Abstract 16411: Intraoperative Nicardipine Use During Rewarming in Norwood Procedures

Introduction: Postoperative tissue edema Norwood procedures contributes significantly to outcomes. As nicardipine preserves ventricular function after hypothermic ischemic arrest, nicardipine treatment could support post-Norwood ventricular function, and decrease edema to improve patient outcomes. Methods: All Norwood procedures completed at a single institute between 1/1/2012 - 12/31/2019 were retrospectively reviewed, and the use of nicardipine during rewarming was initiated midway through the study period. We investigated the effects of nicardipine during rewarming on 12-month postoperative mortality, postoperative intubation times, open chest duration, and disposition at discharge. Results: Thirty-six Norwood procedures were completed, of whom 14 received nicardipine intraoperatively during the rewarming period. The nicardipine group demonstrated significantly lower 12-month postoperative mortality (0% vs 32%, p-value: 0.028) and significantly greater discharges to home (64% vs 18%, p-value: 0.005). The nicardipine group had lower median length of postoperative intubation (123 vs 146 hrs, p-value: 0.311) and open sternum time (2 [1-3] vs 3 [2-5] days, p-value: 0.067), but these analyses did not reach statistical significance (Fig 1). Conclusion: This study demonstrates the safety of nicardipine treatment during Norwood and significant decrease 12-month mortality and increase in discharge to home, with potential for reduced post-Norwood intubation and open sternum times. This study provides the basis for a prospective randomized controlled trial to demonstrate survival benefit provided by intraoperative nicardipine usage during Norwoods.

The immunotherapy revolution in genitourinary malignancies

Immune checkpoint inhibitor (ICI) therapy and therapeutic cancer vaccines have continued to demonstrate survival benefit and durable clinical response in patients with renal cell cancer, prostate cancer and bladder cancer, with limited responses in testicular cancer. The role of immunotherapy in combination with chemotherapy or other targeted therapies in the neo-adjuvant, adjuvant and metastatic setting is actively being explored. We describe the current immunotherapy-related treatment modalities approved for genitourinary cancers, focusing on immune checkpoint inhibitors, vaccines and other modalities, and highlight ongoing studies involving immunotherapy in these cancer types.

Addition of Taxanes to Platinum and Fluoropyrimidines in Adjuvant Setting Did Not Improve Survival in Patients with Gastric Cancer after Curative Gastrectomy

BackgroundTo evaluate whether the addition of taxane to platinum and fluoropyrimidines in adjuvant chemotherapy would result in longer survival than platinum plus fluoropyrimidines in patients who underwent curative gastrectomy.MethodsThis study retrospectively analyzed survival for patients with stage Ⅱ-Ⅲ gastric adenocarcinoma who received curative gastrectomy and adjuvant chemotherapy with platinum plus fluoropyrimidines (PF group) or taxanes and platinum plus fluoropyrimidines (TPF group). Survival curves were estimated using the Kaplan-Meier method, and the differences were compared using the log-rank test.ResultsBaseline characteristics were balanced between the PF group and TPF group. The median disease-free survival (DFS) was 14.9 months (95% CI: 11.0-18.8) in the PF group and 13.8 months (95% CI: 9.3-18.3) in the TPF group (HR=0.90, 95% CI: 0.63-1.29, log-rank test, P=0.560). The median overall survival (OS) was 30.0 months for patients in the PF group (95% CI: 24.5-35.5) and 25.6 months (95% CI: 22.3-28.9) for those in the TPF group (HR=0.93, 95% CI: 0.64-1.35, log-rank test, P=0.705).ConclusionFor stage Ⅱ-Ⅲ gastric adenocarcinoma, the adjuvant triple combination of TPF regimen after curative gastrectomy did not demonstrate survival benefit compared to the PF regimen.

Response rates and survival in primary systemic amyloidosis

Patients (153) with biopsy-proven primary systemic amyloidosis (AL) were evaluated for their response rate to alkylating agent-based chemotherapy. Twenty-seven of the patients (18%) responded. The serum creatinine concentration had an adverse effect on response rate (P = .05). In patients with nephrotic syndrome, a normal serum creatinine value, and no echocardiographic evidence of cardiac amyloidosis, the response rate was 39% (12 of 31). Five of 34 patients with amyloid cardiomyopathy responded. Two of these five are alive 10 years after diagnosis. None of the 18 patients with amyloid peripheral neuropathy showed regression of their disease. The median time to achieve response was 11.7 months. The median survival of the 27 patients was 89.4 months and 21 of 27 survived 5 years (78%). Eight patients remain alive with a minimum follow-up of 90 months. Seven died of acute leukemia or dysmyelopoietic syndrome, a presumed complication of melphalan therapy. In the group of 126 patients who showed no response to alkylating agent- based therapy, the median survival was 14.7 months and 9 (7%) survived over 5 years. All 126 patients have died. Alkylating agent-based chemotherapy for AL is beneficial in a subset of patients and a trial of chemotherapy is strongly recommended. Those patients who do respond demonstrate survival benefit.

Response rates and survival in primary systemic amyloidosis

Patients (153) with biopsy-proven primary systemic amyloidosis (AL) were evaluated for their response rate to alkylating agent-based chemotherapy. Twenty-seven of the patients (18%) responded. The serum creatinine concentration had an adverse effect on response rate (P = .05). In patients with nephrotic syndrome, a normal serum creatinine value, and no echocardiographic evidence of cardiac amyloidosis, the response rate was 39% (12 of 31). Five of 34 patients with amyloid cardiomyopathy responded. Two of these five are alive 10 years after diagnosis. None of the 18 patients with amyloid peripheral neuropathy showed regression of their disease. The median time to achieve response was 11.7 months. The median survival of the 27 patients was 89.4 months and 21 of 27 survived 5 years (78%). Eight patients remain alive with a minimum follow-up of 90 months. Seven died of acute leukemia or dysmyelopoietic syndrome, a presumed complication of melphalan therapy. In the group of 126 patients who showed no response to alkylating agent- based therapy, the median survival was 14.7 months and 9 (7%) survived over 5 years. All 126 patients have died. Alkylating agent-based chemotherapy for AL is beneficial in a subset of patients and a trial of chemotherapy is strongly recommended. Those patients who do respond demonstrate survival benefit.