approach of the Children's Oncology Group Soft Tissue Sarcoma Committee to the next generation of RMS clinical trials, focusing on five themes: improved novel agent identification and preclinical to clinical translation, more efficient trial development and implementation, expanded opportunities for knowledge generation during trials, therapeutic toxicity reduction and quality of life, and patient engagement.
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Affiliation(s)
- Jonathan L Metts
- Sarcoma Department, Moffitt Cancer Center, Tampa, Florida, USA
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Jamie M Aye
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jacquelyn N Crane
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sapna Oberoi
- Department of Pediatric Hematology/Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Frank M Balis
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Bruce Carleton
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Filemon S Dela Cruz
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Katie A Greenzang
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jonathan L Kaufman
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
- Patient Advocacy Committee, Children's Oncology Group, Monrovia, California, USA
| | - Corinne M Linardic
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mark Robertson-Tessi
- Integrated Mathematical Oncology Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Erin R Rudzinski
- Department of Laboratory Medicine and Pathology, Seattle Children's Hospital and University of Washington Medical Center, Seattle, Washington, USA
| | - Alice Soragni
- Department of Orthopedic Surgery, University of California Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, USA
| | - Elizabeth Stewart
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Brenda J Weigel
- Division of Pediatric Hematology Oncology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Aaron R Weiss
- Department of Pediatrics, Maine Medical Center, Portland, Maine, USA
| | | | - Christine M Heske
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
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4
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Zhou B, Kwan B, Desai MJ, Nalawade V, Henk J, Viravalli N, Murphy JD, Nathan PC, Ruddy KJ, Shliakhtsitsava K, Su HI, Whitcomb BW. Association of platinum-based chemotherapy with live birth and infertility in female survivors of adolescent and young adult cancer. Fertil Steril 2024; 121:1020-1030. [PMID: 38316209 PMCID: PMC11128346 DOI: 10.1016/j.fertnstert.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To estimate the effect of platinum-based chemotherapy on live birth (LB) and infertility after cancer, in order to address a lack of treatment-specific fertility risks for female survivors of adolescent and young adult cancer, which limits counseling on fertility preservation decisions. DESIGN Retrospective cohort study. SETTING US administrative database. PATIENTS We identified incident breast, colorectal, and ovarian cancer cases in females aged 15-39 years who received platinum-based chemotherapy or no chemotherapy and matched them to females without cancer. INTERVENTION Platinum-based chemotherapy. MAIN OUTCOME MEASURES We estimated the effect of chemotherapy on the incidence of LB and infertility after cancer, overall, and after accounting for competing events (recurrence, death, and sterilizing surgeries). RESULTS There were 1,287 survivors in the chemotherapy group, 3,192 in the no chemotherapy group, and 34,147 women in the no cancer group, with a mean age of 33 years. Accounting for competing events, the overall 5-year LB incidence was lower in the chemotherapy group (3.9%) vs. the no chemotherapy group (6.4%). Adjusted relative risks vs. no chemotherapy and no cancer groups were 0.61 (95% confidence interval [CI] 0.42-0.82) and 0.70 (95% CI 0.51-0.93), respectively. The overall 5-year infertility incidence was similar in the chemotherapy group (21.8%) compared with the no chemotherapy group (20.7%). The adjusted relative risks vs. no chemotherapy and no cancer groups were 1.05 (95% CI 0.97-1.15) and 1.42 (95% CI 1.31-1.53), respectively. CONCLUSIONS Cancer survivors treated with platinum-based chemotherapy experienced modestly increased adverse fertility outcomes. The estimated effects of platinum-based chemotherapy were affected by competing events, suggesting the importance of this analytic approach for interpretations that ultimately inform clinical fertility preservation decisions.
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Affiliation(s)
- Beth Zhou
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Brian Kwan
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California San Diego, San Diego, California; Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, California
| | - Milli J Desai
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Vinit Nalawade
- Moores Cancer Center, University of California San Diego, San Diego, California; Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Joe Henk
- OptumLabs, Eden Prarie, Minnesota
| | | | - James D Murphy
- Moores Cancer Center, University of California San Diego, San Diego, California; Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Paul C Nathan
- Department of Paediatrics, Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Ksenya Shliakhtsitsava
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - H Irene Su
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California; Moores Cancer Center, University of California San Diego, San Diego, California
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts.
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5
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Schab M, Skoczen S. Nutritional status, body composition and diet quality in children with cancer. Front Oncol 2024; 14:1389657. [PMID: 38706604 PMCID: PMC11066172 DOI: 10.3389/fonc.2024.1389657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
During cancer treatment, nutritional status disorders such as malnutrition or obesity affect the tolerance of cancer treatment, quality of life, but also the pharmacokinetics of drugs. It is hypothesized that changes in fat and lean body mass can modify chemotherapy volume distribution, metabolism and clearance. In children with cancer, lean body mass decreases or remains low during treatment and fat mass increases. Body composition is influenced by the cancer itself, aggressive multimodal-therapies, changes in metabolism, unbalanced diet and reduced physical activity. Due to the side effects of treatment, including changes in the sense of taste and smell, nausea, vomiting, diarrhea, and stress, eating according to recommendation for macronutrients and micronutrients is difficult. Research indicates that throughout cancer treatment, the consumption of fruits, vegetables, and dairy products tends to be insufficient, whereas there is an elevated intake of sugar and unhealthy snacks. Children exhibit a preference for high-carbohydrate, salty, and strongly flavored products. This review revealed the importance of body composition and its changes during cancer treatment in children, as well as eating habits and diet quality.
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Affiliation(s)
- Magdalena Schab
- Doctoral School of Medical and Health Science, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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6
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He Y, Zhao W, Duan A, Xiao H, Zhou X, Zhuo Q. 'Only to reconcile with it'. The coping experience amongst middle-aged and older cancer survivors: A qualitative study. Health Expect 2024; 27:e14048. [PMID: 38606474 PMCID: PMC11009723 DOI: 10.1111/hex.14048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Cancer threat is relevant to age, and the threat of a foreshortened life coupled with a lengthy treatment process negatively affects middle-aged and older adults. Understanding the coping throughout the cancer experience in middle-aged and older cancer survivors will help develop supportive care to promote their physiological and psychological coping effects. OBJECTIVES To explore the cancer coping experiences of middle-aged adults aged 40-59 and older adults over 60. DESIGN A descriptive phenomenological study was employed. METHODS Face-to-face, in-depth, semistructured interviews were conducted with 22 oncology patients in a tertiary university hospital aged 40 or above from August to October 2023. The interview data were analyzed using thematic analysis procedures. RESULTS Five themes and 13 subthemes were formed through analysis: acceptance of cancer (considering cancer as chronic, believing in fate and attributing cancer to karma); having different information needs (desired to be truthfully informed, information-seeking behaviour, information avoidance behaviour); getting families involved (developing dependent behaviours, feeling emotional support, family members suffering worse); striving to maintain positive psychological state (positive thinking, seeking peer support) and negative experience (undesirable, low self-esteem). CONCLUSION Our study reveals that cancer survivors' attitudes towards having cancer have changed from a death sentence to a more positive perception of a chronic disease. Supportive programmes for developing coping strategies should consider the cultural traditions and religious beliefs, different information needs, involvement of family and promoting a positive psychological state while avoiding negative factors. PATIENT OR PUBLIC CONTRIBUTION Participants with experience of coping with cancer were involved in the semistructured interview.
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Affiliation(s)
- Yi He
- Department of Cancer CenterThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Wei Zhao
- Department of Cancer CenterThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - An Duan
- Department of Cancer CenterThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Hong Xiao
- Department of Cancer CenterThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xuemei Zhou
- Department of Cancer CenterThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Qiqi Zhuo
- Department of Cancer CenterThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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7
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Xue L, Tang Y, Wang L, Xu C, Cheng Q, Li X. Epidemiology and risk factors of bloodstream infections among adolescents and young adults with acute lymphoblastic leukaemia: An 11-year retrospective cohort study. Clin Exp Pharmacol Physiol 2024; 51:e13850. [PMID: 38452755 DOI: 10.1111/1440-1681.13850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/18/2024] [Accepted: 02/13/2024] [Indexed: 03/09/2024]
Abstract
Adolescent and young adults (AYAs) belong to a unique category of patients diagnosed with acute lymphoblastic leukaemia (ALL). Bloodstream infection (BSI) is a leading cause of treatment-related mortality in ALL patients. However, the epidemiology and risk factors for mortality from BSIs in AYA patients remain unclear. In this study, we analysed these aspects in AYAs patients and compared similarities and differences with children (<15 years old) and older adults (>39 years old). We analysed the pathogenic epidemiology, antibiotic resistance and BSI risk factors of 73 children, 180 AYAs, and 110 older adults with ALL in three comprehensive hospitals from January 2010 to August 2021. The data on BSIs in AYAs were compared to that of the other two groups. In this study, the epidemiology of BSIs in AYAs was similar to that of older adult patients. Concerning clinical characteristics, most AYAs and older adults with BSIs were in a relapsed or uncontrolled state (34.5% vs. 35.4%, p = 0.861). In terms of pathogen distribution, Gram-negative bacteria (GNB) were the most common causative pathogens in AYAs and older adult groups. Extended-spectrum beta-lactamase (ESBL)-producing bacteria were more commonly found in AYAs than in children (32.8% vs. 16.4%, p = 0.09). Regarding risk factors, the length of hospitalization (>14 days) and renal inadequacy (creatinine ≥ 177 μmol/L) were influencing factors for 30-day mortality in AYAs patients with BSIs. In our study, AYA patients with BSIs showed clinical characteristics and pathogen distributions similar to those of older adult patients but quite different from those of children.
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Affiliation(s)
- Longlong Xue
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Yishu Tang
- Department of Emergency, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Liwen Wang
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Cong Xu
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
- Department of Hematology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, People's Republic of China
| | - Qian Cheng
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Xin Li
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
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8
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Picher EA, Wahajuddin M, Barth S, Chisholm J, Shipley J, Pors K. The Capacity of Drug-Metabolising Enzymes in Modulating the Therapeutic Efficacy of Drugs to Treat Rhabdomyosarcoma. Cancers (Basel) 2024; 16:1012. [PMID: 38473371 DOI: 10.3390/cancers16051012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Rhabdomyosarcoma (RMS) is a rare soft tissue sarcoma (STS) that predominantly affects children and teenagers. It is the most common STS in children (40%) and accounts for 5-8% of total childhood malignancies. Apart from surgery and radiotherapy in eligible patients, standard chemotherapy is the only therapeutic option clinically available for RMS patients. While survival rates for this childhood cancer have considerably improved over the last few decades for low-risk and intermediate-risk cases, the mortality rate remains exceptionally high in high-risk RMS patients with recurrent and/or metastatic disease. The intensification of chemotherapeutic protocols in advanced-stage RMS has historically induced aggravated toxicity with only very modest therapeutic gain. In this review, we critically analyse what has been achieved so far in RMS therapy and provide insight into how a diverse group of drug-metabolising enzymes (DMEs) possess the capacity to modify the clinical efficacy of chemotherapy. We provide suggestions for new therapeutic strategies that exploit the presence of DMEs for prodrug activation, targeted chemotherapy that does not rely on DMEs, and RMS-molecular-subtype-targeted therapies that have the potential to enter clinical evaluation.
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Affiliation(s)
- Enric Arasanz Picher
- Institute of Cancer Therapeutics, Faculty of Life Sciences, University of Bradford, Bradford BD7 1DP, UK
| | - Muhammad Wahajuddin
- Institute of Cancer Therapeutics, Faculty of Life Sciences, University of Bradford, Bradford BD7 1DP, UK
| | - Stefan Barth
- Medical Biotechnology and Immunotherapy Research Unit, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
| | - Julia Chisholm
- Children and Young People's Unit, Royal Marsden Hospital, Institute of Cancer Research, Sutton SM2 5PR, UK
| | - Janet Shipley
- Sarcoma Molecular Pathology Group, Division of Molecular Pathology, The Institute of Cancer Research, Sutton SM2 5NG, UK
| | - Klaus Pors
- Institute of Cancer Therapeutics, Faculty of Life Sciences, University of Bradford, Bradford BD7 1DP, UK
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9
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Veluvolu SM, Grohar PJ. Importance of pharmacologic considerations in the development of targeted anticancer agents for children. Curr Opin Pediatr 2023; 35:91-96. [PMID: 36562272 DOI: 10.1097/mop.0000000000001208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe key pharmacologic considerations to inform strategies in drug development for pediatric cancer. RECENT FINDINGS Main themes that will be discussed include considering patient specific factors, epigenetic/genetic tumor context, and drug schedule when optimizing protocols to treat pediatric cancers. SUMMARY Considering these factors will allow us to more effectively translate novel targeted therapies to benefit pediatric patients.
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Affiliation(s)
- Sridhar M Veluvolu
- Division of Oncology, Center of Childhood Cancer Research, Children's Hospital of Philadelphia
| | - Patrick J Grohar
- Division of Oncology, Center of Childhood Cancer Research, Children's Hospital of Philadelphia
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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10
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Ferrari A, Gatz SA, Minard-Colin V, Alaggio R, Hovsepyan S, Orbach D, Gasparini P, Defachelles AS, Casanova M, Milano GM, Chisholm JC, Jenney M, Bisogno G, Rogers T, Mandeville HC, Shipley J, Miah AB, Merks JHM, van der Graaf WTA. Shedding a Light on the Challenges of Adolescents and Young Adults with Rhabdomyosarcoma. Cancers (Basel) 2022; 14:6060. [PMID: 36551545 PMCID: PMC9775932 DOI: 10.3390/cancers14246060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is a typical tumour of childhood but can occur at any age. Several studies have reported that adolescent and young adult (AYA) patients with RMS have poorer survival than do younger patients. This review discusses the specific challenges in AYA patients with pediatric-type RMS, exploring possible underlying factors which may influence different outcomes. Reasons for AYA survival gap are likely multifactorial, and might be related to differences in tumor biology and intrinsic aggressiveness, or differences in clinical management (that could include patient referral patterns, time to diagnosis, enrolment into clinical trials, the adequacy and intensity of treatment), as well as patient factors (including physiology and comorbidity that may influence treatment tolerability, drug pharmacokinetics and efficacy). However, improved survival has been reported in the most recent studies for AYA patients treated on pediatric RMS protocols. Different strategies may help to further improve outcome, such as supporting trans-age academic societies and national/international collaborations; developing specific clinical trials without upper age limit; defining integrated and comprehensive approach to AYA patients, including the genomic aspects; establishing multidisciplinary tumor boards with involvement of both pediatric and adult oncologists to discuss all pediatric-type RMS patients; developing dedicated projects with specific treatment recommendations and registry/database.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Susanne Andrea Gatz
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Veronique Minard-Colin
- Department of Paediatric and Adolescent Oncology, Gustave-Roussy, Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Rita Alaggio
- Pathology Department, Ospedale Pediatrico Bambino Gesù IRCCS, 00165 Roma, Italy
| | - Shushan Hovsepyan
- Pediatric Cancer and Blood Disorders Centre of Armenia, Yerevan 0014, Armenia
| | - Daniel Orbach
- SIREDO Oncology Center, Institut Curie, PSL University, 75005 Paris, France
| | - Patrizia Gasparini
- Tumor Genomics Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | | | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | | | - Julia C. Chisholm
- Children and Young People’s Unit, Royal Marsden Hospital and The Institute of Cancer Research, Sutton SM2 5PT, UK
| | - Meriel Jenney
- Department of Paediatric Oncology, Children′s Hospital for Wales, Heath Park, Cardiff CF14 4XW, UK
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
| | - Timothy Rogers
- Department of Paediatric Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Henry C. Mandeville
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton SM2 5PT, UK
| | - Janet Shipley
- Sarcoma Molecular Pathology Team, Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London SM2 5NG, UK
| | - Aisha B. Miah
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London SM2 5NG, UK
| | - Johannes H. M. Merks
- Princess Máxima Center for Paediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Winette T. A. van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3062 PA Rotterdam, The Netherlands
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11
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Optimizing Rhabdomyosarcoma Treatment in Adolescents and Young Adults. Cancers (Basel) 2022; 14:cancers14092270. [PMID: 35565399 PMCID: PMC9105996 DOI: 10.3390/cancers14092270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is the most common form of soft tissue sarcoma in children, but can also develop in adolescents and young adults (AYA). The mainstay of treatment is multi-agent chemotherapy, ideally with concomitant local treatment, including surgical resection and/or radiation therapy. Although most treatment decisions for RMS in AYA are based on scientific evidence accumulated through clinical studies of pediatric RMS, treatment outcomes are significantly inferior in AYA patients than in children. Factors responsible for the significantly poor outcomes in AYA are tumor biology, the physiology specific to the age group concerned, refractoriness to multimodal treatments, and various psychosocial and medical care issues. The present review aims to examine the various issues involved in the treatment and care of AYA patients with RMS, discuss possible solutions, and provide an overview of the literature on the topic with several observations from the author's own experience. Clinical trials for RMS in AYA are the best way to develop an optimal treatment. However, a well-designed clinical trial requires a great deal of time and resources, especially when targeting such a rare population. Until clinical trials are designed and implemented, and their findings duly analyzed, we must provide the best possible practice for RMS treatment in AYA patients based on our own expertise in manipulating the dosage schedules of various chemotherapeutic agents and administering local treatments in a manner appropriate for each patient. Precision medicine based on state-of-the-art cancer genomics will also form an integral part of this personalized approach. In the current situation, the only way to realize such a holistic treatment approach is to integrate new developments and findings, such as gene-based diagnostics and treatments, with older, fundamental evidence that can be selectively applied to individual cases.
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12
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Pinto N, Navarro SL, Rimorin C, Wurscher M, Hawkins DS, McCune JS. Pharmacogenomic associations of cyclophosphamide pharmacokinetic candidate genes with event-free survival in intermediate-risk rhabdomyosarcoma: A report from the Children's Oncology Group. Pediatr Blood Cancer 2021; 68:e29203. [PMID: 34245211 PMCID: PMC8719493 DOI: 10.1002/pbc.29203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/02/2021] [Accepted: 06/16/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND In vitro data suggest that the growth of rhabdomyosarcoma (RMS) cells is suppressed in a concentration-dependent manner by 4-hydroxycyclophosphamide (4HCY), the principal precursor to the cytotoxic metabolite of cyclophosphamide (CY). Various retrospective studies on the relationship between genes encoding proteins involved in the formation and elimination of 4HCY (i.e., 4HCY pharmacokinetics) and cyclophosphamide (CY) efficacy and toxicity have been conflicting. PROCEDURES We evaluated germline pharmacogenetics in 262 patients with newly diagnosed intermediate-risk RMS who participated in one prospective Children's Oncology Group clinical trial, ARST0531. Patients were treated with either vincristine/actinomycin/cyclophosphamide (VAC) or VAC alternating with vincristine/irinotecan (VAC/VI). We analyzed the associations between event-free survival and 394 single-nucleotide polymorphisms (SNP) in 14 drug metabolizing enzymes or transporters involved in 4HCY pharmacokinetics. RESULTS Eight SNPs were associated (p-value < .05 by univariate analysis) with 3-year event-free survival; no SNPs survived a false discovery rate < 0.05. CONCLUSIONS Our data suggest that a pharmacogenomic approach to therapy personalization of cyclophosphamide in intermediate-risk rhabdomyosarcoma is not viable. Other methods to personalize therapy should be explored.
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Affiliation(s)
- Navin Pinto
- Seattle Children’s Hospital, Seattle, Washington, USA,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Sandi L. Navarro
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Christine Rimorin
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Michelle Wurscher
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Douglas S. Hawkins
- Seattle Children’s Hospital, Seattle, Washington, USA,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Jeannine S. McCune
- Department of Hematologic Malignances Translational Sciences, City of Hope, Duarte, California, USA
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13
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Friend BD, Schiller GJ. Beyond steroids: A systematic review and proposed solutions to managing acute graft-versus-host disease in adolescents and young adults. Blood Rev 2021; 52:100886. [PMID: 34509319 DOI: 10.1016/j.blre.2021.100886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 12/11/2022]
Abstract
The outcomes of allogeneic hematopoietic cell transplantation (HCT) in adolescents and young adults (AYAs) with hematologic malignancies have been shown to be poorer when compared to results in children, due to a combination of higher relapse rates and greater treatment-related mortality (TRM). Although differences in relapse risk have been studied extensively, toxicity has been examined and reported less often. In this systematic review, we summarize recently published studies that have examined the differences in rates of TRM and acute graft-versus-host disease (GVHD) in AYAs and children with hematologic malignancies, and attempt to explain why these disparities exist and how they impact outcomes. In addition, we present best practices for management of steroid-refractory GVHD that are likely to improve survival in this patient population. Further, we propose the development of personalized, risk-based approaches for the prevention and treatment of GVHD that incorporate novel platforms and interventions. We believe this individualized approach is likely to reduce toxicity and greatly improve outcomes for this vulnerable population.
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Affiliation(s)
- Brian D Friend
- Department of Pediatrics, Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, 1102 Bates Ave, Suite 1630, Houston, TX 77030, USA.
| | - Gary J Schiller
- Department of Medicine, Division of Hematology-Oncology, University of California Los Angeles, 10833 Le Conte Ave, 42-121 CHS, Los Angeles, CA 90095, USA.
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14
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Ellis JA, Malalasekera VS, Allan C, Choong PF, Hansford JR, Hehir R, Morello N, O'Callaghan S, Orme L, Phillipson N, Rosenthal MA, Sawyer S, Strong R, Super L, Watt A, Williams C, Woollett A, Robertson A, Lewin J. Systems-Level Change to Alleviate Barriers to Cancer Clinical Trial Access for Adolescents and Young Adults in Australia. J Adolesc Young Adult Oncol 2021; 11:173-180. [PMID: 34297611 PMCID: PMC9057899 DOI: 10.1089/jayao.2021.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: International data demonstrate association between clinical trial participation and reduced cancer mortality. Adolescents and young adults (AYA) have low clinical trial enrollment rates. We established a program to understand local barriers and develop targeted solutions that lead to greater AYA clinical trial participation. Methods: A steering committee (SC) with expertise in adult and pediatric oncology, research ethics, and consumer representation was formed. The SC mapped barriers related to AYA trial access and established working groups (WGs) around three themes. Results: The Regulatory Awareness WG identified a lack of understanding of processes that support protocol approval for clinical trials across the AYA age range. A guideline to raise awareness was developed. The Access WG identified challenges for young adults (18–25 years) to access a pediatric hospital to enroll in a pediatric trial. A procedure was developed to streamline applications for access. The first six applications using this procedure have been successful. The Availability WG identified lack of pediatric–adult oncology reciprocal relationships as a barrier to awareness of open trials, and future collaboration. An AYA Craft Group Framework was established to grow relationships within tumor streams across institutions; two craft groups are now operating locally. An additional achievement was a successful request to the Therapeutic Goods Administration for Australian adoption of the Food and Drug Administration Guidance on Considerations for the Inclusion of Adolescent Patients in Adult Oncology Clinical Trials. Conclusion: This multipronged approach to improving AYA clinical trial access has relevance for other health environments. Our knowledge products are available as an online toolkit.
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Affiliation(s)
- Justine A Ellis
- Royal Children's Hospital, Melbourne, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Vajiranee S Malalasekera
- Royal Children's Hospital, Melbourne, Australia.,ONTrac at PeterMac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Peter F Choong
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia.,Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jordan R Hansford
- Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Molecular and Translational Science, Hudson Institute, Monash University, Melbourne, Australia
| | - Ryan Hehir
- Royal Children's Hospital, Melbourne, Australia
| | - Natasha Morello
- Victorian Comprehensive Cancer Centre Consumer Representative, Melbourne, Australia
| | | | - Lisa Orme
- Royal Children's Hospital, Melbourne, Australia.,ONTrac at PeterMac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia.,Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Mark A Rosenthal
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Susan Sawyer
- Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Robyn Strong
- Australian and New Zealand Children's Haematology/Oncology Group
| | - Leanne Super
- Royal Children's Hospital, Melbourne, Australia.,Monash Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Angela Watt
- Office for Research, Melbourne Health, Melbourne, Australia
| | - Chris Williams
- Royal Children's Hospital, Melbourne, Australia.,Paediatric Integrated Cancer Service, Melbourne, Australia
| | - Anne Woollett
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Alexandra Robertson
- Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Jeremy Lewin
- ONTrac at PeterMac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia.,Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
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15
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Noel GJ, Nelson RM, Bucci-Rechtweg C, Portman R, Miller T, Green DJ, Snyder D, Moreno C, Hovinga C, Connor E. Inclusion of Adolescents in Adult Clinical Trials: Report of the Institute for Advanced Clinical Trials for Children's Pediatric Innovation Research Forum. Ther Innov Regul Sci 2021; 55:773-778. [PMID: 33811302 PMCID: PMC8018511 DOI: 10.1007/s43441-021-00283-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/17/2021] [Indexed: 01/22/2023]
Abstract
Including adolescents in adult clinical trials can play an important role in making innovative new medicines available to children in a timelier fashion. Stakeholders involved in the processes leading to regulatory approval and labeling of new drugs recognize that challenges exist in involving adolescents and older children in clinical trials before the safety and efficacy of these drugs are established for adults. However, it has been possible to design and execute phase 3 trials that combine adults with adolescents which are medically and scientifically sound and ethically justified. Based on this experience and considerations of the medical and scientific, ethical, and operation-related matters, the 2019 Pediatric Innovation Research Forum advocated for the position that adolescents routinely be considered for enrollment in phase 3 clinical trials. The Forum also concluded that exclusion of adolescents in adult pivotal trials occur only when a thorough evaluation of the target disease and the potential benefit and risks of the study intervention supports a delay in their involvement until after completion of clinical trials in adults.
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Affiliation(s)
- Gary J Noel
- The Institute for Advanced Clinical Trials for Children, 9211 Corporate Blvd. Suite 260, Rockville, MD, 20850, USA.
- Weill-Cornell Medical College, New York, NY, USA.
| | | | | | - Ronald Portman
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Donna Snyder
- US Food and Drug Administration, Silver Spring, MD, USA
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Collin Hovinga
- The Institute for Advanced Clinical Trials for Children, 9211 Corporate Blvd. Suite 260, Rockville, MD, 20850, USA
| | - Edward Connor
- The Institute for Advanced Clinical Trials for Children, 9211 Corporate Blvd. Suite 260, Rockville, MD, 20850, USA
- George Washington School of Medicine, Washington, DC, USA
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16
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Outcomes of Adolescent Patients with Acute Lymphoblastic Leukemia: Long-term Follow-up of 335 Patients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e658-e665. [PMID: 33941506 DOI: 10.1016/j.clml.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adolescents (aged 10-17 years) with acute lymphoblastic leukemia (ALL) represent a unique patient population, with a disproportionate survival disadvantage compared with younger patients. We aimed to determine the outcomes and prognostic factors of adolescent patients treated at our institution. PATIENTS AND METHODS Between 2005 and 2017, 335 adolescents with ALL were enrolled; clinical characteristics and treatment outcomes were analyzed and compared between adolescents and younger children (1-9 years old, n = 704). RESULTS Adolescents were more likely to have high-risk factors such as hyperleukocytosis, a T-cell immunophenotype, BCR-ABL1, and/or poor early treatment responses. Compared with younger children, adolescents had significantly worse 5-year event-free survival (EFS) (73.0% ± 2.5% vs. 82.6% ± 1.5%; P < .001) and overall survival (OS) (77.1% ± 2.3% vs. 87.7% ± 1.3%; P < .001). Furthermore, younger adolescents (10-14 years) tended to have better outcomes compared with those older than 15 years (5-year OS: 79.3% ± 2.5% vs. 68.4% ± 5.7%; P = .042), mainly because of the lower frequencies of toxicities. On multivariate analysis, white blood count ≥ 50 × 109/L and extramedullary involvement at diagnosis were the most powerful prognostic factors for both OS and EFS. CONCLUSION The outcomes among adolescent patients were not as good as that of younger children. Further studies are required to define optimal treatment strategies for adolescents, particularly those aged 15 to 17 years.
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17
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Duan Y, Wang L, Sun Q, Liu X, Ding S, Cheng Q, Xie J, Cheng ASK. Prevalence and Determinants of Psychological Distress in Adolescent and Young Adult Patients with Cancer: A Multicenter Survey. Asia Pac J Oncol Nurs 2021; 8:314-321. [PMID: 33850965 PMCID: PMC8030586 DOI: 10.4103/2347-5625.311005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/25/2020] [Indexed: 01/01/2023] Open
Abstract
Objective This study aimed to investigate the current prevalence and determinants of psychological distress and the association of distress with general information, character strengths, medical coping, and social support in Chinese adolescents and young adults (AYAs) aged 15-39 years with cancer. Methods A multicenter survey was carried out. Eight hundred and nine patients completed the Chinese version of the National Comprehensive Cancer Network distress thermometer (DT), the three-dimensional inventory of character strengths, the medical coping modes questionnaire, and the Social Support Rating Scale. Results The current prevalence of psychological distress in Chinese AYAs with cancer was 83.4%. Binary logistic regression analysis showed that gender, age, educational level, marriage, monthly income, exercise intensity, cancer classifications, treatments, self-control, confrontation, avoidance, and subjective support were all associated with distress. AYA cancer patients who were female, younger, or divorced or had a lower monthly income, education level, or exercise intensity were more likely to have higher level of distress. Compared to AYAs with other cancer classifications, patients with digestive system malignancies, breast cancers, and head and neck malignancies had a higher prevalence of distress. Patients receiving chemotherapy or radiotherapy were more likely to be distressed. The higher the self-control, confrontation, avoidance, and subjective support scores were, the lower the prevalence of distress was among AYA cancer patients. Conclusions The prevalence of psychological distress in AYA cancer patients was relatively high. Potential interventions targeting exercise intensity, character strengths, medical coping, and social support may decrease the prevalence of psychological distress in this patient population.
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Affiliation(s)
- Yinglong Duan
- Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lu Wang
- Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qian Sun
- Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiangyu Liu
- Health Management Centre, Hunan Cancer Hospital, Changsha, China
| | - Siqing Ding
- Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qinqin Cheng
- Pain Management Department, Hunan Cancer Hospital, Changsha, China
| | - Jianfei Xie
- Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Andy S K Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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18
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Matsushima S, Kobayashi R, Sano H, Hori D, Yanagi M, Kodama K, Suzuki D, Kobayashi K. Comparison of myelosuppression using the D-index between children and adolescents/young adults with acute lymphoblastic leukemia during induction chemotherapy. Pediatr Blood Cancer 2021; 68:e28763. [PMID: 33047887 DOI: 10.1002/pbc.28763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) are more likely to have chemotherapy-related complications than children. In addition, several reports have shown that infections account for most of the therapy-related mortality during cancer treatment in AYAs. Thus, we hypothesized that chemotherapy-induced myelosuppression is more severe in AYAs than in children, and the state of neutropenia was compared between children and AYAs using the D-index, a numerical value calculated from the duration and depth of neutropenia. PROCEDURE This study retrospectively analyzed 95 patients newly diagnosed with ALL at our institution between 2007 and 2019. Of these, 81 were children (<15 years old) and 14 were AYAs (≥15 years old). The D-index and duration of neutropenia during induction chemotherapy for ALL were compared between children and AYAs. RESULTS The median D-index of children was significantly higher than that of AYAs (8187 vs 6446, respectively, P = .017). Moreover, the median duration of neutropenia was also significantly longer in children than in AYAs (24.0 days vs 11.5 days, respectively, P = .007). CONCLUSION Contrary to our expectations, myelosuppressive toxicity during induction chemotherapy for ALL was more severe in children than in AYAs.
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Affiliation(s)
- Satoru Matsushima
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Ryoji Kobayashi
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Hirozumi Sano
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Daiki Hori
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Masato Yanagi
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Koya Kodama
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Kunihiko Kobayashi
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan
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19
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Gupta A, Damania RC, Talati R, O'Riordan MA, Matloub YH, Ahuja SP. Increased Toxicity Among Adolescents and Young Adults Compared with Children Hospitalized with Acute Lymphoblastic Leukemia at Children's Hospitals in the United States. J Adolesc Young Adult Oncol 2021; 10:645-653. [PMID: 33512257 DOI: 10.1089/jayao.2020.0154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose: Adolescent and young adult (AYA) patients (15-39 years old) with acute lymphoblastic leukemia (ALL) have less favorable outcomes and higher treatment-related mortality as compared with older children with ALL. Minimal data exist regarding how well AYA patients tolerate the intensity of chemotherapy at doses and regimens designed for children, and the toxicities suffered by this population at children's hospitals have not been thoroughly characterized. Methods: Pediatric Health Information Systems database was queried to analyze health care outcomes in pediatric (ages 10-14) and AYA patients (ages 15-39) with ALL hospitalized between January 1999 and December 2014. We extracted relevant ICD-9 data for each patient related to grades 3 or 4 toxicities as outlined by the NCI. Results: A total of 5345 hospital admissions met inclusion criteria, representing 4046 unique patients. Of these admissions, 2195 (41.1%) were in the AYA age group, and the remainder were in the 10-14-year-old group. AYA patients had a significantly higher incidence of intensive care unit stay but no difference in median hospital stay nor mortality. AYA patients had increased toxicities in almost every organ system as compared with older children. Conclusions: In this large multicenter US database study, we found an overall increased number of toxicities among AYA patients with ALL in children's hospitals. Compared with children between the ages of 10 and 15, AYA patients developed disproportionately higher toxicities from drugs commonly used in pediatric protocols for ALL. Prospective studies are needed to assess whether dose modifications for certain chemotherapeutics may improve the toxicity profile and health care burden of AYA patients with ALL treated in children's hospitals.
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Affiliation(s)
- Ajay Gupta
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Rahul C Damania
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Ravi Talati
- Division of Hematology, Oncology, and Blood and Marrow Transplant, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Mary Ann O'Riordan
- Women's & Children's Services, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
| | - Yousif H Matloub
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sanjay P Ahuja
- Division of Pediatric Hematology/Oncology, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
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20
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Bi Y, Liu J, Li L, Yu J, Bhattaram A, Bewernitz M, Li RJ, Liu C, Earp J, Ma L, Zhuang L, Yang Y, Zhang X, Zhu H, Wang Y. Role of Model-Informed Drug Development in Pediatric Drug Development, Regulatory Evaluation, and Labeling. J Clin Pharmacol 2020; 59 Suppl 1:S104-S111. [PMID: 31502691 DOI: 10.1002/jcph.1478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 11/12/2022]
Abstract
The unique challenges in pediatric drug development require efficient and innovative tools. Model-informed drug development (MIDD) offers many powerful tools that have been frequently applied in pediatric drug development. MIDD refers to the application of quantitative models to integrate and leverage existing knowledge to bridge knowledge gaps and facilitate development and decision-making processes. This article discusses the current practices and visions of applying MIDD in pediatric drug development, regulatory evaluation, and labeling, with detailed examples. The application of MIDD in pediatric drug development can be broadly classified into 3 categories: leveraging knowledge for bridging the gap, dose selection and optimization, and informing clinical trial design. In particular, MIDD can provide evidence for the assumption of exposure-response similarity in bridging existing knowledge from reference to target population, support the dose selection and optimization based on the "exposure-matching" principle in the pediatric population, and increase the efficiency and success rate of pediatric trials. In addition, the role of physiologically based pharmacokinetics in drug-drug interaction in children and adolescents and in utilizing ontogeny data to predict pharmacokinetics in neonates and infants has also been illustrated. Moving forward, MIDD should be incorporated into all pediatric drug development programs at every stage to inform clinical trial design and dose selection, with both its strengths and limitations clearly laid out. The accumulated experience and knowledge of MIDD has and will continue to drive regulatory policy development and refinement, which will ultimately improve the consistency and efficiency of pediatric drug development.
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Affiliation(s)
- Youwei Bi
- Food and Drug Administration, Silver Spring, MD, USA
| | - Jiang Liu
- Food and Drug Administration, Silver Spring, MD, USA
| | - Lingjue Li
- Food and Drug Administration, Silver Spring, MD, USA
| | - Jingyu Yu
- Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Ruo-Jing Li
- Food and Drug Administration, Silver Spring, MD, USA
| | - Chao Liu
- Food and Drug Administration, Silver Spring, MD, USA
| | - Justin Earp
- Food and Drug Administration, Silver Spring, MD, USA
| | - Lian Ma
- Food and Drug Administration, Silver Spring, MD, USA
| | - Luning Zhuang
- Food and Drug Administration, Silver Spring, MD, USA
| | - Yuching Yang
- Food and Drug Administration, Silver Spring, MD, USA
| | - Xinyuan Zhang
- Food and Drug Administration, Silver Spring, MD, USA
| | - Hao Zhu
- Food and Drug Administration, Silver Spring, MD, USA
| | - Yaning Wang
- Food and Drug Administration, Silver Spring, MD, USA
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21
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Ferrari A, Bernasconi A, Bergamaschi L, Botta L, Andreano A, Castaing M, Rugge M, Bisogno G, Falcini F, Sacerdote C, Tagliabue G, Michiara M, Cirilli C, Barchielli A, Filiberti RA, Vitale MF, Tumino R, Stracci F, Chiaravalli S, Casanova M, Gasparini P, Milano GM, Gatta G, Trama A. Impact of Rhabdomyosarcoma Treatment Modalities by Age in a Population-Based Setting. J Adolesc Young Adult Oncol 2020; 10:309-315. [PMID: 32758055 DOI: 10.1089/jayao.2020.0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Rhabdomyosarcoma (RMS) has a worse prognosis in adults than in children, but there is evidence of a better outcome in the former if treated using a pediatric-like approach. This study describes treatment for RMS in patients more than 10 years old and examines to what extent treatment contributes to explain the different age-related survival observed and to what extent treatment centers impact treatment appropriateness. Methods: A retrospective population-based study was developed considering 104 RMS cases (excluding the pleomorphic subtype) diagnosed in Italy between 2000 and 2015. Patients were grouped by age (10-19 vs. 20-60 years old) and scored according to whether or not their chemotherapy was consistent with the schemes used in pediatric protocols (score 1 = chemotherapy in line with pediatric protocols). Treatment centers were grouped according to whether or not they have a pediatric-dedicated unit affiliated to the national pediatric oncology network (Associazione Italiana Ematologia Oncologia Pediatrica [AIEOP]). Results: Older patients were more likely to have tumors at unfavorable sites (p = 0.045). A treatment score of 1 was assigned to 85% of younger patients, but only to 32% of older patients (p < 0.001). Furthermore, the proportion of score 1 was higher in younger patients treated in centers with an AIEOP Unit. A multivariate model confirmed age as a significant prognostic factor (Hazard rate ratio [HR] = 2.06; p = 0.04) and showed a significant impact of treatment on survival (HR = 2.13; p = 0.03). Conclusions: Adult RMS patients are still relatively unlikely to be treated with pediatric protocols and in centers with a pediatric oncology expertise. This may explain the survival gap between older and younger patients.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Anita Andreano
- Epidemiology Unit, Agency for Health Protection (ATS) of Milan, Milan, Italy
| | - Marine Castaing
- Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Department of Hygiene and Public Health, Università di Catania, Catania, Italy
| | - Massimo Rugge
- Veneto Tumour Registry, Azienda Zero, Padova, Italy.,Department of Medicine, University of Padova, Padova, Italy
| | - Gianni Bisogno
- Hematology-Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (Forlì), Italy-Azienda Usl della Romagna, Forlì, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza-University of Turin and Center for Cancer Prevention, Turin, Italy
| | - Giovanna Tagliabue
- Cancer Registry Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Maria Michiara
- Parma Cancer Registry, Oncology Department, Azienda Ospedaliera Universitaria Parma, Parma, Italy
| | | | - Alessandro Barchielli
- Clinical Epidemiology Unit, Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Firenze, Italy
| | | | | | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP), Ragusa, Italy
| | - Fabrizio Stracci
- Umbria Cancer Registry, Public Health section Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Patrizia Gasparini
- Tumor Genomics Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Gemma Gatta
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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22
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Triarico S, Capozza MA, Mastrangelo S, Attinà G, Maurizi P, Ruggiero A. Gynecological cancer among adolescents and young adults (AYA). ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:397. [PMID: 32355841 PMCID: PMC7186636 DOI: 10.21037/atm.2020.02.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Adolescents and young adults (AYA) patients with cancer show specific biological, sociodemographic and behavioral features, with lower survival rates than younger group. Gynecologic malignancies that occur among AYA requires a multidisciplinary management and a tailored model of care, in order to enhance the early diagnosis, the adherence to the treatment, the enrollment in clinical trials, the rate of survival and the quality of life (QoL). In this article, we review the main gynecological tumors that may occur in AYA, with a focus on the clinical signs at the diagnosis and the modality of treatment. In addition, we proposed a model of multidisciplinary and personalized care for AYA with gynecological tumors, which can help the clinicians to manage the specific gynecologic concerns, such as ovarian failure, contraception, fertility, late psychosocial effects.
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Affiliation(s)
- Silvia Triarico
- Unità di Oncologia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Stefano Mastrangelo
- Unità di Oncologia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.,Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Attinà
- Unità di Oncologia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Palma Maurizi
- Unità di Oncologia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.,Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Ruggiero
- Unità di Oncologia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.,Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
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23
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Abstract
AIM The aims of this study were to assess survival outcome of pediatric patients with localized osteosarcoma of the extremities in Upper Egypt, identify factors of prognostic significance for survival, and to determine factors predictive of surgical methods used in these patients, as well as developing a clinical model for risk prediction. PATIENTS AND METHODS A retrospective analysis of data assembled from medical records of 30 pediatric patients with a histologically verified nonmetastatic osteosarcoma of the extremities treated at South Egypt Cancer Institute with a unified chemotherapy protocol between January 2001 and December 2015 was carried out. Prognostic factors were determined using univariable and multivariable methods. A model for surgical outcomes in these patients based on the baseline clinical factors, and the parameters predictive of their tumor response to chemotherapy, was developed. RESULTS With a median follow-up of 63 months for the study population, the estimates for event-free survival and overall survival (OS) at 3 and 5 years were 69.5% and 79% and 65.2% and 65.3%, respectively. Age 16 years or above was independently associated with both worse metastasis-free survival (hazard ratio [HR]=6.05, 95% confidence interval [CI]: 1.43-25.6, P=0.015) and OS (HR=7.9, 95% CI: 1.71-36.2, P=0.008). In the multivariable analysis, a proximal location within the limb gained a statistical significance to be independently associated with worse OS (HR=2.4, 95% CI: 1.13-22.1, P=0.003). Poor response to chemotherapy was marginally associated with worse metastasis-free survival (HR=4.9, 95% CI: 1.02-23.8, P=0.047) only in the univariable analysis. The patients found to be more likely to undergo an amputation surgery (odds ratio=14.1, 95% CI: 1.34-149.4, P=0.028) were those in whom a tumor was poorly responding to chemotherapy. CONCLUSION In Upper Egypt, despite the reasonable survival outcomes in nonmetastatic osteosarcoma, a relatively high limb amputation rate has been encountered. The development of a clinical prediction model for future planning of possible outcome improvement in these patients, however, is still feasible.
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24
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Lewin J, Bell JAH, Wang K, Forcina V, Tam S, Srikanthan A, Lin YC, Taback N, Mitchell L, Gupta AA. Evaluation of Adolescents’ and Young Adults’ Attitudes Toward Participation in Cancer Clinical Trials. JCO Oncol Pract 2020; 16:e280-e289. [DOI: 10.1200/jop.19.00450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE: Participation in cancer clinical trials (CCTs) for adolescents and young adults (AYAs) remains the lowest of any patient group with cancer. Little is known about the personal barriers to AYA accrual. The aim of this study was to explore AYA attitudes that influence CCT participation. METHODS: A mixed-methods approach was used. AYAs and non-AYAs (≥ 40 years) completed the Cancer Treatment subscale of the Attitudes Toward Cancer Trials Scales and 9 supplementary questions formed from interview analysis. Differences between AYA and non-AYA cohorts were analyzed using the Mann-Whitney U test, and logistic regression models were constructed to evaluate the effect of demographics on perceptions of CCTs. RESULTS: Surveys were distributed to 61 AYAs (median age, 29 years; range, 17-39 years) and 74 non-AYAs (median age, 55 years; range, 40-88 years). Compared with non-AYAs, AYAs perceived CCTs to be unsafe/more difficult (Personal Barrier/Safety domain; P = .01). There were no differences based on age in other domains. AYAs were also more concerned with CCT interference in their long-term goals ( P = .04). Multivariable ordered logistic regression identified increased personal barriers in the Personal Barrier/Safety domain for AYAs ( P = .01), in patients with English as a second language (ESL; P < .01), and in patients previously not offered a clinical trial ( P = .03). Long-term goals were identified as a barrier in particular tumor types ( P = .01) and in patients with ESL ( P < .01), with a trend identified in AYAs ( P = .12). CONCLUSION: Age-related differences in attitudes toward CCTs suggest that tailored approaches to CCT accrual are warranted. Patient-centered delivery of information regarding CCTs, particularly in patients with ESL and who are trial naïve, may improve accrual.
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Affiliation(s)
- Jeremy Lewin
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medical Oncology and Hematology, Princes Margaret Cancer Center, Toronto, Ontario, Canada
| | - Jennifer A. H. Bell
- Department of Bioethics, University Health Network; Department of Supportive Care, Princess Margaret Cancer Centre; and Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kate Wang
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Victoria Forcina
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Seline Tam
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Amirrtha Srikanthan
- Department of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Yu-Chung Lin
- Departments of Statistical Science and Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Taback
- Departments of Statistical Science and Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Laura Mitchell
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Abha A. Gupta
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medical Oncology and Hematology, Princes Margaret Cancer Center, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
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25
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Marec-Berard P, Laurence V, Occean BV, Ray-Coquard I, Linassier C, Corradini N, Collard O, Chaigneau L, Cupissol D, Kerbrat P, Saada-Bouzid E, Delcambre C, Gouin F, Guillemet C, Jimenez M, Lervat C, Gaspar N, Le Deley MC, Brugieres L, Piperno-Neumann S. Methotrexate-Etoposide-Ifosfamide Compared with Doxorubicin-Cisplatin-Ifosfamide Chemotherapy in Osteosarcoma Treatment, Patients Aged 18-25 Years. J Adolesc Young Adult Oncol 2019; 9:172-182. [PMID: 31702419 DOI: 10.1089/jayao.2019.0085] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Purpose: The French standard chemotherapy for osteosarcoma combines high-dose methotrexate (HDM) and etoposide-ifosfamide (EI) in children and adolescents, and API-AI (doxorubicin-cisplatin-ifosfamide) in adults. We herein present the results of M-EI and API-AI in 18- to 25-year-old patients. Methods: Patients, 18-25 years old, received either M-EI or API-AI regimens. M-EI comprised seven M and two EI doses preoperatively then M-EI in standard-risk patients (good histological response without metastasis) and five M-AP (methotrexate-doxorubicin-cisplatin) in high-risk patients (poor histological response, metastasis, and/or unresectable primary), postoperatively. API-AI comprised three API and two AI doses preoperatively, then two AI and two PI in standard-risk patients and five EI in high-risk patients, postoperatively. Results: We analyzed 95 patients 18-25 years of age: 55 received M-EI and 40 API-AI. The groups had similar baseline characteristics. Eighty-nine patients (94%) had surgery. Twenty-nine of 55 M-EI patients (60%) and 16/40 API-AI patients (41%) had good histological responses to preoperative chemotherapy. At 5 years, event-free survival was 50% (95% confidence interval [CI]: 39-60) and overall survival was 65% (95% CI: 54-74). Acute toxicity was similar, without treatment-related deaths. Conclusions: Survival outcomes with M-EI and API-AI were not significantly different. Tolerance was acceptable with both regimens. HDM is thus feasible for young adults. However, our study limitations preclude any definitive conclusions.
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Affiliation(s)
- Perrine Marec-Berard
- Unité de Traitement de la Douleur de l'Enfant, Centre Léon Bérard, Institut d'Hématologie et d'Oncologie Pédiatrie, Lyon, France
| | | | - Bob-Valéry Occean
- Biostatistics and Epidemiology Unit, Institut Gustave Roussy, Villejuif, France
| | | | - Claude Linassier
- Department of Cancer Medicine, Centre Hospitalo-Universitaire, Tours, France
| | - Nadège Corradini
- Department of Pediatric and Adolescent Hematology-Oncology, Hôpital Mère-Enfant, Nantes, France
| | - Olivier Collard
- Department of Medical Oncology, Institut de Cancérologie de la Loire, Lucien Neuwirth, St Priest en Jarez, France
| | - Loïc Chaigneau
- Department of Medical Oncology, CHRU Jean Minjoz, Besançon, France
| | - Didier Cupissol
- Department of Medical Oncology, Centre Val d'Aurelle, Montpellier, France
| | - Pierre Kerbrat
- Department of Medical Oncology, Centre Eugène-Marquis, Rennes, France
| | - Esma Saada-Bouzid
- Medical Oncology Department, Centre Antoine Lacassagne, Nice, France
| | | | - François Gouin
- CHU Nantes Hôtel-Dieu/Laboratoire UMR1238 Phyos, Faculté de Médecine de Nantes, Nantes, France
| | - Cécile Guillemet
- Medical Oncology Department, Centre Henri Becquerel, Rouen, France
| | | | - Cyril Lervat
- Pediatric Oncology Unit-Adolescents and Young Adults, Centre Oscar Lambret, Lille, France
| | - Nathalie Gaspar
- Department of Pediatric Oncology, Institut Gustave Roussy, Villejuif, France
| | | | - Laurence Brugieres
- Department of Pediatric Oncology, Institut Gustave Roussy, Villejuif, France
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26
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Outcomes of allogeneic hematopoietic cell transplant for acute myeloid leukemia in adolescent patients. Bone Marrow Transplant 2019; 55:182-188. [DOI: 10.1038/s41409-019-0667-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 07/30/2019] [Accepted: 08/06/2019] [Indexed: 12/24/2022]
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27
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Stoneham S, Murray M, Thomas B, Williamson M, Sweeney C, Frazier L. AYA testis cancer: The unmet challenge. Pediatr Blood Cancer 2019; 66:e27796. [PMID: 31066223 DOI: 10.1002/pbc.27796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 12/12/2022]
Abstract
Testis cancer is considered a rare-incidence cancer but comprises the third most common cancer diagnosed within the adolescent and young adult (AYA) years (15-39 years). Most testis cancer patients can anticipate a survival outcome in excess of 95%. However, there are subgroups of AYA patients where outcomes are considerably worse, including younger adolescents, patients with certain histological subtypes, or from certain ethnic backgrounds. For those cured with chemotherapy, the toxicity of treatment and burden of late effects is significant. Newer germ cell tumor-specific biomarkers may identify patients who do not require further treatment interventions or may detect early recurrence, potentially reducing the burden of treatment required for cure. An international collaboration for this rare tumor is creating the forum for trial design, where these biomarker research questions are embedded. Going forward, AYA testis cancer patients could benefit from having a more personalized treatment plan, tailored to risk, that minimizes the overall burden of late effects.
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Affiliation(s)
- Sara Stoneham
- Department of Paediatrics and Child Health, University College Hospital London NHS Foundation Trust, London, UK
| | - Matthew Murray
- Department of Pathology, University of Cambridge, UK.,Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Benjamin Thomas
- Oncology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Max Williamson
- Life Sciences Faculty, University College London, London, UK
| | - Christopher Sweeney
- Dana-Farber Cancer Institute, Department of Medical Oncology and Division of Population Sciences, Boston, Massachusetts
| | - Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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28
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Unique Challenges of Hematopoietic Cell Transplantation in Adolescent and Young Adults with Hematologic Malignancies. Biol Blood Marrow Transplant 2018; 24:e11-e19. [DOI: 10.1016/j.bbmt.2018.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/08/2018] [Indexed: 12/16/2022]
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29
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Liu Z, Martin J, Orme L, Seddon B, Desai J, Nicholls W, Thomson D, Porter D, McCowage G, Underhill C, Cranswick N, Michael M, Zacharin M, Herschtal A, Sivasuthan J, Thomas DM. Gender differences in doxorubicin pharmacology for subjects with chemosensitive cancers of young adulthood. Cancer Chemother Pharmacol 2018; 82:887-898. [PMID: 30206658 DOI: 10.1007/s00280-018-3683-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/01/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE For many cancers, adolescents and young adults (AYA) have worse outcomes than for children and adults. Many factors may contribute to the AYA survival gap, including differences in biology, therapeutic intent, and adherence to therapy. It has been observed that male AYAs have poorer outcomes than females. The purpose of this work was to test the proposition that gender-related pharmacologic factors may account for a component of the AYA survival gap. PATIENTS AND METHODS A prospective, multi-institutional pharmacologic study of 79 patients in total with chemosensitive cancers (Ewing sarcoma, osteosarcoma and Hodgkin lymphoma) was conducted, with conventional doxorubicin treatment. Pharmacokinetic data of 13 children, 40 AYAs and 13 adults were valid for analysis. Population pharmacokinetics models were developed for doxorubicin and its metabolite doxorubicinol based on the data created in this study. Consequently, model-based analysis was conducted to investigate the relevant topics. RESULTS The clearance of doxorubicinol (normalized to body surface area), the main active metabolite of doxorubicin, appears faster in male AYAs than female (p = 0.04, 95% CI 0.1-3.9 L/h). The exposure of doxorubicinol (normalized to dose) is lower in male AYA than female (p = 0.03, 95% CI - 0.005 to - 0.0002 h/L). These might be correlated to the observed difference on nadir neutrophil count between male AYA and female (p = 0.027, 95% CI 0.09-1.4). CONCLUSION Gender-related differences in doxorubicin pharmacology may account for worse outcomes for male AYAs with chemosensitive cancers compared to females. These findings may reduce the AYA survival gap compared to other age groups.
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Affiliation(s)
- Z Liu
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia. .,Clinical Pharmacology and Department of Medicine, The Royal Children's Hospital, Melbourne, Australia.
| | - J Martin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - L Orme
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Brisbane, QLD, Australia
| | - B Seddon
- University College London Hospital, London, UK
| | - J Desai
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - W Nicholls
- Brisbane Children's Hospital, Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - D Thomson
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - D Porter
- Starship Children's Hospital, Auckland, New Zealand
| | - G McCowage
- Children's Hospital Westmead, Sydney, NSW, Australia
| | - C Underhill
- Border Medical Oncology, Albury-Wodonga, VIC, Australia
| | - N Cranswick
- Clinical Pharmacology and Department of Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - M Michael
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - M Zacharin
- Clinical Pharmacology and Department of Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - A Herschtal
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - J Sivasuthan
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - D M Thomas
- Cancer Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
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30
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Ryan J, Patel J, Lucas CJ, Martin JH. Optimal cancer drug dosing in adolescents: new issues and the old unaddressed ones. Intern Med J 2018; 48:1023-1027. [PMID: 30182398 DOI: 10.1111/imj.14020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Jessica Ryan
- Discipline of Clinical Pharmacology, School of Medicine and Public Health, University of Newcastle, Level 3 Hunter Medical Research Institute, and Hunter New England Local Health District, Kookaburra Circuit, Newcastle, New South Wales, Australia
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31
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Hochberg J, Flower A, Brugieres L, Cairo MS. NHL in adolescents and young adults: A unique population. Pediatr Blood Cancer 2018; 65:e27073. [PMID: 29741220 DOI: 10.1002/pbc.27073] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 02/07/2018] [Accepted: 03/04/2018] [Indexed: 12/21/2022]
Abstract
Non-Hodgkin lymphoma (NHL) is a heterogeneous group of lymphoid malignancies with high incidence in adolescents and young adults (AYAs). The most common diseases include diffuse large B-cell lymphoma, anaplastic large cell lymphoma, Burkitt lymphoma, lymphoblastic lymphoma, and primary mediastinal large B-cell lymphoma. In comparison to younger children and adults, AYAs (15-39 years) with NHL present a specific set of challenges including variations in tumor biology, inconsistent treatment, pharmacodynamics, and psychosocial barriers. While survival of AYAs with NHL has improved, cure rates remain suboptimal. Incorporation of novel agents into pediatric-inspired treatment regimens specifically designed for NHL in AYAs has led to improved outcomes. Consideration of AYAs as a distinct population in the diagnosis and treatment of NHL is encouraged.
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Affiliation(s)
- Jessica Hochberg
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Allyson Flower
- Department of Pediatrics, New York Medical College, Valhalla, New York.,Department of Microbiology & Immunology, New York Medical College, Valhalla, New York
| | | | - Mitchell S Cairo
- Department of Pediatrics, New York Medical College, Valhalla, New York.,Department of Microbiology & Immunology, New York Medical College, Valhalla, New York.,Department of Medicine, New York Medical College, Valhalla, New York.,Department of Pathology, New York Medical College, Valhalla, New York.,Department of Cell Biology & Anatomy, New York Medical College, Valhalla, New York
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32
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Current situation of cancer among adolescents and young adults in Japan. Int J Clin Oncol 2018; 23:1201-1211. [DOI: 10.1007/s10147-018-1323-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
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33
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Sano H, Kobayashi R, Suzuki D, Kishimoto K, Hori D, Matsushima S, Yoshida M, Sarashina T, Toriumi N, Kobayashi K. Differential efficacy of empirical antibiotic therapy for febrile neutropenia in adolescent/young adult (AYA) and child patients. Int J Hematol 2018; 108:543-549. [DOI: 10.1007/s12185-018-2503-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/04/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
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34
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Ferrari A, Bleyer A, Patel S, Chiaravalli S, Gasparini P, Casanova M. The challenge of the management of adolescents and young adults with soft tissue sarcomas. Pediatr Blood Cancer 2018; 65:e27013. [PMID: 29493075 DOI: 10.1002/pbc.27013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 01/14/2023]
Abstract
Soft tissue sarcomas are relatively frequent in adolescents and young adults and their clinical management may be complex, partly due to tumor associated factors, but also because different approaches have been adopted by pediatric and adult medical oncologists dealing with the same disease. However, times are changing and in the last few years, management has tended to converge towards a common strategy. Continued and increased international collaboration between pediatric and adult sarcoma groups is of critical importance to improve the quality of treatment as well as research programs dedicated to young patients with soft tissue sarcomas.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Archie Bleyer
- Department of Radiation Medicine, Oregon Health and Sciences University, Portland, Oregon
| | - Shreyaskumar Patel
- Department of Sarcoma Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Patrizia Gasparini
- Tumor Genomics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Hughes N, Stark D. The management of adolescents and young adults with cancer. Cancer Treat Rev 2018; 67:45-53. [PMID: 29753962 DOI: 10.1016/j.ctrv.2018.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 12/11/2022]
Abstract
Adolescents and Young Adults (AYA) with cancer are young people developing serious illness when at the interface between the responsibilities of paediatric and adult cancer services. Personally, they are in a period of transition both biologically and in major social roles (Sawyer et al., 2018) [1]. For these and other reasons they present a unique set of clinical challenges in their management. Over the last 20 years the requirement for specific services to address their needs has been identified and this has become a growing field of research. Despite this survival rates still lag behind those of children and older adults with cancer (Gatta et al., 2009) [2]. Why do AYA patients have worse outcomes? The observation is that the reason is multifactorial with path to diagnosis, unique cancer biology, uncertainty of treatment protocol, compliance issues and poor recruitment to clinical trials all playing a part. In this review we will discuss the unique challenges faced by healthcare professionals when managing AYA patients who are commonly and accurately described as being in an 'interface' position.
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Affiliation(s)
- Nicola Hughes
- Leeds Institute of Cardiovascular and Molecular Medicine, University of Leeds, UK.
| | - Dan Stark
- Leeds Institute of Cancer and Pathology, St James's Institute of Oncology, Beckett Street, Leeds, UK
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Gaspar N, Marshall LV, Binner D, Herold R, Rousseau R, Blanc P, Capdeville R, Carleer J, Copland C, Kerloeguen Y, Norga K, Pacaud L, Sevaux MA, Spadoni C, Sterba J, Ligas F, Taube T, Uttenreuther-Fischer M, Chioato S, O'Connell MA, Geoerger B, Blay JY, Soria JC, Kaye S, Wulff B, Brugières L, Vassal G, Pearson ADJ. Joint adolescent-adult early phase clinical trials to improve access to new drugs for adolescents with cancer: proposals from the multi-stakeholder platform-ACCELERATE. Ann Oncol 2018; 29:766-771. [PMID: 29351570 PMCID: PMC5889024 DOI: 10.1093/annonc/mdy002] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- N Gaspar
- Department of Oncology for Children and Adolescents, Gustave Roussy Cancer Campus, Villejuif, France.
| | - L V Marshall
- Paediatric and Adolescent Drug Development Team, Oak Centre for Children & Young People, The Royal Marsden Hospital & The Institute of Cancer Research, London, UK
| | - D Binner
- Create for Chloe and UK Representative for aPODD, European Medicines Agency, London, UK
| | - R Herold
- Product Development Scientific Support Department, European Medicines Agency, London, UK
| | - R Rousseau
- Gritstone Oncology, Inc., Emeryville, USA
| | - P Blanc
- Imagine for Margo, Fourqueux, France
| | | | - J Carleer
- Belgium Federal Agency for Medicines and Health Products, EUROSTATION, Brussels, Belgium
| | - C Copland
- Centre for English Language Teaching, University of York, York, UK
| | - Y Kerloeguen
- Pharmaceuticals Division, PDOA, Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - K Norga
- Paediatric and Adolescent Drug Development Team, Oak Centre for Children & Young People, The Royal Marsden Hospital & The Institute of Cancer Research, London, UK; Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | | | | | - C Spadoni
- aPODD Foundation, City Point, London, UK
| | - J Sterba
- Pediatric Oncology Department, University Hospital Brno, School of Medicine Masaryk University Brno, Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, ICRC Brno, St. Anna University Hospital Brno, Czech Republic
| | - F Ligas
- Product Development Scientific Support Department, European Medicines Agency, London, UK
| | - T Taube
- Boehringer Ingelheim, Pharma GmbH&Co KG, TA Oncology, Biberach, Germany
| | | | - S Chioato
- Regulatory Strategy Oncology, Pfizer Italia, Milano, Italy
| | - M A O'Connell
- Regulatory Strategy Oncology, Pfizer Italia, Milano, Italy
| | - B Geoerger
- Department of Oncology for Children and Adolescents, Gustave Roussy Cancer Campus, Villejuif, France
| | - J-Y Blay
- Centre Léon Bérard and University Claude Bernard Lyon 1, Lyon
| | - J C Soria
- Drug Development Department (DITEP), Gustave Roussy, Villejuif and University Paris-Sud, Orsay, France
| | - S Kaye
- Adult Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - B Wulff
- Paediatric Haematology/Oncology, Clinical Research/Paediatric Drug Development, University Childreńs Hospital III Hufelandstraße, Essen, Germany
| | - L Brugières
- Department of Oncology for Children and Adolescents, Gustave Roussy Cancer Campus, Villejuif, France
| | - G Vassal
- Department of Clinical Research, Gustave Roussy, Villejuif and Paris-Sud University, Le Kremlin-Bicêtre, France
| | - A D J Pearson
- Paediatric and Adolescent Drug Development Team, Oak Centre for Children & Young People, The Royal Marsden Hospital & The Institute of Cancer Research, London, UK
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Patient characteristics and outcomes in adolescents and young adults with classical Philadelphia chromosome-negative myeloproliferative neoplasms. Ann Hematol 2017; 97:109-121. [DOI: 10.1007/s00277-017-3165-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 10/30/2017] [Indexed: 02/01/2023]
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Rotz SJ, Nagarajan R, Sorger JI, Pressey JG. Challenges in the Treatment of Sarcomas of Adolescents and Young Adults. J Adolesc Young Adult Oncol 2017; 6:406-413. [DOI: 10.1089/jayao.2017.0007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Seth J. Rotz
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rajaram Nagarajan
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joel I. Sorger
- Division of Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joseph G. Pressey
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Abstract
BACKGROUND Psychosocial distress is common among cancer patients. Significant associations between coping and social support with distress and quality of life in adult cancer patients have been identified before, but little is known about the interrelationships between distress, medical coping, and social support in adolescents and young adults (AYAs). OBJECTIVE The aims of this study are to investigate the prevalence of psychological distress in Chinese AYAs with cancer and examine the associations among distress, anxiety and depression, medical coping, and social support in the same population. METHODS A total of 610 AYA patients were recruited for this study; 551 patients completed the Chinese version of the National Comprehensive Cancer Network Distress Thermometer (DT), the Hospital Anxiety and Depression Scale, the Medical Coping Modes Questionnaire, and the Social Support Rating Scale. RESULTS The prevalence of psychological distress was 89.1% in Chinese AYAs with cancer. The DT scores were the highest in the 21- to 25-year-old patients; the DT scores were positively correlated with anxiety and depression (P < .01) but negatively correlated with medical coping and social support (P < .01). CONCLUSION The prevalence of psychological distress in AYA cancer patients was higher than that in the general cancer population. Medical coping and social support can lower the prevalence of psychological distress in AYA cancer patients. IMPLICATIONS FOR PRACTICE Findings suggest the need for evidence-based intervention strategies to enhance medical coping and social support in AYA cancer patients. Nurses are crucial to implementing psychological interventions in AYA cancer patients.
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Escherich G, Bielack S, Maier S, Braungart R, Brümmendorf TH, Freund M, Grosse R, Hoferer A, Kampschulte R, Koch B, Lauten M, Milani V, Ross H, Schilling F, Wöhrle D, Cario H, Dirksen U. Building a National Framework for Adolescent and Young Adult Hematology and Oncology and Transition from Pediatric to Adult Care: Report of the Inaugural Meeting of the “AjET” Working Group of the German Society for Pediatric Oncology and Hematology. J Adolesc Young Adult Oncol 2017; 6:194-199. [DOI: 10.1089/jayao.2016.0075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Gabriele Escherich
- University Medical Centre Eppendorf, Clinic of Pediatric Hematology and Oncology, Hamburg, Germany
| | - Stefan Bielack
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart—Olgahospital, Stuttgart Cancer Center, Stuttgart, Germany
| | - Stephan Maier
- Katharinenhöhe, Rehabilitationsklinik GmbH, Schönwald, Germany
| | - Ralf Braungart
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart—Olgahospital, Stuttgart Cancer Center, Stuttgart, Germany
| | - Tim H. Brümmendorf
- Department of Hematology and Oncology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Mathias Freund
- Deutsche Stiftung für Junge Erwachsene mit Krebs, Berlin, Germany
| | - Regine Grosse
- University Medical Centre Eppendorf, Clinic of Pediatric Hematology and Oncology, Hamburg, Germany
| | - Anette Hoferer
- Haematology/Oncology Department for Adolescent Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Rebecca Kampschulte
- Netzwerk für die Versorgung Schwerkranker Kinder und Jugendlicher e.V., Department of Paediatric Haematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Barbara Koch
- University Medical Centre Eppendorf, Clinic of Pediatric Hematology and Oncology, Hamburg, Germany
| | - Melchior Lauten
- Department of Pediatrics, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | - Valeria Milani
- MVZ Facharztzentrum Fürstenfeldbruck, Fürstenfeldbruck, Germany
| | - Henning Ross
- Katharinenhöhe, Rehabilitationsklinik GmbH, Schönwald, Germany
| | - Freimut Schilling
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart—Olgahospital, Stuttgart Cancer Center, Stuttgart, Germany
| | - Dieter Wöhrle
- Jugend & Zukunft Berufliche Beratung für Junge Menschen mit Krebserkrankung, München, Germany
| | - Holger Cario
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Uta Dirksen
- University Hospital Muenster, Westfalian Wilhelms University Muenster, Muenster, Germany
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Vignon M, Andreoli A, Dhédin N, Lengliné E, Masson E, Robin M, Granier C, Larghero J, Schlageter MH, de Latour RP, Socié G, Boissel N. Graft-Versus-Host Disease in Adolescents and Young Adults (15–24 Years Old) After Allogeneic Hematopoietic Stem Cell Transplantation for Acute Leukemia in First Complete Remission. J Adolesc Young Adult Oncol 2017; 6:299-306. [DOI: 10.1089/jayao.2016.0060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Marguerite Vignon
- Unité d'Hématologie–Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot, Paris, France
| | - Annalisa Andreoli
- Unité d'Hématologie–Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot, Paris, France
| | - Nathalie Dhédin
- Unité d'Hématologie–Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot, Paris, France
| | - Etienne Lengliné
- Unité d'Hématologie–Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot, Paris, France
| | - Emeline Masson
- Laboratoire d'Histocompatibilité, Hôpital Saint-Louis, Paris, France
| | - Marie Robin
- Service d'Hématologie–Greffe, INSERM U940, Hôpital Saint-Louis, Université Paris 7 Denis Diderot, Paris, France
| | - Clémence Granier
- Laboratoire d'Histocompatibilité, Hôpital Saint-Louis, Paris, France
| | - Jérôme Larghero
- Unité de Thérapie Cellulaire, Centre d'Investigation Clinique en Biothérapies CIC-BT501, Hôpital Saint-Louis, Paris, France
| | | | - Régis Peffault de Latour
- Service d'Hématologie–Greffe, INSERM U940, Hôpital Saint-Louis, Université Paris 7 Denis Diderot, Paris, France
| | - Gérard Socié
- Service d'Hématologie–Greffe, INSERM U940, Hôpital Saint-Louis, Université Paris 7 Denis Diderot, Paris, France
| | - Nicolas Boissel
- Unité d'Hématologie–Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot, Paris, France
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Rugbjerg K, Maraldo M, Aznar MC, Cutter DJ, Darby SC, Specht L, Olsen JH. Long-term hospitalisation rates among 5-year survivors of Hodgkin lymphoma in adolescence or young adulthood: A nationwide cohort study. Int J Cancer 2017; 140:2232-2245. [PMID: 28213927 PMCID: PMC5396317 DOI: 10.1002/ijc.30655] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 01/21/2023]
Abstract
In the present study, we report on the full range of physical diseases acquired by survivors of Hodgkin lymphoma diagnosed in adolescence or young adulthood. In a Danish nationwide population-based cohort study, 1,768 five-year survivors of Hodgkin lymphoma diagnosed at ages 15-39 years during 1943-2004 and 228,447 comparison subjects matched to survivors on age and year of birth were included. Hospital discharge diagnoses and bed-days during 1977-2010 were obtained from the Danish Patient Register for 145 specific disease categories gathered in 14 main diagnostic groups. The analysis was conducted separately on three subcohorts of survivors, that is, survivors diagnosed 1943-1976 for whom we had no information on rehospitalisation for Hodgkin lymphoma and survivors diagnosed 1977-2004, split into a subcohort with no expected relapses and a subcohort for whom a rehospitalisation for Hodgkin lymphoma indicated a relapse. The overall standardised hospitalisation rate ratios (RRs) were 2.0 [95% confidence interval (CI), 1.9-2.1], 1.5 (1.4-1.6) and 2.9 (2.6-3.1) respectively, and the corresponding RRs for bed-days were 3.5 (3.4-3.5), 1.8 (1.8-1.9) and 10.4 (10.3-10.6). Highest RRs were seen for nonmalignant haematological conditions (RR: 2.6; 3.1 and 9.7), malignant neoplasms (RR: 3.2; 2.5 and 4.7) and all infections combined (RR: 2.5; 2.2 and 5.3). Survivors of Hodgkin lymphoma in adolescence or young adulthood are at increased risk for a wide range of diseases that require hospitalisation. The risk depends on calendar period of treatment and on whether the survivors were rehospitalised for Hodgkin lymphoma, and thus likely had a relapse.
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Affiliation(s)
- Kathrine Rugbjerg
- Department of Survivorship UnitDanish Cancer Society Research CenterStrandboulevarden 49Copenhagen2100Denmark
| | - Maja Maraldo
- Department of OncologyRigshospitalet, University of CopenhagenBlegdamsvej 9Copenhagen2100Denmark
| | - Marianne C. Aznar
- Department of OncologyRigshospitalet, University of CopenhagenBlegdamsvej 9Copenhagen2100Denmark
- Nuffield Department of Population HealthUniversity of OxfordRichard Doll Building, Old Road CampusOxfordOX3 7LFUnited Kingdom
| | - David J. Cutter
- Nuffield Department of Population HealthUniversity of OxfordRichard Doll Building, Old Road CampusOxfordOX3 7LFUnited Kingdom
- Department of Oncology, Oxford Cancer and Haematology CentreOxford University Hospitals NHS Foundation TrustOld RoadOxfordOX3 7LEUnited Kingdom
| | - Sarah C. Darby
- Nuffield Department of Population HealthUniversity of OxfordRichard Doll Building, Old Road CampusOxfordOX3 7LFUnited Kingdom
| | - Lena Specht
- Department of OncologyRigshospitalet, University of CopenhagenBlegdamsvej 9Copenhagen2100Denmark
- Department of HaematologyRigshospitalet, University of CopenhagenBlegdamsvej 9Copenhagen2100Denmark
| | - Jørgen H. Olsen
- Danish Cancer Society Research CenterStrandboulevarden 49Copenhagen2100Denmark
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Lee H, Park HJ, Park EH, Ju HY, Oh CM, Kong HJ, Jung KW, Park BK, Lee E, Eom HS, Won YJ. Nationwide Statistical Analysis of Lymphoid Malignancies in Korea. Cancer Res Treat 2017; 50:222-238. [PMID: 28361523 PMCID: PMC5784621 DOI: 10.4143/crt.2017.093] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/20/2017] [Indexed: 01/06/2023] Open
Abstract
Purpose Regional differences in the incidence of lymphoid malignancies have been reported worldwide, but there has been no large-scale epidemiologic analysis in Korea. The aim of this study was to provide a nationwide population-based statistical analysis of Korean patients with lymphoid malignancies. Materials and Methods The Korea Central Cancer Registry analyzed the incidence and survival of patients with lymphoid malignancies from the Korean National Cancer Incidence Database. Diseases were grouped by clinically relevant categories based on the 2008 World Health Organization classification. Results Overall 65,948 lymphoid diseases were identified between 1999 and 2012. The incidence of most subtypes increased with age, except for precursor cell neoplasms. Male predominance (male:female ratio=1.28:1) was observed. In 2012, annual age-standardized incidence rates per 100,000 persons of Hodgkin’s lymphoma, mature B-cell neoplasm, mature T/natural killer (NK)–cell neoplasm, and precursor cell neoplasm were 0.46, 6.60, 0.95, and 1.50, respectively, and they increased yearly from 1999. Composite Hodgkin’s and non-Hodgkin’s lymphomas were extremely rare. Survival improvement estimated using 5-year relative survival rate was observed in patients with Hodgkin’s lymphoma (71.1%-83.0%), diffuse large B-cell lymphoma (49.5%-61.5%), plasma cell neoplasms (20.2%-36.9%), and lymphoblastic lymphoma/leukemia (41.5%-56.3%) between 1993 and 2012. However, survival rates of T/NK-cell lymphoma (excluding cutaneous T-cell lymphoma) ranged from 40.5%-43.5% during the study period. Survival rates decreased with age in most subtypes. Conclusion This report presented the subtype-specific statistical analysis of lymphoid malignancies in the Korean population, showing increasing incidences and survival rates in most subtypes.
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Affiliation(s)
- Hyewon Lee
- Center for Hematologic Malignancy, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyeon Jin Park
- Center for Pediatric Oncology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Eun-Hye Park
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Hee Young Ju
- Center for Pediatric Oncology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Chang-Mo Oh
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Hyun-Joo Kong
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Kyu-Won Jung
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Byung-Kiu Park
- Center for Pediatric Oncology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Eunyoung Lee
- Center for Hematologic Malignancy, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyeon-Seok Eom
- Center for Hematologic Malignancy, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Department of System Cancer Science Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Young-Joo Won
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea.,Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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van der Graaf WTA, Orbach D, Judson IR, Ferrari A. Soft tissue sarcomas in adolescents and young adults: a comparison with their paediatric and adult counterparts. Lancet Oncol 2017; 18:e166-e175. [PMID: 28271871 DOI: 10.1016/s1470-2045(17)30099-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/07/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
Survival outcomes for adolescent and young adult patients with soft tissue sarcomas lag behind those of children diagnosed with histologically similar tumours. To help understand these differences in outcomes, we discuss the following issues with regard to the management of these patients with soft tissue sarcomas: delays in diagnosis, trial availability and participation, aspects of the organisation of care (with an emphasis on age-specific needs), national centralisation of sarcoma care, international consortia, and factors related to tumour biology. Improved understanding of the causes of the survival gap between adolescents and young adults with sarcomas will help drive new initiatives to improve final health outcomes in these populations. In this Review, we specifically focus on embryonal and alveolar rhabdomyosarcoma, synovial sarcoma, and adult soft tissue sarcomas diagnosed in adolescents and young adults, and discuss the age-specific needs of these patients.
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Affiliation(s)
- Winette T A van der Graaf
- Division of Clinical Studies, Institute of Cancer Research, London, UK; Sarcoma Unit of the Royal Marsden NHS Foundation Trust, London, UK; Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Daniel Orbach
- Pediatric, Adolescent and Young Adult Oncology Department, Institut Curie, Paris, France
| | - Ian R Judson
- Division of Clinical Studies, Institute of Cancer Research, London, UK; Sarcoma Unit of the Royal Marsden NHS Foundation Trust, London, UK
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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47
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Chuk MK, Mulugeta Y, Roth-Cline M, Mehrotra N, Reaman GH. Enrolling Adolescents in Disease/Target-Appropriate Adult Oncology Clinical Trials of Investigational Agents. Clin Cancer Res 2016; 23:9-12. [PMID: 27780857 DOI: 10.1158/1078-0432.ccr-16-1367] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022]
Abstract
The enrollment of adolescents with cancer in clinical trials is much lower than that of younger pediatric patients. For adolescents with "adult-type" cancers, lack of access to relevant trials is cited as one of the reasons for this discrepancy. Adolescents are generally not eligible for enrollment in adult oncology trials, and initial pediatric trials for many drugs are conducted years later, often after the drug is approved. As a result, accrual of adolescents to these trials may be slow due to off-label use, prospectively collected safety and efficacy data are lacking at the time of initial approval, and, most importantly, these adolescents have delayed access to effective therapies. To facilitate earlier access to investigational and approved drugs for adolescent patients with cancer, and because drug exposure is most often similar in adolescents and adults, we recommend the inclusion of adolescents (ages 12-17) in disease- and target-appropriate adult oncology trials. This approach requires careful monitoring for any differential safety signals, appropriate pharmacokinetic evaluations, and ensuring that ethical requirements are met. Inclusion of adolescents in adult oncology trials will require the cooperation of investigators, cooperative groups, industry, institutional review boards, and regulatory agencies to overcome real and perceived barriers. Clin Cancer Res; 23(1); 9-12. ©2016 AACR.
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Affiliation(s)
- Meredith K Chuk
- Office of Hematology and Oncology Products, U.S. Food and Drug Administration, Silver Spring, Maryland.
| | - Yeruk Mulugeta
- Office of Clinical Pharmacology, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Michelle Roth-Cline
- Office of Pediatric Therapeutics, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Nitin Mehrotra
- Office of Clinical Pharmacology, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Gregory H Reaman
- Office of Hematology and Oncology Products, U.S. Food and Drug Administration, Silver Spring, Maryland
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Løhmann DJA, Abrahamsson J, Ha SY, Jónsson ÓG, Koskenvuo M, Lausen B, Palle J, Zeller B, Hasle H. Effect of age and body weight on toxicity and survival in pediatric acute myeloid leukemia: results from NOPHO-AML 2004. Haematologica 2016; 101:1359-1367. [PMID: 27470605 DOI: 10.3324/haematol.2016.146175] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 07/25/2016] [Indexed: 12/14/2022] Open
Abstract
Treatment for pediatric acute myeloid leukemia is very toxic and the association between outcome and age and Body Mass Index is unclear. We investigated effect of age and Body Mass Index on toxicity and survival in pediatric acute myeloid leukemia. We studied all patients who completed first induction course of NOPHO-AML 2004 (n=318). Toxicity following induction and consolidation courses (n=6) was analyzed. The probabilities of toxicity and death were determined using time-to-event analyses with Cox multivariate proportional hazard regression for comparative analyses. Age 10-17 years was associated with sepsis with hypotension [hazard ratio 2.3 (95% confidence interval 1.1-4.6)]. Being overweight (>1 standard deviation) was associated with requiring supplemental oxygen [1.9 (1.0-3.5)]. The 5-year event-free and overall survival were 47% and 71%. Children aged 10-17 years showed a trend for inferior 5-year overall survival compared to children aged 2-9 (64% vs. 76%; P=0.07). Infants showed a trend for superior 5-year event-free survival (66% vs. 43%; P=0.06). Overweight children aged 10-17 years showed a trend for superior survival [5-year event-free survival 59% vs. 40% (P=0.09) and 5-year overall survival 78% vs. 56% (P=0.06)] compared to healthy weight children aged 10-17 years. In conclusion, children aged 10-17 years and overweight children had a higher risk of grade 3-4 toxicity. Children aged 10-17 years showed inferior survival, but, unexpectedly, in this age group overweight children tended to have increased survival. This suggests different pharmacokinetics of chemotherapeutic drugs in adolescents and warrants further studies.
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Affiliation(s)
- Ditte J A Løhmann
- Department of Pediatrics, Aarhus University Hospital Skejby, Denmark
| | - Jonas Abrahamsson
- Institution for Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Shau-Yin Ha
- Department of Pediatrics, Queen Mary Hospital and Hong Kong Pediatric Hematology & Oncology Study Group (HKPHOSG), Hong Kong, China
| | | | - Minna Koskenvuo
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital and Helsinki University Central Hospital, Finland
| | - Birgitte Lausen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Josefine Palle
- Department of Woman's and Children's Health, Uppsala University, Sweden
| | - Bernward Zeller
- Department of Pediatric Medicine, Oslo University Hospital, Norway
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Denmark
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Jin SL, Hahn SM, Kim HS, Shin YJ, Kim SH, Lee YS, Lyu CJ, Han JW. Symptom Interval and Patient Delay Affect Survival Outcomes in Adolescent Cancer Patients. Yonsei Med J 2016; 57:572-9. [PMID: 26996554 PMCID: PMC4800344 DOI: 10.3349/ymj.2016.57.3.572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/29/2015] [Accepted: 09/07/2015] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Unique features of adolescent cancer patients include cancer types, developmental stages, and psychosocial issues. In this study, we evaluated the relationship between diagnostic delay and survival to improve adolescent cancer care. MATERIALS AND METHODS A total of 592 patients aged 0-18 years with eight common cancers were grouped according to age (adolescents, ≥10 years; children, <10 years). We retrospectively reviewed their symptom intervals (SIs, between first symptom/sign of disease and diagnosis), patient delay (PD, between first symptom/sign of disease and first contact with a physician), patient delay proportion (PDP), and overall survival (OS). RESULTS Mean SI was significantly longer in adolescents than in children (66.4 days vs. 28.4 days; p<0.001), and OS rates were higher in patients with longer SIs (p=0.001). In children with long SIs, OS did not differ according to PDP (p=0.753). In adolescents with long SIs, OS was worse when PDP was ≥0.6 (67.2%) than <0.6 (95.5%, p=0.007). In a multivariate analysis, adolescents in the long SI/PDP ≥0.6 group tended to have a higher hazard ratio (HR, 6.483; p=0.069) than those in the long SI/PDP <0.6 group (HR=1, reference). CONCLUSION Adolescents with a long SI/PDP ≥0.6 had lower survival rates than those with a short SI/all PDP or a long SI/PDP <0.6. They should be encouraged to seek prompt medical assistance by a physician or oncologist to lessen PDs.
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Affiliation(s)
- Song Lee Jin
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Seung Min Hahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Hyo Sun Kim
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoon Jung Shin
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Sun Hee Kim
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoon Sun Lee
- Department of Pharmacy, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.
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50
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Kaul S, Fluchel M, Spraker-Perlman H, Parmeter CF, Kirchhoff AC. Health care experiences of long-term survivors of adolescent and young adult cancer. Support Care Cancer 2016; 24:3967-77. [DOI: 10.1007/s00520-016-3235-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/17/2016] [Indexed: 11/27/2022]
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