1
|
Arshad S, Fang X, Ahn KW, Kaur M, Scordo M, Sauter CS, Furqan F, Awan FT, Hamadani M. Impact of thiotepa dose-intensity in primary diffuse large B-cell lymphoma of the central nervous system undergoing autologous hematopoietic cell transplant with thiotepa/carmustine conditioning. Bone Marrow Transplant 2023; 58:1203-1208. [PMID: 37563283 PMCID: PMC11078515 DOI: 10.1038/s41409-023-02071-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/29/2023] [Accepted: 07/17/2023] [Indexed: 08/12/2023]
Abstract
Thiotepa/carmustine (TT-BCNU) is a commonly used autologous transplant (ASCT) conditioning regimen for primary DLBCL of the CNS (PCNSL). The total thiotepa dose varies among TT-BCNU recipients, with some centers administering a total dose of 20 mg/kg, while others using 10 mg/kg. We retrospectively assessed the impact of thiotepa dose intensity on ASCT outcomes in 218 adult PCNSL patients who underwent a first ASCT with TT-BCNU conditioning and received either a total thiotepa dose of 10 mg/kg (TT-10 group; N = 90), or 20 mg/kg (TT-20 group; N = 128). The median follow-up of survivors was 22 months. The cumulative incidence of 1-year non-relapse mortality (NRM) for TT-10 and TT-20 cohorts were 6% (95%CI = 2-12%) vs. 4% (95%CI = 1-8%), respectively (p = 0.66). The 3-year cumulative incidence of relapse (15% vs. 13%; p = 0.67), progression-free survival (PFS) (71% vs. 80%; p = 0.25) and overall survival (OS) (79% vs. 83%; p = 0.56) were similar in the TT-10 and TT-20 groups, respectively. On multivariate analysis compared to TT-10, the TT-20 cohort was not associated with significantly different risk of NRM (Hazard ration [HR] = 0.77; p = 0.64), relapse/progression (HR = 0.87; p = 0.74), PFS (HR = 0.80; p = 0.48) or OS (HR = 1.10; p = 0.80). In conclusion thiotepa dose-intensity in TT-BCNU conditioning does not impact ASCT outcomes of PCNSL patients.
Collapse
Affiliation(s)
- Shanze Arshad
- School of Medicine, University of Kentucky, Lexington, KY, USA
| | - Xi Fang
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kwang W Ahn
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Manmeet Kaur
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael Scordo
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Fateeha Furqan
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Farrukh T Awan
- Division of Hematology and Oncology, UT Southwestern, Dallas, TX, USA
| | - Mehdi Hamadani
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
2
|
Canton C, Boussari O, Boulin M, Le Malicot K, Taieb J, Dahan L, Lopez A, Lepage C, Bachet JB. Impact of G-CSF Prophylaxis on Chemotherapy Dose-Intensity, Link Between Dose-Intensity and Survival in Patients with Metastatic Pancreatic Adenocarcinoma. Oncologist 2022; 27:e571-e579. [PMID: 35289915 PMCID: PMC9255980 DOI: 10.1093/oncolo/oyac055] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In metastatic pancreatic adenocarcinoma, few data are available on the use of granulocyte-colony stimulating factor (G-CSF) prophylaxis and its impact on dose-intensity (DI), or the link between DI and progression-free survival (PFS). This study assessed the impact of G-CSF prophylaxis on the DI received by patients and the relationship between full DI and PFS according to chemotherapy regimens. PATIENTS AND METHODS Patients from three first-line randomized phase II clinical trials were included in this retrospective cohort. G-CSF prophylaxis groups were identified and balanced according to baseline characteristics using a propensity score. Patients were classified into 2 treatment groups (FOLFIRINOX vs FOLFIRI/nab-paclitaxel (NAB)). DI was a binary variable (full/reduced). Adverse events were defined using NCI-CTCAE v4.0. RESULTS Of the 498 patients, 154 (31%) were in "prophylaxis" group; 179 (36%) were treated by FOLFIRINOX and 319 (64%) by FOLFIRI/NAB. In FOLFIRINOX group, G-CSF prophylaxis was significantly associated with a higher rate of full DI (OR, 5.07; 95% CI, 1.52-16.90; P < .01) while in FOLFIRI/NAB group, it was significantly associated with a lower rate of full DI (OR, 0.23; 95% CI, 0.06-0.83; P = .03). Full DI was associated with a non-significant increase in PFS (FOLFIRINOX group: HR 0.83; 95% CI, 0.59-1.16; P = .27; FOLFIRI/NAB group: HR 0.84; 95% CI, 0.63-1.11; P = .22). CONCLUSION Granulocyte-colony stimulating factor prophylaxis was associated with a higher rate of full DI with FOLFIRINOX. Full DI was associated with a non-significant increase in PFS. These results need to be confirmed prospectively.
Collapse
Affiliation(s)
- Clémence Canton
- Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Dijon, Dijon, France
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
| | - Olayidé Boussari
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
- Fédération Francophone de Cancérologie Digestive, Dijon, France
| | - Mathieu Boulin
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
- Department of Pharmacy, University Hospital of Dijon, Dijon, France
| | - Karine Le Malicot
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
- Fédération Francophone de Cancérologie Digestive, Dijon, France
| | - Julien Taieb
- Department of Hepato-Gastroenterology, Georges Pompidou European Hospital, Carpem, Sorbonne Paris City, Paris Descartes University, Paris, France
| | - Laetitia Dahan
- Department of Hepato-Gastroenterology and Digestive Oncology, La Timone, AMU, Marseille, France
| | - Anthony Lopez
- Department of Hepato-Gastroenterology, University Hospital Nancy-Brabois, Nancy, France
| | - Come Lepage
- Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Dijon, Dijon, France
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
| | - Jean-Baptiste Bachet
- Department of Hepato-Gastroenterology, Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
3
|
Nitipir C, Vrabie R, Parosanu AI, Tulin R, Cretu B, Cursaru A, Slavu I, Miron A, Calu V, Orlov Slavu MC. Clinical Impact of the Administration of FOLFIRINOX Beyond Six Months in Advanced Pancreatic Adenocarcinoma: A Cohort Study. Cureus 2021; 13:e19361. [PMID: 34925974 PMCID: PMC8654089 DOI: 10.7759/cureus.19361] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/14/2022] Open
Abstract
Background Although a toxic regimen, FOLFIRINOX is one of the most efficient chemotherapy regimens in advanced pancreatic adenocarcinoma. There is no standard number of cycles in locally advanced or metastatic stages. Materials and method The present retrospective study reports the experience of a single center with this regimen administered until disease progression or unacceptable toxicity. The authors of this retrospective study analyzed the data on patients with this diagnosis treated in our clinic during 2017-2021. Forty-two patients were included in the study, 21 who received six courses or less and 21 who received more than six courses. Progression-free survival (PFS) and overall survival (OS) were analyzed according to this stratification. The oncological response was also reported according to dose reduction and treatment delay, irrespective of the number of courses administered. Results Median PFS was 7.5 months, and median OS was 13.6 months in the entire studied population. When patients were compared according to the number of courses received (under six vs. over six), there were obvious differences (PFS: 5.17 months vs. 11.2, p = 0.8, OS: 8 months vs. 17.3 months, p = 0.6). However, when stratifying survival by treatment delay and the presence or absence of dose reduction, better results were seen with lower doses (p<0.001) and treatment temporization (p=0.03). The general incidence of hematologic and neurologic toxicity was higher than the ones reported in the literature. Conclusion The study revealed that patients benefit from the administration of FOLFIRINOX for more than six months, but that the administration of full dose and the maintaining dose intensity does not necessarily favor the patient.
Collapse
Affiliation(s)
- Cornelia Nitipir
- Oncology, Elias Emergency University Hospital, Bucharest, ROU.,Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Radu Vrabie
- Oncology, Elias Emergency University Hospital, Bucharest, ROU.,Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Andreea Ioana Parosanu
- Oncology, Elias Emergency University Hospital, Bucharest, ROU.,Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Raluca Tulin
- Endocrinology, Emergency Hospital Prof. Dr. Agrippa Ionescu, Bucharest, ROU
| | - Bogdan Cretu
- Orthopedics and Traumatology, University Emergency Hospital Bucharest, Bucharest, ROU.,Orthopedics, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Adrian Cursaru
- Orthopedics and Traumatology, University Emergency Hospital Bucharest, Bucharest, ROU.,Orthopedics, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Iulian Slavu
- Surgery, Emergency Hospital Prof. Dr. Agrippa Ionescu, Bucharest, ROU
| | - Adrian Miron
- Surgery, Elias Emergency University Hospital, Bucharest, ROU
| | - Valentin Calu
- Surgery, Elias Emergency University Hospital, Bucharest, ROU
| | - Maria Cristina Orlov Slavu
- Oncology, Elias Emergency University Hospital, Bucharest, ROU.,Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| |
Collapse
|
4
|
Kiriukova M, de la Iglesia Garcia D, Panic N, Bozhychko M, Avci B, Maisonneuve P, de-Madaria E, Capurso G, Sandru V. Pancreatic Cancer Malnutrition and Pancreatic Exocrine Insufficiency in the Course of Chemotherapy in Unresectable Pancreatic Cancer. Front Med (Lausanne) 2020; 7:495. [PMID: 33015088 PMCID: PMC7509408 DOI: 10.3389/fmed.2020.00495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 07/20/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Malnutrition and cachexia are common in patients with advanced pancreatic ductal adenocarcinoma (PDAC) and have a significant influence on the tolerance and response to treatments. If timely identified, malnourished PDAC patients could be treated to increase their capacity to complete the planned treatments and, therefore, possibly, improve their efficacy. Aims: The aim of this study is to assess the impact of nutritional status, pancreatic exocrine insufficiency (PEI), and other clinical factors on patient outcomes in patients with advanced PDAC. Methods: PAncreatic Cancer MAlnutrition and Pancreatic Exocrine INsufficiency in the Course of Chemotherapy in Unresectable Pancreatic Cancer (PAC-MAIN) is an international multicenter prospective observational cohort study. The nutritional status will be determined by means of Mini-Nutritional Assessment score and laboratory blood tests. PEI will be defined by reduced fecal elastase levels. Main outcome: adherence to planned chemotherapy in the first 12 weeks following the diagnosis, according to patients' baseline nutritional status and quantified and reported as “percent of standard chemotherapy dose delivered.” Secondary outcomes: rate of chemotherapy-related toxicity, progression-free survival, survival at 6 months, overall survival, quality of life, and the number of hospitalizations. Analysis: chemotherapy dosing over the first 12 weeks of therapy (i.e., percent of chemotherapy received in the first 12 weeks, as defined above) will be compared between well-nourished and malnourished patients. Sample size: based on an expected percentage of chemotherapy delivered of 70% in well-nourished patients, with a type I error of 0.05 and a type II error of 0.20, a sample size of 93 patients per group will be required in case of a percentage difference of chemotherapy delivered of 20% between well-nourished and malnourished patients, 163 patients per group in case of a difference of 15% between the groups, and 356 patients per group in case of a 10% difference. Centers from Russia, Romania, Turkey, Spain, Serbia, and Italy will participate in the study upon Local Ethics Committee approval. Discussion: PAC-MAIN will provide insights into the role of malnutrition and PEI in the outcomes of PDAC. The study protocol was registered at clinicaltrials.gov as NCT04112836.
Collapse
Affiliation(s)
- Mariia Kiriukova
- Department of Upper Gastrointestinal, Pancreatic, and Biliary Diseases, Moscow Clinical Scientific Center, Moscow, Russia
| | - Daniel de la Iglesia Garcia
- Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Nikola Panic
- Digestive Endoscopy Department, University Clinic "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Maryana Bozhychko
- Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain
| | - Bartu Avci
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Patrick Maisonneuve
- Unit of Clinical Epidemiology, Division of Epidemiology and Biostatistics, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vasile Sandru
- Gastroenterology and Interventional Endoscopy Department, Clinical Emergency Hospital Bucharest, Bucharest, Romania
| |
Collapse
|
5
|
Jung SM, Han S, Kwon HY. Dose-Intensity of Bisphosphonates and the Risk of Osteonecrosis of the Jaw in Osteoporosis Patients. Front Pharmacol 2018; 9:796. [PMID: 30079024 PMCID: PMC6062614 DOI: 10.3389/fphar.2018.00796] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/29/2018] [Indexed: 11/26/2022] Open
Abstract
Objective: To examine the incidence rates and association between dose-intensity, stratified by exposure duration, of bisphosphonates and the risk of osteonecrosis of the jaw among Korean osteoporotic patients older than 50 years. Study Design and Setting: Using the population-based National Health Insurance Claims Data of Korea from January 1, 2006, through December 3, 2012, 13,730 new bisphosphonate users as of 2006 were identified. Truncated age-standardized incidence rate estimation and multivariate logistic regression analyses were conducted. Results: In this retrospective cohort study, increasing age-standardized incidence rates of ONJ attributed to bisphosphonate exposure were observed for individuals with less than 1 year, 1–2 years, over 2 years of defined daily dose (DDD) of bisphosphonate exposure (13.85, 16.19, and 38.20, respectively), using a truncated 2000 United States Standard Population. Also, over 2 years of bisphosphonate DDDs was associated with an increased risk of developing of ONJ with an adjusted odds ratio of 1.51 (95% confidence interval: 1.31–1.75), compared to individuals with less than 1 year of bisphosphonate exposure. Conclusion: Our data provided the evidence to support the association between risk of ONJ and duration of bisphosphonate exposure used in the treatment or prevention of osteoporosis.
Collapse
Affiliation(s)
- Sung-Mok Jung
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sujeong Han
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, South Korea
| |
Collapse
|