scholarly journals Pituitary carcinoma: The University of Texas MD Anderson Cancer Center experience

2018 ◽  
Author(s):  
Fernando Santos-Pinheiro ◽  
Marta Penas-Prado ◽  
Carlos Kamiya-Matsuoka ◽  
Steven G Waguespack ◽  
Anita Mahajan ◽  
...  
Keyword(s):  
Survival Rate ◽  
Disease Control ◽  
Survival Rates ◽  
Pituitary Carcinoma ◽  
Cancer Center ◽  
Ki 67 ◽  
Entire Cohort ◽  
University Of Texas ◽  
Single Center Experience ◽  
Md Anderson

AbstractBackground: Pituitary carcinoma (PC) is an aggressive neuroendocrine tumor diagnosed when a pituitary adenoma (PA) becomes metastatic. PCs are typically resistant to therapy and frequently recur. Recently, treatment with temozolomide (TMZ) has shown promising results, although the lack of prospective trials limits accurate assessment. Methods: We describe a single-center experience in managing PC over a 22-year period and review previously published PC series. Results: 17 patients were identified. Median age at PC diagnosis was 44 years (range 16-82), and the median PA-to-PC conversion time was 5 years (range 1-29). Median follow-up was 28 months (range 8-158) with 7 deaths. Most PC were hormone-positive based on immunohistochemistry (n=12): ACTH (n=5), PRL (n=4), LH/FSH (n=2), GH (n=1). All patients underwent at least one resection and one course of radiation after PC diagnosis. Immunohistochemistry showed high Ki-67 labeling index (>3%) in 10/15 cases. Eight patients (47%) had metastases only to the CNS, and 6 (35%) had combined CNS and systemic metastases. The most commonly used chemotherapy was TMZ, and TMZ-based therapy was associated with the longest period of disease control in 12 (71%) cases, as well as the longest period from PC diagnosis to first progression in 8 (47%) cases. The 2, 3 and 5-year survival rate of the entire cohort was 71%, 59% and 35%, respectively. All patients surviving >5 years were treated with TMZ-based therapy. Conclusions: PC treatment requires a multidisciplinary approach and multimodality therapy including surgery, radiation and chemotherapy. TMZ-based therapy was associated with higher survival rates and longer disease control.PrecisWe describe 17 PC patients who were diagnosed and treated at MDACC over a 22-year period. We have found that TMZ-based therapy correlated with longer disease control and higher survival rate.

scholarly journals Pituitary carcinoma: The University of Texas MD Anderson Cancer Center experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 2068-2068
Author(s):  
Fernando Santos Pinheiro ◽  
Marta Penas-Prado ◽  
Ian E. McCutcheon ◽  
Anita Mahajan ◽  
Paul D. Brown ◽  
...  
Keyword(s):  
Single Agent ◽  
Survival Rates ◽  
Pituitary Tumors ◽  
Progression Free Survival ◽  
Pituitary Carcinoma ◽  
Cancer Center ◽  
Ki 67 ◽  
University Of Texas ◽  
Md Anderson

2068 Background: Pituitary carcinoma (PC) is a rare and aggressive neuroendocrine tumor diagnosed once a pituitary adenoma (PA) becomes metastatic. Although no standard treatment currently exists, surgery, radiation (XRT) and/or chemotherapy are most commonly used. Recently, treatment with temozolomide (TMZ) has shown promising results, although the lack of prospective trials limits accurate outcome assessment. Methods: We describe a single-center multidisciplinary team experience in managing PC patients over a 13-year period (Oct, 2003 to Jan, 2017). Results: A total of 17 patients (9 males) were seen. Median age at diagnosis of PC was 44 years (range 16-82 years) and the median time from PA to PC conversion was 6 years (range 1-29 years). Median follow-up time: 28 months (range 8-158 months) with 7 reported deaths. The majority of PC was hormone-secreting (HS) subtype (n = 12): ACTH (n = 5), PRL (n = 4), FSH/LH (n = 2), GH (n = 1). After PC diagnosis, all pituitary tumors were locally invasive, all underwent at least one resection (mean 2.3) and all received at least one course of XRT alone (IMRT = 76%, SRS = 29%, IMPT = 12%) or concurrent with chemotherapy (18%). Immunohistochemistry showed high Ki-67 labeling index ( > 3%) in 9 (53%) cases. Most cases (n = 14) had metastases to the CNS, 35% of those had combined CNS and systemic foci. Ten (59%) cases underwent focal treatment of metastases, 90% of which underwent XRT. The most common chemotherapy used was TMZ [n = 14 (82%): single agent (n = 10); TMZ+capecitabine (n = 5); concurrent TMZ+XRT (n = 3); concurrent TMZ+XRT with adjuvant TMZ (n = 1)]. The median longest progression-free survival (LPFS) was 18 months (range 4-45 months). TMZ was associated with the chemotherapy-related LPFS in 9 (75%) cases. The 2, 3 and 5 year survival rate was 65%, 53% and 35%, respectively. All patients surviving > 5 years were treated with TMZ (n = 5, 2 survived > 10 years). Two refractory cases are currently on PD-1 inhibitor agent. Eighty percent of non-functioning PC were alive at last follow-up (HS-PC, 58%). Recurrence occurred in 11 (65%) cases. Conclusions: Treatment of PC requires a multidisciplinary approach. Multimodality therapy with surgery, radiation and TMZ was associated with higher survival rates and longer PFS.

scholarly journals Treatment and long-term outcomes in pituitary carcinoma: a cohort study

2019 ◽  
Vol 181 (4) ◽  
pp. 397-407 ◽  
Author(s):  
Fernando Santos-Pinheiro ◽  
Marta Penas-Prado ◽  
Carlos Kamiya-Matsuoka ◽  
Steven G Waguespack ◽  
Anita Mahajan ◽  
...  
Keyword(s):  
Survival Rates ◽  
Multidisciplinary Care ◽  
Pituitary Carcinoma ◽  
High Survival ◽  
Ki 67 ◽  
Entire Cohort ◽  
Prospective Trials ◽  
Multiple Recurrences

Background Pituitary carcinoma (PC) is an aggressive neuroendocrine tumor diagnosed when a pituitary adenoma (PA) becomes metastatic. PCs are typically resistant to therapy and develop multiple recurrences despite surgery, radiotherapy and chemotherapy. Recently, treatment with temozolomide (TMZ) has shown promising results, although the lack of prospective trials limits assessment of benefit. Methods We describe a single-center multidisciplinary experience in managing PC patients over a 22-year period and review previously published PC series. Results Seventeen patients were identified. Median age at PC diagnosis was 44 years (range 16–82 years), and the median time from PA to PC transformation was 5 years (range 1–29 years). Median follow-up time was 28 months. Most PCs were hormone-positive (n = 12): ACTH (n = 5), PRL (n = 4), LH/FSH (n = 2) and GH (n = 1). All patients underwent at least one resection and at least one course of radiation after PC diagnosis. Immunohistochemistry showed high Ki-67 labeling index (>3%) in 10/15 cases. Eight patients (47%) had only central nervous system (CNS) metastases; six (35%) had combined CNS and systemic metastases. The most commonly used chemotherapy was TMZ, and TMZ-based therapy was associated with the longest PFS in 12 (71%) cases, as well as the longest period from PC diagnosis to first progression (median 30 months). The 2, 3 and 5-year survival rate of the entire cohort was 71, 59 and 35%, respectively. All patients surviving >5 years had been treated with TMZ-based therapy. Conclusions PC management benefits from multidisciplinary care and multimodality therapy. TMZ-based regimens were associated with high survival rates and long disease control.

scholarly journals MLH1-rheMac hereditary nonpolyposis colorectal cancer syndrome in rhesus macaques

2018 ◽  
Vol 115 (11) ◽  
pp. 2806-2811 ◽  
Author(s):  
David W. Brammer ◽  
Patrick J. Gillespie ◽  
Mei Tian ◽  
Daniel Young ◽  
Muthuswamy Raveendran ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Hereditary Nonpolyposis Colorectal Cancer ◽  
Rhesus Macaques ◽  
Pedigree Analysis ◽  
Hepatic Flexure ◽  
Cancer Center ◽  
Cancer Syndrome ◽  
University Of Texas ◽  
Hereditary Nonpolyposis ◽  
Md Anderson

Over the past two decades, 33 cases of colonic adenocarcinomas have been diagnosed in rhesus macaques (Macaca mulatta) at the nonhuman primate colony of the Keeling Center for Comparative Medicine and Research at The University of Texas MD Anderson Cancer Center. The distinctive feature in these cases, based on PET/computed tomography (CT) imaging, was the presence of two or three tumor lesions in different locations, including proximal to the ileocecal juncture, proximal to the hepatic flexure, and/or in the sigmoid colon. These colon carcinoma lesions selectively accumulated [18F]fluorodeoxyglucose ([18F]FDG) and [18F]fluoroacetate ([18F]FACE) at high levels, reflecting elevated carbohydrate and fatty acid metabolism in these tumors. In contrast, the accumulation of [18F]fluorothymidine ([18F]FLT) was less significant, reflecting slow proliferative activity in these tumors. The diagnoses of colon carcinomas were confirmed by endoscopy. The expression of MLH1, MSH2, and MSH6 proteins and the degree of microsatellite instability (MSI) was assessed in colon carcinomas. The loss of MLH1 protein expression was observed in all tumors and was associated with a deletion mutation in the MLH1 promoter region and/or multiple single-nucleotide polymorphism (SNP) mutations in the MLH1 gene. All tumors exhibited various degrees of MSI. The pedigree analysis of this rhesus macaque population revealed several clusters of affected animals related to each other over several generations, suggesting an autosomal dominant transmission of susceptibility for colon cancer. The newly discovered hereditary nonpolyposis colorectal cancer syndrome in rhesus macaques, termed MLH1-rheMac, may serve as a model for development of novel approaches to diagnosis and therapy of Lynch syndrome in humans.

Program development of a preceptor bootcamp for operational pharmacy preceptors

2020 ◽  
Vol 77 (Supplement_1) ◽  
pp. S2-S7
Author(s):  
Devlin V Smith ◽  
Stefani Gautreaux ◽  
Alison M Gulbis ◽  
Jeffrey J Bruno ◽  
Kevin Garey ◽  
...  
Keyword(s):  
Survey Methodology ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cancer Center ◽  
University Of Texas ◽  
Qualitative Feedback ◽  
Md Anderson ◽  
The University ◽  
Functional Areas ◽  
The Impact

Abstract Purpose To describe the development, design, and implementation of a pilot preceptor development bootcamp and feedback related to its feasibility and impact on operational pharmacy preceptors. Summary The University of Texas MD Anderson Cancer Center designed and implemented a pilot preceptor development bootcamp for operational staff pharmacists serving as residency preceptors for longitudinal weekend staffing experiences. A systematic, multipronged approach was taken to identify preceptor development gaps and design a full-day bootcamp curriculum. The resultant curriculum was comprised of content in major functional areas including using the 4 preceptor roles, documenting performance, giving and receiving feedback, and dealing with difficult situations or learners. The impact of the pilot preceptor development bootcamp was assessed using survey methodology and qualitative feedback from debrief discussions. Conclusion Implementation of a pilot preceptor bootcamp program addressing major areas of precepting skill was well received, resulted in positive feedback from operational pharmacy preceptors, and was feasible to implement at a large academic medical center.

Impact of care at Memorial Sloan Kettering Cancer Center (MSKCC): A comprehensive cancer center on overall survival (OS) in patients (pts) with AJCC stage IV pancreas adenocarcinoma (PDAC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18128-e18128
Author(s):  
Fiona Boland ◽  
Ahmad Cheema ◽  
Maeve Aine Lowery ◽  
Kenneth H. Yu ◽  
Anna M. Varghese ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rates ◽  
Stage Iv ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Contributing Factors ◽  
Term Survival ◽  
Entire Cohort ◽  
Line Therapy ◽  
Centralized Care

e18128 Background: PDAC has a rising incidence and relatively static mortality rates. Current cytotoxic regimens confer median survivals of 8.5- 11 months (Von Hoff, Conroy, et al. NEJM 2013, 2011). National Cancer Institute-designated Comprehensive Cancer Centers potentially allow greater access to multidisciplinary consultation for complex cancer care. Although the widespread benefits of NCICCCs are acknowledged, there is limited data demonstrating superior outcomes for patients treated at these centers. Methods: Patients with stage IV PDAC, diagnosed between 01/01/13 and 12/31/14, were identified and followed until death or 12/31/2016. These patients had care centralized to MSKCC and the analysis was conducted to evaluate key patient (pt) and disease characteristics, systemic therapies and outcomes.Survival times were calculated from the date of diagnosis. Results: N=391 pts identified, 210 males (54%), 181 females (46%). Median age 66 years (range 27-91). Table 1 outlines key points. For entire cohort, median overall survival (mOS): 11.4 + 9 months, 1-year (yr) and 2-yr survival rates (SR) of 48% and 15.1% respectively. N= 165 (42%) received mFOLFIRINOX-based regimen as 1st-line therapy with mOS 13.2 + 8.9 months, 1-yr and 2-yr SR of 59.4.% and 20% respectively. N= 118 (30.1%) received gemcitabine + nab-paclitaxel- based regimen as 1st line therapy had a mOS of 11.6 + 9 months with 1-yr and 2-yr SR of 49.1% and 16.2% respectively. Conclusions: At MSKCC, a major referral center for PDAC, outcomes for stage IV disease compare favorably to contemporary trial outcomes with notable 2-yr survivorship (long-term survival analysis of MPACT trial showed 1-yr and 2-yr SR of 35% and 10% respectively). Contributing factors likely reflect multidisciplinary expertize, patient selection and biases. Centralized care for complex illnesses may improve outcomes. [Table: see text]

Preliminary analysis of FOLFIRI regimen with or without bevacizumab as second-line systemic therapy in patients with metastatic gastroenteropancreatic neuroendocrine carcinoma.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 469-469
Author(s):  
Xiaoying Zhao ◽  
Chen Chen Wang ◽  
Wen Zhang ◽  
Xiaodong Zhu ◽  
Weijian Guo ◽  
...  
Keyword(s):  
Partial Response ◽  
Disease Control ◽  
Stable Disease ◽  
Median Number ◽  
Cancer Center ◽  
Second Line ◽  
First Line ◽  
Ki 67 ◽  
Mild Anemia ◽  
Line Chemotherapy

469 Background: Patients with gastroenterpancreatic neuroendocrine carcinomas (NECs) have a very poor prognosis. And the role of the second-line therapy remains unknown. Methods: We retrospectively analyzed 11 patients with gastroenteropancreatic NEC after failure of first-line chemotherapy in the last two years in our cancer center. Data examined included clinical and pathological characteristics at the time of diagnosis, efficacy and safety. Results: Median age was 51 (17-64) years old. Most were male (81.8%). Tumor origin included pancreas (6pts, 54.5%), colon-rectum (3pts, 27.3%), one stomach and one liver. Metastatic disease was evident at diagnosis in all patients (liver metastases: 100%, celiac lymph nodes: 72.7%, bone: 18.2%, pleural effusion and peritoneal metastasis: 18.2%). Median Ki-67 index was 80%. Etoposide-cisplatin combinations as first line chemotherapy were administered in 8 (72.7%) patients and 2 (18.2%) capecitabine based regimen and 1(9.1%) gemcitabine with nab-paclitaxel. All patients received the FOLFIRI regimen with a median number of 8 (3-36) courses. Three patients (27.3%) had partial response, 4 (36.4%) stable disease, and 4 (36.4 %%) tumor progression. But in 6 patients received the FOLFIRI plus bevacizumab, disease control rate was 66.7%, 3 (50.0%) partial response, 1(16.7%) stable disease. The median PFS in all 11 pts was 3.77 (1.77-24.07) months, in 6pts with bevacizumab was 4.77(1.83-24.07) months. The most severe toxicities was grade 3 neutropenia (27.2%), the other adverse effects were mild to moderate, including mild anemia, transient transferase elevation and proteinuria. Conclusions: FOLFIRI regimen is a potentially effective and safe chemotherapy given as second-line in patients with NEC. Additional anti-VEGF therapy with bevacizumab may improve the disease control and PFS time.

scholarly journals Emerging Therapies in Myelofibrosis: Highlights From SOHO 2020

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Lisa Nodzon, PhD, ARNP, AOCNP
Keyword(s):  
Annual Meeting ◽  
Cancer Center ◽  
University Of Texas ◽  
New Therapies ◽  
Emerging Therapies ◽  
Md Anderson ◽  
The University

Lisa Nodzon, PhD, ARNP, AOCNP®, of Moffitt Cancer Center, highlights new therapies in development for myelofibrosis that were discussed by Srdan Verstovsek, MD, PhD, of The University of Texas MD Anderson Cancer Center, at the 2020 SOHO Annual Meeting.

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