Background
The optimal treatment for advanced leiomyosarcoma is still debated. Given histotype‐specific prospective controlled data lacking, this study retrospectively evaluated doxorubicin plus ...dacarbazine, doxorubicin plus ifosfamide, and doxorubicin alone as first‐line treatments for advanced/metastatic leiomyosarcoma treated at European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group (EORTC‐STBSG) sites.
Methods
The inclusion criteria were a confirmed histological diagnosis, treatment between January 2010 and December 2015, measurable disease (Response Evaluation Criteria in Solid Tumors 1.1), an Eastern Cooperative Oncology Group performance status ≤2, and an age ≥ 18 years. The endpoints were progression‐free survival (PFS), overall survival (OS), and overall response rate (ORR). PFS was analyzed with methods for interval‐censored data. Patients were matched according to their propensity scores, which were estimated with a logistic regression model accounting for histology, grade, age, sex, performance status, tumor site, and tumor extent.
Results
Three hundred three patients from 18 EORTC‐STBSG sites were identified. One hundred seventeen (39%) received doxorubicin plus dacarbazine, 71 (23%) received doxorubicin plus ifosfamide, and 115 (38%) received doxorubicin. In the 2:1:2 propensity score–matched population (205 patients), the estimated median PFS was 9.2 months (95% confidence interval CI, 5.2‐9.7 months), 8.2 months (95% CI, 5.2‐10.1 months), and 4.8 months (95% CI, 2.3‐6.0 months) with ORRs of 30.9%, 19.5%, and 25.6% for doxorubicin plus dacarbazine, doxorubicin plus ifosfamide, and doxorubicin alone, respectively. PFS was significantly longer with doxorubicin plus dacarbazine versus doxorubicin (hazard ratio HR, 0.72; 95% CI, 0.52‐0.99). Doxorubicin plus dacarbazine was associated with longer OS (median, 36.8 months; 95% CI, 27.9‐47.2 months) in comparison with both doxorubicin plus ifosfamide (median, 21.9 months; 95% CI, 16.7‐33.4 months; HR, 0.65; 95% CI, 0.40‐1.06) and doxorubicin (median, 30.3 months; 95% CI, 21.0‐36.3 months; HR, 0.66; 95% CI, 0.43‐0.99). Adjusted analyses retained an effect for PFS but not for OS. None of the factors selected for multivariate analysis had a significant interaction with the received treatment for both PFS and OS.
Conclusions
This is the largest retrospective study of first‐line treatment for advanced leiomyosarcoma. In the propensity score–matched population, doxorubicin and dacarbazine showed favorable activity in terms of both ORR and PFS and warrants further evaluation in prospective trials.
In this propensity score‐adjusted, multi‐institutional series, doxorubicin and dacarbazine show better outcomes for the first‐line treatment of advanced leiomyosarcoma and warrant further studies. This series represents a benchmark for the future development of trials for leiomyosarcoma.
The impact of COVID-19 on patients with asthma Izquierdo, José Luis; Almonacid, Carlos; González, Yolanda ...
The European respiratory journal,
03/2021, Letnik:
57, Številka:
3
Journal Article
Recenzirano
Odprti dostop
An association between the severity of coronavirus disease 2019 (COVID-19) and the presence of certain chronic conditions has been suggested. However, unlike influenza and other viruses, the disease ...burden of COVID-19 in patients with asthma has been less evident.
To understand the impact of COVID-19 in patients with asthma.
Using big-data analytics and artificial intelligence through the SAVANA Manager clinical platform, we analysed clinical data from patients with asthma from January 1 to May 10, 2020.
Out of 71 182 patients with asthma, 1006 (1.41%) suffered from COVID-19. Compared to asthmatic individuals without COVID-19, patients with asthma and COVID-19 were significantly older (55
42 years), predominantly female (66%
59%), smoked more frequently and had higher prevalence of hypertension, dyslipidaemias, diabetes and obesity. Allergy-related factors such as rhinitis and eczema were less common in asthmatic patients with COVID-19 (p<0.001). In addition, higher prevalence of these comorbidities was observed in patients with COVID-19 who required hospital admission. The use of inhaled corticosteroids (ICS) was lower in patients who required hospitalisation due to COVID-19, as compared to non-hospitalised patients (48.3%
61.5%; OR 0.58, 95% CI 0.44-0.77). Although patients treated with biologics (n=865; 1.21%) showed increased severity and more comorbidities at the ear, nose and throat level, COVID-19-related hospitalisations in these patients were relatively low (0.23%).
Patients with asthma and COVID-19 were older and at increased risk due to comorbidity-related factors. ICS and biologics are generally safe and may be associated with a protective effect against severe COVID-19 infection.
Abstract
Background
Patients hospitalized with coronavirus disease 2019 (COVID-19) frequently require mechanical ventilation and have high mortality rates. However, the impact of viral burden on ...these outcomes is unknown.
Methods
We conducted a retrospective cohort study of patients hospitalized with COVID-19 from 30 March 2020 to 30 April 2020 at 2 hospitals in New York City. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load was assessed using cycle threshold (Ct) values from a reverse transcription-polymerase chain reaction assay applied to nasopharyngeal swab samples. We compared characteristics and outcomes of patients with high, medium, and low admission viral loads and assessed whether viral load was independently associated with intubation and in-hospital mortality.
Results
We evaluated 678 patients with COVID-19. Higher viral load was associated with increased age, comorbidities, smoking status, and recent chemotherapy. In-hospital mortality was 35.0% (Ct <25; n = 220), 17.6% (Ct 25–30; n = 216), and 6.2% (Ct >30; n = 242) with high, medium, and low viral loads, respectively (P < .001). The risk of intubation was also higher in patients with a high viral load (29.1%) compared with those with a medium (20.8%) or low viral load (14.9%; P < .001). High viral load was independently associated with mortality (adjusted odds ratio aOR, 6.05; 95% confidence interval CI, 2.92–12.52) and intubation (aOR, 2.73; 95% CI, 1.68–4.44).
Conclusions
Admission SARS-CoV-2 viral load among hospitalized patients with COVID-19 independently correlates with the risk of intubation and in-hospital mortality. Providing this information to clinicians could potentially be used to guide patient care.
We evaluated 678 hospitalized patients with coronavirus disease 2019 and found that 35.0% of patients with a high severe acute respiratory syndrome coronavirus 2 viral load on admission died compared with 17.6% and 6.2% of patients with medium and low viral loads, respectively.
Breast cancer (BC) is a heterogeneous disease in which estrogen receptor (ER) expression plays an important role in most tumors. A clinical dilemma may arise when a metastasis biopsy to determine the ...ER status cannot be performed safely or when ER heterogeneity is suspected between tumor lesions. Whole-body ER imaging, such as 16α-
F-fluoro-17β-estradiol (
F-FES) PET, may have added value in these situations. However, the role of this imaging technique in routine clinical practice remains to be further determined. Therefore, we assessed whether the physician's remaining clinical dilemma after the standard workup was solved by the
F-FES PET scan.
This retrospective study included
F-FES PET scans of patients who had (or were suspected to have) ER-positive metastatic BC and for whom a clinical dilemma remained after the standard workup. The scans were performed at the University Medical Center of Groningen between November 2009 and January 2019. We investigated whether the physician's clinical dilemma was solved, defined either as solving the clinical dilemma through the
F-FES PET results or as basing a treatment decision directly on the
F-FES PET results. In addition, the category of the clinical dilemma was reported, as well as the rate of
F-FES-positive or -negative PET scans, and any correlation to the frequency of solved dilemmas was determined.
One hundred
F-FES PET scans were performed on 83 patients. The clinical dilemma categories were inability to determine the extent of metastatic disease or suspected metastatic disease with the standard workup (
= 52), unclear ER status of the tumor (
= 31), and inability to determine which primary tumor caused the metastases (
= 17). The dilemmas were solved by
F-FES PET in 87 of 100 scans (87%). In 81 of 87 scans, a treatment decision was based directly on
F-FES PET results (treatment change, 51 scans; continuance, 30 scans). The frequency of solved dilemmas was not related to the clinical dilemma category (
= 0.334). However, the frequency of solved dilemmas was related to whether scans were
F-FES-positive (
= 63) or
F-FES-negative (
= 37;
< 0.001).
For various indications, the
F-FES PET scan can help to solve most clinical dilemmas that may remain after the standard workup. Therefore, the
F-FES PET scan has added value in BC patients who present the physician with a clinical dilemma.
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