Weekly vs Every-3-Week Carboplatin with Weekly Paclitaxel in Neoadjuvant Chemotherapy for Triple-Negative Breast Cancer: A Retrospective Analysis.

Background: Adding carboplatin to weekly paclitaxel as part of neoadjuvant chemotherapy (NACT) for stage II-III triple negative breast cancer (TNBC) has been shown to significantly increase the pathologic complete response (pCR) rate. Hematologic toxicities associated with every 3-week dosing of carboplatin have led some oncologists to explore weekly dosing as an alternative, but there are little published data comparing the two dosing schedules. Methods: We performed a retrospective analysis of patients who received paclitaxel and carboplatin, usually followed by AC, as initial NACT for TNBC at two academic cancer centers between 2008 and 2018 for whom pathologic results and post-operative follow-up were available. We recorded pCR, defined as ypT0/isN0, treatment delivery and disease-free survival, censored as of the patient's last follow-up visit. Results: A total of 76 patients were identified (median age 49 years). A total of 47 received weekly carboplatin, of whom 83% received at least 11 of 12 planned doses, and 29 received every 3-week carboplatin, of whom 90% received all 4 planned doses. pCR rates were similar, 53% with weekly and 55% with every 3-week carboplatin dosing. At median follow-up of 18 months (range <1-118), 93% of patients who achieved pCR were alive and free from recurrence, compared to 74% of those who did not. Conclusion: pCR rates were similar between patients receiving weekly or every 3-week carboplatin and were similar to those reported in prior trials with carboplatin. These data suggest that providers can choose either weekly or every 3-week carboplatin dosing without compromising the likelihood of achieving pCR.

De Novo Myelodysplastic Syndrome and Subsequent Diagnosis of Primary Solid Tumors: Evidence from the National Cancer Institute 2001-2011.

BACKGROUND: To our knowledge there are no population-level studies on the association between non-treatment-related myelodysplastic syndrome (MDS) and subsequent primary solid tumors. MATERIALS AND METHODS: Adult patients diagnosed with non-treatment-related MDS were selected from the SEER 18 database and the risk of subsequent primary solid tumor was calculated. RESULTS: A total of 40,780 patients with a diagnosis of MDS were reported in the SEER 18 registry during 2001 to 2011. In these patients, 2,111 subsequent primary solid tumors were diagnosed with an observed/expected (O/E) ratio of 1.16 and an absolute excess risk of 26.86 per 10,000. Diagnosis of subsequent solid tumor was most likely immediately after diagnosis of MDS or within 1 year of diagnosis. CONCLUSION: The risk of diagnosis of primary solid tumor malignancy in adult patients with de novo MDS is significantly higher compared to the general population. It is unclear whether this is due to detection bias or underlying pathophysiology.

The Palliative Care Information Act and Access to Palliative Care in Terminally ill Patients: A Retrospective Study.

BACKGROUND: Studies have shown that over 50% of end-of-life discussions take place for the first time in the hospital and that terminally ill patients often have unrealistic views regarding the possible scope of treatment. The Palliative Care information Act (PCIA) was passed in an attempt to address the lack of access for terminally ill patients to palliative care services. A multi-database systematic review was performed on published studies from 2010 to present, and there were none found measuring the effectiveness of the PCIA. OBJECTIVES: We aimed to study the effect of the PCIA on access to palliative care services. METHODS: We conducted a retrospective chart review of all terminally ill patients who died at Kingsbrook Jewish Medical Center from January 2010 to August 2013 in relation to passing of the PCIA. RESULTS: Prelaw (prior to the law passing), 12.3% of the terminal patients received palliative care consults, 25% during the transition period (time between passing of law and when it came into effect) and 37.7% postlaw (after coming into effect) (P < 0.001). CONCLUSIONS: Legislation can have a significant effect on terminally ill patient's access to palliative care services and can change the culture of a hospital to be more pro-palliative for the appropriate populations.