Browsing Over 908 Presentations
471P - Factors influencing late presentation for treatment, palliative care services among cancer patients attending Hospice Africa Uganda (HAU) (ID 805)
- N. Bandese
- N. Bandese
Abstract
Background
Hospice Africa Uganda has three branches, Mobile Hospice Mbarara, Hospice Kampala, and Little Hospice Hoima project to help patients get treatment for cancer (palliative care). In view of this we aimed to find out the factors which influence their late presentation at Hospitals. The World Health Organization (2015) has reported that cancer is the second most common cause of death and was responsible for over 25000 deaths in 2015, approximately 80% occurring in developing countries. It was projected that thiswill increase by 25% over the next 10 years if nothing is done such as putting adequate screening, treatment and prevention measures in place.
Methods
The study took place across the three sites of Hospice Africa Uganda. It has cared for about 70500 patients of which 55300 are cancer patients. A qualitative study was used to interview the patients so as to get a deep understanding of the reasons why patients with cancer present late for treatment at regional hospitals and national referral hospitals. Using the semi structured questionnaire guided the interviewers because it helped the patients to discuss freely the reasons why they report late. Then, data was transcribed and analyzed. A report was written and shared with the team of Hospice Africa Uganda across the three branches. These patients were interviewed at the three sites of hospice because come for the palliative care and during the outreach only patients with cancer were elegible for the study. The researchers used local language during the interviews since the majority of patients are more fluent in local language than English. A recording tape was used to store all the discussions for flexibility.
Results
Of theses patients, 68.5% did not have financial support to carry out early investigation, were peasant farmers, with little knowledge of cancer,17.9% had the financial support but were lazy to go to the hospital for checkup.14.3% did not give clear reason, while others were coming far away from the health units.
Conclusions
There is a very big role for the government, and health workers to sensitize the public, set up more health facilities and train more healthcare workers.
Legal entity responsible for the study
Hospice
Funding
None
Disclosure
All authors have declared no conflicts of interest.
273P - Prognostic significance of pre- to postoperative dynamics of prognostic nutritional index in patients with renal cell carcinoma who underwent radical nephrectomy (ID 1198)
- M. Kang
- M. Kang
- H. Sung
- H. Jeon
- B. Jeong
- S. Seo
- S. Jeon
- H. Choi
- H. Lee
Abstract
Background
Prognostic nutritional index (PNI), based on serum lymphocyte counts and albumin levels, has been introduced as a simple and easily measurable biomarker, representing the nutritional and immunological status of cancer patients. However, the nutritional and inflammatory conditions can be different between pre- and post-operative statuses because of eradication of primary tumors, and major surgeries can influence the general condition and immune reaction of a host. Here, we aimed to examine the prognostic role of prognostic nutritional index (PNI) dynamics in the pre- and postoperative periods in patients with renal cell carcinoma (RCC) who underwent radical nephrectomy (RN).
Methods
We analyzed 324 patients with RCC who underwent RN. Overall population was classified into 4 groups according to 4 types of pre- to postoperative PNI dynamics as follows: Group 1 (low → low PNI), 2 (low → high PNI), 3 (high → low PNI) and 4 (high → high PNI). The level of PNI was calculated using the following formula: 10 × serum albumin level (g/dL) + 0.005 × absolute lymphocyte counts in blood (/mm3). Primary and secondary endpoints were cancer-specific survival (CSS) and overall survival (OS), respectively.
Results
Patients with higher pre- and postoperative PNI (> 45) had better survival outcomes than those with lower pre- and postoperative PNI (≤ 45). Notably, patients in Group 4 showed the best CSS and OS rates, whereas patients in Group 1 had the worst survival outcomes. Furthermore, PNI dynamics was identified as an independent predictor for CSS and OS outcomes, in addition to pre- and postoperative PNI, tumor size, and pathologic T (pT) stage. Patients with localized RCC (≤ pT2) showed significant differences in both CSS and OS estimates, while patients with advanced pT stage (≥ pT3) demonstrated a difference only in OS outcomes, according to PNI dynamics.
Conclusions
In summary, PNI dynamics in pre- and postoperative status was identified as a valuable predictor of survival outcomes in patients with RCC undergoing RN. Our study is the first that provides the independent prognostic importance of dynamics of nutritional status for patients with RCC.
Legal entity responsible for the study
Samsung Medical Center, Sungkyunkwan University School of Medicine.
Funding
Korea Health Industry Development Institute (KHIDI)
Disclosure
All authors have declared no conflicts of interest.
89TiP - KEYNOTE-355: Randomized, double-blind, phase III study of pembrolizumab (pembro) + chemotherapy (chemo) vs placebo (pbo) + chemo for previously untreated, locally recurrent, inoperable or metastatic triple-negative breast cancer (mTNBC) (ID 1242)
- J. Cortes Castan
- J. Cortes Castan
- Z. Guo
- V. Karantza
- G. Aktan
Abstract
Background
Pembro monotherapy demonstrated promising antitumor activity and acceptable safety in pretreated patients (pts) with PD-L1+ mTNBC in the phase Ib KEYNOTE-012 study. The addition of pembro to chemo may enhance antitumor activity. KEYNOTE-355 is a global phase III study comparing pembro + chemo to PBO + chemo in pts with locally recurrent, inoperable, and previously untreated TNBC/mTNBC.
Trial design
Eligible pts are ≥18 y, have centrally confirmed, locally recurrent inoperable TNBC or mTNBC not treated previously with chemo (prior [neo]adjuvant chemo allowed); measurable disease per RECIST v1.1; ECOG PS 0-1; ≥6 mo between definitive breast surgery or last dose of adjuvant chemo (whichever was last) and first disease recurrence (≥12 mo if prior treatment with same-class agent). Part 1 is an open-label, unblinded safety run-in of ∼30 pts distributed over 3 arms (pembro + nab-paclitaxel, pembro + paclitaxel, pembro + gemcitabine/carboplatin). Part 2 is a double-blind, PBO-controlled study of ∼828 pts randomized 2:1 to pembro 200 mg Q3W + chemo (nab-paclitaxel 100 mg/m2 on d 1, 8, and 15 every 28 d; paclitaxel 90 mg/m2 on d 1, 8, and 15 every 28 d; or gemcitabine 1000 mg/m2 + carboplatin AUC 2 on d 1 and 8 every 21 d) or PBO + chemo. Crossover is not allowed. Stratification factors are study chemo (taxane vs gemcitabine/carboplatin), prior therapy with same-class agent in (neo)adjuvant setting (yes/no), and tumor PD-L1 expression (+/-). Treatment will occur for ≤35 administrations (pembro/PBO only) or until confirmed disease progression, unacceptable toxicity, decision to discontinue, or withdrawal of consent. Primary end points are safety in part 1 and PFS (by RECIST v1.1, central radiology review) and OS in part 2. Secondary end points include ORR (by RECIST v1.1, central radiology review) and duration of response. AEs will be graded per NCI CTCAE v4.0. Responses will be assessed at wk 8, 16, 24, then at 9-wk intervals up to 1 y, and 12-wk intervals thereafter. An interim safety analysis will occur in part 1 after pts complete 1 treatment cycle.
Clinical trial identification
NCT02819518.
Legal entity responsible for the study
Merck & Co., Inc., Kenilworth, NJ, USA
Funding
Merck & Co., Inc., Kenilworth, NJ, USA
Disclosure
J. Cortes Castan: Advisory board: Roche, Celgene, AztraZeneca, Cellestia Biotech, and Biothera Honoraria: Roche, Novartis, Eisai, Celgene, Pfizer, Z. Guo, V. Karantza: Employment and stock ownership: Merck & Co., Inc. G. Aktan: Employment and stock ownership: Merck & Co., Inc. Travel expenses: Merck & Co., Inc.
Immune and neoantigen profiling in lung cancer (ID 700)
- S. Quezada
- S. Quezada
LBA3_PR - Randomized, non-inferiority, phase III trial of second-line chemotherapy for metastatic colorectal cancer (mCRC), comparing the efficacy and safety of XELIRI + bevacizumab versus FOLFIRI + bevacizumab (AXEPT) (ID 1728)
- T. Kim
- T. Kim
- Y. Park
- K. Muro
- R. Xu
- S. Han
- K. Yamazaki
- W. Wang
- J. Ahn
- H. Uetake
- Y. Deng
- S. Cho
- H. Matsumoto
- Y. Ba
- K. Lee
- T. Nishina
- T. Zhang
- S. Iwasa
- S. Morita
- J. Sakamoto
Abstract
Background
Capecitabine and irinotecan combination (XELIRI) regimen has not been recommended by major guidelines due to substantial toxicities. Recently, modified XELIRI (irinotecan 200 mg/m2 on day 1, capecitabine 1600 mg/m2 on days 1–14 every 3 weeks: mXELIRI) has shown favorable tolerability and efficacy with or without bevacizumab (BEV). We conducted “Asian XELIRI ProjecT” (AXEPT) to demonstrate the OS non-inferiority of XELIRI±BEV versus standard FOLFIRI±BEV as second-line chemotherapy for mCRC.
Methods
Patients with histologically confirmed mCRC, ECOG performance status (PS) 0–2, and disease progression or intolerance of the first-line regimen were eligible. Patients were randomized (1:1) to receive standard FOLFIRI±BEV (5 mg/kg on day 1), repeated every 2 weeks (FOLIRI arm) or mXELIRI±BEV (7.5 mg/kg on day 1) repeated every 3 weeks (mXELIRI arm). A total of 464 events were estimated as necessary to show OS non-inferiority with a power of 80% at a one-sided α of 0.025, requiring a target sample size of 600 patients. The 95% confidence interval upper limit of the hazard ratio was pre-specified as less than 1.3. Stratification factors included country, ECOG PS, number of metastatic sites, prior oxaliplatin treatment, and concomitant BEV treatment.
Results
Between Dec 2013 and Aug 2015, 650 patients were enrolled and randomized either to receive mXELIRI±BEV (n = 326) or FOLFIRI±BEV (n = 324). After a median follow-up of 15.8 months (IQR; 8.7–24.9), median overall survival was 16.8 months in the mXELIRI arm and 15.4 months in the FOLFIRI arm (HR 0.85, 95% CI 0.71–1.02, non-inferiority test p < 0.0001). Overall, the incidence of grade 3/4 adverse events with mXELIRI was significantly lower than that with FOLFIRI (53.9% vs 72.3%; p < 0.0001). The most common grade 3/4 adverse event was neutropenia 16.8% and 42·9% patients in mXELIRI and FOLFIRI ams, respectively; p < 0·0001). The incidences of grade 3/4 diarrhea were low in both arms (7.1% vs 3.2%; p = 0.0443).
Conclusions
mXELIRI±Bev is well-tolerated and non-inferior to FOLFIRI±Bev in terms of OS. mXELIRI could be an alternative to FOLFIRI as a standard second-line backbone treatment for mCRC.
Clinical trial identification
NCT01996306; UMIN000012263
Legal entity responsible for the study
This trial is supported by Epidemiological and Clinical Research Information Network (ECRIN: global sponsor).
Funding
This trial was funded by Chugai Pharmaceutical Co., Ltd. and F. Hoffmann-La Roche Ltd.
Disclosure
T.W. Kim: Research Fund: Roche, Merck Serono, Bayer. K. Muro: Research grants from MSD, Daiichi Sankyo, Ono, Shionogi, Kyowa Hakko Kirin, and Gilead Sciences, and also honoraria from Chugai, Takeda, Eli Lilly, Merck Serono, Taiho, and Yakult. K. Yamazaki: Honoraria: Takeda, Chugai, Taiho, Yakult, Merck Serono, Bristol Myers Squib, Lily, Sanofi, S. Morita: Honoraria from Chugai and Daiichi-Sankyo. All other authors have declared no conflicts of interest.
529P - Association between illness perception and health related quality of life in Indonesian cancer patients (ID 1887)
- A. Vatvani
- A. Vatvani
- C. Gunawan
- K. Waren
- A. Kurniawan
Abstract
Background
People that are diagnosed with cancer respond to the illness and medical care in their own way. Patient’s illness perception may have an effect on the mental health and on how they deal with medical conditions. Knowledge on illness perception and quality of life (QOL) can help the cancer patients to cope more effectively. In developing countries, there is very limited information about perception of cancer patients towards their condition. The aim of this study is to identify the association between illness perception and health related quality of life in Indonesian cancer patients.
Methods
This study is a cross sectional study that took place in Siloam General Teaching Hospital located in a suburban area of Tangerang. This study took place from July 2016 to January 2017. The samples included in this study were adult solid cancer patients. Health related QOL was measured using EORTC QLQ-C30. Illness perception was measured using Brief Illness Perception Questionnaire (B-IPQ). Analysis was done using Pearson or Spearman correlation.
Results
From total 56 patients, 50 (89.3%) were female. The mean age of the patients was 48.6 (±10.9) years. Breast cancer was the most common type of cancer (76.7%), followed by adenocarcinoma of the colon (8.9%). The emotional representation subscale has significant correlation with global health status (r = -0.268;
Conclusions
Several subscales of illness perception had significant association with health related QOL. The knowledge about the relation between illness perception and QOL will allow the development of strategies in order to improve the global health status and functioning of solid cancer patients in our centre.
Legal entity responsible for the study
Faculty of Medicine, Pelita Harapan University
Funding
None
Disclosure
All authors have declared no conflicts of interest.
311P - Efficacy and feasibility of paclitaxel and carboplatin-based concurrent chemoradiotherapy for patients with advanced cervical cancer with renal dysfunction (ID 1603)
- N. Kamiya
- N. Kamiya
- Y. Imai
- M. Asai-Sato
- Y. Ota
- Y. Suzuki
- N. Ruiz-Yokota
- T. Matsunaga
- E. Miyagi
Abstract
Background
Concurrent chemoradiotherapy (CCRT) with cisplatin is widely recommended as a treatment option for patients with advanced cervical cancer because of its better prognosis than radiotherapy. However, cisplatin should be reluctantly avoided or reduced for patients with renal dysfunction because of nephrotoxicity. In contrast, carboplatin is adjusted to a dose according to renal function, to insure safety independent of renal function. Here we evaluated the efficacy and feasibility of CCRT with paclitaxel and carboplatin (TC) for patients with advanced cervical cancer with renal dysfunction.
Methods
We retrospectively analyzed the safety and efficacy of TC-CCRT for 11 patients with advanced cervical cancer with renal dysfunction between December 2015 and May 2017 in our hospital (TC-group). Patients who underwent radiotherapy alone between January 2012 and December 2015 (RT-group, n = 15) because of renal dysfunction served as historical controls. Chemotherapy using 135 mg/m2 paclitaxel followed by carboplatin with a dosage at area under the curve = 5 mg/ml/min was given every 3 weeks. Three cycles, maximum, were expected. Radiotherapy of both groups was performed using whole pelvic external irradiation and brachytherapy.
Results
The TC group received triweekly chemotherapy (average 2.4 cycles). All patients received the planned full radiation. Radiotherapy was temporarily discontinued for two patients (18.2%) in the TC-group and for one patient (6.7%) in the RT group because of toxicity. The TC-group required 6.0 days (average) extended radiation therapy, which was not significantly longer than the RT-group (7.0 days). The rates of local complete response did not differ significantly between groups (90.9% vs 86.7%).
Conclusions
TC–CCRT for patients with advanced cervical cancer with renal dysfunction was safe, with minimal postponement of radiotherapy because of toxicity, suggesting that this therapy is effective. The advantage of TC–CCRT for increasing survival compared with RT or CCRT using reduced doses of cisplatin is further evaluated.
Legal entity responsible for the study
Yokohama City University Hospital, Department of Obstetrics and Gynecology
Funding
None
Disclosure
All authors have declared no conflicts of interest.
129P - Outcomes and prognostic factors in re-irradiation of intracranial gliomas: Single institution experience (ID 1144)
- S. Paul
- S. Paul
- N. Sesikeran
- V. Reddy
- K. Bhattacharyya
- S. Ahmed
- R. Patlola
- P. Upadhyay
- V. Reddy
- K. Mohanti
- S. Reddy
Abstract
Background
The treatment options for recurrent gliomas are limited. Re-irradiation is being increasingly considered as an option, in view of the advances in treatment techniques, the ability to document doses and overlay plans. However, there is lack of data on outcomes, cumulative doses and prognostic factors in re-irradiation of gliomas. This study attempts to collate a single institutions’ data on re-irradiation of gliomas.
Methods
This is a retrospective analysis of outcomes and prognostic factors in re-irradiation of intracranial gliomas. All patients of gliomas who received re-irradiation between January 2012 to January 2017 were included. Medical records were evaluated to collect data on outcomes of 22 patients treated in a single institution. Survival curve was estimated using Kaplan maier method. Pearsons correlation co-efficient was used to identify factors correlating with better survival.
Results
Median age of patients undergoing re-irradiation was 45yrs (8-66yrs), of which 59% were female, 41% male. The histopathological diagnosis at initial radiation was predominantly grade2 (50%) and grade 3 (31.8%), only 18.1% were glioblastomas. However, at the time of re-irradiation, most common diagnosis was grade 3 glioma (40.9%). Glioblastomas were 36.3%, grade 2 gliomas were 18.1% and 4.5% did not undergo biopsy or surgery at recurrence. Median cumulative dose in 2Gy equivalent – NTD (Normalized Total Dose) was 108Gy (94Gy – 120Gy). Re-irradiation was delivered at standard fractionation in all except one patient, who received hypofractionated dose of 3.5Gy per fraction. Median time interval between the two courses of radiation was 38 months (12-360 months). All patients received IMRT, image guidance. Median re-irradiation volume was 405cc. ROC curve was generated, which showed thatcummulative dose of 115Gy and above was associated with better survival. There were no reported cases of symptomatic brainnecrosis. Median survival was 24 months following re-irradiation. Among the various prognostic factors tested, tumor volume at the time of re-irradiation was the only factor which correlated with survival.
Conclusions
Re-irradiation of gliomas should be considered a valid option in select cases, particularly in small volume recurrences. IMRT with image guidance with conventional fractionation upto total cumulative dose of 115Gy can be considered safe.
Legal entity responsible for the study
Department of Radiation Oncology, Apollo Cancer Institute, Hyderabad
Funding
None
Disclosure
All authors have declared no conflicts of interest.
Local treatment and surgery after neo-adjuvant therapy (ID 733)
- P. Rutkowski
- P. Rutkowski
Introduction to ESMO Guidelines (ID 2229)
- G. Pentheroudakis
- G. Pentheroudakis
564P - The impact of cancer location and periodontal condition on osteonecrosis of the jaw: A population-based study (ID 1139)
- Y. Huang
- Y. Huang
- C. Chang
- S. Liu
- C. Muo
Abstract
Background
Similar genotoxic factors develop osteonecrosis of the jaw (ONJ) and periodontitis in cancer patients, the etiopathogenetic link between these two diseases is controversial. The aims of this study were to investigate the impact of periodontal condition on ONJ occurrence among different cancer locations.
Methods
8,234 ONJ patients and 32,912 age- and gender-matched comparisons were collected from malignancy patients, the longitudinal health insurance database was derived from National Health Insurance of Taiwan from 2000 to 2010. The population was subdivided into groups based on different cancer location, severity of periodontitis and dental care. Chi-square test was used to test the difference of demographic characteristics and medical history between ONJ and comparison group. Multivariable logistic regression analysis performed by the SAS software version 9.4 was used to assess the association between ONJ and ONJ -associated risk factor.
Results
The lip, oral cavity, and pharynx malignancy had the highest ONJ risk (adjusted OR, 5.45; 95% CI, 4.69–5.45) among all cancer locations. There was a positive correlation between periodontal condition and ONJ. Patients with serious periodontitis had 3.52-fold risk to develop ONJ (95% CI, 2.80–4.42) than those who had no periodontitis; patients with good dental care had lower ONJ risk than those with poor dental care (trend test
Conclusions
This study revealed the close association between ONJ and different cancer locations. There is strong correlation between periodontal condition and the risk of ONJ. According to the linear relationship between severity periodontitis and ONJ, the severity of periodontitis might be regarded as the predicting target for ONJ incidence among the most of cancer patients in clinic. Poor dental care population had higher incidence of ONJ and we could speculate the good dental care might be the supreme principle to prevent the ONJ in cancer patients. That the periodontal condition and cancer location significantly impact on the risk of ONJ after the BPs used was adjusted, and highlighted the importance of dental care for preventing ONJ in cancer patients.
Legal entity responsible for the study
This study was approved by the Institutional Review Board in China Medical University Hospital.
Funding
This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW105-TDU-B-212-133019), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10501010037), NRPB Stroke Clinical Trial Consortium (MOST 104-2325-B-039-005), Chang Gung Memorial Hospital (CMRPG3E1341), Far Eastern Memorial Hospital (FEMH-2016-C-036), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.
Disclosure
All authors have declared no conflicts of interest.
354P - Study of immunohistochemical expression of VEGF and its association with HPV E6 And E7 oncoproteins in oral and oropharyngeal squamous cell carcinoma (ID 1115)
- A. Sharma
- A. Sharma
- K. Agarwal
- S. Agarwal
- S. Kumar
- A. Bharti
Abstract
Background
HPV infection is now established as a major etiologic factor for oropharyngeal cancer. E6 and E7 oncogenes of high risk HPV are known to stimulate angiogenesis by inducing the expression of Vascular Endothelial Growth Factor (VEGF). VEGF plays a central role in regulating angiogenesis and vasculogenesis in solid tumors and is tightly associated with the angiogenic switch. There is paucity of studies related to immunohistochemical expression of VEGF and its association with E6 and E7 oncoproteins of human papillomavirus in patients of oral and oropharyngeal carcinoma. Hence the purpose of this study is to find out and establish any correlation, if proven may be helpful in better management.
Methods
This study is a Hospital based descriptive observational cross sectional study conducted in the Department of Pathology in collaboration with Department of Otorhinolaryngology, Lady Hardinge Medical College and Associated hospitals, New Delhi and Institute of Cytology and Preventive Oncology (I.C.M.R.), Noida. 80 newly diagnosed histollogically proven cases of oral or oropharyngeal squamous cell carcinoma from November 2014 to March 2016 were included in the study after taking their consent. Tissue received from ENT department was fixed and processed. IHC for VEGF was put in LHMC and IHC for E6 and E7 was put in ICPO, Noida.
Results
85% OSCC cases showed increased VEGF expression. 37.5% cases showed positivity for E6 (HPV16/18), 26.25% for E7 (HPV 16) and 20% for E7 (HPV 18) oncoprotein expression.
Conclusions
Increased VEGF expression was seen in tumor compared to dysplasia which was statistically significant (p = 0.004). No correlation was found between VEGF expression and age, gender, addiction, tumor size, lymph node staging, TNM staging. VEGF expression decreased significantly from well differentiated to moderately differentiated to poorly differentiated OSCC (p = 0.031). No difference was found in the VEGF expression between E6 (HPV 16/18) positive and negative, E7 (HPV 16) positive and negative and E7 (HPV 18) positive and negative OSCC cases.
Legal entity responsible for the study
Central Government of India
Funding
None
Disclosure
All authors have declared no conflicts of interest.