To analyze the feasibility, safety, and acceptability of immersive virtual tasks.
The authors recruited 11 young adults and 10 older adults. The participants performed three virtual reaching tasks ...while walking on a virtual path. The descriptive analysis and comparison between participants were performed using the Mann-Whitney U test and chi-square test for nonparametric and nominal variables, respectively. The authors also used analysis of variance for a between-groups comparison for normal variables.
Twenty percent of older adults and 81.8% of young adults completed all three tasks (chi-square test; p = .005). Both groups reported minor symptoms, with no significant differences. The older adults were more motivated to practice the tasks (Mann-Whitney U test; p = .015) and would be more likely to suggest them to others (chi-square test; p = .034).
All three tasks were feasible for young adults. All participants, except for one, had cybersickness. The symptoms were mostly mild and subsided once the interaction was complete.
Spatial orientation is a cognitive domain frequently impaired in Alzheimer's Disease and can be one of its earliest symptoms.
This paper describes the results of tolerability, sense of presence and ...usability of two immersive virtual reality tasks for the assessment of spatial orientation, using VR headset in adults.
31 healthy adults recruited from university and the local community performed two experimental immersive virtual reality tasks of spatial orientation: the SOIVET-Maze for the assessment of allocentric to egocentric spatial abilities and the SOIVET-Route for the assessment of spatial memory and landmark recognition. Participants completed questionnaires about sense of presence, cybersickness symptoms, technology use profile and motion sickness history. Usability measures were assessed by spontaneous feedback from participants.
All participants were able to understand the task instructions and how to interact with the system. Both tasks seemed to induce a strong sense of presence, as assessed by the Witmer and Singer Presence Questionnaires (M=128 and 143 for SOIVET-Maze and SOIVET-Route, respectively). The SOIVET-Route had a small numeric advantage over the SOIVET-Maze tolerability scores assessed by the Cybersickness Questionnaire (M=4.19, SD=5.576 and M=3.52, SD=6.418 for SOIVET-Maze and SOIVET-Route respectively). Also, there were no drop-outs on the SOIVET-Route due to tolerability issues, unlike the SOIVET-Maze, which had two drop-outs. However, this difference was not statistically significant (Z= -.901, p= 0.368, Wilcoxon signed-rank test).
Gastric cancer (GC) remains a formidable global health challenge, ranking among the top-five causes of cancer-related deaths worldwide. The majority of patients face advanced stages at diagnosis, ...with a mere 6% five-year survival rate. First-line treatment for metastatic GC typically involves a fluoropyrimidine and platinum agent combination; yet, predictive molecular markers have proven elusive. This review navigates the evolving landscape of GC biomarkers, with a specific focus on Claudin 18.2 (CLDN18.2) as an emerging and promising target. Recent phase III trials have unveiled the efficacy of Zolbetuximab, a CLDN18.2-targeting antibody, in combination with oxaliplatin-based chemotherapy for CLDN18.2-positive metastatic GC. As this novel therapeutic avenue unfolds, understanding the nuanced decision making regarding the selection of anti-CLDN18.2 therapies over other targeted agents in metastatic GC becomes crucial. This manuscript reviews the evolving role of CLDN18.2 as a biomarker in GC and explores the current status of CLDN18.2-targeting agents in clinical development. The aim is to provide concise insights into the potential of CLDN18.2 as a therapeutic target and guide future clinical decisions in the management of metastatic GC.
Identifying polymorphisms in the dihydropyrimidine dehydrogenase (DPYD) genes is gaining importance as predictors of fluoropyrimidine-associated toxicity. The recommendation of dose adjustment for ...chemotherapy guided by the presence of polymorphisms of the
gene can potentially improve treatment safety for a large number of patients, saving lives, avoiding complications and reducing health care costs. This article discusses how personalisation of fluoropyrimidine treatment based on the identification of DPYD variants can mitigate toxicities and be cost effective.
Introduction: Pancreatic neuroendocrine neoplasms (pNEN) have poor prognosis. Available treatment options are limited. We aimed to evaluate the clinical characteristics and outcomes in patients with ...pNEN undergoing systemic chemotherapy. Methods: Retrospective study of patients with metastatic pNEN diagnosed between January 2000 and April 2018 in A.C. Camargo Cancer Center. We evaluated epidemiological characteristics and outcomes of patients who received systemic chemotherapy between the first and third-lines. Results: 35 patients with median age of 54.4 years; 51.4% had diabetes mellitus and 62.9% had smoking history. Most primary tumors were located in pancreatic body or tail and 34.3% were described as well or moderately differentiated, 40% were of high grade. Overall, chemotherapy from first to third-line was prescribed 50 times, 62% consisted of platin doublet, the chosen schema 50% of times when Ki-67<20%, 55.5% for Ki-67 between 20% and 55% and 66.7% for Ki-67>55%. The median PFS and RR were 7.8 months and 40.7%; 13 months and 33.3% and 3 months and 0% in the first, second and third-line, respectively. The estimated OS was 53.4 months. We found that female (HR 2.8, p=0.034), DM (HR 4.5, p=0.004), smoking (HR 3.5, p=0.017), high grade tumors (HR 3.8, p=0.025) and tumors localized in head/ neck of the pancreas (HR 7.1, p<0.001) were negative prognostic factors for OS in univariate analysis. Conclusion: Our real world data shows that doublet platin is a preferred and active schema for treating pNEN, especially in first and second line. It brings the greatest benefit for undifferentiated tumors. Nevertheless, the prognosis remains poor and some factors may contribute to worse outcomes, such as female gender, silent tumors that do not manifest DM, poorly differentiated tumours, smoking and location in the head and neck of the pancreas.
Background
Pancreatic cancer plays an important role in cancer‐related mortality. Few studies have been performed in Brazil to characterize patients affected by this disease. We aimed to describe the ...clinico‐pathological characteristics and the survival of patients with pancreatic cancer seen at AC Camargo Cancer Center (ACCCC).
Methods
We included patients ≥ 18‐year old, with a histologically confirmed diagnosis of exocrine pancreatic cancer, that attended at least one visit at ACCCC from 2008 to 2016.
Results
The study included 739 patients. Median age at diagnosis was 64 years. Most patients were male. About 5% presented a family history of pancreatic cancer. A total of 40% had diabetes and 51.4% presented with ECOG performance status 1. Tumors most often arose in the pancreatic head and roughly half of the patients had metastatic disease at presentation. Median overall survival of patients with potentially resectable disease submitted to surgery at ACCCC was 35.4 months. Median overall survival times of patients with the unresectable and metastatic disease were 14.1 and 9.3 months, respectively.
Conclusions
The features of our population match those of studies done in developed countries. We believe multicentric data from patients with pancreatic cancer in Brazil could enable more effective preventive and therapeutic approaches to the disease.
FOLFIRINOX stands a major breakthrough in the management of metastatic pancreatic adenocarcinoma (MPA). Nonetheless, significant side-effects have been reported using standard FOLFIRINOX. We aimed to ...compare survival outcomes, response rates and toxicity of patients treated with standard or modified FOLFIRINOX in MPA.
We included patients aged ≥18 years old, with pathologically confirmed MPA, treated with FOLFIRINOX in the first-line setting. Patients submitted to at least one cycle of full-dose FOLFIRINOX were grouped in the standard FOLFIRINOX group.
Patients treated with standard FOLFIRINOX were younger and had less comorbidity. We observed no differences in overall survival or in progression-free survival between the two treatment arms. The only variable independently associated with OS was log10neutrophil-to-lymphocyte ratio (NLR). Modified FOLFIRINOX was associated with a lower dose reduction rate, but a slightly increased incidence of severe toxicity.
Modified FOLFIRINOX presents the same activity against MPA as standard FOLFIRINOX. We found no significant differences in toxicity, possibly due to patient selection and a higher dose reduction rate in the standard FOLFIRINOX arm. NLR stood as an important prognostic marker and further research is needed to comprehend its biological meaning in pancreatic cancer.
Introduction: Older adults require attention to risks of treatment toxicity. The purpose of this study was to evaluate epidemiological data and clinical outcomes of patients with lung cancer treated ...with non-curative intent assessed by geriatric assessment (GA) and restricted access to new therapies. Methods: We evaluated older adults with non-small cell lung cancer treated with palliative chemotherapy or first generation target therapy who underwent GA. Overall survival (OS) was calculated and we performed univariate and multivariate analysis to determine prognostic factors for OS. Results: Fifty-four patients aged ≥70 years had a median age of 76 years, 76% was classified as Katz A and 50% as Lawton <27. 68.5% were at risk of malnutrition or malnourished; 61.1% had ≥2 comorbidities. The mean OS was 17.1 months. In the univariate analysis, lower survival results were observed for patients with ECOG≥2 (HR=5.9; p<0.001), higher number of metastasis sites (HR=2.0; p=0.04) and liver metastasis (HR=12.6; p<0.001). In multivariate analysis, male gender, ECOG≥2, more than 2 metastatic sites and liver metastases were associated with higher risk of death. We did not observe differences in survival according to functional capacity. Conclusion: GA showed no prognostic relationship in our small population. Patients with ECOG≥2, more than 2 metastatic sites and hepatic metastasis presented higher risk of death. For the older population, new treatment modalities are fundamental and outweigh the prognostic importance of the clinical factors of GA.
Metastatic pancreatic adenocarcinoma (MPA) represents a highly lethal condition. Despite the improvements seen with FOLFIRINOX, there is no randomized data to guide treatment selection beyond this ...regimen. We aimed to evaluate the outcomes of patients with MPA progressing on FOLFIRINOX who were treated with Gemcitabine-based chemotherapy afterwards.
We included patients aged 18 years or older, treated for MPA with FOLFIRINOX in the first-line setting and who experienced disease progression, with Eastern Cooperative Oncology Group (ECOG) performance status 0-2, and treated with at least one cycle of Gemcitabine-based chemotherapy in second or further lines of treatment. We used descriptive statistics to characterize the study population and Cox proportional-hazards models to describe factors associated with survival. As an exploratory analysis, we compared the outcomes of patients treated with single-agent Gemcitabine with those of patients undergoing Gemcitabine-based polychemotherapy.
The study population consisted of 42 patients. Median age was 59 years and 78.6% of patients presented ECOG 0-1. Thirty-three patients (78.6%) were treated with Gemcitabine-based chemotherapy in the second-line setting and 27 patients (64.3%) were treated with single-agent Gemcitabine. Objective response rate and disease control rate were 2.4% and 33.4%, respectively. Median progression-free survival (PFS) and median overall survival (OS) were 2.9 and 5.5 months, respectively. Six-month PFS and OS rates were 19.2% and 46.2%, respectively. We observed no significant difference in OS according to the type of Gemcitabine-based chemotherapy, despite numerically improved disease control rate and PFS for those treated with Gemcitabine-based polychemotherapy. In multivariate analysis, ECOG 2 (
ECOG 0-1) was the only factor significantly associated with inferior PFS and OS.
a subgroup of patients with MPA derives benefit from treatment with Gemcitabine-based regimens after FOLFIRINOX. There is a suggestion that Gemcitabine-based combinations, in particular Gemcitabine plus Nab-Paclitaxel, provide superior outcomes compared to single-agent Gemcitabine. Additionally, treatment in this setting should be offered carefully to patients with ECOG 2, as they present shorter survival and increased risk of toxicity.
To evaluate the applicability and compliance with guidelines for early initiation of long-term prophylaxis in infants with severe hemophilia A and to identify factors associated with guideline ...compliance.
This real-world, prospective, multicenter, population-based FranceCoag study included almost all French boys with severe hemophilia A, born between 2000 and 2009 (ie, after guideline implementation).
We included 333 boys in the study cohort. The cumulative incidence of long-term prophylaxis use was 61.2% at 3 years of age vs 9.5% in a historical cohort of 39 boys born in 1996 (ie, before guideline implementation). The guidelines were not applicable in 23.1% of patients due to an early intracranial bleeding or inhibitor development. Long-term prophylaxis was delayed in 10.8% of patients. In the multivariate analysis, 2 variables were significantly associated with “timely long-term prophylaxis” as compared with “delayed long-term prophylaxis”: hemophilia treating center location in the southern regions of France (OR 23.6, 95% CI 1.9-286.7, P = .013 vs Paris area) and older age at long-term prophylaxis indication (OR 7.2 for each additional year, 95% CI 1.2-43.2, P = .031). Long-term prophylaxis anticipation was observed in 39.0% of patients. Earlier birth year (OR 0.5, 95% CI 0.3-0.8, P = .010 for birth years 2005-2009 vs 2000-2004) and age at first factor replacement (OR 1.9 for each additional year, 95% CI 1.2-3.0, P = .005) were significantly associated with “long-term prophylaxis guideline compliance” vs “long-term prophylaxis anticipation.”
This study suggests that long-term prophylaxis guidelines are associated with increased long-term prophylaxis use. However, early initiation of long-term prophylaxis remains a challenge.
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