Association of patient and disease characteristics with outcomes of regorafenib in patients with metastatic colorectal cancer

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Background: Regorafenib (rego) is a multikinase inhibitor approved for use in metastatic colorectal cancer (mCRC). No predictive biomarkers have been identified for rego. We conducted a real-world multi-institutional retrospective study to identify the patient and tumor characteristics associated with outcomes of rego in mCRC patients. Methods: Patients from University of Pittsburgh Medical Center and Montefiore Medical Center who received rego for mCRC were included. Patient characteristics, tumor pathology and molecular profiles, treatment history, and response to rego were collected. Primary and secondary outcomes were best objective response and progression free survival (PFS) on rego, respectively. Univariate and multivariate analyses were conducted using Fisher’s exact test, Mann-Whitney U test, Firth logistic regression and Cox proportional-hazards model. Results: 76 patients were included (median age 64, 42% females, 84% whites). Rego yielded a disease control rate of 32% (including 2 complete responses) and a median PFS of 3.6 months. Tumors with high microsatellite instability (MSI-H) had a significantly lower odds of progression of disease (POD) as best objective response (p = 0.01) and a significantly longer median PFS (p = 0.022) compared with tumors with microsatellite stability (MSS) in multivariable models (Table). 75% of MSI-H mCRC patients had not received immunotherapy (IO) prior to rego. Presence of peritoneal carcinomatosis and older age were associated with higher odds of POD (p = 0.093) and a significantly shorter PFS (p = 0.029), respectively. Compared to Whites, Black patients had a numerically higher odds of POD and shorter PFS. Sex, smoking, alcohol, sidedness of CRC, previous treatments, organs involved, and KRAS mutation were not associated with treatment response or PFS. Conclusions: Our study showed that MSI-H mCRC was associated with significantly better response to rego and PFS, even in the absence of prior IO. Other predicting factors for worse outcomes of rego included older age, and potentially peritoneal carcinomatosis and Black race. None of the mutations was found associated with treatment outcomes, with the limitation of lack of comprehensive molecular testing in many patients. Studies to further examine potential biomarkers such as MCL-1 and FBW7 mutations and correlation to clinical outcomes are ongoing. [Table: see text]

Temporal trend of microbiological profiles among patients with bloodstream infections: A comparison between cancer and noncancer patients in a nationwide database

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Background: Bloodstream infection (BSI) is a leading cause of in-hospital mortality for cancer patients. Our goal is to describe the temporal trend of microbiological profiles and inpatient outcomes through a large national database. Methods: National Inpatient Sample is the largest U.S. database of hospitalized patients including 20% of patients from 4,378 hospitals. Hospitalizations of patients with BSI were identified by ICD-9 codes for bacteremia and fungemia from 2006-2014. 21 common microorganisms were identified by ICD-9-CM codes as the cause of BSI. We assessed the trend of incidence and mortality by linear regression and compared the in-hospital mortality between cancer and noncancer BSI patients by propensity score adjusted Cox proportional hazard model. Results: A total of 13,996,374 patients with BSI were identified (cancer 13.6%, noncancer 86.4%). Among cancer patients, gram positive bacteria (GPB) are the leading pathogens (27.38%), followed by gram negative bacteria (GNB) (23.59%), fungus (4.81%) and anaerobe (1.21%). Anaerobe had the fastest annual increase rate of incidence (16.54%), followed by GNB (15.77%), fungus (11.61%) and GPB (7.41%). Cancer patients had a faster increase rate of incidence than noncancer patients. The in-hospital mortality was highest for anaerobe (16.14%), followed by fungus (15.71%), GPB (13.65%) and GNB (12.14%). Except for fungal BSI, the mortality for other types of BSI decreased significantly. GNB had the most annual mortality decrease (-2.51%), followed by GPB (-2.48%) and anaerobe (-1.47%). Cancer patients had higher in-hospital mortality than noncancer patients (PS-matched HR 1.25, 95%CI: 1.24, 1.26), especially in GNB BSI (PS-matched HR 1.29, 95%CI: 1.27, 1.31). Using breast cancer patients as reference, lung cancer BSI patients had the worst relative mortality risk (1.65, 95%CI: 1.60, 1.69). Conclusions: The incidence of BSI increased steadily among cancer patients from 2006-2014, with GNB BSI increasing at the highest rate. Except for fungus, mortality of GNB, GPB and anaerobe decreased continually. Compared with noncancer patients, cancer patients had a larger increase in the incidence of all types of BSI, especially anaerobes, and higher mortality than noncancer patients. BSI in lung cancer patients was associated with the highest mortality rate.

The Association Between Internet Use and Ambulatory Care-Seeking Behaviors in Taiwan: A Cross-Sectional Study

Background

Compared with the traditional ways of gaining health-related information from newspapers, magazines, radio, and television, the Internet is inexpensive, accessible, and conveys diverse opinions. Several studies on how increasing Internet use affected outpatient clinic visits were inconclusive.

Objective

The objective of this study was to examine the role of Internet use on ambulatory care-seeking behaviors as indicated by the number of outpatient clinic visits after adjusting for confounding variables.

Methods

We conducted this study using a sample randomly selected from the general population in Taiwan. To handle the missing data, we built a multivariate logistic regression model for propensity score matching using age and sex as the independent variables. The questionnaires with no missing data were then included in a multivariate linear regression model for examining the association between Internet use and outpatient clinic visits.

Results

We included a sample of 293 participants who answered the questionnaire with no missing data in the multivariate linear regression model. We found that Internet use was significantly associated with more outpatient clinic visits (P=.04). The participants with chronic diseases tended to make more outpatient clinic visits (P<.01).

Conclusions

The inconsistent quality of health-related information obtained from the Internet may be associated with patients’ increasing need for interpreting and discussing the information with health care professionals, thus resulting in an increasing number of outpatient clinic visits. In addition, the media literacy of Web-based health-related information seekers may also affect their ambulatory care-seeking behaviors, such as outpatient clinic visits.