American Journal of Clinical Oncology最新文献

{"title":"Outcomes of Immune Checkpoint Inhibitor-related Diarrhea or Colitis in Cancer Patients With Superimposed Gastrointestinal Infections.","authors":"Weijie Ma,&nbsp;Zimu Gong,&nbsp;Hamzah Abu-Sbeih,&nbsp;Yuanzun Peng,&nbsp;Frederick Peng,&nbsp;Fangwen Zou,&nbsp;Aline Charabaty,&nbsp;Pablo C Okhuysen,&nbsp;Jennifer L McQuade,&nbsp;Mehmet Altan,&nbsp;Hao Chi Zhang,&nbsp;Anusha S Thomas,&nbsp;Yinghong Wang","doi":"10.1097/COC.0000000000000841","DOIUrl":"https://doi.org/10.1097/COC.0000000000000841","url":null,"abstract":"<p><strong>Background and objective: </strong>Immune-mediated diarrhea and colitis (IMDC) is a common adverse event in cancer patients receiving immune checkpoint inhibitors (ICIs). Gastrointestinal (GI) infections can co-occur with IMDC, and its impact on the course and outcome of IMDC remains unclear.</p><p><strong>Patients and methods: </strong>We retrospectively reviewed cancer patients who received ICIs and developed IMDC between January 2015 and September 2019. GI multiplex panel is used to assess GI infection. The study group included patients with positive infection except those who are only positive for Clostridioides difficile or cytomegalovirus. The control group is IMDC patients with negative infection using frequency matching. Patients' disease course and outcome were compared between groups.</p><p><strong>Results: </strong>A total of 72 patients with IMDC were included: 22 in the study group and 50 as control. Escherichia coli of different pathotypes was observed in 17 patients. Five patients had viral infections, for example, adenovirus, norovirus, and sapovirus. Patients with GI infections more frequently had grade 3 or 4 colitis (43% vs. 18%, P=0.041). Overall, GI infections were not associated with different risks of IMDC recurrence or overall survival. Antibiotics treatment did not affect the requirement for infliximab or vedolizumab but relate to a higher risk of IMDC recurrence (50.0% vs. 0.0%, P=0.015).</p><p><strong>Conclusions: </strong>In our study, concomitant GI infections are associated with more severe symptoms in IMDC patients. Antimicrobial treatment did not circumvent the need for immunosuppressive therapy for IMDC or improve the clinical outcome. Concomitant GI infection was not associated with a higher risk of IMDC recurrence or poor overall survival.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"402-408"},"PeriodicalIF":2.6,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39078765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Outcomes of Eosinophilic Colitis in Patients With Cancer.","authors":"Shruti Khurana,&nbsp;Hamzah Abu-Sbeih,&nbsp;Weijie Ma,&nbsp;Wei Qiao,&nbsp;Wai Chin Foo,&nbsp;David M Richards,&nbsp;Anusha S Thomas,&nbsp;Anam Khan,&nbsp;Hao Chi Zhang,&nbsp;Yinghong Wang","doi":"10.1097/COC.0000000000000838","DOIUrl":"https://doi.org/10.1097/COC.0000000000000838","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic colitis (EoC) is a rare form of eosinophilic gastrointestinal disease characterized by diffuse eosinophilic infiltration in the deep lamina propria of colonic mucosa. The pathophysiology is unclear, but EoC has been associated with multiple known risk factors.</p><p><strong>Aim: </strong>The aim of this study was to characterize the clinical characteristics and disease course of patients with EoC at a major cancer center.</p><p><strong>Material and methods: </strong>We retrospectively reviewed colonic samples obtained between January 2000 and December 2018 from our institutional database and included cases with significant colonic eosinophilia. Baseline clinical data and EoC-related clinical course and outcomes were documented.</p><p><strong>Results: </strong>Forty-one patients were included. One fourth had coexisting autoimmune conditions. Seventy-eight percent had a cancer diagnosis. Half the patients received chemotherapy, with a median duration of 180 days between chemotherapy and EoC onset. Symptoms were present in 76% of patients. Diarrhea was more prevalent in patients who received chemotherapy (85% vs. 42%). Median duration of EoC symptoms was 30 days in patients with cancer and 240 days in those without cancer (P=0.03). Most patients (88%) had normal colonoscopy findings. Fifteen percent of patients required hospitalization. All-cause mortality was 37%, mostly related to underlying malignancy and organ failure.</p><p><strong>Conclusions: </strong>EoC in cancer patients appears to have more diarrhea-predominant symptoms, particularly in patients receiving chemotherapy, but a shorter disease duration compared with patients without cancer. Hospitalization can be required for serious cases. Treatment may be reserved for patients requiring symptom management, as most patients with EoC have good clinical outcomes regardless of treatment.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"395-401"},"PeriodicalIF":2.6,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39065512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world Patterns of Adjuvant Chemotherapy Following Neoadjuvant Chemoradiation for Patients With Resected Rectal Adenocarcinoma.","authors":"Omar Abdel-Rahman,&nbsp;Karen King,&nbsp;Andrew Scarfe","doi":"10.1097/COC.0000000000000834","DOIUrl":"https://doi.org/10.1097/COC.0000000000000834","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to analyze patterns of adjuvant chemotherapy among patients with resected rectal adenocarcinomas following neoadjuvant chemoradiation and surgical resection.</p><p><strong>Methods: </strong>Alberta Cancer Registry and other provincial electronic medical registries (2004 to 2018) identified patients with nonmetastatic rectal cancer who received neoadjuvant chemoradiation followed by surgical resection and either oxaliplatin-based or fluoropyrimidine-only adjuvant chemotherapy. Multivariable logistic regression analysis was then undertaken to identify factors associated with the use of either regimen. Kaplan-Meier survival estimates were used to compare overall survival between both groups and multivariable Cox regression analysis was then used to identify factors associated with worse overall survival.</p><p><strong>Results: </strong>A total of 532 patients who fulfilled eligibility criteria were included in the current study: 347 patients received adjuvant fluoropyrimidine-only chemotherapy and 185 patients received adjuvant oxaliplatin-based chemotherapy. The following variables were associated with use of fluoropyrimidine-only adjuvant chemotherapy: older age (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.02-1.06), higher Charlson comorbidity index (OR: 1.47; 95% CI: 1.00-2.15), and no involved lymph nodes in the surgical pathology (OR: 5.55; 95% CI: 3.66-8.41). Using Kaplan-Meier survival estimates, no difference in overall survival between patients treated with adjuvant oxaliplatin-based chemotherapy and those treated with adjuvant fluoropyrimidine-only chemotherapy was identified (P=0.152). Within multivariable Cox regression analysis, type of chemotherapy was not associated with a difference in overall survival (hazard ratio for fluoropyrimidine-only chemotherapy vs. oxaliplatin-based chemotherapy: 1.02; 95% CI: 0.61-1.71).</p><p><strong>Conclusion: </strong>Oxaliplatin-based adjuvant chemotherapy is not associated with improved survival outcomes compared with fluoropyrimidine-only chemotherapy in this real-world study.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"383-387"},"PeriodicalIF":2.6,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38964280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management Strategies for Patients With Epithelioid Hemangioendothelioma: Charting an Indolent Disease Course.","authors":"Ilana R Yurkiewicz,&nbsp;Maggie Zhou,&nbsp;Kristen N Ganjoo,&nbsp;Gregory W Charville,&nbsp;Sanjana Bolleddu,&nbsp;Marti Lohman,&nbsp;Nam Bui","doi":"10.1097/COC.0000000000000827","DOIUrl":"https://doi.org/10.1097/COC.0000000000000827","url":null,"abstract":"<p><strong>Background: </strong>Epithelioid hemangioendothelioma (EHE) is a malignant vascular neoplasm representing ∼1% of sarcomas. Due to its rarity, its clinical course is not well characterized and optimal treatment remains unknown.</p><p><strong>Materials and methods: </strong>This was a retrospective review of patients with EHE treated at Stanford University between 1998 and 2020. Demographic characteristics, pathology results, treatment modalities, and clinical outcomes were collected from the electronic medical records.</p><p><strong>Results: </strong>A total of 58 patients had a mean age of 50.6 years and a slight female predominance (52%). Primary disease sites were liver (33%), soft tissue (29%), lung (14%), bone (9%), and mediastinum (9%). A majority (55%) had advanced or metastatic disease. Median overall survival (OS) was 16.9 years, with OS 89% at 1 year, 68% at 5 years, and 64% at 10 years. The longest median OS was associated with soft tissue sites and shortest with lung and mediastinal disease (P=0.03). The localized disease had improved median OS compared with metastatic disease (P=0.02). There was no OS difference between tumors >3 cm and those equal or smaller (P=0.85). Surgery was a common treatment (71%), while radiation and ablation were sometimes used (28% and 9%, respectively). The median time to initiating therapy of any kind was 68 days. The median time to systemic therapy was 114 days.</p><p><strong>Conclusions: </strong>We report on the clinical characteristics and outcomes of patients with EHE at a large academic center. Treatment options included surgical excision, liver transplant, ablation, radiation, and systemic therapy. A subset of patients had indolent disease not requiring treatment upfront.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"419-422"},"PeriodicalIF":2.6,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39013360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is There a Role for Perioperative Pelvic Radiotherapy in Surgically Resected Stage IV Rectal Cancer?: A Propensity Score-matched Analysis.","authors":"Jeanny Kwon,&nbsp;Jun-Sang Kim,&nbsp;Byoung Hyuck Kim","doi":"10.1097/COC.0000000000000821","DOIUrl":"https://doi.org/10.1097/COC.0000000000000821","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine whether perioperative pelvic radiotherapy (RT) improves outcomes in stage IV rectal cancer patients treated with primary surgical resection and systemic chemotherapy and to identify predictive factors for selection of patients for these approaches.</p><p><strong>Materials and methods: </strong>We searched the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed between 2010 and 2015 with stage IV rectal cancer, but without brain or bone metastases. After applying the exclusion criteria, a total of 26,132 patients were included in the analysis; propensity score matching was used to balance their individual characteristics.</p><p><strong>Results: </strong>Overall, 3283 (12.6%) patients received perioperative RT; the 3-year overall survival (OS) rates were 43.6% in the surgery group and 50.5% in the surgery with RT group (P<0.001). The survival benefit of RT was maintained after propensity score matching and multivariate adjustment (hazard ratio: 0.70; 95% confidence interval: 0.66-0.81; P<0.001). Interaction testing of the prognostic variables showed a significant interaction between RT and the presence of lung metastasis (P<0.001): the benefit of RT was observed only in patients without lung metastases (3 y OS 52.1% vs. 44.1%, P<0.001), but it was observed regardless of liver metastases. In addition, we developed a web-based calculator (http://bit.do/mRC_surv) to provide individualized estimates of OS benefit based on the receipt of perioperative pelvic RT.</p><p><strong>Conclusions: </strong>Perioperative pelvic RT significantly improved OS rates, especially in patients without lung metastases. We successfully developed a nomogram and web-based calculator that could predict survival benefit with the addition of RT for these patients.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"308-314"},"PeriodicalIF":2.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38945107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Phase II Study of the Combination of Oxaliplatin, Capecitabine, and Trastuzumab and Chemoradiotherapy in the Adjuvant Setting in Operated Patients With HER2-positive Gastric or Gastroesophageal Junction Cancer (TOXAG Study): A Turkish Oncology Group Study.","authors":"Huseyin Abali,&nbsp;Suayib Yalcin,&nbsp;Huseyin C Onal,&nbsp;Faysal Dane,&nbsp;Berna Oksuzoglu,&nbsp;Nuriye Ozdemir,&nbsp;Huseyin Mertsoylu,&nbsp;Mehmet Artac,&nbsp;Celaletdin Camci,&nbsp;Bulent Karabulut,&nbsp;Fatma B Basal,&nbsp;Burcin Budakoglu,&nbsp;Mehmet A N Sendur,&nbsp;Burce Goktas,&nbsp;Fatih Ozdener,&nbsp;Arzu Baygul","doi":"10.1097/COC.0000000000000825","DOIUrl":"https://doi.org/10.1097/COC.0000000000000825","url":null,"abstract":"<p><strong>Background: </strong>Trastuzumab prolonged the overall survival in patients with advanced gastric cancer with human epidermal growth factor receptor 2 (HER2) overexpression in combination with chemotherapy. In this phase II open-label prospective study, the tolerability and safety of trastuzumab with chemotherapy, and chemoradiotherapy for curatively resected patients with HER2-positive gastric carcinoma was investigated.</p><p><strong>Methods: </strong>The patients with HER2-positive gastric, or gastroesophageal junction adenocarcinoma, after gastrectomy plus D2 dissection, were included. They received 3 cycles of oxaliplatin (100 mg/m2 intravenously day 1) plus capecitabine (850 mg/m2 orally days 1 to 14), trastuzumab (8 mg/kg intravenously day 1 in cycle 1, 6 mg/kg thereafter) every 21 days, followed by chemoradiotherapy. Trastuzumab was given for 1 year.</p><p><strong>Results: </strong>Of the 212 patients screened, 35 were eligible, and 34 were treated. The median age was 56 years (minimum to maximum: 35 to 75 y), male patients constituted 73.5% (n=25), and 33 (97.1%) had gastric adenocarcinoma. R0 resection was performed in 30 (88.2%). The majority (26, 61.7%) were in stage III disease. Most of the adverse events were grade I/II, the most frequent grade III side effects were nausea (3, 8.8%), vomiting (3, 8.8%), diarrhea (2, 5.9%), and weight loss (n=2, 5.9%). Two patients died during the first 3 cycles of chemotherapy and chemoradiotherapy; 1 secondary to pulmonary thromboembolism, and the other due to cerebral ischemia. After excluding 2 with early progression and 1 consent withdrawal, of the remaining 31 patients, 28 (90.3%) were able to complete the chemotherapy and chemoradiotherapy part of the trial. After the 25 months follow-up period, 21 patients (61.8%) were alive. Overall survival at 12 and 24 months was 75.0% and 58.0%, while disease-free survival at 12 and 24 months was 65.7% and 55.0%, respectively.</p><p><strong>Conclusions: </strong>Trastuzumab in combination with capecitabine, oxaliplatin following chemoradiotherapy as the adjuvant therapy for gastric or gastroesophageal junction adenocarcinoma was considered as safe and tolerable. The frequency of HER2 overexpression in curatively resected patients is comparable to that in patients with metastatic disease (trial registration: clinicaltrials.gov the identifier: NCT01748773, December 13, 2012, https://clinicaltrials.gov/ct2/show/NCT01748773).</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"301-307"},"PeriodicalIF":2.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38974119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Factors of Second-line Immune Checkpoint Inhibitors in Patients With Advanced-stage Non-Small Cell Lung Cancer: A Multicenter, Retrospective Study.","authors":"Jiyeon Roh,&nbsp;Jung Seop Eom,&nbsp;Min Ki Lee,&nbsp;Jehun Kim,&nbsp;Taewon Jang,&nbsp;Seong Hoon Yoon,&nbsp;Choon-Hee Son,&nbsp;Hyun-Kyung Lee,&nbsp;Hyun-Kuk Kim,&nbsp;Shin Yup Lee,&nbsp;Kyeong Choel Shin,&nbsp;Mi-Hyun Kim","doi":"10.1097/COC.0000000000000828","DOIUrl":"https://doi.org/10.1097/COC.0000000000000828","url":null,"abstract":"<p><strong>Objectives: </strong>Immune checkpoint inhibitors (ICIs) targeting the programmed cell death receptor-1 and its ligand have achieved impressive success in treating patients with advanced-stage non-small cell lung cancer (NSCLC) after failed first-line cytotoxic chemotherapy. However, knowledge on clinical biomarkers that could help select patients who will respond well to second-line ICI therapy is limited.</p><p><strong>Patients and methods: </strong>Medical records of patients with NSCLC treated with first-line platinum-based chemotherapy and subsequent second-line ICI were collected from 6 medical centers between January 2018 and June 2020. Clinical information, pathologic variables, and radiologic findings of the data collected were reviewed. The patients were followed up until the date of the last visit, the death of any cause, or the end of data recording (December 31, 2020).</p><p><strong>Results: </strong>A total of 181 patients with NSCLC were treated with second-line ICI following first-line platinum-based doublet chemotherapy. The median progression-free survival was 2.0 months (interquartile range, 1.0 to 5.5 mo), and the median overall survival was 12.0 months (interquartile range, 6.0 to 20.0 mo). Low body mass index (BMI) was independently associated with progression-free survival (odds ratio [OR], 0.826; 95% confidence interval [CI], 0.723-0.945; P=0.005). Similarly, a low BMI (OR, 0.839; 95% CI, 0.740-0.952; P=0.005) and a high number of metastatic organs (OR, 1.682; 95% CI, 1.156-2.448; P=0.007) were independently associated with the overall survival after second-line ICI therapy.</p><p><strong>Conclusion: </strong>BMI and the number of metastatic sites were significantly associated with second-line ICI therapy outcomes in patients with NSCLC receiving first-line platinum-based chemotherapy.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"356-360"},"PeriodicalIF":2.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39002313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selection of Mediastinal Lymphoma Patients for Proton Therapy Within the Proton Collaborative Group Registry: Concordance With the ILROG Guidelines.","authors":"Yolanda D Tseng,&nbsp;Mark Pankuch,&nbsp;Pranshu Mohindra,&nbsp;Lisa McGee,&nbsp;Carl Rossi,&nbsp;Stella Flampouri,&nbsp;Carla Hajj,&nbsp;Jason K Molitoris,&nbsp;John H Chang,&nbsp;Henry Tsai,&nbsp;Craig Stevens,&nbsp;Lane Rosen,&nbsp;Carlos Vargas,&nbsp;William Hartsell","doi":"10.1097/COC.0000000000000819","DOIUrl":"https://doi.org/10.1097/COC.0000000000000819","url":null,"abstract":"<p><strong>Purpose: </strong>As patients with mediastinal lymphoma are typically young with curable disease, advanced radiation techniques such as proton therapy are often considered to minimize subacute and late toxicity. However, it is unclear which mediastinal lymphoma patients are treated with proton therapy. Within a prospective, multi-institutional proton registry, we characterized mediastinal lymphoma patients treated with proton therapy and assessed concordance with consensus recommendations published in 2018 by the International Lymphoma Radiation Oncology Group (ILROG).</p><p><strong>Methods: </strong>Eligible patients included those with lymphoma of the mediastinum treated exclusively with proton therapy for whom digital imaging and communications in medicine (DICOM) treatment data were available for review. Given the challenge with reliably visualizing the left mainstem coronary artery, the inferior-most aspect of the left pulmonary artery (PA) was used as a surrogate. Extent of disease was characterized as upper mediastinum (above level of left PA), middle mediastinum (below left PA but at or above level of T8), or low mediastinum (below T8).</p><p><strong>Results: </strong>Between November 2012 and April 2019, 56 patients were treated and met inclusion criteria. Patients treated with proton therapy were young (median, 24 y; range: 12 to 88), with over half being female (55%). Patients were most commonly treated at initial diagnosis (86%) and had Hodgkin lymphoma (79%). Most patients (96%) had mediastinal disease that extended down to the level of the heart: 48% had middle and 48% had low mediastinal involvement. Nearly all patients (96%) met the ILROG consensus recommendations: 95% had lower mediastinal disease, 46% were young females, and 9% were heavily pretreated. Heart (mean) and lung dose (mean, V5, V20) were significantly associated with lowest extent of mediastinal disease.</p><p><strong>Conclusions: </strong>Mediastinal lymphoma patients treated with proton therapy are typically young with lower mediastinal involvement. Within a prospective, multi-institutional proton registry, nearly all treated patients fit the ILROG consensus recommendations regarding which mediastinal lymphoma patients may most benefit from proton therapy.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"269-274"},"PeriodicalIF":2.6,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25587927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Use of Antibiotics on Response to Immune Checkpoint Inhibitors and Tumor Microenvironment.","authors":"Uqba Khan,&nbsp;Kaylee Ho,&nbsp;Eun Kyeong Hwang,&nbsp;Cristian Peña,&nbsp;Julianna Brouwer,&nbsp;Katherine Hoffman,&nbsp;Doron Betel,&nbsp;Gregory F Sonnenberg,&nbsp;Bishoy Faltas,&nbsp;Ashish Saxena,&nbsp;Kaitlin Eng Weisiger,&nbsp;Sarah Oh,&nbsp;Erika Hissong,&nbsp;Arindam RoyChoudhury,&nbsp;Manish A Shah","doi":"10.1097/COC.0000000000000813","DOIUrl":"https://doi.org/10.1097/COC.0000000000000813","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic use can result in reduced efficacy of immune checkpoint blockade (ICB), presumably because of dysbiosis of the intestinal microbiome. We sought to determine the precise temporal relation between antibiotic therapy and its possible effects on ICB efficacy. We also investigated the histologic changes in the tumor microenvironment secondary to antibiotics use.</p><p><strong>Methods and objectives: </strong>This was a single institution retrospective study that evaluated the impact of antibiotics on outcomes of patients with advanced or metastatic malignancy who were treated with ICB. Use of antibiotics among patients treated with ICB was assessed during a 12-week period before and after initiation of ICB. The primary outcome was response to ICB. Histologic changes in the tumor microenvironment following antibiotics use were also examined.</p><p><strong>Results: </strong>Between January 1, 2011 and December 31, 2018, 414 patients were identified who received ICB, and 207 patients (50%) received antibiotics within 12 weeks (before/after) of initiation of ICB. In univariate analysis, antibiotic use following initiation of ICB was associated with a significantly reduced response (odds ratio [OR]: 0.33, 95% confidence interval [CI]: 0.2-0.52, P<0.001). There was no significant negative impact on response to immunotherapy when antibiotics were used before ICB initiation (OR: 0.87, 95% CI: 0.55-1.34, P=0.52). The maximal negative impact of antibiotics occurred in the first 6 weeks after initiating ICB, and was independently associated with significantly reduced likelihood of response to immunotherapy in multivariable analysis (OR: 0.48, 95% CI: 0.29-0.8, P=0.01).</p><p><strong>Conclusions: </strong>This study demonstrates that the use of antibiotics during ICB significantly negatively impacts the efficacy of immunotherapy. The maximal negative impact occurs if the antibiotics are used in the first 6 weeks after initiating ICB.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"247-253"},"PeriodicalIF":2.6,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25570119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot Study of Short-course Nivolumab and Low-dose Ipilimumab for Adjuvant Treatment of Melanoma: Brown University Oncology Research Group Trial, BrUOG 324.","authors":"Maria Constantinou,&nbsp;Thomas J Miner,&nbsp;John M Vatkevitch,&nbsp;Ali Naboush,&nbsp;Sopha Dionson,&nbsp;Jasmine Anderson,&nbsp;Taylor Kolvek,&nbsp;Maria Medeiros,&nbsp;Kelsey MacKinnon,&nbsp;Roxanne Wood,&nbsp;Howard Safran","doi":"10.1097/COC.0000000000000820","DOIUrl":"https://doi.org/10.1097/COC.0000000000000820","url":null,"abstract":"<p><strong>Background: </strong>Combined cytotoxic T-lymphocyte-associated antigen 4 and programmed death 1 inhibitor blockade is a promising strategy in advanced melanoma and other solid tumors. This pilot study assessed the safety and toxicity of nivolumab plus low-dose ipilimumab in patients with high-risk completely resected melanoma.</p><p><strong>Patients and methods: </strong>Patients received ipilimumab, 1 mg/kg every 6 weeks, and nivolumab, 3 mg/kg every 2 weeks, for a total of 24 weeks (4 cycles). The primary objective was to assess the toxicity of the combined regimen.</p><p><strong>Results: </strong>Twenty-one patients with resected melanoma were enrolled. One patient was stage IIC, 16 patients were stage III and 4 patients had resected stage 4 disease. Ten of 21 (48%) had grade 3 treatment-related toxicities but there was no grade 4 or grade 5 toxicities. The rate of grade 3 nonhematologic toxicities exceeded the toxicity limits defined by the study. Fifteen of 21 patients (71%) completed all 4 cycles of therapy. The median follow-up is 41 months. The 2-year recurrence-free survival is 85.7% and the 2-year overall survival is 90.5%.</p><p><strong>Conclusion: </strong>A 6-month course of nivolumab and low-dose ipilimumab may be a promising adjuvant treatment for patients with resected melanoma. Further studies of this regimen are indicated.</p>","PeriodicalId":501816,"journal":{"name":"American Journal of Clinical Oncology","volume":" ","pages":"254-257"},"PeriodicalIF":2.6,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38909225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}