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Bosch-Ramírez M, Sánchez-Guillén L, Alcaide-Quirós MJ, Aguilar-Martínez MM, Bellón-López M, López Delgado A, López-Rodríguez-Arias F, Muñoz-Duyos A, Barber-Valles X, Arroyo A. Long-term efficacy of percutaneous tibial nerve stimulation for faecal incontinence and a new approach for partial responders. Tech Coloproctol 2023; 27:443-451. [PMID: 36222850 PMCID: PMC10169891 DOI: 10.1007/s10151-022-02711-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/30/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the long-term efficacy of percutaneous tibial nerve stimulation (PTNS) for patients with faecal incontinence (FI) refractory to conservative treatment. Secondary aims were to identify predictors of response and validate new treatment pathways for partial responders. METHODS A prospective, interventional study was carried out in a specialist defecatory disorder unit from a university hospital between January 2010 and June 2017 on patients > 18 years old with FI refractory to conservative treatment. Thirty-minute PTNS sessions were performed in three phases (weekly, biweekly and monthly) up to a year, with clinical reassessment at 3, 6, 12 and 36 months. Patients were classified as optimal responders when their pretreatment Wexner score decreased > 50%; partial responders when it decreased 25-50%; and insufficient responders if it decreased < 25%. Only optimal and partial responders progressed into successive phases. RESULTS Between 2010 and 2017, 139 patients (110 women, median age 63 years [range 22-82 years]) were recruited. After the first phase, 4 patients were optimal responders, 93 were partial responders and 36 were insufficient responders. At 6 and 12 months, 66 and 89 patients respectively were optimal responders, with an optimal response rate of 64% at the end of treatment. A total of 93.3% patients with a partial response initially finally became optimal responders. Furthermore, at 36 months, 71.9% of patients were still optimal responders without supplementary treatment, although their quality of life did not improve significantly. Baseline Wexner scores ≤ 10 and symptom duration < 1 year were identified as predictive factors for positive responses to PTNS. CONCLUSIONS Patients undergoing PTNS for 1 year following this protocol had optimal long-term responses. PTNS sessions for up to 1 year in patients who were partial responders prevents a high percentage of them from needing more invasive treatments, and maintains long-term continence in patients who were optimal responders.
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Affiliation(s)
- M. Bosch-Ramírez
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Camino de la Almazara 11, 03203 Elche, Alicante Spain
| | - L. Sánchez-Guillén
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Camino de la Almazara 11, 03203 Elche, Alicante Spain
| | - M. J. Alcaide-Quirós
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Camino de la Almazara 11, 03203 Elche, Alicante Spain
| | - M. M. Aguilar-Martínez
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Camino de la Almazara 11, 03203 Elche, Alicante Spain
| | - M. Bellón-López
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Camino de la Almazara 11, 03203 Elche, Alicante Spain
| | - A. López Delgado
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Camino de la Almazara 11, 03203 Elche, Alicante Spain
| | - F. López-Rodríguez-Arias
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Camino de la Almazara 11, 03203 Elche, Alicante Spain
| | - A. Muñoz-Duyos
- Department of General Surgery, Colorectal Unit, Mútua Terrassa University Hospital, University of Barcelona, Terrassa, Barcelona Spain
| | - X. Barber-Valles
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Camino de la Almazara 11, 03203 Elche, Alicante Spain
- Center for Operations Research, University Miguel Hernández of Elche, Elche, Alicante Spain
- Joint Research Unit on Statistical Methods in Health Sciences UMH-FISABIO, University Miguel Hernández of Elche, Elche, Spain
| | - A. Arroyo
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Camino de la Almazara 11, 03203 Elche, Alicante Spain
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Sheng QJ, Han C, Li YW, Zhang C, Dou XG, Ding Y. [Clinical efficacy analysis of TMF for the treatment of hyperviremia HBeAg-positive chronic hepatitis B patients with incomplete response to first-line oral antiviral nucleos(t)ide analogues]. Zhonghua Gan Zang Bing Za Zhi 2023; 31:252-257. [PMID: 37137850 DOI: 10.3760/cma.j.cn501113-20230212-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Objective: To prospectively explore the treatment strategies for clinical difficulties in patients with hyperviremia HBeAg-positive chronic hepatitis B with incomplete response to first-line nucleos(t)ide analogues (NAs). Methods: Patients with hyperviremia HBeAg-positive chronic hepatitis B were treated with first-line NAs, including entecavir, tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate (TAF) for 48 weeks or more. Tenofovir amibufenamide (TMF) or TAF therapy was changed when HBV DNA remained positive and then divided into a TMF group and a TAF group. Clinical efficacy of treatment was evaluated at 24 and 48 weeks, including HBV DNA undetectable rates and virological and serological responses in both patient groups. Results: In the TMF group and the TAF groups, 30 and 26 cases completed 24-week follow-up, while 18 and 12 cases completed 48-week follow-up. There were no statistically significant differences in baseline HBV DNA, HBsAg, and HBeAg levels between the two groups before switching to TMF/TAF therapy (P > 0.05). At 24 weeks of treatment, 19 (19/30, 63.33%) cases in the TMF group had HBV DNA negative conversion, while 14 (14/26, 53.85%) cases in the TAF group had HBV DNA negative conversion (P > 0.05). Among the patients who completed 48 weeks of follow-up, 15 (15/18, 83.33%) cases in the TMF group and 7 (7/12, 58.33%) cases in the TAF group had negative HBV DNA tests (P > 0.05). The changes in HBsAg and HBeAg levels between the two groups of patients at 24 and 48 weeks of treatment were not statistically significant compared to baseline (P > 0.05). Conclusion: TMF is effective in treating patients with hyperviremia HBeAg-positive CHB with an incomplete response to first-line NAs treatment, but there is no significant difference compared to TAF.
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Affiliation(s)
- Q J Sheng
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Liaoning Province Key Laboratory of Viral Hepatitis, Shenyang 110022, China
| | - C Han
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Liaoning Province Key Laboratory of Viral Hepatitis, Shenyang 110022, China
| | - Y W Li
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Liaoning Province Key Laboratory of Viral Hepatitis, Shenyang 110022, China
| | - C Zhang
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Liaoning Province Key Laboratory of Viral Hepatitis, Shenyang 110022, China
| | - X G Dou
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Liaoning Province Key Laboratory of Viral Hepatitis, Shenyang 110022, China
| | - Y Ding
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Liaoning Province Key Laboratory of Viral Hepatitis, Shenyang 110022, China
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Liu ZH, Hao X, Hou JL. [Treat-all: challenges of partial response and low-level viremia]. Zhonghua Gan Zang Bing Za Zhi 2023; 31:242-246. [PMID: 37137848 DOI: 10.3760/cma.j.cn501113-20230316-00117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The recently updated "Guidelines for the Prevention and Treatment of Chronic Hepatitis B" in China have brought about significant changes. The new treatment indications almost mandate the implementation of a Treat-all strategy for the chronically HBV-infected population in China. While simultaneous negativity for hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) DNA has long been an accepted criterion for treatment discontinuation, there has been controversies over the initiation of treatment criteria starting with HBsAg and HBV DNA positivity. Despite the inconsistent treatment criteria, the academic community has started supporting treat-all strategies in recent years due to the decreasing cost of treatment, prolonged management duration, and growing evidence of poor outcomes in untreated populations. Therefore, this update to the Chinese HBV guidelines represents a new direction that suggests "The greatest truths are the simplest." However, in the process of rolling out the Treat-all strategy, we must remain cautious of possible issues arising from the new strategy. Among them, the problem of partial response or low-level viremia following treatment may become more prominent due to the inclusion of a significant number of patients with normal or low levels of alanine transaminase. As existing evidence suggests that low-level viremia increases the risk of HCC in patients, it is essential to monitor and explore optimal therapeutic options for these patients.
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Affiliation(s)
- Z H Liu
- Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Institutes of Liver Diseases Research of Guangdong Province, Guangzhou 510515, China
| | - X Hao
- Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Institutes of Liver Diseases Research of Guangdong Province, Guangzhou 510515, China
| | - J L Hou
- Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Institutes of Liver Diseases Research of Guangdong Province, Guangzhou 510515, China
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Mataix-Cols D, Andersson E, Aspvall K, Boberg J, Crowley JJ, de Schipper E, Fernández de la Cruz L, Flygare O, Ivanova E, Lenhard F, Lundström L, Rück C, Serlachius E, Cervin M. Operational Definitions of Treatment Response and Remission in Obsessive-Compulsive Disorder Capture Meaningful Improvements in Everyday Life. Psychother Psychosom 2022; 91:424-430. [PMID: 36382651 PMCID: PMC9838085 DOI: 10.1159/000527115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/08/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The operational definitions of treatment response, partial response, and remission in obsessive-compulsive disorder (OCD) are widely used in clinical trials and regular practice. However, the clinimetric sensitivity of these definitions, that is, whether they identify patients that experience meaningful changes in their everyday life, remains unexplored. OBJECTIVE The objective was to examine the clinimetric sensitivity of the operational definitions of treatment response, partial response, and remission in children and adults with OCD. METHODS Pre- and post-treatment data from five clinical trials and three cohort studies of children and adults with OCD (n = 1,528; 55.3% children, 61.1% female) were pooled. We compared (1) responders, partial responders, and non-responders and (2) remitters and non-remitters on self-reported OCD symptoms, clinician-rated general functioning, and self-reported quality of life. Remission was also evaluated against post-treatment diagnostic interviews. RESULTS Responders and remitters experienced large improvements across validators. Responders had greater improvements than partial responders and non-responders on self-reported OCD symptoms (Cohen's d 0.65-1.13), clinician-rated functioning (Cohen's d 0.53-1.03), and self-reported quality of life (Cohen's d 0.63-0.73). Few meaningful differences emerged between partial responders and non-responders. Remitters had better outcomes across most validators than non-remitters. Remission criteria corresponded well with absence of post-treatment diagnosis (sensitivity/specificity: 93%/83%). Using both the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression Scale yielded more conservative results and more robust changes across validators, compared to only using the Y-BOCS. CONCLUSIONS The current definitions of treatment response and remission capture meaningful improvements in the everyday life of individuals with OCD, whereas the concept of partial response has dubious clinimetric sensitivity.
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Affiliation(s)
- David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden,*David Mataix-Cols,
| | - Erik Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kristina Aspvall
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Julia Boberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - James J. Crowley
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Genetics at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Department of Psychiatry at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elles de Schipper
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Oskar Flygare
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Ekaterina Ivanova
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Fabian Lenhard
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lina Lundström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Matti Cervin
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Maskal S, Al Marzooqi R, Fafaj A, Zolin S, Naples R, Iyer A, Petro C, Krpata D, Prabhu A, Rosen M, Rosenblatt S. Clinical and surgical outcomes of splenectomy for autoimmune hemolytic anemia. Surg Endosc 2022. [PMID: 35194660 DOI: 10.1007/s00464-022-09116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION We investigated short and long-term remission rates after splenectomy in patients with primary and secondary autoimmune hemolytic anemia (AIHA). METHODS All adults who underwent splenectomy for primary or secondary AIHA at a single center (2004-2018) were retrospectively reviewed. Short-term response was determined at 30-day postoperatively and long-term at one year. Complete response was defined as hemoglobin > 10 g/dL without hemolysis, transfusions, or need for additional medical therapy for > 6 months. RESULTS Short-term complete response was attained in 22 of 36 patients (61%), partial response in 3 (8%), no response in 11 (31%). The response rate at 1 year was complete in 14/36 (39%), partial in 14 (39%), and 8 non-response (22%). At last available follow-up (median 33.1 months (IQR 19-59), 16/37 patients had experienced a complete response (43%), 14 partial response (38%), 7 non-response (19%). 80% of partial responders with primary AIHA required maintenance therapy compared to 100% with secondary AIHA. CONCLUSION Splenectomy is associated with short- and long-term improvement in anemia and hemolysis in the majority of patients with AIHA. Immunosuppressants remain important supplemental therapy.
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Jin LL, Wu ZZ, Wang YL, Chen DS, Li S, Xiao M, Zhao X. Icotinib, an effective treatment option for patients with lung adenocarcinoma harboring compound EGFR L858R and A871G mutation. Invest New Drugs 2021; 39:1419-1421. [PMID: 33835358 DOI: 10.1007/s10637-021-01108-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
Compound epidermal growth factor receptor (EGFR) mutations are defined as double or multiple independent mutations of the EGFR tyrosine kinase domain (TKD), in which an EGFR-tyrosine kinase inhibitor (TKI)-sensitizing mutation is identified together with a mutation of unclarified clinical significance. Lung adenocarcinoma with compound EGFR mutation shows poor clinical response to EGFR-TKIs. Kobayashi et al. reported a non-small-cell lung cancer (NSCLC) patient whose tumor had EGFR exon21 L858R/A871G mutation presented rapid disease progression to erlotinib. However, in this case, we present an EGFR exon21 L858R/A871G mutation patient exerted significant benefit to icotinib, another first-generation EGFR-TKI, indicating that different EGFR-TKIs have diversiform sensitive sites and therapeutic effects, consistent mutation sites might achieve heterogeneous benefits from different EGFR-TKIs. Our case report provides promising EGFR-TKI for clinical treatment with EGFR exon21 L858R/A871G mutation in NSCLC. More dedicated efforts are needed to clarify their biologic effects on disease course and drug responsiveness.
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Affiliation(s)
- Lin-Ling Jin
- Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University , Nanjing, 210002, China
| | - Zhen-Zhen Wu
- Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University , Nanjing, 210002, China
| | - Yan-Li Wang
- Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University , Nanjing, 210002, China
| | - Dong-Sheng Chen
- The State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, 210002, China
| | - Si Li
- The State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, 210002, China
| | - Mingzhe Xiao
- The State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, 210002, China
| | - Xin Zhao
- Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University , Nanjing, 210002, China.
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Shen Q, Kalyani FS, Qu J, Chen Z, Zhang J, Zhou J. A Case of Small Cell Lung Carcinoma Harboring an EML4-ALK Fusion with Partial Response to Crizotinib. Clin Lung Cancer 2021; 22:e799-e803. [PMID: 33896729 DOI: 10.1016/j.cllc.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/26/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Qian Shen
- Department of Respiratory Diseases, Thoracic Disease Centre, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Farhin Shaheed Kalyani
- Department of Respiratory Diseases, Thoracic Disease Centre, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jingjing Qu
- Department of Respiratory Diseases, Thoracic Disease Centre, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhen Chen
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jing Zhang
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianying Zhou
- Department of Respiratory Diseases, Thoracic Disease Centre, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Bedke J, Merseburger AS, Loriot Y, Castellano D, Choy E, Duran I, Rosenberg JE, Petrylak DP, Dreicer R, Perez-Gracia JL, Hoffman-Censits JH, Van Der Heijden MS, Pavlova J, Thiebach L, de Ducla S, Fear S, Powles T, Sternberg CN. Partial Response and Stable Disease Correlate with Positive Outcomes in Atezolizumab-treated Patients with Advanced Urinary Tract Carcinoma. Eur Urol Focus 2020; 7:1084-1091. [PMID: 33168461 DOI: 10.1016/j.euf.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/01/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The value of a complete response to immune checkpoint inhibitor treatment for urothelial cancer is well recognised, but less is known about long-term outcomes in patients with a partial response or the benefit of achieving disease stabilisation. OBJECTIVE To determine clinical outcomes in patients with a partial response or stable disease on atezolizumab therapy for advanced urinary tract carcinoma (UTC). DESIGN, SETTING, AND PARTICIPANTS Data were extracted from three prospective trials (IMvigor210 cohort 2, SAUL, and IMvigor211) evaluating single-agent atezolizumab therapy for platinum-pretreated advanced UTC. The analysis population included 604 atezolizumab-treated and 208 chemotherapy-treated patients (229 achieving a partial response and 583 achieving stable disease). INTERVENTION Atezolizumab 1200 mg every 3 wk until progression or unacceptable toxicity or single-agent chemotherapy for patients in the control arm of IMvigor211. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Baseline characteristics, treatment exposure, overall survival, duration of disease control. Partial response and stable disease populations were analysed separately. RESULTS AND LIMITATIONS The population of patients with a partial response included more patients with programmed cell death ligand 1 (PD-L1) expression on ≥5% of tumour-infiltrating immune cells than the stable disease population. The median time to best response was 2.1 mo across trials and treatments, regardless of the type of response. Atezolizumab-treated patients with a partial response had sustained disease control (median overall survival not reached); durations of disease control and overall survival were longer with atezolizumab than with chemotherapy. In patients with stable disease, median overall survival was numerically longer with atezolizumab (exceeding 1 yr) than with chemotherapy. Irrespective of treatment, durations of disease control and survival were shorter in patients with stable disease than in those achieving a partial response. These analyses are limited by their post hoc exploratory nature and relatively short follow-up. CONCLUSIONS Stable disease and partial response are meaningful clinical outcomes in atezolizumab-treated patients with advanced UTC. PATIENT SUMMARY In this report, we looked at the outcomes in patients whose tumours responded to treatment to some extent, but the tumour did not disappear completely. We aimed to understand whether a modest response to treatment was associated with meaningful long-term outcomes for patients. We found that on average, life expectancy was >1 yr in patients whose disease was stabilised and even longer in those whose tumours showed some shrinkage in response to treatment.
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Affiliation(s)
- Jens Bedke
- Department of Urology, University of Tübingen, Tübingen, Germany.
| | - Axel S Merseburger
- Department of Urology, Campus Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Yohann Loriot
- Department of Cancer Medicine and Institut National de la Santé et de la Recherche Médicale (INSERM) U981, Université Paris-Sud, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Daniel Castellano
- Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ernest Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Ignacio Duran
- Hospital Universitario Virgen del Rocio, Seville, Spain
| | | | | | - Robert Dreicer
- University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Jose L Perez-Gracia
- Clínica Universidad de Navarra, University of Navarra, Pamplona, Navarre, Spain
| | | | | | | | | | | | - Simon Fear
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Thomas Powles
- Barts Cancer Institute, Experimental Cancer Medicine Centre, Queen Mary University of London, St Bartholomew's Hospital, London, UK
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Couturier A, Giocanti-Auregan A, Massin P. [Treatment switch in diabetic macular edema: Literature review and management algorithm]. J Fr Ophtalmol 2020; 43:710-717. [PMID: 32653096 DOI: 10.1016/j.jfo.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/21/2019] [Accepted: 12/27/2019] [Indexed: 12/01/2022]
Abstract
Initial management of diabetic macular edema (DME) is well-defined, but there is a lack of national or international consensus for patients who do not respond or respond only partially to these treatments. Several studies, mostly retrospective, have assessed medication switches, but currently, the literature contains no randomized studies. The goal of this article is to present an algorithm for switching medications, which can be proposed to DME patients treated with anti-VEGF agents, as defined by a group of French retina experts, supported by the existing literature on the subject. After initiation of an anti-VEGF treatment for DME, the response is usually assessed after 5 monthly injections. A partial anatomical response (reduction of central retinal thickness between 10 and 20%), seen in 30 to 40% of patients, is associated with a favorable visual prognosis according to randomized studies. Continuation of the anti-VEGF injections after the induction phase is thus possible. If the response remains incomplete after 3 additional anti-VEGF injections, a complete ophthalmologic examination should be performed, and a switch to another therapeutic class (corticosteroids) may be proposed in the absence of contraindications. If a complete non-response is seen initially (reduction of central retinal thickness<10%), the switch is proposed immediately after the induction phase.
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Affiliation(s)
- A Couturier
- Service d'ophtalmologie, hôpital Lariboisière, université de Paris, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - A Giocanti-Auregan
- Service d'ophtalmologie, hôpital Avicenne, DHU vision et handicaps, université Paris, 13, AP-HP, Bobigny, France
| | - P Massin
- Centre d'ophtalmologie Breteuil, centre Broca, hôpital Lariboisière, Paris, France
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Zhang Y, Zheng Q, Chen J, Jiang JJ, Zhu YY. [Efficacy of sequential therapy with telbivudine in treatment of HBeAg-positive chronic hepatitis B patients with partial response to pegylated interferon-α therapy]. Zhonghua Gan Zang Bing Za Zhi 2019; 26:102-107. [PMID: 29804375 DOI: 10.3760/cma.j.issn.1007-3418.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the efficacy of sequential therapy with telbivudine in the treatment of HBeAg-positive chronic hepatitis B (CHB) patients with partial response after a standard course of interferon therapy. Methods: A retrospective cohort study was performed for 58 HBeAg-positive CHB patients with partial response at the end of interferon therapy (48-60 weeks) from January 2009 to December 2013. According to whether telbivudine was used sequentially or withdrawn at the end of the course of treatment, the patients were divided into telbivudine sequential therapy group and withdrawal group, and the two groups were compared with in terms of biochemical, virological, and serological response rates. The chi-square test, the t-test, and the non-parametric test were used based on data type. Results: A total of 58 patients were enrolled in this study, with 31 in the telbivudine sequential therapy group and 27 in the withdrawal group. At 12 and 24 weeks after interferon therapy ended, the telbivudine sequential therapy group had a significantly higher HBeAg clearance rate than the withdrawal group (22.6%/29.0% vs 0%/3.7%, P < 0.05). At week 48 of follow-up, the telbivudine sequential therapy group had a significantly higher combined response rate than the withdrawal group (22.6% vs 0%, P = 0.015). Among the 31 patients in the telbivudine sequential therapy group, 11 had an increase in creatine kinase during the administration of telbivudine. No patient in either group experienced serious adverse reactions during follow-up, such as muscular soreness, myositis, peripheral neuropathy, renal dysfunction, and liver function decompensation. Conclusion: In HBeAg-positive CHB patients with partial response to interferon therapy, sequential therapy with telbivudine can increase serological HBeAg clearance rate and combined response rate at week 48, and it is safe in HBeAg-positive CHB patients achieving partial response at the end of interferon therapy.
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Affiliation(s)
- Y Zhang
- Department of Liver Research Center, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
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11
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Nagai G, Mihara K, Kagawa S, Nakamura A, Suzuki T, Nemoto K, Kondo T. A Partial Response at Week 4 Can Predict Subsequent Outcome during Lamotrigine Augmentation Therapy in Treatment-Resistant Depressive Disorder: A Preliminary Study. Neuropsychobiology 2018; 76:187-192. [PMID: 29961057 DOI: 10.1159/000489967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/10/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The present study prospectively examined whether or not a partial response at week 4 predicts subsequent response at week 8 during lamotrigine augmentation therapy in 51 (16 males and 35 females) inpatients with treatment-resistant depressive disorder using an open-study design. METHODS The subjects were 51 depressed patients who had already shown insufficient response to at least 3 psychotropics including antidepressants, mood stabilizers, and atypical antipsychotics. The diagnoses were major depressive disorder (n = 19), bipolar I disorder (n = 9), and bipolar II disorder (n = 23). The final doses of lamotrigine were 100 mg/day for 29 subjects who were not taking valproate and 75 mg/day for 22 subjects taking valproate. Depressive symptoms were evaluated by the Montgomery-Åsberg Depression Rating Scale (MADRS) before the start of lamotrigine and then at week 4, and finally after the 8th week of treatment. RESULTS A significant linear relationship was found between percent improvements in MADRS scores at weeks 4 and 8 (r = 0.492, y = 0.438x + 30.223, R2 = 0.226, p < 0.001). The receiver operating characteristics analysis indicated that a percent improvement of 16% or greater at week 4 was significantly (p < 0.01) predictive of response (50% or more reduction in the MADRS score). The patients were significantly divided by the cut-off point into the responders and the nonresponders (18/26 vs. 1/25, p < 0.001). CONCLUSION The present study suggests that a partial response at week 4 can predict subsequent outcome at week 8 during lamotrigine augmentation therapy in patients with treatment-resistant depressive disorder, and that the absence of a partial improvement at week 4 is highly predictive of nonresponse.
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Affiliation(s)
- Goyo Nagai
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kazuo Mihara
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shoko Kagawa
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Akifumi Nakamura
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takeshi Suzuki
- Department of Hospital Pharmacy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kenji Nemoto
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tsuyoshi Kondo
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Haslbauer F. Long-Term Progression-Free Survival in a Patient with Metastatic Leiomyosarcoma of the Inguinal Region Treated with Trabectedin. Case Rep Oncol 2018; 11:246-251. [PMID: 29805376 PMCID: PMC5968288 DOI: 10.1159/000487937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 02/26/2018] [Indexed: 12/11/2022] Open
Abstract
Presented here is the case of an elderly leiomyosarcoma patient with multiple comorbidities and relapses from prior lines of treatment, who experienced a long-lasting progression-free survival. After initial diagnosis, standard treatment protocols with surgery and subsequent adjuvant radiochemotherapy were administered, followed by a short course of oral pazopanib at the patient's request, which led to a rapid relapse. Afterwards, the patient received trabectedin for 22 months, achieving disease control with good quality of life over an extended period of time. After progression from trabectedin, the patient was switched to eribulin. Future clinical trials are needed to investigate the efficacy of trabectedin maintenance treatment and to identify predictive criteria for response to trabectedin among patients with advanced sarcoma.
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Kesarwala AH, Lu DJ, Xanthopoulos E, Apisarnthanarax S, Cengel KA, Evans TL, Aggarwal C, Cohen RB, Langer CJ, Rengan R, Simone CB. The Role of Advanced Imaging in Assessing Response to Definitive Chemoradiation Before Prophylactic Cranial Irradiation in Limited-Stage Small-Cell Lung Cancer. Clin Lung Cancer 2017; 19:e205-e209. [PMID: 29153967 DOI: 10.1016/j.cllc.2017.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 07/26/2017] [Accepted: 10/04/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Prophylactic cranial irradiation (PCI) improves survival for small-cell lung cancer (SCLC). Evidence for PCI in limited-stage SCLC largely derives from studies requiring only chest x-ray (CXR) to determine remission status. We analyzed thoracic chemoradiation therapy (TCRT) outcomes according to imaging modality to determine which patients benefitted most from PCI. PATIENTS AND METHODS All limited-stage SCLC patients who received TCRT as well as PCI at our institution were reviewed. Imaging between TCRT end and PCI start was characterized as complete (CR), partial (PR), or other response. RESULTS Thirty-eight consecutive patients were assessed for TCRT response before PCI with CXR (n = 21), chest computed tomography (CT; n = 27), and/or positron emission tomography (PET)/CT (n = 11). CR was identified on 71% of CXRs, 41% of CT scans, and 18% of PET/CT scans. Median survival was 28.3 months for the entire cohort and did not differ for patients who had CXR alone versus CT and/or PET/CT for restaging (P = .78) or those with PR using any modality versus CR using all modalities (22.6 months vs. 45.5 months; P = .22). CT CR patients had numerical but not statistically significant improved 2-year (P = .18) and 3-year (P = .13) survival compared with CT PR. CONCLUSION CXR remains an appropriate modality to assess TCRT response before PCI in limited-stage SCLC. Advanced imaging did not inform the decision to offer PCI in this study. Because of similar excellent survival profiles independent of imaging modality and TCRT response, this analysis suggests limited-stage SCLC patients with PR using any modality should not be denied PCI, akin to standards for extensive-stage SCLC.
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Affiliation(s)
- Aparna H Kesarwala
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Diana J Lu
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Eric Xanthopoulos
- Department of Radiation Oncology, Columbia University Medical Center, New York, NY
| | - Smith Apisarnthanarax
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA
| | - Keith A Cengel
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Tracey L Evans
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Charu Aggarwal
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Roger B Cohen
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Corey J Langer
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD
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Lee H, Kim YR, Kim SJ, Park Y, Eom HS, Oh SY, Kim HJ, Kang HJ, Lee WS, Moon JH, Won YW, Kim TS, Kim JS. Clinical outcomes in patients with diffuse large B cell lymphoma with a partial response to first-line R-CHOP chemotherapy: prognostic value of secondary International Prognostic Index scores and Deauville scores. Ann Hematol 2017; 96:1873-1881. [PMID: 28831584 DOI: 10.1007/s00277-017-3107-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/16/2017] [Indexed: 12/21/2022]
Abstract
After introducing a rituximab-containing chemoimmunotherapy (R-CHOP) for diffuse large B cell lymphoma (DLBCL), a partial response (PR) which is regarded as treatment failure is still observed. To investigate the prognostic factors for the DLBCL patients with a PR to R-CHOP, we retrospectively evaluated 758 newly diagnosed DLBCL patients. After R-CHOP, 88 (11.6%) achieved a PR. Three-year progression-free and overall survival rates measured from the date of PR achievement (PFS2 and OS2) were 57.4 and 67.8%, respectively. The secondary International Prognostic Index (IPI2) scores after R-CHOP were low (0-1) in 68.2% and high (2-3) in 31.8% of the patients. The Deauville scores from 18-fluorodeoxyglucose positron emission tomography after R-CHOP showed low (2-3) in 58.0% and high (4) in 42.0% of the patients. High IPI2 and high Deauville scores were associated with worse PFS2 (P < 0.001 and P = 0.009) and OS2 (P = 0.013 and P = 0.067). The high-risk group defined by the IPI2 and Deauville scores, whose scores were both high, showed significantly lower 3-year PFS2 (P < 0.001) and OS2 (P = 0.006) rates compared with those of the other groups. In multivariate analyses, the IPI score of ≥ 3 at diagnosis and bone marrow involvement at diagnosis were independent prognostic factors. In addition, high IPI2-Deauville score after R-CHOP was significantly associated with poor PFS2 (P = 0.009) and demonstrated a trend toward inferior OS2. In conclusion, DLBCL patients who partially responded to R-CHOP are still a heterogeneous group, for which IPI2 and Deauville scores should be evaluated for prediction of prognosis.
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Affiliation(s)
- Hyewon Lee
- Center for Hematologic Malignancy, National Cancer Center, Goyang, South Korea
| | - Yu Ri Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea
| | - Soo-Jeong Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Yong Park
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Hyeon-Seok Eom
- Center for Hematologic Malignancy, National Cancer Center, Goyang, South Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Hyo Jung Kim
- Division of Hematology-Oncology, Department of Internal Medicine, College of Medicine, Hallym University, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Hye Jin Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Won-Sik Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Joon Ho Moon
- Department of Hematology and Medical Oncology, Kyungpook National University Hospital, Daegu, South Korea
| | - Young-Woong Won
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Tae-Sung Kim
- Department of Nuclear Medicine, National Cancer Center, Goyang, South Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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15
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Yoshino K, Manaka D, Kudo R, Kanai S, Mitsuoka E, Kanto S, Hamasu S, Konishi S, Nishitai R. Metastatic colorectal cancer responsive to regorafenib for 2 years: a case report. J Med Case Rep 2017; 11:227. [PMID: 28818109 PMCID: PMC5561601 DOI: 10.1186/s13256-017-1366-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regorafenib is an oral multikinase inhibitor that has been demonstrated as clinically effective in patients with metastatic colorectal cancer in phase III studies. Although disease control was achieved in 40% of the pretreated patients with metastatic colorectal cancer in the pivotal studies, radiological response has rarely been reported. Severe adverse events associated with regorafenib are known to occur during the first and second courses of treatment. We present a case of a 62-year-old Japanese patient whose metastatic colorectal cancer has been responding to treatment with regorafenib for 2 years. CASE PRESENTATION A 54-year-old Japanese man visited our institute exhibiting general malaise, and he was diagnosed with ascending colon cancer in April 2006. He underwent right hemicolectomy, and the final staging was T3N0M0, stage II. After 19 months, pulmonary metastasis and anastomotic recurrences were detected, and a series of operations were performed to resect both metastatic lesions. After that, liver metastasis, a duodenal metastasis with right renal invasion, right adrenal metastasis, and para-aortic lymph node metastases were observed during follow-up, and chemotherapy and resection were performed. The patient had metastatic para-aortic lymph nodes after the fifth tumor resection and underwent multiple lines of chemotherapy in April 2014. Regorafenib monotherapy was started at 80 mg/day. Then, regorafenib was increased to 120 mg/day in the second cycle. Regorafenib monotherapy led to 60% tumor shrinkage within the initial 2 months, and the tumor further decreased in size over 4 months until it became unrecognizable on imaging studies. The clinical effects of regorafenib monotherapy have shown a partial response according to Response Evaluation Criteria in Solid Tumors criteria. No severe adverse events were observed, except for mild fatigue and hand-foot syndrome. The patient has received 24 courses of regorafenib over 2 years without exhibiting tumor progression. CONCLUSIONS To the best of our knowledge, this is the longest treatment with regorafenib without tumor progression ever reported. A reduced dosage of regorafenib at induction may ameliorate the cutaneous and hepatic toxicity associated with its use.
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Affiliation(s)
- Kenji Yoshino
- Department of Surgery, Kyoto Katsura Hospital, 17, Yamada Hirao-cho, Nishikyo-ku, Kyoto-city, Kyoto, 615-8256, Japan.
| | - Dai Manaka
- Department of Surgery, Kyoto Katsura Hospital, 17, Yamada Hirao-cho, Nishikyo-ku, Kyoto-city, Kyoto, 615-8256, Japan
| | - Ryo Kudo
- Department of Surgery, Kyoto Katsura Hospital, 17, Yamada Hirao-cho, Nishikyo-ku, Kyoto-city, Kyoto, 615-8256, Japan
| | - Shunpei Kanai
- Department of Surgery, Kyoto Katsura Hospital, 17, Yamada Hirao-cho, Nishikyo-ku, Kyoto-city, Kyoto, 615-8256, Japan
| | - Eisei Mitsuoka
- Department of Surgery, Kyoto Katsura Hospital, 17, Yamada Hirao-cho, Nishikyo-ku, Kyoto-city, Kyoto, 615-8256, Japan
| | - Satoshi Kanto
- Department of Surgery, Kyoto Katsura Hospital, 17, Yamada Hirao-cho, Nishikyo-ku, Kyoto-city, Kyoto, 615-8256, Japan
| | - Shinya Hamasu
- Department of Surgery, Kyoto Katsura Hospital, 17, Yamada Hirao-cho, Nishikyo-ku, Kyoto-city, Kyoto, 615-8256, Japan
| | - Sayuri Konishi
- Department of Surgery, Kyoto Katsura Hospital, 17, Yamada Hirao-cho, Nishikyo-ku, Kyoto-city, Kyoto, 615-8256, Japan
| | - Ryuta Nishitai
- Department of Surgery, Kyoto Katsura Hospital, 17, Yamada Hirao-cho, Nishikyo-ku, Kyoto-city, Kyoto, 615-8256, Japan
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Sudulagunta SR, Kumbhat M, Sodalagunta MB, Settikere Nataraju A, Bangalore Raja SK, Thejaswi KC, Deepak R, Mohammed AH, Sunny SP, Visweswar A, Suvarna M, Nanjappa R. Warm Autoimmune Hemolytic Anemia: Clinical Profile and Management. J Hematol 2017; 6:12-20. [PMID: 32300386 PMCID: PMC7155818 DOI: 10.14740/jh303w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2017] [Indexed: 12/20/2022] Open
Abstract
Background Autoimmune hemolytic anemia (AIHA) is a rare autoimmune disease in which autoantibodies target red blood cells leading to marked decrease in their lifespan. The classification of AIHA is based on the immunochemical properties of the RBC autoantibody. Warm antibody AIHA (wAIHA) accounts for 75-80% of all adult AIHA cases. The treatment of wAIHA is mainly corticosteroids. Our retrospective study aimed to study the clinical profile and management of wAIHA. Methods Data of 75 patients admitted with wAIHA or presented to outpatient department (previous medical records) with wAIHA between January 2003 and January 2016 were analyzed. Results In our study, females constituted 12 and 26 patients of primary and secondary wAIHA, while males constituted 17 and 20 patients of primary and secondary wAIHA, respectively. Mean hemoglobin level at AIHA onset was found to be 7.1 ± 1.7 g/dL in primary wAIHA group and 6.3 ± 1.2 g/dL in secondary wAIHA group, which is statistically significant. Splenectomy was used as mode of treatment in one (3.4%) patient of primary wAIHA group and 15 (32.60%) patients of secondary wAIHA group, which is statistically significant. Mean age of wAIHA onset was 69.7 ± 21.5 years in wAIHA group secondary to lymphoma and 54.3 ± 25.7 years in other wAIHA group, which is statistically significant. Conclusion The most common causes of secondary wAIHA are B-cell lymphoma, systemic lupus erythematosus, rheumatoid arthritis, chronic lymphocytic leukemia (CLL), common variable immune deficiency, renal cell carcinoma and secondary to drug usage (alpha methyldopa and carbamazepine), respectively. Reducing the cumulative dose of corticosteroids with second line treatment whenever possible and therefore reducing the risk of sepsis, specifically in older patients with comorbidities will reduce morbidity and mortality.
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Affiliation(s)
| | - Monica Kumbhat
- Department of Pathology, Sri Ramachandra Medical College, Chennai, India
| | | | | | | | | | - Raj Deepak
- Department of General Medicine, Dr.B.R.Ambedkar Medical College, Bangalore, India
| | | | - Sony P Sunny
- Department of General Medicine, Dr.B.R.Ambedkar Medical College, Bangalore, India
| | - Amulya Visweswar
- Department of General Medicine, Dr.B.R.Ambedkar Medical College, Bangalore, India
| | - Mikita Suvarna
- Department of General Medicine, Dr.B.R.Ambedkar Medical College, Bangalore, India
| | - Rashmi Nanjappa
- Department of General Medicine, Dr.B.R.Ambedkar Medical College, Bangalore, India
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Gibelin C, Avrillon V, De La Fouchardiere A, Mc Leer-Florin A, Lantuejoul S, Fayette J. Clinical relevance of ROS1 rearrangements detection in advanced squamous cell carcinomas. Lung Cancer 2016; 102:42-43. [PMID: 27987587 DOI: 10.1016/j.lungcan.2016.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/12/2016] [Accepted: 10/16/2016] [Indexed: 10/20/2022]
Abstract
Non-small cell lung cancers (NSCLCs) have molecular characterization and most druggable genetic and molecular abnormalities, such as EGFR, ERBB2 and BRAF mutations, and ALK and ROS1 rearrangements, have been observed in a subset of adenocarcinomas or large cell carcinomas [1]. Even if these abnormalities are seldom detected in squamous cell carcinomas (SQCC), some rare cases of SQCC have been reported to harbor EGFR, ROS1 or ALK genetic alterations with in some cases a response to targeted therapies [2,3]. Here, we describe a patient with a SQCC harboring ROS1 rearrangement and a response to the target therapy, crizotinib.
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Affiliation(s)
| | - Virginie Avrillon
- Clinical Oncology, Cancer Center « Centre Léon Bérard » Lyon, University of Lyon, France
| | | | - Anne Mc Leer-Florin
- Molecular Genetics Platform, Department of Pathology, CHU Grenoble, University of Grenoble Alpes, Institute A. Bonniot INSERM U 823 La Tronche, France
| | - Sylvie Lantuejoul
- Department of Biopathology, Cancer center « Centre Léon Bérard » Lyon, University of Lyon, France,; University of Grenoble Alpes, Institute A. Bonniot INSERM U 823 La Tronche, France
| | - Jérôme Fayette
- Clinical Oncology, Cancer Center « Centre Léon Bérard » Lyon, University of Lyon, France
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18
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Carter CA, Oronsky B, Caroen S, Scicinski J, Degesys A, Cabrales P, Reid TR, Brzezniak C. Partial Response in an RRx-001-Primed Patient with Refractory Small-Cell Lung Cancer after a Third Introduction of Platinum Doublets. Case Rep Oncol 2016; 9:285-9. [PMID: 27403127 PMCID: PMC4924447 DOI: 10.1159/000446209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Small-cell lung cancer (SCLC), initially exquisitely sensitive to first-line cisplatin/etoposide, invariably relapses and acquires a multidrug chemoresistant phenotype that generally renders retreatment with first-line therapy both futile and counterproductive. This report presents the case of a 77-year-old Caucasian male with extensive-stage refractory SCLC who was restarted on platinum doublets as part of a clinical trial called TRIPLE THREAT (NCT02489903) involving pretreatment with the epi-immunotherapeutic agent RRx-001, and who achieved a partial response after only 4 cycles. The patient had received a platinum drug twice before, in 2009 for a diagnosis of non-small-cell lung cancer (squamous cell carcinoma) and in 2015 for SCLC, suggesting that RRx-001 pretreatment may sensitize or resensitize refractory SCLC patients to first-line chemotherapy.
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Affiliation(s)
| | | | | | | | | | - Pedro Cabrales
- Department of Bioengineering, University of California, La Jolla, Calif., USA
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Zoulim F, Białkowska-Warzecha J, Diculescu MM, Goldis AE, Heyne R, Mach T, Marcellin P, Petersen J, Simon K, Bendahmane S, Klauck I, Wasiak W, Janssen HL. Entecavir plus tenofovir combination therapy for chronic hepatitis B in patients with previous nucleos(t)ide treatment failure. Hepatol Int 2016; 10:779-88. [PMID: 27206517 DOI: 10.1007/s12072-016-9737-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/24/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS In patients with chronic hepatitis B (CHB) who have failed on other nucleos(t)ide analogs (NUCs), the combination of entecavir (ETV) plus tenofovir disoproxil fumarate (TDF), two potent agents with non-overlapping resistance profiles, may provide a single rescue regimen. METHODS In this single-arm, open-label study, 92 CHB patients with a primary non-response, partial response, or virologic breakthrough on their current NUC were switched to ETV (1 mg) plus TDF (300 mg) and treated for 96 weeks. RESULTS At baseline, 62 % of patients were HBeAg(+) and mean HBV DNA was 4.4 log10IU/mL. Patients had received ≥1 line of prior NUC therapy, with the latest regimen consisting of monotherapy with ETV (53 %), lamivudine (LVD 22 %), TDF (12 %), adefovir (ADV 4 %), or telbivudine (2 %), or combinations of these agents (7 %); 58 % had evidence of single- or multidrug resistance mutations (LVD 52 %, ETV 26 %; ADV 7 %). Response rates for HBV DNA <50 IU/mL were 76 % (70/92) at week 48 (primary endpoint), and 85 % (78/92) at week 96, including 80 % (16/20) in prior LVD failures, 100 % (4/4) in ADV failures, 82 % (9/11) in TDF failures, and 88 % (42/48) in ETV failures. No treatment-emergent resistance to ETV or ADV was observed. ETV/TDF was well tolerated, with no significant renal or additive toxicities observed. CONCLUSIONS In NUC-experienced patients who have failed prior NUC therapy, ETV/TDF was well tolerated and effective, achieving virologic suppression through 96 weeks in the majority (85 %), irrespective of prior NUC exposure, without occurrence of treatment-emergent resistance to either agent.
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Carter CA, Oronsky BT, Caroen SZ, Scicinski JJ, Cabrales P, Reid T, Degesys A, Jenkins J, Brzezniak C. Partial Response to Platinum Doublets in Refractory EGFR-Positive Non-Small Cell Lung Cancer Patients after RRx-001: Evidence of Episensitization. Case Rep Oncol 2016; 9:62-7. [PMID: 26933421 PMCID: PMC4772628 DOI: 10.1159/000443725] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
RRx-001, an experimental systemically non-toxic epi-immunotherapeutic agent, which potentiates the resensitization of resistant cancer cells to formerly effective therapies, is under active investigation in several clinical trials that are based on sequential or concomitant rechallenge to resistant first- or second-line regimens. One of these trials is designated TRIPLE THREAT (NCT02489903), because it explores the conditioning or priming effect of RRx-001 on three tumor types – non-small cell lung cancer (NSCLC), small cell lung cancer and high-grade neuroendocrine tumors – prior to re-administration of platinum doublets. In follow-up to a recent case study, which describes early monotherapeutic benefit with RRx-001 in a refractory EGFR-mutated NSCLC tumor, we present subsequent evidence of a radiological partial response to reintroduced platinum doublets after RRx-001. For the 50% of patients with EGFR-mutated NSCLC who progress on EGFR-tyrosine kinase inhibitors (without evidence of a T790M mutations) as well as platinum doublets and pemetrexed/taxane, no other clinically established treatment options exist. A retrial of these therapies in EGFR-positive NSCLC patients via priming with epigenetic agents such as RRx-001 constitutes a strategy to ‘episensitize’ tumors (i.e. reverse resistance by epigenetic means) and to extend overall survival.
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Affiliation(s)
- Corey A Carter
- Walter Reed National Military Medical Center, Bethesda, Md., USA
| | | | | | | | - Pedro Cabrales
- Department of Bioengineering, University of California, La Jolla, Calif., USA
| | - Tony Reid
- Moores Cancer Center, University of California and San Diego, La Jolla, Calif., USA
| | - Aiste Degesys
- Walter Reed National Military Medical Center, Bethesda, Md., USA
| | - John Jenkins
- Walter Reed National Military Medical Center, Bethesda, Md., USA
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Sukeepaisarnjaroen W, Pham T, Tanwandee T, Nazareth S, Galhenage S, Mollison L, Totten L, Wigg A, Altus R, Colman A, Morales B, Mason S, Jones T, Leembruggen N, Fragomelli V, Sendall C, Guan R, Sutedja D, Tan SS, Dan YY, Lee YM, Luman W, Teo EK, Than YM, Piratvisuth T, Lim SG. Boceprevir early-access for advanced-fibrosis/cirrhosis in Asia-pacific hepatitis C virus genotype 1 non-responders/relapsers. World J Gastroenterol 2015; 21:8660-8669. [PMID: 26229408 PMCID: PMC4515847 DOI: 10.3748/wjg.v21.i28.8660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To examined the efficacy and safety of treatment with boceprevir, PEGylated-interferon and ribavirin (PR) in hepatitis C virus genotype 1 (HCVGT1) PR treatment-failures in Asia.
METHODS: The Boceprevir Named-Patient Program provided boceprevir to HCVGT1 PR treatment-failures. Participating physicians were invited to contribute data from their patients: baseline characteristics, on-treatment responses, sustained virological response at week 12 (SVR12), and safety were collected and analysed. Multivariate analysis was performed to determine predictors of response.
RESULTS: 150 patients were enrolled from Australia, Malaysia, Singapore and Thailand (Asians = 86, Caucasians = 63). Overall SVR12 was 61% (Asians = 59.3%, Caucasians = 63.5%). SVR12 was higher in relapsers (78%) compared with non-responders (34%). On-treatment responses predicted SVR, with undetectable HCVRNA at week 4, 8 and 12 leading to SVR12s of 100%, 87%, and 82% respectively, and detectable HCVRNA at week 4, 8 and 12, leading to SVR12s of 58%, 22% and 6% respectively. Asian patients were similar to Caucasian patients with regards to on-treatment responses. Patients with cirrhosis (n = 69) also behaved in the same manner with regards to on-treatment responses. Those with the IL28B CC genotype (80%) had higher SVRs than those with the CT/TT (56%) genotype (P = 0.010). Multivariate analysis showed that TW8 and TW12 responses were independent predictors of SVR. Serious adverse events occurred in 18.6%: sepsis (2%), decompensation (2.7%) and blood transfusion (14%). Discontinuations occurred in 30.7%, with 18.6% fulfilling stopping rules.
CONCLUSION: Boceprevir can be used successfully in PR treatment failures with a SVR12 > 80% if they have good on-treatment responses; however, discontinuations occurred in 30% because of virological failure or adverse events.
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22
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Álvarez E, Olivares JM, Carrasco JL, López-Gómez V, Rejas J. Clinical and economic outcomes of adjunctive therapy with pregabalin or usual care in generalized anxiety disorder patients with partial response to selective serotonin reuptake inhibitors. Ann Gen Psychiatry 2015; 14:2. [PMID: 25632294 PMCID: PMC4308936 DOI: 10.1186/s12991-014-0040-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 12/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study is done to compare the effect of adjunctive therapy with pregabalin versus usual care (UC) on health-care costs and clinical and patients consequences in generalized anxiety disorder (GAD) subjects with partial response (PR) to a previous selective serotonin reuptake inhibitor (SSRI) course in medical practice in Spain. METHODS Post hoc analysis of patients with PR to SSRI monotherapy enrolled in a prospective 6-month naturalistic study was done. PR was defined as a Clinical Global Impression (CGI) scale score ≥3 and insufficient response with persistence of anxiety symptoms ≥16 in the Hamilton Anxiety Rating Scale (HAM-A). Two groups were analyzed: 1) adjunctive therapy (AT) with pregabalin (150-600 mg/day) to existing therapy and 2) UC (switching to a different SSRI or adding another anxiolytic different than pregabalin). Costs included GAD-related health-care resources utilization. Consequences were a combination of psychiatrist-based measurements [HAM-A, CGI, and Montgomery-Asberg Depression Rating Scale (MADRS)] and patient-reported outcomes [Medical Outcomes Study Sleep (MOS-sleep) scale, disability (World Health Organization Disability Assessment Schedule II (WHO-DAS II) and quality-of-life (Euro Qol-5D (EQ-5D)]. Changes in both health-care costs and scale scores were compared separately at end-of-trial visit by a general linear model with covariates. RESULTS Four hundred eighty-six newly prescribed pregabalin and 239 UC GAD patients [mean (SD) HAM-A 26.7 (6.9) and CGI 4.1 (0.5)] were analyzed. Adding pregabalin was associated with significantly higher mean (95% CI) score reductions vs. UC in HAM-A [-14.9 (-15.6; -14.2) vs. -11.2 (-12.2; -10.2), p < 0.001] and MADRS [-11.6 (-12.2; -10.9) vs. -7.8 (-8.7; -6.8), p < 0.001]. Changes in all patient-reported outcomes favored significantly patients receiving pregabalin, including quality-of-life gain; 26.4 (24.7; 28.1) vs. 19.4 (17.1; 21.6) in the EQ-VAS, p < 0.001. Health-care costs were significantly reduced in both cohorts yielding similar 6-month costs; €1,565 (1,426; 1,703) pregabalin and €1,406 (1,200; 1,611) UC, p = 0.777. The effect of sex on costs and consequences were negligible. CONCLUSION In medical practice, GAD patients with PR to SSRI experienced greater consequence improvements with adjunctive therapy with pregabalin versus UC, without increasing health-care cost. The effect of pregabalin was independent of patient gender.
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Affiliation(s)
- Enrique Álvarez
- Department of Psychiatry, Hospital de la Santa Creu i San Pau, Universitat Autónoma de Barcelona, CiberSam, Carrer Sant Quintí, 89, 08026 Barcelona, Spain
| | - José M Olivares
- Department of Psychiatry, Hospital Meixoeiro, Complejo Hospitalario Universitario, Vigo, Spain
| | - José L Carrasco
- Department of Psychiatry, Hospital Clínico San Carlos, Universidad Complutense de Madrid, CiberSam, Madrid, Spain
| | | | - Javier Rejas
- Health Economics and Outcomes Research Department, Pfizer, S.L.U., Alcobendas, MD Spain
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23
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Lenox-Smith A, Martinez JM, Perahia D, Dowsett SA, Dennehy EB, Lopez-Romero P, Demyttenaere K. Treatment and outcomes for patients with depression who are partial responders to SSRI treatment: post-hoc analysis findings from the FINDER European observational study. J Affect Disord 2014; 169:149-56. [PMID: 25194783 DOI: 10.1016/j.jad.2014.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/22/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Remission is the goal in depression, but in practice many patients only experience a partial response to treatment. We sought to determine the prevalence, management and subsequent outcomes of partial responder patients. METHODS Patients enrolled in the naturalistic Factors Influencing Depression Endpoints Research (FINDER) study with the Hospital Anxiety and Depression Scale depression subscale (HADS-D) score >10 at baseline who received only SSRI(s) between 0 and 3 months comprised the study cohort (n=1147). Patients were categorized as remitters, partial responders or non-responders at 3 months and then followed up at 6 months. RESULTS At 3 months, 29.4% of the study population were considered non-responders, 27.6% were partial responders, and 39.3% were remitters. Most partial responders at 3 months remained on the same SSRI for the next 3 months. Of the 247 partial responders at 3 months and remained on the same SSRI(s) between 3 and 6 months, 10.9% met criteria for non-response at 6 months, 32.4% remained partial responders, and 56.3% achieved remission. Quality of life outcomes for the partial responders were significantly worse than those in remission (p<0.05). LIMITATIONS FINDER was an observational study; the current analysis was conducted post-hoc. Multivariable methods were not applied and findings are primarily descriptive and exploratory. CONCLUSIONS Partial response is common and patients in partial response have a poorer quality of life than those achieving remission. Despite this, the majority of partial responders continue to take the same SSRI. Our findings underscore the importance of continuing to strive for remission.
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Affiliation(s)
| | | | | | | | - E B Dennehy
- Eli Lilly & Company, Indianapolis, IN, USA; Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | | | - K Demyttenaere
- Section of Psychiatry, University Psychiatric Center KuLeuven-Campus Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
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24
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Vierling JM, Davis M, Flamm S, Gordon SC, Lawitz E, Yoshida EM, Galati J, Luketic V, McCone J, Jacobson I, Marcellin P, Muir AJ, Poordad F, Pedicone LD, Albrecht J, Brass C, Howe AYM, Colvard LY, Helmond FA, Deng W, Treitel M, Wahl J, Bronowicki JP. Boceprevir for chronic HCV genotype 1 infection in patients with prior treatment failure to peginterferon/ribavirin, including prior null response. J Hepatol 2014; 60:748-56. [PMID: 24362076 DOI: 10.1016/j.jhep.2013.12.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/19/2013] [Accepted: 12/08/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Boceprevir with peginterferon/ribavirin (BOC/PR) leads to significantly higher sustained virological response (SVR) rates in patients with chronic hepatitis C and partial response or relapse after prior treatment with peginterferon/ribavirin. We studied the efficacy of BOC/PR in patients with prior treatment failure, including those with a null response (<2-log10 decline in HCV RNA), to peginterferon/ribavirin. METHODS Patients in the control arms of boceprevir Phase 2/3 studies who did not achieve SVR were re-treated with BOC/PR for up to 44 weeks. Patients enrolling >2 weeks after end-of-treatment in the prior study received PR for 4 weeks before adding boceprevir. RESULTS Of 168 patients enrolled, four discontinued from the PR lead-in and 164 received BOC/PR. Baseline viral load was >800,000 IU/ml in 77% of patients; 62% had HCV genotype 1a, and 10% were cirrhotic. In the ITT analysis (all 168 patients), SVR was achieved in 20 (38%) of 52 patients with prior null response, 57 (67%) of 85 with prior partial response, and 27 (93%) of 29 with prior relapse. In the mITT analysis (164 BOC/PR-treated patients), SVR rates were 41% (20/49), 67% (57/85), and 96% (27/28), respectively. SVR was achieved by 48% of patients with <1-log10 decline in HCV-RNA after lead-in and 76% of those with ⩾ 1-log10 decline or undetectable HCV-RNA after lead-in. The most common adverse events were anemia (49%), fatigue (48%), and dysgeusia (35%); 8% of patients discontinued due to adverse events. CONCLUSIONS Re-treatment with BOC/PR improved SVR rates in all patient subgroups, including those with prior null response.
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Affiliation(s)
| | - Mitchell Davis
- South Florida Center of Gastroenterology, Wellington, FL, United States
| | - Steven Flamm
- Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | | | - Eric Lawitz
- The Texas Liver Institute, University of Texas Health Science Center, San Antonio, TX, United States
| | - Eric M Yoshida
- University of British Columbia and Vancouver General Hospital, Vancouver, Canada
| | - Joseph Galati
- Liver Specialists of Texas, Houston, TX, United States
| | - Velimir Luketic
- Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | | | - Ira Jacobson
- Weill Cornell Medical College, New York, NY, United States
| | | | - Andrew J Muir
- Duke University School of Medicine, Durham, NC, United States
| | - Fred Poordad
- The Texas Liver Institute, University of Texas Health Science Center, San Antonio, TX, United States
| | - Lisa D Pedicone
- Merck Sharp & Dohme Corp, Whitehouse Station, NJ, United States
| | - Janice Albrecht
- Merck Sharp & Dohme Corp, Whitehouse Station, NJ, United States
| | - Clifford Brass
- Merck Sharp & Dohme Corp, Whitehouse Station, NJ, United States
| | - Anita Y M Howe
- Merck Sharp & Dohme Corp, Whitehouse Station, NJ, United States
| | - Lynn Y Colvard
- Merck Sharp & Dohme Corp, Whitehouse Station, NJ, United States
| | - Frans A Helmond
- Merck Sharp & Dohme Corp, Whitehouse Station, NJ, United States
| | - Weiping Deng
- Merck Sharp & Dohme Corp, Whitehouse Station, NJ, United States
| | | | - Janice Wahl
- Merck Sharp & Dohme Corp, Whitehouse Station, NJ, United States
| | - Jean-Pierre Bronowicki
- INSERM U954, Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Vandoeuvre-lès-Nancy, France
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25
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Fouquet G, Hebraud B, Garciaz S, Stoppa AM, Roussel M, Caillot D, Chrétien ML, Arnulf B, Szalat R, Garderet L, Benajiba L, Pegourie B, Regny C, Royer B, Caulier A, Touzeau C, Tessoulin B, Fermand JP, Facon T, Attal M, Loiseau HA, Moreau P, Leleu X. Partial Response at Completion of Bortezomib-Thalidomide-Dexamethasone (VTd) Induction Regimen Upfront in Multiple Myeloma Does Not Preclude Response to VTd in Consolidation. J Cancer 2014; 5:248-52. [PMID: 24665349 PMCID: PMC3963082 DOI: 10.7150/jca.8541] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/18/2014] [Indexed: 12/22/2022] Open
Abstract
The impact of consolidation on response rates and PFS has recently been demonstrated after induction and autotransplantation upfront in Multiple Myeloma (MM). We further showed that patients in ≥VGPR following the intensification procedure benefited most from consolidation. Question remains as to the benefit of consolidation for patients in PR at completion of induction - feature of partial resistance to the induction regimen. We collected data from 54 newly diagnosed MM treated with VTd-auto-VTd regimen that reached only PR at completion of the induction procedure. Overall, 37 patients (68%) improved depth of response (≥VGPR) at completion of consolidation, including 35% that reached CR and 38% solely related to consolidation. Of patients that remained on PR or improved depth of response after ASCT, 26% and 38% further responded to consolidation, respectively. With a median follow-up of 36 months, improved depth of response translated into lower relapse rate compared with patients remaining in PR, 19% vs. 36%. This difference was more striking in patients that reached CR vs. others, 8% and 38%, respectively (p=0.039). The median TTP was prolonged in patients that improved depth of response after consolidation (p=0.012), with a 3-year TTP of 87% vs. 18% otherwise. In multivariate analysis, lack of improved depth of response to consolidation independently predicted shorten median TTP [OR=4.4, 95%CI=1-21; p=0.039], with elevated LDH and beta2m, and adverse FISH. This study shows that VTd consolidation should be recommended to patients solely on PR at completion of induction with VTd, feature of lower sensitivity to VTd.
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26
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Go SI, Keam B, Kim TM, Lee SH, Kim DW, Kim HJ, Wu HG, Chung DH, Heo DS. Clinical significance of downstaging in patients with limited-disease small-cell lung cancer. Clin Lung Cancer 2013; 15:e1-6. [PMID: 24356090 DOI: 10.1016/j.cllc.2013.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 08/28/2013] [Accepted: 09/03/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND We investigated the effect of downstaging on OS in LD-SCLC patients treated with first-line treatment. PATIENTS AND METHODS We retrospectively reviewed 210 LD-SCLC patients who were treated with first-line treatment at Seoul National University Hospital between April 1999 and November 2012. Compared with initial tumor, node, metastases (TNM) stage, cases that showed a lower TNM stage after treatment were defined as 'downstaging.' The relationship between downstaging and OS was analyzed, and a subgroup analysis on the responders was performed. RESULTS After first-line treatment, 78 (37.1%) patients achieved complete response, 97 (46.2%) achieved PR, and 35 (16.7%) experienced stable disease or progressive disease. A hundred and fifty one patients (71.9%) showed downstaging of their diseases, and the remaining 59 patients (28.1%) showed no change or upstaging. The median OS for patients achieving downstaging and no change/upstaging were 32.8 months and 13.1 months, respectively (P < .001). Of the 97 patients who achieved PR, the OS was significantly longer in patients who showed downstaging than those who did not (25.8 months vs. 13.8 months, respectively; P = .004). In multivariate analyses, female sex, downstaging, lower initial TNM stage, and prophylactic cranial irradiation were independent good prognostic factors for OS. CONCLUSION Downstaging might be an independent good prognostic factor in LD-SCLC. Specifically, downstaging is expected to be useful for stratification of patients achieving PR. Further prospective studies are warranted to verify whether patients who achieved PR without downstaging can be candidates for consolidation treatments after first-line treatment.
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Affiliation(s)
- Se-Il Go
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Se-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Doo Hyun Chung
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Tang YF, Zhang YB, Luo B, Wang XF, Lin L, Jiang XF, Liang J. Partial response of hepatocellular carcinoma to percutaneous microwave ablation: risk factors and preventive measures. Shijie Huaren Xiaohua Zazhi 2011; 19:1075-1080. [DOI: 10.11569/wcjd.v19.i10.1075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the risk factors and preventive measures for partial response of hepatocellular carcinoma to percutaneous microwave ablation.
METHODS: The clinical data for 465 patients with hepatocellular carcinoma (796 tumor nodules) who underwent percutaneous microwave ablation from October 2004 to June 2010 were retrospectively analyzed. The risk factors and preventive measures for partial response to percutaneous microwave ablation were summarized.
RESULTS: Partial response occurred in 48 patients (69 tumor nodules), and the overall partial response rate was 9.15% (69/754). Of these 48 patients, 45 (64 tumor nodules) underwent percutaneous microwave ablation again and achieved complete ablation in 93.94% (62/64) of tumor nodules; 1 (2 tumor nodules) received percutaneous ethanol injection and achieved successful ablation; and 2 received palliative surgery. The incidence of partial response was positively correlated with large tumor diameter, tumor location (at the hepatic hilum or near the diaphragm or hepatic capsule), multiple tumors, and ill-defined margins on ultrasound(all P < 0.01), and complete ablation was negatively correlated with previous treatment by TACE (3.60% vs 12.39%, P < 0.01). Multivariate analysis showed that tumor size, number of nodules, tumor location, and previous treatment by TACE were independent risk factors for partial response of hepatocellular carcinoma to percutaneous microwave ablation.
CONCLUSION: Large tumor size, multiple tumors, subcapsular lesion, and previous treatment by TACE are often associated with partial response of hepatocellular carcinoma to percutaneous microwave ablation. Percutaneous microwave ablation is an effective and safe method for treatment of partial response of hepatocellular carcinoma.
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