Search

Key Clinical Message: Serum carbohydrate antigen 19‐9 (CA19‐9) is used for recurrence surveillance in patients with resected pancreatic ductal adenocarcinoma (PDAC). This report describes the association of increasing CA19‐9 in a male PDAC survivor with presence of prostatic hyperplasia. Unexplained elevation of CA19‐9 in male PDAC survivors might be attributable to benign prostatic conditions. [ABSTRACT FROM AUTHOR]

Background: Mesenchymal chondrosarcoma (MCS) is an ultra‐rare sarcoma that follows a more aggressive course than conventional chondrosarcoma. This study evaluates prognostic factors, treatments (surgery, chemotherapy, and radiation), and outcomes in an Australian setting. Methods: We collected demographics, clinicopathological variables, treatment characteristics, and survival status from patients with MCS registered on the national ACCORD sarcoma database. Outcomes include overall survival (OS) and progression‐free survival (PFS). Results: We identified 22 patients with MCS between 2001–2022. Median age was 28 (range 10–59) years, 19 (86%) had localised disease at diagnosis of whom 16 had surgery (84%), 11 received radiation (58%), and 10 chemotherapy (53%). Ten (52%) developed recurrence and/or metastases on follow‐up and three patients with initial metastatic disease received surgery, radiation, and chemotherapy. At a median follow‐up of 50.9 (range 0.4–210) months nine patients had died. The median OS was 104.1 months (95% CI 25.8–182.3). There was improved OS for patients with localised disease who had surgical resection of the primary (p = 0.003) and those with ECOG 0–1 compared to 2–3 (p = 0.023) on univariate analysis. Conclusions: This study demonstrates contemporary Australian treatment patterns of MCS. The role of chemotherapy for localised disease remains uncertain. Understanding treatment patterns and outcomes help support treatment decisions and design of trials for novel therapeutic strategies. [ABSTRACT FROM AUTHOR]

Aim: Despite lack of advances in the first‐line systemic therapy, the overall survival (OS) has continued to improve in patients with advanced soft tissue sarcoma (STS) with the recent estimation of median OS at 20 months. Several systemic therapy options are available now for the second‐line and beyond, with more treatment tailored to histology and molecular subtype. The aim of this retrospective study was to characterize current patterns of care in managing patients with advanced STS (aSTS) in Australia. Methods: Sarcoma databases from 7 Australian sarcoma services were accessed to identify patients diagnosed with locally advanced inoperable and/or metastatic STS between January 1, 2010 and December 31, 2015. Baseline clinicopathological factors and initial treatment patterns were descriptively analyzed. For the Victorian cohort where treatment of aSTS and follow‐up details were available, further exploratory analysis was conducted to determine the impact of patient and tumor characteristics and the use of palliative‐intent treatment OS. Results: Of 2261 cases of STS, 671 were deemed as aSTS. Two thirds were relapsed disease with a mean 1.9 years from initial diagnosis. Median age at diagnosis of aSTS was 59 years (18–95 years) and 56.3% was male. Histology classification revealed four main subtypes: undifferentiated pleomorphic sarcoma (UPS) (23.1%), leiomyosarcoma (18.2%), liposarcoma (12.8%), synovial sarcoma (8.2%), and other comprising 14 STS subtypes. For the Victorian cohort (N = 361), approximately 80% of patients accessed palliative‐intent treatment of various modalities. Nearly 40% of patients underwent tumor‐debulking surgery or metastasectomy, of which lung wedge resection was the most common (N = 83, 47.7%). A total of 438 palliative‐intent radiotherapy treatments were delivered to 259 patients (71.7%), with the majority in the form of external beam radiotherapy. Palliative‐intent systemic therapy was delivered to 51.5% of patients (N = 186), mostly (73%). Anthracycline‐based therapy was the most commonly delivered therapy (N = 135, 72.6%). Approximately half of the patients in each line of therapy failed to proceed to the subsequent line of systemic therapy with 29.4% receiving three or more lines of therapy (N = 55). A total of 18.3% of patient (N = 34) participated in clinical trials or accessed off‐label drugs. The median OS for the Victoria cohort was 15.4 months (95% confidence interval: 12.1, 18.2). The UPS histology subtype was associated with poorer OS, whereas receiving any modality of palliative‐intent treatment conferred survival benefit. Conclusion: In Australia, aSTS is managed with diverse treatment approaches comprising various therapy modalities. Further work is planned in describing healthcare resource utilization and estimating costs by this patient cohort. [ABSTRACT FROM AUTHOR]

Background: A single state‐wide upper gastrointestinal (GI) cancer video‐linked multidisciplinary team (MDT) meeting guides management and evidence‐based care for all newly diagnosed upper GI cancer patients in South Australia. This study determined the patterns of care and outcomes for patients diagnosed with gastric and gastro‐oesophageal junction (GOJ) cancers. Methods: Patients diagnosed with gastric cancer and GOJ (Siewert III) cancer between June 2012 and June 2016 were included. Patient demographics, cancer stage, histology, diagnostic modalities and treatment data was analysed from a prospective database. Stage‐specific survival outcomes were determined and analysed for each treatment modality. Results: The study included 218 patients and at diagnosis 132 (61%) patients had stage I–III and 86 (39%) patients had stage IV disease. One hundred and ninety‐five (89%) patients had gastric cancer and 23 (11%) had GOJ cancer (Siewert III). One hundred and nine (50%) patients underwent surgery, with 92% R0 resection rate. Forty‐six patients received perioperative chemotherapy and 111 (51%) patients received palliative intent treatment. Median overall survival for stage II, III and IV cancers was 57.6 (95% CI 57.6‐NR), 22.8 (95% CI 20.4–43.2), and 6.0 months (95% CI 4.8–8.4) respectively (p < 0.001). Median overall survival for patients who underwent perioperative chemotherapy and surgery was not reached as compared to 44.4 months (95% CI 28.8‐NR) for patients who underwent surgery alone. Conclusion: Treatment outcomes for patients with gastric and GOJ cancer managed across South Australia met contemporary evidence‐based practice. However, as most patients continue to present with late‐stage disease, longer‐term survival remains poor. [ABSTRACT FROM AUTHOR]

Introduction: The majority of pancreatic cancers present locally advanced and carry a high mortality rate. Treatment is challenging, with mixed data suggesting use of chemotherapy alone or in combination with radiotherapy. The use of radiotherapy has previously been limited due to lack of ability to deliver radiation to the tumour mass without causing significant toxicity to surrounding organs. Stereotactic body radiotherapy (SBRT) allows delivery of higher biologically equivalent dose in a shorter treatment duration. We sought to investigate the safety and application of this technique in our centre. Method: We enrolled 27 patients from 2015, identified as locally advanced unresectable with histologically confirmed, non‐metastatic, pancreatic adenocarcinoma. All patients had endoscopically inserted fiducial markers and where possible concurrent chemotherapy was administered. Dose schedules ranged from 25 to 42 Gy in 5 or 3 fractions. Results: With an overall median follow up of 9 months (range, 3–32.7), the median survival was 11.6 months. Of those alive at 1 year, the local control rate was 67%. Six patients had Grade 3 toxicity, and other six had Grade 2 toxicity. None had Grade 4 or above toxicity. The most common symptom recorded was fatigue. Conclusion: SBRT for locally advanced pancreatic cancer is technically complex but feasible in a high volume centre. SBRT is unique, allowing safe delivery of high radiation dose resulting in good local control and decreases treatment time making it an attractive option for patients with unresectable pancreatic cancer. The majority of pancreatic cancers present locally advanced and carry a high mortality rate. Treatment is challenging, with mixed data. We have shown that SBRT is a unique technique, allowing safe delivery of high radiation dose resulting in good local control and decreases treatment time making it an attractive option for patients with unresectable pancreatic cancer. [ABSTRACT FROM AUTHOR]

Abstract: Title: Phase II study of celecoxib with docetaxel chemoradiotherapy (CRT) followed by consolidation chemotherapy docetaxel plus cisplatin with maintenance celecoxib in inoperable stage III nonsmall cell lung cancer. Introduction: Concurrent CRT has been associated with improvement in absolute 5‐year survival by 10% and is the standard of care for inoperable stage III nonsmall cell lung cancer. Preclinical evidence suggests that cyclooxygenase‐2 inhibition may increase the efficacy of CRT. Methods: Patients were treated with CRT (weekly docetaxel at 30 mg/m2 over 6 weeks with concurrent external beam radiotherapy with 60 Gy in 30 fractions) followed by consolidation chemotherapy with docetaxel and cisplatin, each at 75 mg/m2 given 3 weekly for four cycles. Patients were to receive celecoxib 400 mg twice daily during treatment. Prophylactic cranial irradiation (30 Gy in 15 fractions) was offered if there was disease response. Results: Twenty‐four patients commenced CRT. Nineteen patients commenced consolidation therapy with 14 patients completing treatment. Twelve patients had treatment with celecoxib. In the total cohort, the median overall survival (mOS) was 21 months and progression‐free survival (PFS) was 16 months. Overall response rate was 59% and disease control rate was 82%. Three patient deaths occurred. Significant grade 3/4 toxicity included radiation pneumonitis (17%), febrile neutropenia (17%), infection/sepsis with or with neutropenia (25%) and esophagitis (12.5%). Retrospective analysis of celecoxib versus no celecoxib treatment showed favorable mOS 26.5 versus 17.5 months and PFS 22 versus 16 months, but this did not reach statistical significance. Conclusions: The activity of this regimen has been demonstrated. Treatment‐related toxicity was substantial. The role of celecoxib in addition to CRT could not be demonstrated in this study because of the small number of patients. [ABSTRACT FROM AUTHOR]

Older people with cancer are at increased risk of falling. Falls risk-increasing drugs (FRIDs), comprising psychotropics and medications that cause orthostatic hypotension, are a potentially modifiable risk factor for falls. The objective of this study was to determine the prevalence and factors associated with use of FRIDs in older people with cancer. Patients aged ≥70 years who presented to a hospital outpatient clinic between January 2009 and July 2010 were included in the study. Information on current medication use, falls in previous 6 months, and frailty criteria was collected. Multinomial logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CIs) for factors associated with levels of FRID use. Overall, 76.1% (n = 293) of 383 patients used FRIDs. This comprised psychotropics (31.2%, n = 120) and medications causing orthostatic hypotension (69.9%, n = 269). In total, 24.0% (n = 92) patients reported falling in the previous 6 months. Risk factors for falling were associated with use of psychotropics but not orthostatic hypotension drugs. Patients with a history of falls had increased odds of using psychotropics (≥3 psychotropics; OR 13.50; 95%CI, 2.64-68.94). Likewise, frail patients had increased odds of using psychotropics (≥3 psychotropics; OR 27.78; 95%CI, 6.06127.42). Risk factors for falling were associated with the use of psychotropics. This suggests that clinicians either do not recognize or underestimate the contribution of medications to falls in this high-risk patient group. Further efforts are needed to rationalize medication regimens at the time of patients' first presentation to outpatient oncology services. [ABSTRACT FROM AUTHOR]

Aim Autologous hematopoietic stem cell transplantation (auto-HSCT) remains an experimental therapy for metastatic breast cancer (MBC) and there is no established protocol for cluster of differentiation 34+ (CD34+) hematopoietic progenitor cell (HPC) mobilization with historic studies using growth factors with or without chemotherapy. This study describes the feasibility and kinetics of CD34+ HPC mobilization following a single administration of docetaxel and the pegylated form of recombinant human granulocyte colony-stimulating factor analogue filgrastim (pegfilgrastim). Methods The study design was serial measurement of peripheral blood CD34+ HPC in patients with MBC following a single administration of intravenous (IV) docetaxel 100 mg/m2 on day 1 and subcutaneous (SC) pegfilgrastim 6 mg on day 2. Results Eight patients with MBC were enrolled. The median age was 56 years (range 51-75 years). All patients had human epidermal growth factor receptor 2 (HER2) negative disease and either hormone refractory or negative disease. Three patients had bone only disease, four had visceral organ disease with or without bone involvement and one had locally unresectable disease only. All patients had prior therapy for early-advanced stage disease and prior therapy for MBC included seven patients receiving at least one line of hormone therapy and three having palliative chemotherapy. Six patients recorded a rise in the CD34+ count greater than 20 cells/μL. The median peak level was 40.2 cells/μL (standard deviation = 28.7) occurring on day 9 and with an average duration of 4 days. Overall, treatment was well tolerated with manageable side-effects. Conclusion The single administration of docetaxel and pegfilgrastim was effective in mobilization of CD34+ HPC and peak levels followed a predictable course. This approach needs validation in prospective studies by preparation of auto-HSCT by leukapheresis and quantification of total CD34+ HPC yields. [ABSTRACT FROM AUTHOR]

Introduction: An MRI audit substudy was conducted in patients who underwent an MRI prior to treatment in Australia and New Zealand as part of the PETACC-6 trial in locally advanced rectal cancer.Methods: A total of 82 patients from 15 centres had rectal MRI scans reviewed for technique, data included in reports and comparison of reports with blinded central reporting by two experienced radiologists.Results: In total, 82% performed minimum T2 sagittal and T2 axial oblique sequences. The high-resolution T2 sequence parameters varied significantly with only 33% obtaining a voxel size of <1.3 mm3 . The rate of inclusion of relevant findings in the reports was T3 distance in mm 21%, N stage 84%, circumferential resection margin (CRM) status 72%, extramural venous invasion (EMVI) status 29% and distance from the puborectalis sling 17%. In total, 31% reports included all of T stage with T3 substage, N stage and CRM involvement. In total, 17% reports included these 3 findings and EMVI. Eleven reports used a template with 82% of these including the first 3 findings. The agreement with central reporters was T stage 76%, N stage 70%, CRM status 57% and EMVI 16%.Conclusion: There is significant variation in scan quality and low rates of including all relevant findings in rectal MRI reports in the audit. The authors recommend adoption of routine sequences and template reports in both trial settings and routine practice to improve scan technique and adequacy of reports in rectal cancer MRI staging scans across Australia and New Zealand. [ABSTRACT FROM AUTHOR]

Background Panitumumab Regimen In Second-line Monotherapy of Head and Neck Cancer (PRISM) trial evaluated the safety and efficacy of panitumumab as second-line monotherapy in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN). Methods This was an open-label, single-arm, multicenter trial that enrolled patients with progressive disease or intolerance to first-line systemic chemotherapy for recurrent or metastatic SCCHN. Patients received panitumumab 9 mg/kg Q3W. The primary endpoint was overall response rate; secondary endpoints included disease control rate, overall survival (OS), progression-free survival (PFS), and safety. Results The overall response rate was 4% (2 of 51 patients) and the disease control rate was 39% (20 of 51 patients). Median PFS was 1.4 months (95% confidence interval [CI] = 1.3-2.4 months). Median OS was 5.1 months (95% CI = 4.3-8.3 months). The most common adverse events were rash/dermatitis acneiform (69%), fatigue (33%), dry skin (21%), and hypomagnesemia (21%). There was one treatment-related death (angioedema). Conclusion Panitumumab monotherapy had limited activity in previously treated patients with recurrent or metastatic SCCHN. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1756-E1761, 2016 [ABSTRACT FROM AUTHOR]

Objectives To investigate statin use and pain in people with cancer aged 70 to 79 and 80 and older. Design Cross-sectional. Setting Medical oncology outpatient clinic at the Royal Adelaide Hospital. Participants Individuals aged 70 and older who presented consecutively between January 2009 and June 2010 (n = 385), of whom 106 were aged 80 and older. Measurements Participants completed a structured data collection instrument, documenting medication use, comorbidities and a general pain assessment (10-point visual analogue scale ( VAS)). Unadjusted and adjusted logistic regression was used to compute odds ratios ( ORs) and 95% confidence intervals ( CIs) for factors associated with statin use. Results The prevalence of statin use was 35% (n = 97) in people aged 70 to 79 and 39% (n = 41) in those aged 80 and older. After adjusting for age, sex, Charlson Comorbidity Index, and analgesic use, statin use was associated with self-reported pain ( VAS ≥5) ( OR = 4.09, 95% CI = 1.32-12.68) in people aged 80 and older but not in those aged 70 to 79. Half of participants using statins (51% n = 70) had a palliative treatment approach. Of the 41 statin users aged 80 and older, 20 (49%) were using statins for primary prevention. Conclusion The prevalence of statin use was similar in people aged 70 to 79 years and those aged 80 and older, with statin use associated with self-reported pain in people aged 80 and older. This highlights a potential benefit of 'deprescribing' statins in older people with cancer, especially those aged 80 and older. [ABSTRACT FROM AUTHOR]

Aim: To assess safety of rapid infusion by measuring infusion-related side effects and toxicities. Methods: Participants received the first rituximab infusion according to the manufacturers' recommendations. If well-tolerated, they then received the second and subsequent infusions at a rate of 20% of the dose over the first 30 min and the remaining 80% over the next hour. Premedication was administered for all the infusions. Results: A total of 243 infusions in 65 consecutive participants were evaluated. Six experienced a grade 1 reaction and one a grade 3 transfusion-related adverse event. Three of these participants were withdrawn from the rapid infusion study. The other four participants (grade 1 only participants) were re-challenged. The same premedication was used as in the first rapid infusion. On experiencing a grade 1 reaction, promethazine 12.5 mg i.v. was administered and infusion recommenced at 50% of the previous rate upon the resolution of symptoms. Three patients developed a grade 1 adverse event and one patient experienced no adverse reaction. The three patients who did not tolerate the second rapid infusion were withdrawn from this study. Conclusion: A rituximab infusion over 90-min was safe and feasible for participants who seek treatment at ambulatory cancer centre. The new regimen has been adopted as a standard practice with better resource utilization. [ABSTRACT FROM AUTHOR]

Synchronous malignancies are rare diagnostic and treatment challenges. Here we present three cases of synchronous ovarian cancer and lymphoma. Both malignancies were recognised in the same histopathology sections. This report discusses diagnosis and management dilemmas with a brief literature review. The simultaneous presentation of ovarian cancer and lymphoma has not previously been reported. [ABSTRACT FROM AUTHOR]

A 72-year-old man presented with erythema and induration of his calves and forearms. He had a past history of stage 1 colorectal carcinoma, treated with resection and primary anastamosis 4 years earlier. A diagnosis of eosinophilic fasciitis was made based on the characteristic clinical appearance, peripheral blood eosinophilia and a skin biopsy. There was no improvement in the condition following treatment with prednisolone or methotrexate. One year later, abnormal liver function studies were noted, and an abdominal computed tomography scan and subsequent needle biopsy of the liver confirmed a neoplastic lesion in the liver consistent with a metastatic colorectal carcinoma. Systemic chemotherapy with oxaliplatin, 5-fluorouracil and capecitabine was commenced, and resulted in partial remission of the colorectal carcinoma. Simultaneously, the indurations of the forearms and calves also improved, suggesting that the eosinophilic fasciitis was a paraneoplastic phenomenon. [ABSTRACT FROM AUTHOR]

The article offers information on COSA's (Clinical Oncological Society of Australia) 40th annual scientific meeting to be held in Adelaide, Australia from November 12 to 14, 2013.

The article offers information on the 2013 Clinical Oncology Society of Australia Annual Scientific Meeting to be held in Adelaide, South Australia from November 12-14, 2013.