6 research outputs found
Evidence of pseudoprogression in patients treated with PD1/ PDL1 antibodies across tumor types
Background: PD(L)1 antibodies (anti-PD(L)-1) have been a major breakthrough
in several types of cancer. Novel patterns of response and progression have been
described with anti-PD(L)-1. We aimed at characterizing pseudoprogression (PSPD)
among patients with various solid tumor types treated by anti-PD(L)-1.
Methods: All consecutive patients (pts) enrolled in phase 1 trials with advanced
solid tumors and lymphomas treated in phase I clinical trials evaluating monotherapy
by anti-PD(L)-1 at Gustave Roussy were analyzed. We aimed to assess prevalence
and outcome of PSPD across tumor types. We also intended to describe potential
clinical and pathological factors associated with PSPD.
Results: A total of 169 patients treated with anti-PD(L)-1 were included in the study.
Most frequent tumor types included melanoma (n = 57) and non-small cell lung cancer (n = 19). At first tumor evaluation 77 patients (46%) presented with immune unconfirmed progressive disease. Six patients (8%) experienced PSPD: 2 patients with
partial response; 4 patients with stable disease. Increase in target lesions in the first
CT-scan was more frequently associated to PSPD (67% vs 33%; P = .04). Patients
with a PSPD had a superior survival when compared to patients progressing (median
OS: 10.7 months vs 8.7 months; P = .07).
Conclusions: A small subset of PSPD patients may experience response after an
initial progression. Assessment of the current strategy for immune-related response
evaluations may require further attention
Evidence of pseudoprogression in patients treated with PD1/ PDL1 antibodies across tumor types
Background: PD(L)1 antibodies (anti-PD(L)-1) have been a major breakthrough
in several types of cancer. Novel patterns of response and progression have been
described with anti-PD(L)-1. We aimed at characterizing pseudoprogression (PSPD)
among patients with various solid tumor types treated by anti-PD(L)-1.
Methods: All consecutive patients (pts) enrolled in phase 1 trials with advanced
solid tumors and lymphomas treated in phase I clinical trials evaluating monotherapy
by anti-PD(L)-1 at Gustave Roussy were analyzed. We aimed to assess prevalence
and outcome of PSPD across tumor types. We also intended to describe potential
clinical and pathological factors associated with PSPD.
Results: A total of 169 patients treated with anti-PD(L)-1 were included in the study.
Most frequent tumor types included melanoma (n = 57) and non-small cell lung cancer (n = 19). At first tumor evaluation 77 patients (46%) presented with immune unconfirmed progressive disease. Six patients (8%) experienced PSPD: 2 patients with
partial response; 4 patients with stable disease. Increase in target lesions in the first
CT-scan was more frequently associated to PSPD (67% vs 33%; P = .04). Patients
with a PSPD had a superior survival when compared to patients progressing (median
OS: 10.7 months vs 8.7 months; P = .07).
Conclusions: A small subset of PSPD patients may experience response after an
initial progression. Assessment of the current strategy for immune-related response
evaluations may require further attention
Access to early-phase clinical trials in older patients with cancer in France: the EGALICAN-2 study
International audienceBackgroundAccess to clinical trials and especially early-phase trials (ECT) is an important issue in geriatric oncology. As cancer can be considered an age-related disease because the incidence of most cancers increases with age, new drugs should also be evaluated in older patients to assess their safety and efficacy. The EGALICAN-2 study was primarily designed to identify social and/or regional inequalities regarding access to ECT. We focused on the factors of inequalities in access to ECT in older patients.Patients and methodsDuring a 1-year period (2015-2016), a survey was conducted in 11 early-phase units certified by the French National Cancer Institute.ResultsA total of 1319 patients were included in the analyses: 1086 patients (82.3%) were 70 years. The most common tumor types at referral in older patients were gastrointestinal (19.3%), hematological (19.3%), and thoracic tumors (18.0%). Most patients referred to the phase I unit had signed informed consent and the rate was similar across age (92.7% in younger patients versus 90.6% in older patients; P = 0.266). The rate of screening failure was also similar across age (28.5% in younger patients versus 24.3% in older patients; P = 0.219). Finally, in older patients, univariate analyses showed that initial care received in the hospital having a phase I unit was statistically associated with first study drug administration (odds ratio 0.49, 90% confidence interval 0.27-0.88; P = 0.045).ConclusionsOlder patients are underrepresented in early clinical trials with 17.7% of patients aged ≥70 years compared with the number of new cases of cancer in France (50%). However, when invited to participate, older patients were prone to sign informed consent
Surgical and regional treatments for colorectal cancer metastases in older patients: A systematic review and meta-analysis.
The present study explored the existing literature to describe the outcomes of surgical and regional treatments for colorectal cancer metastases (mCRC) in older patients.
Methods
A literature search was conducted in PubMed, EMBASE, Cochrane and ClinicalTrials.gov for studies published since 2000 that investigated the short- and long-term outcomes of regional treatments (surgical or non-surgical) for mCRC in patients aged ≥65 years. Pooled data analyses were conducted by calculating the risk ratio (RR), mean differences (MD) and hazard ratio (HR) between older and younger patients or between two different approaches in older patients.
Results
After screening 266 articles, 29 were included in this review. These studies reported the outcomes of surgery (n = 19) and non-surgical local ablation treatments (n = 3) for CRC metastases in older vs. younger patients or compared the outcomes of different interventions in older patients (n = 7). When comparing older vs. younger patients undergoing liver surgery for mCRC, pooled data analysis showed higher postoperative mortality [RR = 2.53 (95%CI: 2.00-3.21)] and shorter overall survival [HR = 1.17 (95%CI: 1.07-1.18)] in older patients, whereas no differences in operative outcomes, postoperative complications and disease-free survival were found. When comparing laparoscopy vs. open surgery for liver resection in older mCRC patients, laparoscopy was associated with fewer postoperative complications [RR = 0.27 (95%CI: 0.10-0.73)].
Conclusion
Liver resection for mCRC should not be disregarded a priori in older patients, who show similar operative and postoperative outcomes as younger patients. However, clinicians should consider that they are at increased risk of postoperative mortality and have a worse overall survival, which may reflect comorbidities and frailty.journal article20202020 04 22importe