scholarly journals A CASE OF MALIGNANT LYMPHOMA WITH A COMPLETE RESPONSE REQUIRING SURGICAL RESECTION DUE TO AN OBSTRUCTION OCCURRING DURING CHEMOTHERAPY

2009 ◽  
Vol 70 (9) ◽  
pp. 2707-2711 ◽  
Author(s):  
Toshiyuki OKUMA ◽  
Kensuke YAMAMURA ◽  
Hiroshi SAWAYAMA ◽  
Yuji YAMAGUCHI ◽  
Seiji MITA ◽  
...  
Keyword(s):  
Malignant Lymphoma ◽  
Surgical Resection ◽  
Complete Response

scholarly journals A Case of Small Intestinal Malignant Lymphoma Requiring Surgical Resection Due to Stenosis after Complete Response to Chemotherapy

2012 ◽  
Vol 45 (6) ◽  
pp. 651-656
Author(s):  
Jun Okamura ◽  
Seiichiro Yamamoto ◽  
Shin Fujita ◽  
Takayuki Akasu ◽  
Yoshihiro Moriya ◽  
...  
Keyword(s):  
Malignant Lymphoma ◽  
Surgical Resection ◽  
Complete Response ◽  
Response To Chemotherapy ◽  
Small Intestinal

Osimertinib as neoadjuvant treatment for resectable stage II-IIIB EGFR mutant lung adenocarcinoma (NEOS).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 8524-8524
Author(s):  
Chao Lyu ◽  
Wentao Fang ◽  
Haitao Ma ◽  
Jia Wang ◽  
Wenjie Jiao ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Surgical Resection ◽  
Interim Analysis ◽  
Kinase Inhibitors ◽  
Response Rate ◽  
Early Stage ◽  
Neoadjuvant Treatment ◽  
Complete Response ◽  
Stage Ii ◽  
Meaningful Improvement

8524 Background: Neoadjuvant treatment has demonstrated efficacy in several types of cancer and is increasingly used for the treatment of early-stage cancers with the potential of cancer downstaging to enhance complete surgical resection and to improve clinical outcomes. Recent evidences have demonstrated that the neoadjuvant use of first/second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) may provide clinically meaningful improvement in EGFRm non-small cell lung cancer (NSCLC) patients, however, limited data were reported on osimertinib, the third-generation EGFR-TKI, in the neoadjuvant setting. Here we present an interim analysis of osimertinib as neoadjuvant treatment for resectable EGFRm NSCLC. Methods: NEOS is a prospective, multi-center, single-arm study to evaluate the efficacy and safety of osimertinib as neoadjuvant treatment in resectable EGFRm (19del/L858R) lung adenocarcinoma. Eligible patients were treated with osimertinib 80 mg orally per day for six weeks followed by surgery. Assessment of response to neoadjuvant therapy was performed according to RECIST 1.1. The primary endpoint was response rate. Secondary endpoints included safety, R0 surgical resection rate, quality of life, major pathologic response (MPR) rate, pathological complete response (pCR) rate, and N2 downstaging rate. Results: As of Dec. 17, 2020, 18 eligible patients (median age 61 [range 46-73], 27.8% male, 22.2% ECOG PS 1) have been enrolled. Patients with clinical stages IIa, IIb, and IIIa (8th AJCC) accounted for 16.7%, 22.2% and 61.1%, respectively. Half (9/18) of the patients had EGFR exon 21 L858R mutations and the other half (9/18) had EGFR exon 19del mutations. Amongst all 15 patients who completed efficacy assessment after neoadjuvant osimertinib, the response rate (RR) was 73.3% (11/15) and the disease control rate (DCR) was 100% (15/15). R0 surgical resection was performed in 93.3% (14/15) patients. Pathological downstaging occurred in 53.3% (8/15) patients. 42.9% (3/7) of the patients with confirmed N2 lymph nodes experienced downstaging to N0 disease after receiving neoadjuvant osimertinib. One patient was identified with a pCR. Adverse events (AEs) were reported in 66.7% (12/18) of patients, with the most common AE being rash (8/18, 44.4%), oral ulceration (8/18, 44.4%), and diarrhea (5/18, 27.8%). No grade 3-5 AEs or serious AEs were reported. Conclusions: Interim analysis from this study indicated neoadjuvant osimertinib as an effective and feasible treatment in patients with resectable stage II-IIIB EGFRm NSCLC. The trial is ongoing and the final results will be provided in the future. Clinical trial information: ChiCTR1800016948.

scholarly journals Successful Use of a Multidisciplinary Approach to Treat a Perforated Duodenal Malignant Lymphoma in an Elderly Patient

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Tomoko Takagishi ◽  
Yuta Niimi ◽  
Goshi Matsuki ◽  
Shinta Nagano ◽  
Junsuke Hinami ◽  
...  
Keyword(s):  
Malignant Lymphoma ◽  
Multidisciplinary Approach ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Duodenal Wall ◽  
Abdominal Ct ◽  
Pet Ct ◽  
Life Threatening ◽  
Consolidation Radiotherapy ◽  
Disease Free

Treatment of duodenal malignant lymphoma is difficult due to life-threatening complications such as intestinal obstruction, perforation, and pancreatitis. Thus, multidisciplinary procedures are required alongside surgical intervention. Contrast abdominal CT images of a 75-year-old female suffering from vomiting revealed thickening of the duodenal wall (from the second to third segment). Gastrojejunostomy and biopsy identified the tumor as diffuse large B-cell lymphoma. A diagnosis of stage II duodenal lymphoma was made. The lymphoma continued to grow, resulting in jaundice and intestinal perforation, which was first treated with two cycles of rituximab and antibiotics. Thereafter, less intensive chemotherapy (two cycles each of R-mini-CHP, CHP, and R-CHOP) was administered, which led to significant improvement upon assessment by PET-CT. Residual lymphoma was treated with consolidation radiotherapy (50 Gy in 25 fractions) over 5 weeks after chemotherapy. The patient attained a complete response and has been disease-free for more than 4 years. Thus, duodenal perforated lymphoma can be treated successfully using a multidisciplinary approach that combines surgery, immunochemotherapy, and radiation therapy.

scholarly journals Combination chemotherapy ("CHOP-Bleo") in advanced (non-Hodgkin) malignant lymphoma

Blood ◽  
1977 ◽  
Vol 49 (3) ◽  
pp. 325-333 ◽  
Author(s):  
V Rodriguez ◽  
F Cabanillas ◽  
MA Burgess ◽  
EM McKelvey ◽  
M Valdivieso ◽  
...  
Keyword(s):  
Malignant Lymphoma ◽  
Median Duration ◽  
Combination Chemotherapy ◽  
Stage Iv ◽  
Complete Response ◽  
Histiocytic Lymphoma ◽  
Duration Of Response ◽  
Severe Infections ◽  
Poorly Differentiated ◽  
Diffuse Histiocytic Lymphoma

Abstract Forty-seven adults with advanced malignant lymphoma (the majority in stage IV) were treated with a combination of cyclophosphamide, hydroxyldaunorubicin (Adriamycin), vincristine (Oncovin), prednisone, and bleomycin (CHOP-Bleo). The complete remission (CR) rate was 66%. The overall response (complete + partial remission) was 92%. The CR rate in patients with diffuse histiocytic lymphoma (DHL) was 69%. Only 3 of the 18 patients with DHL in CR have relapsed; the projected median duration of response was calculated to be greater than 2 yr. In patients with nodular poorly differentiated lymphocytic lymphoma (NPDL), the CR rate was 62%. One of the eight patients with NPDL in CR has relapsed; the projected median duration of complete response will be greater than 4 yr. The median survival for all patients entered in this study has not been reached; however, it was estimated that it will be greater than 3 yr. The survival curves became flat at 70 wk for the patients with DHL and at 1 yr for the patients with NPDL. Major complications during chemotherapy with CHOP-Bleo were myelosuppression and alopecia. Only six severe infections occurred during myelosuppression. No hemorrhagic problems were observed. This study indicates that combination chemotherapy with these agents is effective in increasing the CR rate and survival in patients with diffuse histiocytic lymphoma. In patients with NPDL, further observation will be needed to assess the effect of this combination on survival.

The Response Evaluation Criteria in Solid Tumors Can be Substituted for the International Workshop Criteria?: Comparison Using Japan Clinical Oncology Group Study JCOG0203 for Untreated Indolent B-Cell Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4779-4779
Author(s):  
Kenichi Miyamoto ◽  
Takashi Watanabe ◽  
Hideaki Kitahara ◽  
Masashi Wakabayashi ◽  
Kenichi Nakamura ◽  
...  
Keyword(s):  
B Cell ◽  
Malignant Lymphoma ◽  
Solid Tumors ◽  
Research Funding ◽  
Cell Lymphoma ◽  
International Workshop ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Kappa Coefficient ◽  
Response Evaluation

Abstract Introduction: The International Workshop Criteria (IWC) has been used for response evaluation in malignant lymphoma since 1999. In contrast, the Response Evaluation Criteria in Solid Tumors (RECIST) has been used for most solid tumors since 2000. The IWC is more complicated than RECIST, partly because it requires calculating the sum of the product of bidimensional diameters of the target lesions, whereas RECIST is based on unidimensional assessment of target lesions. If RECIST can be demonstrated to be more valid and precise than the IWC for malignant lymphoma, RECIST would be the substitute for IWC even for malignant lymphoma. The objective of this study was to evaluate whether RECIST could be substituted for the IWC using data from the JCOG0203 trial, a phase II/III study of R-CHOP-21 versus R-CHOP-14 in untreated, advanced-stage indolent B-cell lymphoma where the superiority of R-CHOP-14 in progression-free survival (PFS) was not shown (hazard ratio [HR], 0.92; 95% CI, 0.68-1.25; one-sided log-rank p = 0.30) (J Clin Oncol 2011;29:3990-8). Methods: Three hundred patients aged 20-69 with stage III or IV indolent B-cell NHL were enrolled in the JCOG0203 trial between 2002 and 2007. Patients ineligible after the central pathological review (CPR) or patients with no target lesions for RECIST were excluded from this analysis. We calculated the kappa coefficient to evaluate the degree of agreement between IWC and RECIST. RECIST would be considered better in cases of a kappa coefficient of ≥0.7 because this indicates that both are in good agreement and RECIST is less complicated. If the kappa coefficient is <0.7, RECIST would be considered discordant with IWC. We evaluated which criteria were more predictive for PFS. In particular, criteria that can show a good separation of PFS, namely, the lower point estimate of the hazard ratio (HR) of a complete response (CR, including complete response and unconfirmed CR [CRu]) vs. a non-CR, is defined as more useful criteria. The landmark-time analysis was applied to PFS counted from day 168, when response status (CR vs. non-CR) for all patients was fixed. Results: Overall, 269 patients were included in this analysis, 14 patients were ineligible by the CPR and 17 patients without target lesions for RECIST were excluded.The median age was 54 years, and 46.8% of the patients were men. Two-hundred fifty-six (95.2%) were diagnosed as having follicular lymphoma and 8 (3.0%) with extranodal marginal zone B-cell lymphoma. According to the Follicular Lymphoma International Prognostic Index, 85 (31.6%), 112 (41.6%), and 72 (26.8%) patients were classified as being at low, intermediate, and high risk, respectively.Based on the IWC, 207 patients (77.0%) had a CR/CRu, 54 (20.1%) a partial response (PR), 3 (1.1%) had stable disease (SD), 4 (1.5%) had progressive disease (PD), and 1 (0.4%) was not evaluable (NE). Based on RECIST, 120 (44.6%) had a CR, 137 (50.9%) had a PR, 6 (2.2%) SD, 4 (1.5%) had PD, and 2 (0.7%) were NE. The kappa coefficient between IWC and RECIST was 0.342 (95% CI, 0.261-0.424), indicating poor agreement. Subsequently, we calculated the HR (CR vs. non-CR) of PFS for each criterion with 264 patients in the landmark analysis. The HR of the IWC (0.473: 95% CI, 0.330-0.677, log-rank test p < 0.001) was lower than that of RECIST (0.635: 95% CI, 0.454-0.888, p = 0.0075). In terms of overall survival, the HR (CR vs. non-CR) was 0.500 (95% CI, 0.223-1.119, p = 0.0856) and 0.471 (95% CI, 0.197-1.130, p = 0.0843) according to IWC and RECIST, respectively. Conclusion: RECIST cannot be substituted for the IWC in untreated, advanced-stage indolent B-cell NHL. Although fluorodeoxyglucose-positron emission tomography should be included in the standard response criteria currently used, introduction of unidimensional assessment is not recommended. Disclosures Maruyama: Takeda: Honoraria; Janssen: Honoraria. Tobinai:Chugai Pharma: Research Funding; Ono Pharmaceutical: Research Funding; Abbvie: Research Funding; Takeda: Honoraria, Research Funding; Kyowa Hakko Kirin: Research Funding; Eisai: Honoraria, Research Funding; Janssen Pharmaceuticals: Honoraria, Research Funding; Celgene: Research Funding; HUYA Bioscience: Honoraria; Mundipharma KK: Honoraria, Research Funding; SERVIER: Research Funding; Zenyaku Kogyo: Honoraria; GlaxoSmithKline: Research Funding; Daiichi Sankyo Co., Ltd.: Consultancy. Tsukasaki:Daiichi Sankyo Co., Ltd.: Consultancy; Takeda: Research Funding.

Neoadjuvant concurrent chemoradiation therapy followed by surgical resection in patients with non-small cell lung cancer invading chest wall.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e17554-e17554
Author(s):  
Yoko Yamaguchi ◽  
Kiyotaka Yoh ◽  
Tomoyuki Hishida ◽  
Hironobu Ohmatsu ◽  
Koichi Goto ◽  
...  
Keyword(s):  
Chest Wall ◽  
Surgical Resection ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Chemoradiation Therapy ◽  
Concurrent Chemoradiation ◽  
Nsclc Patients ◽  
Wall Invasion ◽  
Disease Free ◽  
Concurrent Chemoradiation Therapy

e17554 Background: The treatment approach of patients with non-small-cell lung cancer (NSCLC) invading the chest wall (stage T3N0M0) is still controversial. The clinical outcome of NSCLC patients with chest wall invasion has remained poor. The purpose of this study was to determine the efficacy and safety of neoadjuvant concurrent chemoradiation therapy followed by surgical resection in NSCLC patients with chest wall invasion. Methods: We retrospectively reviewed medical records of 19 patients with NSCLC invading chest wall (T3N0M0 or T4N0M0), who underwent neoadjuvant concurrent chemoradiation therapy followed by surgical resection between April 2003 and October 2009. Neoadjuvant chemotherapy was administered intravenously at cisplatin 80 mg/m2 on day 1 and vinorelbine 20 mg/m2 on days 1 and 8, q4w, with a maximum of 2 cycles. Radiotherapy directed at the primary tumor invading chest wall was started in cycle 1, at the total dose of 45Gy in 25 fractions. Surgical resection of the tumor was performed 4 to 8 weeks after the completion of neoadjuvant therapy. Results: Patient characteristics included: median age 61 years (range 43-68); Male/Female=17/2; and stage T3N0M0/T4N0M0=18/1. Six patients (32%) had superior sulcus tumors. Neoadjuvant chemoradiation therapy was generally well tolerated. All patients underwent surgical resection, and complete resection was achieved in 18 patients (95%). There were 10 (53%) patients with pathologic complete response. There were no treatment-related deaths. The 3-year disease-free and overall survival rates for all patients were 58% and 81%, respectively, with a median follow-up of 37 months. The 3-year disease-free survival rate was 78% for patients with a pathologic complete response compared with 25% for those who did not achieve a pathologic complete response. Disease progression occurred mainly in distant sites. Conclusions: Neoadjuvant chemotherapy consists of cisplatin-vinorelbine and radiotherapy followed by surgical resection is effective and tolerable in patients with NSCLC invading chest wall (T3N0M0). This treatment approach produces high rates of pathologic complete response.

Final results of a randomized, open label, perioperative phase II study evaluating nivolumab alone or nivolumab plus ipilimumab in patients with resectable HCC.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4599-4599 ◽  
Author(s):  
Ahmed Omar Kaseb ◽  
Hop Sanderson Tran Cao ◽  
Yehia I. Mohamed ◽  
Aliya Qayyum ◽  
Luis M. Vence ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Phase Ii ◽  
Response Rate ◽  
Pilot Trial ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Pathologic Response ◽  
Open Label ◽  
Neoadjuvant Immunotherapy ◽  
Randomized Phase Ii

4599 Background: In resectable hepatocellular carcinoma (HCC) surgical resection is associated with high recurrence rates. However, there is no approved neoadjuvant or adjuvant therapies yet. Neoadjuvant immunotherapy effect has never been reported in this setting in HCC. Methods: This is a randomized phase II trial of nivolumab (Arm A) or nivolumab + ipilimumab (Arm B) as peri-operative treatment for patients (pts) with HCC who are eligible for surgical resection. Pts in Arm A are given nivolumab 240 mg iv, every 2 weeks (wks) for a total of 3 doses followed by surgery on week 6. Pts in Arm B are treated with nivolumab per same schedule as arm A plus concurrent ipilimumab 1 mg/kg on day 1. Adjuvant part of study starts 4 weeks after surgery, with Nivolumab at 480 mg iv every 4 weeks for 2 years in arm A. Pts in Arm B are treated with nivolumab per same schedule as arm A plus concurrent ipilimumab 1 mg/kg every 6 weeks times 4 doses after resection. The primary objective was the safety/tolerability of nivolumab +/- ipilimumab. Secondary objectives include overall response rate, pathologic complete response (pCR) rate and time to progression. Exploratory objectives include evaluating the pre- and post-treatment immunological changes in tumor tissues and peripheral blood. Results: 30 patients were enrolled, 2 patients withdrew consent, one patient was not eligible at time of therapy, and 27 randomized (13 to Arm A and 14 to Arm B). 21 patients proceeded with resection as planned and surgery was aborted for 6 patients; 1 for frozen abdomen due to old surgery, 2 for small residual volume, and 3 for progressive disease. Pts age ranged between 32-83 yo, 75 % were males, 7 pts had HCV, 7 had HBV and 7 had no hepatitis. Pathologic complete response (pCR) was observed in 5/21 pts (24% pCR rate) – 2 in Arm A and 3 Arm B, and 3/21 pts (16%) – 1 in Arm A, 2 in Arm B, achieved major pathologic response (necrosis effect of 50-99%). 5 patients in Arm B and 1 in Arm A experienced grade 3 or higher toxicity prior to surgery. No grade 4 or higher toxicity were observed and surgery was not delayed or cancelled due to oxicity. Conclusions: Our study reached its primary endpoint of safety. Importantly, we report a 40% pathologic response rate = pCR rate of 24%, and major necrosis rate of 16% for resectable HCC after preoperative immunotherapy in a randomized phase II pilot trial. After future validation, these promising results may contribute to a paradigm shift in the perioperative treatment of resectable HCC. Clinical trial information: NCT03222076 .

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