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Rocha LSDS, Negrao MV, Girardi DDM, Camargo VPD, Alban LBV, Hoff PM, Feher O. Perioperative chemotherapy with cisplatin (CP) and doxorubicin (DOX) with and without high-dose methotrexate (HDM) in adult osteosarcoma (AOT): Is methotrexate warranted? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.10523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Olavo Feher
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Sebastião AM, Rocha LSDS, Gimenez RD, Caires IQDS, Silva SCSD, Barros LABD, Fukushima JT, Miranda VC, Filho DEA, Freitas D, Estevez-Diz MDP. Carboplatin-based chemoradiotherapy in advanced cervical cancer: An alternative to cisplatin-based regimen? J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.5604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ana Morais Sebastião
- Instituto do Cancer do Estado de Sao Paulo- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucila Soares Da Silva Rocha
- Instituto do Cancer do Estado de Sao Paulo- Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | | | | | | | | | - Julia Tizue Fukushima
- Instituto do Cancer do Estado de Sao Paulo- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Vanessa Costa Miranda
- Instituto do Cancer do Estado de Sao Paulo- Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Dr Elias Abdo Filho
- Instituto do Cancer do Estado de Sao Paulo- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniela Freitas
- Instituto do Cancer do Estado de Sao Paulo- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Del Pilar Estevez-Diz
- Instituto do Cancer do Estado de Sao Paulo- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
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Caires-Lima R, Protásio BM, Caires IQDS, Rocha LSDS, De Oliveira JA, Guerra RB, Mak MP, Hoff PM, Castro G. Cancer patients with ECOG-PS higher than 1: Who are those who benefit of palliative chemotherapy? J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.9561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9561 Background: Palliative chemotherapy (PC) is a treatment option in pts with metastatic cancer. Although pts with ECOG-PS > 1 are underrepresented in clinical trials, they are often treated with PC in daily practice. We aimed to identify factors associated with poorer survival and lack of benefit of PC in this subset of pts. Methods: We conducted a case-control retrospective analysis of 301 consecutive pts with solid tumors and ECOG-PS > 1 when initiated PC, selected from 2514 pts who died between Aug/2011 and Jul/2012 in a tertiary cancer care institution or its hospice. Cases were defined as those pts who survived < 90d after the first cycle of first line PC, and controls were those who had a longer survival. Frequencies were compared by chi-square test or Fisher exact test. Risks were estimated by odds ratios (OR) and logistic regression analysis. Overall survival (OS) was calculated by Kaplan-Meier method and curves was compared using log-rank test. Results: 142 cases/159 controls were included: median age 58/63 y.o. (p=0.09; t-test) and 49%/50% female (p=0.941; chi-square). Gastrointestinal and lung cancers were the most frequent primaries (31 and 17%, respectively). Factors associated with poorer OS were age > 60 y.o. (OR 1.7; 95%CI 1.0–2.6), ECOG-PS > 2 (1.9; 1.2–3.1), weight loss > 10% (1.8; 1.1-2.8), hemoglobin < 10 g/dL (2.6; 1.6-4.2), albumin < 3 g/dL (2.7; 1.5-5.1), serum creatinine (sCr) > 1 mg/dL (2.8; 1.6-5.0), C-reactive protein ≥ 5 mg/L (8.6; 1.0-72.9), altered mental status (4.2; 1.4-13.2) and in-hospital PC (3.2; 1.9-5.2). Cases were more likely to experience grade ≥ 3 toxicity (43 vs. 28%; p=0.005), die of toxicity (16 vs. 6%; p = 0.0007) and not be offered palliative care only (47 vs. 71%; p<0.0001). mOS was 204 and 34d among controls and cases, respectively (HR 0.177; 95%CI 0.015-0.033, p<0.0001). Median time to death was 39.5d (0-1103). Logistic regression analysis identified ECOG-PS > 2 (OR 2.3, p=0.044) and sCr > 1 mg/dL (OR 11.2, p=0.0002) as independent predictors of 3-mo fatality. Conclusions: ECOG-PS > 2 and elevated sCr were identified as independent predictors of poor OS in these pts. PC needs to be prescribed with caution in ECOG-PS > 1 pts, since it seems to offer no benefit in OS and could lead to abbreviation of life.
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Affiliation(s)
- Rafael Caires-Lima
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Milena Perez Mak
- Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo M. Hoff
- Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Gilberto Castro
- Clinical Oncology, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, São Paulo, Brazil
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De Oliveira JA, De Santana IA, Caires IQDS, Caires-Lima R, Miranda VC, Protásio BM, Rocha LSDS, Braga HF, Mencarini ACM, Teixeira MJ, Martins Castro LH, Feher O. Prophylactic anticonvulsants in patients (pts) with primary brain tumor (PBT): Have we really agreed to a consensus? J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2060 Background: Routine prophylactic antiepileptic drugs (AED) use to prevent seizures in PBT seizure-naïve pts is not supported by current guidelines. However, the best management of prophylactic AED started in the perioperative setting is still unclear. Additionally, AED can have serious side effects, might have a negative impact on cognition and may present significant drug interactions. Little is known about actual current practice patterns regarding prophylactic AED in PBT. In this report we investigated prophylactic AED use in a tertiary care institution. Methods: We reviewed medical files of 260 consecutive patients, registered in our center between 2008 and 2012, focusing on prophylactic AED use. Collected data included: patient demographics, starting date, AED type, and indication. A descriptive analysis was performed with SPSS IBM version 20.0. Results: Median age was 44.5 years (11 - 83). Most pts had an ECOG PS ≤ 1 (76.4%). Overall, AED were used by 218 pts. Most common agents were: phenytoin (68.8%), carbamazepine (27.1%) and phenobarbital (16.1%). Among 141 seizure-naïve pts, 99 (70.2%) received AED as primary prophylaxis (PP). Only 14 pts (14.1%) had the drug eventually discontinued, in a median time of 5.9 months (1.1 – 76.8m). AED were used as PP in 60% of pts with low-grade gliomas, 73.3% with anaplastic gliomas and 93.9% with glioblastomas. Twenty-seven pts (27.3%) on PP presented seizures, generally associated with tumor progression. For most of them a new anticonvulsant was added for seizure control. Of the 42 seizure-naïve pts who did not receive prophylactic AED, only two presented seizures during or within the first week post-radiotherapy. Conclusions: In our study population, prophylactic AED use in PBT was extremely high (70.2% of seizure-naive pts). Postoperatively, AED were discontinued in a small minority of pts, and even so, only after a prolonged period of time. Very few seizures occurred in pts not receiving prophylactic AED. Our results suggest that practice patterns regarding prophylactic AED in PBT still contradict established guidelines.
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Affiliation(s)
| | - Iuri Amorim De Santana
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Rafael Caires-Lima
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Vanessa Costa Miranda
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Henrique Faria Braga
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Olavo Feher
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
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