Real-world evidence of nivolumab for non-small-cell lung cancer in a developing country

Nivolumab is a human programmed death receptor-1 blocking antibody, used as treatment option in patients with advanced non-small-cell lung cancer (NSCLC). We assessed the nivolumab efficacy in terms of survival and response to treatment as second-line (2L) or third-line (3L) therapy in patients with advanced NSCLC. This is a multicentric observational study. Data of patients with advanced NSCLC who received nivolumab as 2L or 3L treatment were analyzed retrospectively. Information regarding patient demographics and clinical backgrounds, treatment patterns from diagnosis to post-nivolumab treatment, effectiveness, and safety of nivolumab treatment were collected. The outcomes evaluated were overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) to treatment. OS and PFS were estimated with the Kaplan-Meier method and the differences were evaluated through the log-rank test. Data of 178 patients were included. The median follow-up was 26.8 months (interquartile range (IQR): 20.3-40.4). Nivolumab was commonly used as a 2L treatment (77.5%). The outcomes in this setting (2L) were as follows: ORR was 21.0%, and the median PFS and OS were 5.5 months (95% confidence interval (CI): 4.5-6.5) and 12.4 months (95% CI: 10.8-14.0), respectively. In 3L, the ORR with nivolumab was 15.0%, the median PFS and OS were 4.1 months (95% CI: 3.1-5.1) and 10.1 months (95% CI: 9.4-10.6), respectively. Three patients (1.7%) required discontinuation due to toxicity. Nivolumab effectiveness and safety in this scenario was consistent with that reported by previous trials and other real-world data.

Immunotherapy in Hispanic patients with advanced non-small cell lung cancer: A real-world data

e21094

Background: Nivolumab is a human programmed death receptor-1 (PD-1) blocking antibody, used as treatment option in patients with advanced non-small cell lung cancer (NSCLC). We assessed the nivolumab efficacy in terms of survival and response to treatment as second- or third-line therapy in patients with advanced NSCLC. Methods: This is a multicentric observational study. Data of patients with advanced NSCLC who received nivolumab as second (2L) or third-line (3L) treatment were analyzed retrospectively. Information regarding patient demographics and clinical backgrounds, treatment patterns from diagnosis to post-nivolumab treatment, effectiveness, and safety of nivolumab treatment were collected. The outcomes evaluated were overall survival (OS), progression-free survival (PFS), and objective reponse rate to treatment (ORR). OS and PFS were estimated with the Kaplan-Meier method. Statistical analysis was carried out using SPSS version 21.0. Results: Eleven centers distributed across the country (Colombia) participated. Data from 178 patients were included. The median follow-up was 26.8 months (IQR 20.3 - 40.4). Women represented 51.7% of the population, and the median age was 63 years (IQR 56-72 years). Nivolumab was commonly used as a 2L treatment. The ORR with nivolumab as 2L treatment was 21.0%. The median PFS and OS were 5.5 months (95%CI: 4.5 – 6.5) and 12.4 months (95%CI: 10.8 – 14.0), respectively. In 3L the ORR with nivolumab was 15.0%. The overall incidence of adverse events was 1.7%. Conclusions: Nivolumab effectiveness and safety in this scenario was consistent with than reported by previous trials and other real world data.

Emergency Embolization of Pelvic Vessels in Patients With Locally Advanced Cervical Cancer and Massive Vaginal Bleeding: A Case Series in a Latin American Oncological Center

PURPOSE

Locally advanced cervical cancer may present with uncontrollable vaginal bleeding in up to 70% of cases. Pelvic vessel embolization has been used as an urgent maneuver for achieving fast hemostatic control. This report describes outcomes of selective pelvic vessel embolization in patients with severe bleeding due to a locally advanced cervical cancer.

METHODS

In this retrospective study, technical aspects, clinical variables, and bleeding-related morbidity were described. The frequency of recurrent disease and the vital status at 1 year of follow-up were determined. Analysis was performed with statistical software R, version 3.6.2. The setting was Instituto Nacional de Cancerología- Bogotá, Colombia, between January 2009 and July 2017.

RESULTS

A total of 47 patients were included. Median age was 44 years (range, 26-70 years). The pre-embolization median hemoglobin level was 7.9 g/dL (range, 5.0-11.3 g/dL). Blood transfusions were administered to 41 women (87.2%). Bleeding control was achieved in 95.7% of cases in the first 24 hours after the embolization. There were no major complications. In 17 cases (36.2%), minor complications were reported; the most common was pelvic pain. In 17.1% of cases, a second embolization was required. After 12 months of follow-up, 27.7% of patients were alive without disease, 44.7% were alive with disease, and 25.5% of them have died of cervical cancer progression.

CONCLUSION

Selective pelvic vessel embolization is a useful alternative in patients with locally advanced cervical cancer and life-threatening bleeding. Its impact on recurrent disease and death due to oncologic cause is not clear.

Concordance between 21-gene score (Oncotype DX) and clinical-pathologic prognostic models in early-breast cancer in Medellín, Colombia

e12521

Background: The genomic-based 21-gene recurrence-score assay (Oncotype DX, Genomic Health)(ODx) is used to decide on the use of adjuvant chemotherapy (ACT) in luminal-type Early-Breast Cancer (LT-EBC). Patients with low RS can safely avoid ACT. Other predictive models based on standard clinical and histopathological (C&H) variables also have been developed. These include, Magee equations (ME), Predict model (PM), and Tennessee nomogram score (TNS). This study aims to establish the concordance between ODx and ME, PM and TNS models in a set of patients with EBC in Medellín, Colombia. Methods: Patients with unifocal, stage I and IIA, LT-EBC (HR+/Her2-) with results for ODx were included. For inclusion, key standard C&H variables needed to be available as to allow accurate assessment of ME, PM and TNS predictive models. ODx was used as the reference test and the predictive models as index tests. Low-risk (LR) was defined < 18 in all three ME; < 3% in the PM; and a probability calculated for LR > 90% in the TNS. A second analysis was performed in the > 50 years-old cohort (+50C), using standard and a modified criteria. In the last one, intermediate-risk (IR) patients were either excluded or grouped with high-risk scores for analysis. Concordance between the models and the ODx was evaluated using Cohen's kappa index (K). The degree of concordance was classified according to the categories established by Landis and Koch. AUROC (area under receiver operating characteristics) was estimated. Statistical analyses were performed with Stata v16. Results: 122 patients were included. Median age: 58 (IQR 49-66). Main histology was ductal carcinoma (85.2%), and median size was 15 mm (IQR 10-20). LR was adjudicated in 80.3%, 57.4%, 89.3% and 69.7% with ODx, ME, PM and TNS, respectively. Concordance between the ODx and ME and PM in the all patient population was fair, with K of 0.35 (95% CI: 0.18-0.50; p < 0.001), and 0.24 (95% CI: 0, 04 - 0.45; p < 0.001), respectively. Concordance of ODx and TNS was inferior with a K of 0.16 (95% CI: 0.03-0.34, p = 0.04). AUC for ME, PM, and TNS was 0.61 (95% CI: 0.49-0.73), 0.61 (95% CI: 0.52-0.70) and 0.59 (95% CI: 0.48-0.70), respectively. 85 patients were included in the +50C (69.7%). For one analysis, 41 patients with IR with either ME or PM were excluded. Concordance between the ME and the ODx was fair. LR in both ME and ODx was found 41/43 patients (95.5%, 95% CI 87.9-100). As for PM and TNS, the degree of concordance with ODx were low, and non-significant, respectively. Concordance between ODx LR was found in 36/37 patients with LR in all three ME, PM and TNS (97.3%, 95% CI: 90.7-100). Discrimination capacity: 79%. Conclusions: The high cost of ODx can be safely avoided in stage I/IIA luminal-type EBC and > 50 year-old with low-risk scores in all three ME, PM, and TNS.

Epidemiology and genetic diversity of circulating dengue viruses in Medellin, Colombia: a fever surveillance study

Background

Dengue fever is a major public health problem in Colombia. A fever surveillance study was conducted for evaluation of the clinical, epidemiological, and molecular patterns of dengue, prior to Chikungunya and Zika epidemics.

Methods

In November 2011–February 2014, a passive facility-based surveillance was implemented in Santa Cruz Hospital, Medellin, and enrolled eligible febrile patients between 1 and 65 years-of-age. Acute and convalescent blood samples were collected 10–21 days apart and tested for dengue using IgM/IgG ELISA. RNA was extracted for serotyping using RT-PCR on acute samples and genotyping was performed by sequencing.

Results

Among 537 febrile patients enrolled during the study period, 29% (n = 155) were identified to be dengue-positive. Only 7% of dengue cases were hospitalized, but dengue-positive patients were 2.6 times more likely to be hospitalized, compared to non-dengue cases, based on a logistic regression. From those tested with RT-PCR (n = 173), 17 were dengue-confirmed based on PCR and/or virus isolation showing mostly DENV-3 (n = 9) and DENV-4 (n = 7) with 1 DENV-1. Genotyping results showed that: DENV-1 isolate belongs to the genotype V or American/African genotype; DENV-3 isolates belong to genotype III; and DENV-4 isolates belong to the II genotype and specifically to the IIb sub-genotype or linage.

Conclusions

Our surveillance documented considerable dengue burden in Santa Cruz comuna during non-epidemic years, and genetic diversity of circulating DENV isolates, captured prior to Chikungunya epidemic in 2014 and Zika epidemic in 2015. Our study findings underscore the need for continued surveillance and monitoring of dengue and other arboviruses and serve as epidemiological and molecular evidence base for future studies to assess changes in DENV transmission in Medellin, given emerging and re-emerging arboviral diseases in the region.

Abstract P5-22-04: Efficacy of thoracic paravertebral block for reducing acute post-mastectomy pain

Background: Mastectomy is associated with acute and chronic postoperative pain. This study investigated the efficacy of thoracic paravertebral block (TPB) compared to local anesthetic of surgical wound (LASW) in breast cancer patients undergoing mastectomy.

Methods: This phase 3, randomized controlled, single blind, parallel arms and superiority clinical trial aimed to evaluate the efficacy of TPB compared to LASW on acute pain at rest and motion at 24 hours post-mastectomy, measured by a visual analog scale (VAS). The study size of 60 patients is determined to have 90% power to detect a difference of 20% in acute pain in favor of TPB. In TPB group use of ultrasound was mandatory to guide puncture of intervertebral space T3 for infiltrating 0.5% bupivacaine at dose of 1.5 mg/kg. In LASW group was used bupivacaine 0.5% at dose of 1.5mg/kg on subcutaneous tissue of surgical area. VAS was used to measure surgical pain at rest and motion in 2,4,6,12 and 24 hours post-operatives for both groups. Trial Registry: ClinicalTrials.gov; Identifier:NCT02609321.

Findings: From 08-2015 to 09-2016, 60 breast cancer patients were enrolled; 3 dropped off consent. Mean age was 51 year; 78% had stage II and III; and 65% receive neoadjuvant chemotherapy.There were no significant differences in the VAS pain measurement for the groups of BWT compared to LASW in the 24 hour measurement, neither at rest (P=0.6525) nor in movement (P=0.7929). There were no significant differences in both groups for repeated pain measurements (5 measures mean), total dose of opioid administration, time to first dose of opioids or adverse events.

Conclusions: There were not statistical differences for post-mastectomy acute pain in first 24 hours between TPB and LASW patients. According our findings the use of TPB should not routinely recommended for breast cancer patients undergoing mastectomy.

Citation Format: Herazo-Maya F, Egurrola J, Restrepo CE, Torres L, Palacios L, Ossa CA, Borrero M, Angel GA, Marquez JJ, Valencia S, Perez A, Oyola JC, Lobo L, Gomez R, Garcia H. Efficacy of thoracic paravertebral block for reducing acute post-mastectomy pain [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-04.

Dengue virus serological prevalence and seroconversion rates in children and adults in Medellin, Colombia: implications for vaccine introduction

BACKGROUND

Dengue is an important public health problem worldwide. A vaccine has recently been licensed in some countries of Latin America and Asia. Recommendations for dengue vaccine introduction include endemicity and a high serological prevalence of dengue in the territories considering its introduction.

METHODS

A community-based survey was conducted to estimate dengue seroprevalence and age-specific seroconversion rates in a community in Medellin, Colombia, using a dengue serological test (IgG indirect ELISA). Residents were selected at random and were first screened for dengue infection; they were then followed over 2.5 years.

RESULTS

A total of 3684 individuals aged between 1 and 65 years participated in at least one survey. The overall dengue seroprevalence was 61%, and only 3.3% of seropositive subjects self-reported a past history of dengue. Among dengue virus (DENV)-naïve subjects with more than two visits (n=1002), the overall seroconversion rate was 8.7% (95% confidence interval 7.3-10.4) per 1000 person-months, over the study period. Overall, the mean age of DENV prevalent subjects was significantly higher than the mean age of seroconverted subjects. Specifically, DENV seropositivity over 70% was observed in participants over 21 years old. Serotype-specific plaque-reduction neutralization tests (PRNT) revealed that all four dengue serotypes were circulating, with DENV4 being most prevalent.

CONCLUSIONS

These laboratory-based findings could inform dengue vaccine decisions, as they provide age-specific seroprevalence and seroconversion data, evidencing permanent and ongoing dengue transmission in the study area. This study provides evidence for the existing rates of secondary and heterotypic responses, presenting a challenge that must be addressed adequately by the new vaccine candidates.