Causes and Outcomes of Spontaneous Pneumothoraces in Solid Tumor Cancer Patients: An Update for the Medical Oncologist

PurposeDefined as lung collapse in the absence of a recent invasive thoracic procedure, a spontaneous pneumothorax can be a catastrophic event, leading to abrupt shortness of breath, chest pain, hypotension, and occasionally death. A dearth of present day information on this entity in solid tumor cancer patients prompted this single-institution retrospective study on current causes and outcomes.MethodsAll patients with diagnoses of “spontaneous pneumothorax” and “cancer” between 1990 and 2004 had their records retrieved and reviewed. Among 546 patients with a diagnosis of spontaneous pneumothorax, only 25 (5%) met predefined inclusion criteria that included an antecedent diagnosis of an invasive solid tumor malignancy. Lung (n = 5) and bladder cancer (n = 4) were the most common malignancies; eight patients had received radiation and one had received carmustine. Of note, 78% were smokers, 13 had chronic obstructive pulmonary disease, and 12 had no known active cancer at the time of the pneumothorax.ResultsPneumothorax management was associated with great morbidity, including hospitalization in 24 patients and chest tube placement and/or surgery in most patients. Median survival for the group as a whole was 31 months, but patients with known active cancer tended to do poorly, with only a 3-month median survival.ConclusionA spontaneous pneumothorax is rare, and patients with known active cancer tend to do poorly. However, even patients with no known active cancer are at risk, perhaps in part from smoking. The fact that patients with no known active cancer can live for years after this event suggests that the pneumothorax should not be assumed to be related to cancer recurrence, that cancer restaging is not always mandatory, and that there is justification for managing the pneumothorax in this subgroup aggressively

Colorectal cancer patients with liver metastases and severe hyperbilirubinemia: A consecutive series that explores the benefits and risks of chemotherapy

Tamana Walia, J Fernando Quevedo, Timothy J Hobday, Gary Croghan, Aminah JatoiDivision of Medical Oncology, Rochester, MN, USABackground: Do colorectal cancer patients with hyperbilirubinemia and liver metastases benefit from chemotherapy?Methods/Results: This study entailed a review of 3,019 consecutive patients with colorectal cancer. Within this cohort, 20 met the study’s a priori selection criteria, which included a new diagnosis of colorectal cancer, no prior therapy, and a total bilirubin of ≥3.0 mg/dL. All 20 patients had liver metastases, and as a whole the group had a median serum bilirubin of 6.4 mg/dL (range 3.1, 28 mg/dL). Six patients received chemotherapy with an oxaliplatin-containing regimen, and four subsequently sustained a drop in their bilirubin. In one instance, a drop from 27.2 to 2.5 mg/dL occurred. These six patients lived a median of 71 days (range 23+, 283 days), but one treatment-related death occurred. In contrast, patients who received only supportive care lived a median of 28 days.Conclusion: Chemotherapy appears to provide modest benefit to newly diagnosed colorectal cancer patients with severe hyperbilirubinemia.Keywords: colorectal cancer, liver metastases, hyperbilirubinemia, chemotherapy, oxaliplati

Pemetrexed, Carboplatin, and Concomitant Radiation followed by Surgery for Locally Advanced Esophageal Cancer: Results of a Planned Interim Toxicity Analysis of North Central Cancer Treatment Group Study N044E

Purpose This brief report describes a planned, interim, 6-patient toxicity analysis that confirms the safety of pemetrexed, carboplatin, radiation with subsequent surgery, as prescribed in the North Central Cancer Treatment Group trial N044E, in patients with locally advanced esophageal cancer. Methods Six patients with locally advanced, potentially resectable esophageal cancer received pemetrexed 500 mg/m 2 and carboplatin AUC = 6 on days 1 and 22 with 5040 centigray of concomitant radiation in 28 fractions over 5.5 weeks followed by esophagectomy as a prelude to a phase II multi-institutional trial. Results Only 1 of the 6 patients experienced a grade 4 adverse event (neutropenia). This patient also experienced a grade 3 depression. Of the remaining 5 patients, three experienced at least one grade 3 adverse event (neutropenia, nausea/vomiting, and esophagitis). There were no deaths. Incidentally, one patient manifested a complete pathologic response, three a partial pathologic response, and one stable disease. Conclusion These preliminary observations on safety suggest that this regimen can be further studied in this clinical setting

Is social support associated with improved clinical outcomes in geriatric lung cancer patients? Observations from North Central Cancer Treatment Group Studies N9921 and N0222

Aminah Jatoi1, Shauna L Hillman1, Katie L Allen Ziegler1, Philip J Stella2, Gamini S Soori3, Kendrith M Rowland Jr41Mayo Clinic and Mayo Foundation, Rochester, MN, USA; 2Michigan Cancer Research Consortium, Ann Arbor, MI, USA; 3Missouri Valley Cancer Consortium, Omaha, NE, USA; 4Carle Cancer Center CCOP, Urbana, IL, USABackground: Social support is defined as a network of family/friends who provide practical and emotional help. A sizable literature describes a direct relationship between social support and improved cancer clinical outcomes. This study explored the extent of social support and its potential association with survival and adverse events in geriatric lung cancer patients. Methods: One hundred thirteen patients, who were aged 65 years or older, had incurable cancer, and were enrolled in one of two chemotherapy trials, completed the Lubben Social Network Scale, a validated instrument that measures social support. All were followed for survival and chemotherapy-related adverse events.Results: The median age (range) of the cohort was 74 years (65–91), and performance scores of 0, 1, or 2 were observed in 29%, 55%, and 16%, respectively. Forty-two percent were women. This cohort had a high level of social support: 81% reported they “always” had someone to take them to medical appointments. However, there were no gender-based differences in social support and no associations between social support and either survival or adverse events. Conclusion: In this cohort of geriatric lung cancer patients – all of whom were treated during a clinical trial – there was a high level of social support. However, there were no gender-based differences in extent of social support, and the latter did not predict clinical outcomes. Keywords: social support, lung cancer, elderly, adverse events, surviva

Results of a planned interim toxicity analysis with trimodality therapy, including carboplatin AUC = 4, paclitaxel, 5-fluorouracil, amifostine, and radiation for locally advanced esophageal cancer: preliminary analyses and treatment recommendations from the North Central Cancer Treatment Group

PURPOSE: An aggressive trimodality approach from the Minnie Pearl Cancer Research Network [carboplatin AUC = 6, days 1 and 22; 5-fluorouracil 225 mg/m2 continuous infusion, days 1–42, paclitaxel 200 mg/m2, days 1 and 22; 45 Gy] has resulted in remarkable pathologic response rates but notable toxicity. This trial was designed to mitigate this toxicity by starting with a lower carboplatin dose, AUC = 4, and by adding subcutaneous amifostine. METHODS: This phase II trial included patients with locally advanced, potentially resectable esophageal cancer. All were to receive the above regimen with modifications of carboplatin AUC = 4 and amifostine 500 mg subcutaneously before radiation. All were then to undergo an esophagectomy. A planned interim toxicity analysis after the first 10 patients was to determine whether the carboplatin dose should escalate to AUC = 6. RESULTS: Ten patients were enrolled, and all required dose reductions/omissions during neoadjuvant therapy. One patient died from paclitaxel anaphylaxis. Six patients manifested a complete pathologic response. CONCLUSION: With this regimen, carboplatin AUC = 4 for patients with locally advanced esophageal cancer is appropriate

Effect of Pretreatment Renal Function on Treatment and Clinical Outcomes in the Adjuvant Treatment of Older Women With Breast Cancer: Alliance A171201, an Ancillary Study of CALGB/CTSU 49907

CALGB 49907 showed the superiority of standard therapy, which included either cyclophosphamide/doxorubicin (AC) or cyclophosphamide/methotrexate/fluorouracil over single-agent capecitabine in the treatment of patients age ≥ 65 with early-stage breast cancer. The treatment allowed dosing adjustments of methotrexate and capecitabine for pretreatment renal function. The purpose of the current analysis was to assess the relationship between pretreatment renal function and five end points: toxicity, dose modification, therapy completion, relapse-free survival, and overall survival

Acquisition of sexual orientation and gender identity data among NCI Community Oncology Research Program practice groups

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149296/1/cncr31925_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149296/2/cncr31925.pd