Palliative chemotherapy in carcinoma nasopharynx

Introduction: Nasopharyngeal carcinoma is a rare malignancy. We conducted an audit of systemic therapies received in palliative setting in carcinoma nasopharynx and studied their outcomes. Methods: Patients who underwent first-line palliative systemic chemotherapy between January 2014 and April 2017 for carcinoma nasopharynx at the department of medical oncology at authors' institute were selected for this analysis. Toxicities, responses, progression-free survival (PFS), and overall survival (OS) were analyzed. In addition, a Quality-Adjusted Time without Symptoms or Toxicity analysis with threshold utility analysis was performed. Results: Fifty-one patients were included in this analysis. The indication of palliative chemotherapy was locoregionally recurrent disease in 25 (49.0%) patients and metastatic disease in 26 (51.0%) patients. The overall response rate was 62.0% (n = 33). The median PFS was 225 days (95% confidence interval [CI]: 164–274 days) and median OS was 513 days (95% CI: 286–931 days). The restricted mean TOX state duration was 2.6 days (95% CI: 0.3–4.9), restricted mean TWiST duration was 219.2 days (95% CI: 184.0–254.4), and restricted mean REL duration was 74.3 days (95% CI: 38.1–110.4). Conclusion: Systemic cytotoxic therapy in nasopharyngeal cancers is associated with high response rates and clinically meaningful PFS; with low duration of time spent in adverse events.

BIOPSY OF SIGNAL LYMPHATIC NODULES IN PATIENTS WITH BREAST CANCER AFTER NEOAVARIANT CHEMOTHERAPY

One of the advantages of systemic cytotoxic therapy is the «transformation» of positive axillary nodes into negative nodes (cN+ → cN-); a similar concept is used in randomized clinical trials with «post-neoadjuvant» sentinel lymph node - pNsn. In studies of ACOSOG Z1071, SENTINA, SN FNAC, was evaluated the frequency of a false-negative result with a biopsy of the sentinel lymph node (BSLU) after neodjuvant chemotherapy. It was proved that there was no need for immunohistochemical examination of lymph nodes using the BSLU technique followed by adjuvant therapy, since the detected micrometastases did not worsen overall survival. As for patients with biopsy of signaling lymph nodes after neodjuvant chemotherapy, nowadays particular interest of prognostic in significance for micrometastases and individual tumor cells in the lymph nodes, as well as an estimate of the frequency of false-negative result.

Incidence and significance of thromboembolic events (TE) in patients with gastrointestinal (GI) and non-GI malignancies on systemic cytotoxic therapy

9049 Background: Although venous thromboembolic events (TE) are commonly associated with solid tumor malignancies, the precise incidence and significance of TE in cancer patients has not been well established. We previously reported a high incidence of TE in patients with GI malignancies enrolled on clinical studies at Memorial Sloan Kettering (MSKCC) (Asmis, GI ASCO 2007), and now explore the prognostic impact of TE in GI and non-GI malignancies. Methods: All patients above the age of 18 enrolled on prospective, investigator-initiated therapeutic clinical trials at MSKCC from January 1, 2003 to December 31, 2005 were reviewed. Serious adverse event monitoring was recorded prospectively and patients were followed regularly as per their protocol. All patients with Grade 3–4 TE were identified and confirmed at chart review. 100 patients without TE were audited to verify TE status, and 4 patients with TE were identified(sensitivity 96.8%, 95%CI 92.1–99.1%; specificity 100%, 95%CI 96.2–100%). Patients were followed for survival. All records were reviewed for baseline anticoagulation use, prior therapy, and date of cancer diagnosis. Results: 2482 patients with solid tumor malignancies were enrolled from 2003 to 2005: median age 58 (range 18–90), 43% female, 7% baseline anticoagulation, 44% previously untreated. 122 (4.8%, 95%CI 4%- 5.7%) had a TE. TE is associated with decreased median survival in patients with non-GI malignancy (10 months vs. 19.5 months) (p=0.0003), whereas the development of TE was not associated with reduced survival in GI malignancies (16.7 months vs 15.6 months (p=0.45)). Conclusions: In patients with non-GI solid tumors, the development of a venous thromboembolism is significantly associated with poor survival. Understanding why this is the case may provide insight to tumor biology and an opportunity to positively impact patient survival. [Table: see text] No significant financial relationships to disclose.