ABSTRACT
Category: Outcomes of treatment (including chemotherapy, chemo-RT and RT) Purpose: Hypofractionated (5#) radiotherapy for non-metastatic pancreatic cancer was introduced during the COVID-19 pandemic as an alternative to conventional treatment pathways. This study was performed to evaluate clinical outcomes and acute toxicity of 5# radiotherapy. Methods and materials: We retrospectively identified pancreatic cancer patients treated with 5# radiotherapy at Addenbrookes Hospital from March 2020 to September 2021. Patient characteristics, response on follow-up computed tomography (CT) scans, dosimetry and toxicity data were analysed using Excel and SPSS. Result(s): 40 patients were treated with 5# radiotherapy, 60% (n=24) had locally advanced pancreatic cancer, 30% (n=12) operable disease, 7.5% (n=3) postoperative recurrences and 2.5% (n=1) borderline resectable disease. 45% of patients (n=19) had induction chemotherapy. Radiotherapy was delivered as 35 Gy (67.5%, n= 27) and 30 Gy (32.5%, n=13) in 5# in 1.5 weeks using volumetric-modulated arc therapy (VMAT) technique. Median overall survival (mOS) for all patients was 14.2 months (95% CI 10.3-15.6 months). For induction chemotherapy + radiotherapy versus radiotherapy alone, mOS was 14.2 months (95% CI 8.2-17.7 months) versus 13.9 months (95% CI 10.3-15.7 months), p=0.97. Median progression-free survival (mPFS) for all patients was 10.2 months (95% CI 8.0-11.9 months). For induction chemotherapy + radiotherapy versus radiotherapy alone, mPFS was 10.5 months (95% CI 9.5-12.4 months) versus 10.1 months (95% CI 5.5-10.4 months), p=0.99. There were no grade 3 acute toxicities. When compared to 28# radiotherapy, the 5# regimen reduced patient hospital visits by 82%. Conclusion(s): The observed mOS is comparable with mOS of conventional 28# radiotherapy (14.2 versus 15.2 months (SCALOP trial)), 5# radiotherapy for non-metastatic pancreatic cancer is a safe alternative treatment pathway. Copyright © 2022
ABSTRACT
Background: After the introduction of the molecular classification in EC guidelines, Next Generation Sequencing (NGS) analysis has become an essential tool for EC management. Molecular-driven therapies have also been recently tested, and some have obtained FDA approval. This retrospective cohort study aims to determine the clinical benefit rate (CBR) with the use of targeted therapies based on NGS in ECs patients. Method(s): After approval of the local Ethics Committee, a retrospective study was conducted on EC patients undergoing Foundation Medicine testing at Fondazione Policlinico Universitario Agostino Gemelli IRCCS. All patients provided written informed consent. Formalin-fixed, paraffin-embedded (FFPE) tumor tissue specimens were analyzed by Foundation One CDx, which detects 324 genes known to be drivers of solid tumors based on NGS assay. Efficacy outcomes were estimated by the Kaplan-Meier method and expressed as median with its 95% confidence interval. IBM-SPSS v.27.0 software was used for statistical analyses. Result(s): Out of 35 tests performed, 11 patients received a targeted therapy based on actionable mutations detected with the NGS assays. All the 11 patients had been heavily pretreated (>=3 prior lines). One patient died because of COVID-19 and thus was excluded from the analysis. Out of the 10 patients included, targeted therapies showed an overall CBR of 80% in 8 patients (10% CR, 33.3% PR, 40% SD, and 20% PD). 7 patients were treated with a targeted agent belonging to the PI3K pathway, with 3 PR (42.9%), 3 SD (42.9%), and 1 PD (14.2%). 3 patients received PARP inhibitor treatment according to their HRD status, with 1 CR (33.3%), 1 SD (33.3%), and 1 PD (33.3%). Conclusion(s): In our series, an outstanding CBR of 80% was achieved with the use of targeted therapy according to NGS assays in heavily pretreated patients (>=3 prior lines). Our finding underlines the importance of molecular-driven treatments and requires further investigation to confirm these results in terms of clinical benefit in a broader population. Besides, the use of molecular-driven treatments may avoid unnecessary exposure to potentially more toxic therapies and reduce the costs associated with inappropriate treatments. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: V. Salutari: Financial Interests, Personal and Institutional, Advisory Board: AstraZeneca, Clovis, GSK, Tesaro, MSD, Roche, PharmaMar, Eisai. G. Scambia: Financial Interests, Personal, Invited Speaker, Speaker: Johnson & Johnson, AstraZeneca & MSD, Olympus Europa, Baxter Healthcare, Intuitive Surgical Inc., GlaxoSmithKline;Financial Interests, Personal, Expert Testimony, Trainer: Covidien AG (Medtronic company);Financial Interests, Institutional, Invited Speaker, 'IsoMSLN' in Ovarian Cancer and Malignant Pleural Mesothelioma: Kiromic;Financial Interests, Institutional, Invited Speaker, Roll-over study for patients who have completed a previous cancer study with olaparib and who the investigator believes can benefit from continued treatment - ROSY-O: AstraZeneca;Financial Interests, Institutional, Invited Speaker, CATCH-R: Roll-over study to provide continuous access to clinical therapy with rucaparib: Clovis Oncology;Financial Interests, Institutional, Invited Speaker, Phase III, multicenter, placebo-controlled clinical study comparing chemo-immunotherapy (paclitaxel-carboplatin-oregovomab) versus chemotherapy (paclitaxel-carboplatin-placebo) in patients with advanced epithelial ovarian, tubal cancer of fallopian or peritoneal (FLORA-5): Oncoquest Pharmaceuticals Inc.;Financial Interests, Institutional, Invited Speaker, Phase IIb randomized, open-label, active comparator, parallel-group, multicenter study designed to evaluate the efficacy and safety of three different doses of the P2X3 receptor antagonist (BAY 1817080) versus placebo and Elagolix 150 mg in women with symptomatic endometriosis: Bayer AG;Financial Interests, Institutional, Invited Speaker, Usability of ITE transducers for sending electr c fields for tumor treatment (TTFields): Novocure Ltd.;Financial Interests, Institutional, Invited Speaker, Phase III, multicentre, open-label extension trial to evaluate long-term safety and efficacy in patients with advanced cancers currently undergoing treatment or in follow-up in a pembrolizumab trial: Merck. D. Lorusso: Financial Interests, Personal, Advisory Board, Participation in Advisory Boards and Invited Speaker: GSK, Clovis Oncology, PharmaMar;Financial Interests, Personal, Advisory Board, Participation in Advisory Boards and Invited Speakers: AstraZeneca, MSD;Financial Interests, Personal, Other, Consultancy: PharmaMar, Amgen, AstraZeneca, Clovis Oncology, GSK, MSD, Immunogen, Genmab, Seagen;Financial Interests, Personal, Advisory Board, Participation in Advisory Boards: Merck Serono;Financial Interests, Personal, Advisory Board, Invited member of advisory board: Seagen, Immunogen, Genmab, Oncoinvest, Corcept, Sutro;Financial Interests, Institutional, Funding, Grant for founding academic trial: MSD, Clovis Oncology, PharmaMar;Financial Interests, Institutional, Funding, Grant for founding academic trial: GSK;Financial Interests, Institutional, Invited Speaker, ENGOT trial with institutional support for coordination: Clovis Oncology;Financial Interests, Institutional, Invited Speaker, ENGOT trial with institutional support for coordination: Genmab, MSD;Financial Interests, Institutional, Funding, Clinical trial/contracted research: AstraZeneca, Clovis Oncology, GSK, MSD, Seagen;Financial Interests, Institutional, Funding, Clinical trials/contracted research: Genmab, Immunogen, Incyte, Novartis, Roche;Non-Financial Interests, Personal, Principal Investigator, PI of several trials, no compensation received: GSK;Non-Financial Interests, Personal, Principal Investigator, PI of several trials. No personal compensation received: AstraZeneca, Genmab;Non-Financial Interests, Personal, Principal Investigator, PI in several trials. No personal compensation received: MSD;Non-Financial Interests, Personal, Principal Investigator, PI of clinical trial. No personal compensation received: Immunogen, Clovis, Incyte;Non-Financial Interests, Personal, Principal Investigator, PI of clinical trial. No personal compensation receive: Roche;Non-Financial Int rests, Personal, Member, Board of Directors: GCIG. All other authors have declared no conflicts of interest. Copyright © 2022 European Society for Medical Oncology
ABSTRACT
Background: When the COVID-19 pandemic struck, primary care and specialist visits declined. During the pandemic, Baltimore City Mobile Integrated Health (MIH) continued with targeted home visits among complex patients to help reduce hospital readmission rates. Many provider offices and specialists were closed for in-person clinic visits, creating disruption in continual care of chronic disease. To fill in gaps in care, MIH sought to facilitate these visits via telemedicine for their complex patient population. Methods: A retrospective chart review of MIH-enrolled patients was performed from March 2020 to August 2020. State health information exchange systems were also reviewed for hospital contact. To evaluate if the telemedicine visit was effective in reducing the readmission rate, the study compared the risk-adjusted readmission rate and chi square analysis of patients who received a telemedicine visit with their primary care/specialist as a part of their MIH visit versus MIH patients who did not. Results: From March 2020-August 2020, telemedicine was utilized 26 times for 14 patients to connect with their providers. The risk-adjusted readmission rate for MIH patients that received telemedicine primary care/specialist visits were 7.7%;the rate for MIH patients who did not was 16%. Chi square analysis did not reveal statistical significance among the two groups. Conclusion: Flexible and innovative use of telemedicine technology improves team communication and can also be used to facilitate existing care relationships between underserved populations and their care providers. The University of Maryland Medical Center (UMMC) partnered with the Baltimore City Fire Department (BCFD) to form Mobile Integrated Health (MIH) in 2018. This partnership aims to support medically complex patients’ transition to home after hospital admissions. This innovative, community-based program supports the health of individuals through a comprehensive, multidisciplinary care model that provides patient care outside the hospital setting. The program is designed to reduce health disparities, decrease emergency department visits, and prevent hospital readmissions. One of the main objectives for this MIH program is to have patients connect with their primary care providers (PCPs) shortly after discharge so that the PCPs can continue to manage their chronic health conditions and medications and prevent readmission to the hospital. Prior to March 2020, none of the patients enrolled in UMMC-BCFD MIH utilized telemedicine for their medical visits (Mobile Integrated Health Community Paramedicine Program, 2020). During the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) issued guidance advising patients and health care providers to practice social distancing and encouraged the use of telehealth (Koonin et al., 2020). A study conducted by the Department of Veteran Affairs (VA) found that there was a 56% decrease in in-person outpatient visits during the COVID-19 pandemic (Baum, et al., 2021). However, the UMMC-BCFD MIH program remained in operation with no change in staffing or practice. With the need to connect patients with their PCPs, the UMMC-BCFD MIH program needed to pivot their normal operations to continue to meet the needs of the patients. A retrospective chart review was completed to evaluate the enrollment rate of visits facilitating PCP and/or specialist encounters and if in-person visits impacted hospital re-admission rates among this population. Prior to the pandemic, patients that were enrolled in the MIH program regularly saw their PCPs in-person from 40-80% of the time during their enrollment. However, when COVID restrictions began, those in-person visits decreased to about 20% of the enrolled patients seeing their PCPs. The MIH program was able to change its normal operation to connect patients to primary care providers and specialists via telemedicine to meet the needs of medically complex patients during a pandemic.