Interstitial lung disease (ILD) is the most frequent cause of drug-related mortality from EGFR tyrosine kinase inhibitors (TKIs). Yet, for patients with symptomatic osimertinib-induced ILD, the risk ...of recurrent ILD associated with EGFR TKI rechallenge, either with osimertinib or another TKI, such as erlotinib, is unclear.
Retrospective study of 913 patients who received osimertinib treatment for EGFR mutation-positive NSCLC. Clinical characteristics, ILD treatment history, and subsequent anticancer therapy of patients with symptomatic osimertinib-induced ILD were collated. The primary end point was to compare the incidence of recurrent ILD with osimertinib versus erlotinib rechallenge.
Of 913 patients, 35 (3.8%) had symptomatic osimertinib-induced ILD, of which 12 (34%), 15 (43%), and eight (23%) had grade 2, 3 to 4, and 5 ILD, respectively. On ILD recovery, 17 patients had EGFR TKI rechallenge with eight received osimertinib and nine received erlotinib. The risk of recurrent ILD was higher with osimertinib rechallenge than erlotinib (p = 0.0498). Of eight, five (63%) developed recurrent ILD on osimertinib rechallenge, including three patients with fatal outcomes. In contrast, only one of nine patients (11%) treated with erlotinib had recurrent ILD. Median time to second ILD occurrence was 4.7 (range 0.7–12) weeks. Median time-to-treatment failure of patients with erlotinib rechallenge was 13.2 months (95% confidence interval: 8.6–15.0).
The risk of recurrent ILD was considerably higher with osimertinib rechallenge than erlotinib. Osimertinib rechallenge should be avoided, whereas erlotinib may be considered in patients with symptomatic osimertinib-induced ILD.
Colorectal cancer is the commonest cancer in Hong Kong. The Cancer Expert Working Group on Cancer Prevention and Screening was established in 2002 under the Cancer Coordinating Committee to review ...local and international scientific evidence, assess and formulate local recommendations on cancer prevention and screening. At present, the Cancer Expert Working Group recommends that average-risk individuals aged 50 to 75 years and without significant family history consult their doctors to consider screening by: (1) annual or biennial faecal occult blood test, (2) sigmoidoscopy every 5 years, or (3) colonoscopy every 10 years. Increased-risk individuals with significant family history such as those with a first-degree relative diagnosed with colorectal cancer at age ≤60 years; those who have more than one first-degree relative diagnosed with colorectal cancer irrespective of age at diagnosis; or carriers of genetic mutations associated with familial adenomatous polyposis or Lynch syndrome should start colonoscopy screening earlier in life and repeat it at shorter intervals.
Temozolomide is the first chemotherapeutic agent proven effective for patients with newly diagnosed glioblastoma. The drug is well tolerated for its low toxicity. The current standard practice is ...concomitant chemoradiotherapy for 6 weeks followed by 6 cycles of adjuvant temozolomide. Some Caucasian studies have suggested that patients might benefit from extended adjuvant cycles of temozolomide (>6 cycles) to lengthen both progression-free survival and overall survival. In the present study, we compared differences in survival and toxicity profile between patients who received conventional 6-cycle temozolomide and those who received more than 6 cycles of temozolomide.
Patients with newly diagnosed glioblastoma without progressive disease and completed concomitant chemoradiotherapy during a 4-year period were studied. Progression-free survival was compared using Kaplan-Meier survival curves.
Test,
test, and correlation were chosen accordingly to examine the impact of age, extent of resection, MGMT promoter methylation status and adjuvant cycles on progression-free survival. For factors with a P value of <0.05 in univariate analyses, Cox regression hazard model was adopted to determine the strongest factors related to progression-free survival.
The median progression-free survival was 17.0 months for patients who received 6 cycles of temozolomide (n=7) and 43.4 months for those who received more than 6 cycles (n=7) P=0.007, log-rank test. Two patients in the former group and one in the latter group encountered grade 1 toxicity and recovered following dose adjustment. Cycles of adjuvant temozolomide were correlated with progression-free survival (P=0.016, hazard ratio=0.68).
Extended cycles of temozolomide are safe and feasible for Chinese patients with disease responsive to temozolomide.
The aim of this study is to address the paucity of epidemiological data regarding the characteristics, treatment patterns and survival outcomes of Chinese glioblastoma patients.
This was a ...population-level study of Hong Kong adult (
18 years) Chinese patients with newly diagnosed histologically confirmed glioblastoma between 2006 and 2019. The age standardized incidence rate (ASIR), patient-, tumor- treatment-related characteristics, overall survival (OS) as well as its predictors were determined.
One thousand and ten patients with a median follow-up of 10.0 months were reviewed. The ASIR of glioblastoma was 1.0 per 100 000 population with no significant change during the study period. The mean age was 57
14 years. The median OS was 10.6 months (IQR: 5.2-18.4). Independent predictors for survival were: Karnofsky performance score
80 (adjusted OR: 0.8; 95% CI: 0.6-0.9),
mutant (aOR: 0.7; 95% CI: 0.5-0.9) or
methylated (aOR: 0.7; 95% CI: 0.5-0.8) glioblastomas, gross total resection (aOR: 0.8; 95% CI: 0.5-0.8) and temozolomide chemoradiotherapy (aOR 0.4; 95% CI: 0.3-0.6). Despite the significant increased administration of temozolomide chemoradiotherapy from 39% (127/326) of patients in 2006-2010 to 63% (227/356) in 2015-2019 (
-value < .001), median OS did not improve (2006-2010: 10.3 months vs 2015-2019: 11.8 months) (OR: 1.1; 95% CI: 0.9-1.3).
The incidence of glioblastoma in the Chinese general population is low. We charted the development of neuro-oncological care of glioblastoma patients in Hong Kong during the temozolomide era. Although there was an increased adoption of temozolomide chemoradiotherapy, a corresponding improvement in survival was not observed.
Surgical resection used to be the mainstay of treatment for glioma. In the last decade, however, opinion has changed about the goal of surgical resection in treating glioma. Ample evidence shows that ...maximum safe resection in glioblastoma improves survival. Neurosurgeons have therefore revised their objective of surgery from diagnostic biopsy or limited debulking to maximum safe resection. Given these changes in the management of glioma, we compared the survival of local Chinese patients with glioblastoma multiforme over a period of 10 years.
We retrospectively reviewed the data of the brain tumour registry of the CUHK Otto Wong Brain Tumour Centre in Hong Kong. Data of patients with glioblastoma multiforme were reviewed for two periods, during 1 January 2003 to 31 December 2005 and 1 January 2010 to 31 December 2012. Overall survival during these two periods of time was assessed by Kaplan-Meier survival estimates. Risk factors including age, type and extent of resection, use of chemotherapy, and methylation status of O
-methylguanine-DNA methyltransferase were also assessed.
There were 26 patients with glioblastoma multiforme with a mean age of 52.2 years during 2003 to 2005, and 42 patients with a mean age of 55.1 years during 2010 to 2012. The mean overall survival during these two periods was 7.4 months and 12.7 months, respectively (P<0.001). The proportion of patients who underwent surgical resection was similar: 69.2% in 2003 to 2005 versus 78.6% in 2010 to 2012 (P=0.404). There was a higher proportion of patients in whom surgery achieved total removal in 2010 to 2012 than in 2003 to 2005 (35.7% and 7.7%, respectively; P=0.015). During 2010 to 2012, patients who were given concomitant chemoradiotherapy showed definitively longer survival than those who were not (17.9 months vs 4.5 months; P=0.001). The proportion of patients who survived 2 years after surgery increased from 11.5% in 2003 to 2005 to 21.4% in 2010 to 2012.
Hong Kong has made substantial improvements in the management of glioblastoma multiforme over the last decade with corresponding improved survival outcomes. The combination of an aggressive surgical strategy and concomitant chemoradiotherapy are probably the driving force for the improvement.
Background
Antiviral therapy for hepatitis B virus (HBV) infection is frequently prescribed for patients with chronic HBV infection during surveillance for hepatocellular carcinoma (HCC). In patients ...who subsequently develop HCC, the impact of antiviral therapy on the outcome of HCC remains unclear.
Aims
We aimed to study the impact of antiviral therapy on the survival of patients who developed HCC.
Methods
From two prospective surveillance cohorts, the use of antiviral therapy for patients with HCC was retrospectively reviewed. We compared the overall survival, liver function and tumour characteristics between patients with and without antiviral therapy during surveillance. Multivariate analysis was conducted to determine the independent prognostication of antiviral therapy.
Results
During a median follow‐up of 10.1 years of 1429 patients, 148 cases of HCC were diagnosed and followed up for a median of 5.7 years. Twenty‐nine patients were given antiviral therapy during surveillance and continued treatment after diagnosis of HCC. The median survival of this group of patients was better than the rest of cohorts (hazard ratio: 0.472; 95% CI: 0.25–0.89; P = 0.0191). Use of antiviral therapy remained an independent prognostic factor after adjustment for demographic factors and tumour staging on multivariate analysis. Exploratory analysis revealed that patients who commenced antiviral therapy during surveillance had lower HBV DNA, lower serum alanine transaminase, better hepatic reserves and higher rate of local treatment at diagnosis of HCC.
Conclusion
This study provides evidence that commencement of antiviral therapy during the surveillance period is associated with improvement in overall survival in HBV‐related HCC.
The integration of next-generation sequencing (NGS) comprehensive gene profiling (CGP) into clinical practice is playing an increasingly important role in oncology. Therefore, the HKU-HKSH ...Multi-disciplinary Molecular Tumour Board (MTB) was established to advance precision oncology in Hong Kong. A multicenter retrospective study investigated the feasibility of the HKU-HKSH MTB in determining genome-guided therapy for treatment-refractory solid cancers in Hong Kong.
Patients who were presented at the HKU-HKSH MTB between August 2018 and June 2022 were included in this study. The primary study endpoints were the proportion of patients who receive MTB-guided therapy based on genomic analysis and overall survival (OS). Secondary endpoints included the proportion of patients with actionable genomic alterations, objective response rate (ORR), and disease control rate (DCR). The Kaplan–Meier method was used in the survival analyses, and hazard ratios were calculated using univariate Cox regression.
122 patients were reviewed at the HKU-HKSH MTB, and 63% (n = 77) adopted treatment per the MTB recommendations. These patients achieved a significantly longer median OS than those who did not receive MTB-guided therapy (12.7 months vs. 5.2 months, P = 0.0073). Their ORR and DCR were 29% and 65%, respectively.
Our study demonstrated that among patients with heavily pre-treated advanced solid cancers, MTB-guided treatment could positively impact survival outcomes, thus illustrating the applicability of NGS CGPs in real-world clinical practice.
The study was supported by the Li Shu Pui Medical Foundation. Dr Aya El Helali was supported by the Li Shu Pui Medical Foundation Fellowship grant from the Li Shu Pui Medical Foundation. Funders had no role in study design, data collection, data analysis, interpretation, or writing of the report.
Management of Malignancies Developing in AYA Leung, Alex WK; Loong, Herbert HF; Tse, Teresa ...
Clinical pediatric hematology-oncology,
04/2021, Letnik:
28, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Adolescent and young adult (AYA) with cancers have distinct spectrum of cancers as compared to younger and older age groups. The definition of age limits of AYA varies among countries, from 15-25 ...years to 12-39 years. The differences in age definition lead to variation in report of incidence, types of cancers and survival. In younger AYA patients, hematological malignancies are leading cause of cancers. In older AYA patients, testicular cancers are common in males while breast cancers and cervical cancers are predominant types in females. There is increasing incidence of AYA cancers worldwide in the past two decades. Overall survival and treatment outcome of AYA cancer has been improving in the last few decades. Specialized centers for AYA with cancers provide more comprehensive care and have been reported to have superior outcome. About 80% of AYA with cancers survive at 5 years after diagnosis but they are higher risk of developing second malignancies. Barriers to AYA cancer treatment included social economic status, insurance system and accessibility to clinical trials. Survivors of AYA cancers are also at higher risk dying from cardiovascular diseases and respiratory diseases. Survivorship program should be in place to enhance education and surveillance.
e18000
Background: According to practice guidelines, concurrent chemoradiotherapy or induction chemotherapy with subsequent chemoradiotherapy is the recommended regimen for Stage III-IV NPCA. ...Unfortunately, local and distant recurrence continue to be primary reasons for treatment failure. To improve existing treatment regimens, replacing infusional 5-fluorouracil with oral fluoropyrimidine equivalents was suggested due to lower hazard of death and progression. In this meta-analysis we will be investigating the use of oral fluoropyrimidines, namely capecitabine and tegafur/gimeracil/oteracil, to elucidate their efficacy and effectiveness in Nasopharyngeal Carcinoma (NPCA) compared to standard chemotherapy regimens. Methods: A literature search of PubMed, Cochrane CENTRAL, and ClinicalTrials.gov was done in compliance with the PRISMA-P guidelines. After screening 908 records and selecting 32 articles for full-text assessment, 29 articles were included in the systematic-review and 15 in the meta-analysis. Outcomes were assessed for quality of evidence using a modified GRADE criteria. Overall Survival (OS) was assessed as the primary endpoint. Secondary outcomes were Progression Free Survival (PFS), Disease Free Survival (DFS), Distant Metastasis Free Survival (DMFS) and Locoregional Recurrence Free Survival (LRFS). Risk Ratio (RR) was used as the measure of association for all outcomes. Significance was assessed using p-values and I
2
for the presence of heterogeneity. All pooled outcomes were assessed with 95% confidence intervals (CI). Statistical analysis was done using Stata and Review Manager 5. Results: The PFS RR of the adjuvant/maintenance group and induction group, respectively, were 0.53 95%CI 0.38, 0.72; I
2
= 41% (p < 0.001) and 0.59 95%CI 0.37, 0.95; I
2
= 0% (p = 0.03). DFS, LRFS, and DMFS of the adjuvant/maintenance group were 0.61 95%CI 0.44, 0.83; I
2
= 0% (p = 0.002), 0.48 95%CI 0.28, 0.83; I
2
= 0% (p = 0.008) and 0.67 95%CI 0.44, 1.01; I
2
= 0% (p = 0.06), respectively. The induction group's LRFS and DMFS, respectively, were 0.55 95%CI 0.37, 0.82 (p = 0.004); I
2
= 0% and 0.60 95%CI 0.40, 0.91; I
2
= 25% (p = 0.02). The OS for the adjuvant and induction group were 0.51 95%CI 0.38, 0.69; I
2
= 21% (p < 0.001) and 0.72 95%CI 0.52, 1.00; I
2
= 14% (p = 0.05), respectively. Conclusions: Based on “Low to Moderate” levels of evidence, induction oral fluoropyrimidine-containing regimens are associated with significantly higher 2-3 year PFS and 3-5 year LRFS as well as DMFS with equivalent 2-5 year OS in previously-untreated Stage III-IVB NPCA. Meanwhile, adjuvant/maintenance oral fluoropyrimidine-containing regimens lead to significantly higher 2-5 year OS and 3-5 year PFS, DFS, DMFS and LRFS compared to induction CCRT alone in previously-untreated Stage III-IVB NPCA.
International guidelines on fertility preservation in cancer patients recommend that physicians discuss, as early as possible, with all patients of reproductive age their risk of infertility from the ...disease and/or treatment and their interest in having children after cancer, and help with informed decisions about fertility preservation.1 2 A local study performed in a major teaching hospital reported that up to 32% of male cancer patients encountered deterioration of semen parameters after gonadotoxic treatments.3 The thought of the possibility or actual prior experience of treatment-related infertility can lead to psychological stress.4 5 Patients prefer maintaining their fertility and future reproductive function at the time of cancer diagnosis.6 Fertility concerns may also affect the decision to pursue treatment.7 8 9 As recommended by the American Society of Clinical Oncology2 and the European Society for Medical Oncology,1 sperm cryopreservation and embryo/oocyte cryopreservation are standard strategies for fertility preservation in male and female patients, respectively. Whilst these guidelines and recommendations are readily accessible, the ‘bottom-line' of whether a suitable patient is referred for fertility preservation is entirely dependent on the treating physicians' awareness and understanding as well as the local availability of fertility-preservation techniques. ...a higher percentage of the same OandG specialists in this study reported to be familiar with “all of the above” fertility-preservation techniques previously itemised, compared with being ‘aware of' fertility preservation per se (63.6% vs 50.7%). ...even if knowledge is indeed improved, suitable patients may still not be able to receive appropriate counselling and care, as only a little more than half (55%) of all respondents were aware that there are dedicated clinics and specialists who would be willing to accept referrals for fertility preservation.
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