4 results on '"Robert G. Uzzo"'
Search Results
2. Effectiveness of androgen-deprivation therapy and radiotherapy for older men with locally advanced prostate cancer.
- Author
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Bekelman JE, Mitra N, Handorf EA, Uzzo RG, Hahn SA, Polsky D, and Armstrong K
- Subjects
- Aged, Aged, 80 and over, Chemotherapy, Adjuvant, Humans, Male, Medicare, Neoplasm Grading, Propensity Score, Prostatic Neoplasms mortality, Prostatic Neoplasms pathology, Radiotherapy, Adjuvant, Retrospective Studies, SEER Program, Treatment Outcome, United States epidemiology, Androgen Antagonists therapeutic use, Antineoplastic Agents, Hormonal therapeutic use, Prostatic Neoplasms drug therapy, Prostatic Neoplasms radiotherapy
- Abstract
Purpose: We examined whether the survival advantage of androgen-deprivation therapy with radiotherapy (ADT plus RT) relative to ADT alone for men with locally advanced prostate cancer reported in two randomized trials holds in real-world clinical practice and extended the evidence to patients poorly represented in the trials., Methods: We conducted nonrandomized effectiveness studies of ADT plus RT versus ADT in three groups of patients diagnosed between 1995 and 2007 and observed through 2009 in the SEER-Medicare data set: (1) the randomized clinical trial (RCT) cohort, which included men age 65 to 75 years and was most consistent with participants in the randomized trials; (2) the elderly cohort, which included men age > 75 years with locally advanced prostate cancer; and (3) the screen-detected cohort, which included men age ≥ 65 years with screen-detected high-risk prostate cancer. We evaluated cause-specific and all-cause mortality using propensity score, instrumental variable (IV), and sensitivity analyses., Results: In the RCT cohort, ADT plus RT was associated with reduced cause-specific and all-cause mortality relative to ADT alone (cause-specific propensity score-adjusted hazard ratio [HR], 0.43; 95% CI, 0.37 to 0.49; all-cause propensity score-adjusted HR, 0.63; 95% CI, 0.59 to 0.67). Effectiveness estimates for the RCT cohort were not significantly different from those from randomized trials (P > .1). In the elderly and screen-detected cohorts, ADT plus RT was also associated with reduced cause-specific and all-cause mortality. IV analyses produced estimates similar to those from propensity score-adjusted methods., Conclusion: Older men with locally advanced or screen-detected high-risk prostate cancer who receive ADT alone risk decrements in cause-specific and overall survival., (© 2015 by American Society of Clinical Oncology.)
- Published
- 2015
- Full Text
- View/download PDF
3. Accelerated methotrexate, vinblastine, doxorubicin, and cisplatin is safe, effective, and efficient neoadjuvant treatment for muscle-invasive bladder cancer: results of a multicenter phase II study with molecular correlates of response and toxicity.
- Author
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Plimack ER, Hoffman-Censits JH, Viterbo R, Trabulsi EJ, Ross EA, Greenberg RE, Chen DY, Lallas CD, Wong YN, Lin J, Kutikov A, Dotan E, Brennan TA, Palma N, Dulaimi E, Mehrazin R, Boorjian SA, Kelly WK, Uzzo RG, and Hudes GR
- Subjects
- Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Bone Marrow drug effects, Carcinoma, Transitional Cell pathology, Chemotherapy, Adjuvant, Cisplatin administration & dosage, Disease-Free Survival, Doxorubicin administration & dosage, Drug Administration Schedule, Fatigue chemically induced, Female, Filgrastim, Gene Expression Profiling, Humans, Kaplan-Meier Estimate, Male, Methotrexate administration & dosage, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Polyethylene Glycols, Prospective Studies, Protective Agents therapeutic use, Recombinant Proteins therapeutic use, Treatment Outcome, Urinary Bladder Neoplasms pathology, Vinblastine administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Biomarkers, Tumor analysis, Carcinoma, Transitional Cell chemistry, Carcinoma, Transitional Cell drug therapy, Granulocyte Colony-Stimulating Factor therapeutic use, Neoadjuvant Therapy methods, Urinary Bladder Neoplasms chemistry, Urinary Bladder Neoplasms drug therapy
- Abstract
Purpose: Neoadjuvant cisplatin-based chemotherapy is standard of care for muscle-invasive bladder cancer (MIBC); however, it is infrequently adopted in practice because of concerns regarding toxicity and delay to cystectomy. We hypothesized that three cycles of neoadjuvant accelerated methotrexate, vinblastine, doxorubicin, and cisplatin (AMVAC) would be safe, shorten the time to surgery, and yield similar pathologic complete response (pT0) rates compared with historical controls., Patients and Methods: Patients with cT2-T4a and N0-N1 MIBC were eligible and received three cycles of AMVAC with pegfilgrastim followed by radical cystectomy with lymph node dissection. The primary end point was pT0 rate. Telomere length (TL) and p53 mutation status were correlated with response and toxicity., Results: Forty-four patients were accrued; 60% had stage III to IV disease; median age was 64 years. Forty patients were evaluable for response, with 15 (38%; 95% CI, 23% to 53%) showing pT0 at cystectomy, meeting the primary end point of the study. Another six patients (14%) were downstaged to non-muscle invasive disease. Most (82%) experienced only grade 1 to 2 treatment-related toxicities. There were no grade 3 or 4 renal toxicities and no treatment-related deaths. One patient developed metastases and thus did not undergo cystectomy; all others (n = 43) proceeded to cystectomy within 8 weeks after last chemotherapy administration. Median time from start of chemotherapy to cystectomy was 9.7 weeks. TL and p53 mutation did not predict response or toxicity., Conclusion: AMVAC is well tolerated and results in similar pT0 rates with 6 weeks of treatment compared with standard 12-week regimens. Further analysis is ongoing to ascertain whether molecular alterations in tumor samples can predict response to chemotherapy., (© 2014 by American Society of Clinical Oncology.)
- Published
- 2014
- Full Text
- View/download PDF
4. Randomized trial of hypofractionated external-beam radiotherapy for prostate cancer.
- Author
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Pollack A, Walker G, Horwitz EM, Price R, Feigenberg S, Konski AA, Stoyanova R, Movsas B, Greenberg RE, Uzzo RG, Ma C, and Buyyounouski MK
- Subjects
- Aged, Dose Fractionation, Radiation, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Neoplasm Recurrence, Local epidemiology, Neoplasm Recurrence, Local prevention & control, Prostate-Specific Antigen blood, Prostatic Neoplasms mortality, Radiotherapy, Intensity-Modulated adverse effects, Treatment Outcome, Prostatic Neoplasms radiotherapy, Radiotherapy, Intensity-Modulated methods
- Abstract
Purpose: To determine if escalated radiation dose using hypofractionation significantly reduces biochemical and/or clinical disease failure (BCDF) in men treated primarily for prostate cancer., Patients and Methods: Between June 2002 and May 2006, men with favorable- to high-risk prostate cancer were randomly allocated to receive 76 Gy in 38 fractions at 2.0 Gy per fraction (conventional fractionation intensity-modulated radiation therapy [CIMRT]) versus 70.2 Gy in 26 fractions at 2.7 Gy per fraction (hypofractionated IMRT [HIMRT]); the latter was estimated to be equivalent to 84.4 Gy in 2.0 Gy fractions. High-risk patients received long-term androgen deprivation therapy (ADT), and some intermediate-risk patients received short-term ADT. The primary end point was the cumulative incidence of BCDF. Secondarily, toxicity was assessed., Results: There were 303 assessable patients with a median follow-up of 68.4 months. No significant differences were seen between the treatment arms in terms of the distribution of patients by clinicopathologic or treatment-related (ADT use and length) factors. The 5-year rates of BCDF were 21.4% (95% CI, 14.8% to 28.7%) for CIMRT and 23.3% (95% CI, 16.4% to 31.0%) for HIMRT (P = .745). There were no statistically significant differences in late toxicity between the arms; however, in subgroup analysis, patients with compromised urinary function before enrollment had significantly worse urinary function after HIMRT., Conclusion: The hypofractionation regimen did not result in a significant reduction in BCDF; however, it is delivered in 2.5 fewer weeks. Men with compromised urinary function before treatment may not be ideal candidates for this approach.
- Published
- 2013
- Full Text
- View/download PDF
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