Liposomal irinotecan in metastatic pancreatic adenocarcinoma in Asian patients: Subgroup analysis of the NAPOLI-1 study

The global, randomized NAPOLI-1 phase 3 trial reported a survival benefit with liposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (nal-IRI+5-FU/LV) in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) after previous gemcitabine-based therapy. Median overall survival (OS) with nal-IRI+5-FU/LV was 6.1 vs 4.2 months with 5-FU/LV alone (unstratified hazard ratio [HR] = 0.67, P =.012). Herein, we report efficacy and safety results from a post-hoc subgroup analysis of Asian patients treated at Asian centers. Primary study endpoint was OS; secondary endpoints included progression-free survival (PFS), objective response rate (ORR), and safety. Patients receiving nal-IRI+5-FU/LV (n = 34) had significantly longer median OS versus 5-FU/LV (n = 35) (8.9 vs 3.7 months; unstratified HR = 0.51, P =.025). Patients had significantly increased median PFS with nal-IRI+5-FU/LV versus 5-FU/LV (4.0 vs 1.4; unstratified HR = 0.48, P =.011), and increased ORR (8.8% vs 0; P =.114). nal-IRI monotherapy (n = 50) numerically improved efficacy endpoints versus 5-FU/ LV (n = 48): median OS was 5.8 versus 4.3 months (HR = 0.83, P =.423) a nd m edian PFS was 2.8 versus 1.4 months (HR = 0.69, P =.155). Grade =3 neutropenia was reported more frequently with nal-IRI+5-FU/LV versus 5-FU/LV (54.5% vs 3.4%), and incidence of grade =3 diarrhea was comparable between the two arms (3.0% vs 6.9%). This subgroup analysis confirms nal-IRI+5-FU/LV as an efficacious treatment option that improves survival in Asian patients with mPDAC that progressed after gemcitabine-based therapy, with a safety profile agreeing with previous findings. The nal-IRI+5-FU/LV regimen should represent a new standard of care for these patients in Asia. (Clinicaltrials. gov: NCT01494506)

Intra-Arterial Chemotherapy with Doxorubicin and Cisplatin Is Effective for Advanced Hepatocellular Cell Carcinoma

Advanced hepatocellular carcinoma (HCC) remains a fatal disease even in the era of targeted therapies. Intra-arterial chemotherapy (IACT) can provide therapeutic benefits for patients with locally advanced HCC who are not eligible for local therapies or are refractory to targeted therapies. The aim of this retrospective study was to analyze the effect of IACT with cisplatin and doxorubicin on advanced HCC. Methods. Patients with advanced HCC who were not eligible for local therapies or were refractory to sorafenib received doxorubicin (50 mg/m2) and cisplatin (50 mg/m2) infusions into the liver via the transhepatic artery. Between January 2005 and December 2011, a total of 50 patients with advanced HCC received this treatment regimen. The overall response rate (ORR) was 22% in all treated patients. In patients who received at least 2 cycles of IACT, the ORR was 36.7%, and the disease control rate was 70%. Survival rate differed significantly between patients who received only one cycle of IACT (group I) and those who received several cycles (group II). The median progression-free survival was 1.3 months and 5.8 months in groups I and II, respectively (P<0.0001). The median overall survival was 8.3 months for all patients and was 3.1 months and 12.0 months in groups I and II, respectively (P<0.0001). The most common toxicity was alopecia. Four patients developed grade 3 or 4 leukopenia. Worsening of liver function, nausea, and vomiting were uncommon side effects. This study demonstrated clinical efficacy and tolerable side effects of repeated IACT with doxorubicin and cisplatin in advanced HCC. Our regimen can be an alternative choice for patients with adequate liver function who do not want to receive continuous infusion of IACT

Development and psychometric testing of a short version of the Barriers Questionnaire-Taiwan form for cancer patients

Background: A comprehensive assessment of patient hesitancy to use analgesics and accurate knowledge related to the promotion of analgesic adherence is necessary for effective pain management. Unfortunately, there has been a lack of a short and concise questionnaire to assess patients' hesitancy to use analgesics in clinical practice. Objective: This paper is a report of the development and psychometric properties of the short version of the Barriers Questionnaire-Taiwan form (S-BQT). Design: This study employed a descriptive design. Setting: A convenience sample was recruited from oncology clinics at two medical centers in Taiwan. Participants: One hundred and eighty-three (N=. 183) patients receiving analgesics for cancer pain participated in the study. Methods: Instruments included the Barriers Questionnaire-Taiwan form (BQT), the Taiwanese version of the Morisky Medication Adherence Measure-Taiwan form (MMAM-T). Two self-administered questionnaires were performed at the same time, and the ratio of analgesic usage was computed over a two-week period. Reliability was established by calculating Cronbach's α and test-retest reliability. The validity was estimated by construct validity, criterion-related validity, and known group validity. Results: To develop the S-BQT, we used reliability analysis to extract nine items from nine subscales. Internal consistency of the S-BQT was indicated by a Cronbach's alphas score of 0.86. Test-retest reliability was assessed as 0.83 over a two-week interval. Factor analysis revealed two factor structures. Criterion-related validity was examined by correlating the S-BQT score, and MMAM-T score, and the ratio of analgesic use. Known group validity was examined by comparing the S-BQT scores of patients with hesitancy to report pain and take analgesics vs. patients demonstrating no such hesitancy in the previous week. Known group validity was also established by comparing the S-BQT scores among patients with low, moderate, and high adherence to the usage of medication. Conclusions: The S-BQT shows excellent reliability and validity. The use of this instrument can help to improve communication between patients and clinicians regarding the use of analgesics in the management of pain. © 2011 Elsevier Ltd.Link_to_subscribed_fulltex

Longitudinal study on the impact of physical activity on the symptoms of lung cancer survivors

© 2015, Springer-Verlag Berlin Heidelberg.Purpose: To examine the effect of physical activity on the physical and psychosocial symptoms of lung cancer survivors. Methods: A longitudinal design was used in this study. Participants were recruited from the chest and surgical departments of medical centers in Taiwan. The instruments used were the Godin Leisure-Time Exercise Questionnaire and the Taiwanese version of the M.D. Anderson Symptom Inventory. Results: In total, 185 survivors were followed up for 6 months (response rate 66 %). Disturbed sleep was the most prevalent symptom in the participants. A generalized estimating equation (GEE) method was employed to analyze the relationships among intensity of physical activity, symptom severity, and symptom interference in the daily life of the participants. Regarding symptom severity, significant differences were observed in fatigue, drowsiness, and disturbed sleep between the participants who engaged in moderate physical activity and those who did not engage in any physical activity. Regarding symptom interference, the participants who engaged in light physical activity experienced a significantly lower level of symptom interference than did those with a sedentary lifestyle. Conclusion: This is the first study to explore the role of physical activity in alleviating symptoms in lung cancer survivors by using the GEE method. The results suggest that physical activity plays an essential role in alleviating the physical and psychological symptoms of lung cancer survivors.Link_to_subscribed_fulltex

Exchange Rate Volatility and the Timing of Foreign Direct Investment: Market-Seeking versus Export-Substituting

This paper examines the impact of exchange rate uncertainty on the timing of foreign direct investment (FDI) with heterogeneous investing motives. We first extend Dixit-Pindyck's real options model to show that while an increase in exchange rate volatility tends to delay FDI of a market-seeking firm, it might accelerate FDI of an export-substituting firm if the firm's degree of risk aversion is high enough. The rationale behind this finding is that a market-seeking FDI might increase the exposure of the firm's profits to exchange rate risk, while an export-substituting FDI might reduce it. Empirical evidence from a survival analysis based on firm-level data on the entry by Taiwanese firms into China over the period between 1987 and 2002 is consistent with the theory. These results reveal that the relationship between exchange rate uncertainty and FDI is crucially dependent on the motives of the investing firms. Copyright (C) 2010 Blackwell Publishing Ltd.

Effects of physical activity on the quality of life in Taiwanese lung cancer patients receiving active treatment or off treatment

BACKGROUND:: Lung cancer is the leading cause of cancer deaths in the world. Physical activity can enhance the quality of life (QOL) of cancer patients. However, the best timing according to cancer therapy to implement physical activities for lung cancer patients is not yet clear. OBJECTIVE:: The purpose of our study was to examine the relationship between physical activity and QOL in different cancer-treatment periods among lung cancer patients. METHODS:: This study used a cross-sectional design. Instruments included the Functional Assessment of Cancer Therapy-Lung Cancer and the Godin Leisure-Time Exercise Questionnaire. RESULTS:: In total, 185 patients participated in this study, and results showed that only 25% of participants achieved recommended physical-activity guidelines. Of all patients, 50.3% engaged in light physical activity, such as walking. During active-treatment periods, lung cancer patients who engaged in light or moderate activity had significantly higher scores for the overall QOL than did those who were completely sedentary. However, during off-treatment periods, there were no significant differences in the overall QOL with different activity levels. CONCLUSIONS:: The QOL may be improved by engaging in light or moderate physical activity during active-treatment periods among lung cancer patients. IMPLICATIONS FOR PRACTICE:: It is important for healthcare providers to consider promoting physical activity based on different cancer treatments to improve the QOL of Taiwanese lung cancer patients. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.Link_to_subscribed_fulltex

The effects of hospice-shared care for gastric cancer patients.

Hospice care has been proved to result in changes to the medical behaviors of terminally ill patients. The aim of this study was to evaluate the effects and medical behavior changes of hospice-shared care intervention among terminally ill gastric cancer patients.A total of 174 patients who died of gastric cancer between 2012 and 2014 were identified. These patients were divided into two groups: a hospice-shared care group (n = 93) and a control group (n = 81).Among the 174 patients, 84% had advanced stage (stage III or stage IV) cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001) and those cared by other physicians (63% vs 41%, p = 0.004). Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, p<0.001), intubation (1% vs 27%, p<0.001), cardiopulmonary-cerebral resuscitation (0% vs 11%, p = 0.001), ventilator use (1% vs 27%, p<0.001), inotropic agent use (8% vs 46%, p<0.001), total or partial parenteral nutrition use (38% vs. 58%, p = 0.029), and blood transfusion (45% vs 74%, p<0.001). Besides, the hospice-shared care group had a higher percentage of palliative treatments than the control group, including signed Do-Not-Resuscitate (DNR) orders (95% vs 37%, p<0.001), receiving home hospice care (16% vs 1%, p<0.001), and indicating home as the realistically preferred place of death (41% vs 19%, p = 0.001). The hospice ward admission rate in the hospice-shared care group increased from 30% to 53% from 2012 to 2014.The use of hospice-shared care for gastric cancer patients could increase the rate of signed DNR orders, decrease the use of life sustaining and aggressive/palliative treatments, and improve quality of life

Prognostic factors of patients with gastroenteropancreatic neuroendocrine neoplasms

There is an increasing trend in the incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) worldwide. The aim of the present study was to identify the prognostic factors of patients with GEP-NENs. A cross-sectional, retrospective chart review study was conducted among patients with pathologically proven GEP-NENs between January 2003 and December 2016 at Kaohsiung Chung-Gung Memorial Hospital. A total of 97 patients who met the inclusion criteria were included (male/female = 56/41, age: 57.7 ± 15.4 years). The presentation, clinical characteristics, and disease outcomes were reviewed and analyzed. The most common primary site of the GEP-NENs was the rectum (49.5%), followed by the pancreas (17.5%), duodenum (11.3%), stomach (10.3%), colon (6.2%), and appendix (5.2%), and most GEP-NENs were hormonally nonfunctional (94.8%). There were 56 tumors classified as G1 neuroendocrine tumors (NETs), 9 as G2 NETs, and 14 as G3 neuroendocrine carcinoma (NEC). Metastasis was found in 15 patients (15%). Curative treatments, such as surgery or endoscopic resection, were performed in 83.5% of patients (n = 81). The mean overall survival duration was 107.2 ± 7.8 months. The estimated 3- and 5-year overall survival rates for all patients were 84% and 82%, respectively. Logistic regression analysis showed that large tumor size, non-rectal NENs, high histopathological grading, lymphatic metastases and distant metastases were associated with poor survival. This study suggested that the presence of lymphatic or distant metastases at diagnosis is an independent risk factor for poor prognosis in patients with GEP-NENs. Keywords: Gastroenteropancreatic neuroendocrine tumors, Clinical outcome, Prognostic factor