6 results on '"Adelstein, David J."'
Search Results
2. Immunotherapy of head and neck cancer: Emerging clinical trials from a National Cancer Institute Head and Neck Cancer Steering Committee Planning Meeting.
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Bauman, Julie E, Cohen, Ezra, Ferris, Robert L, Adelstein, David J, Brizel, David M, Ridge, John A, O'Sullivan, Brian, Burtness, Barbara A, Butterfield, Lisa H, Carson, William E, Disis, Mary L, Fox, Bernard A, Gajewski, Thomas F, Gillison, Maura L, Hodge, James W, Le, Quynh-Thu, Raben, David, Strome, Scott E, Lynn, Jean, and Malik, Shakun
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IMMUNOLOGICAL adjuvants ,THERAPEUTIC use of monoclonal antibodies ,DRUG therapy ,CLINICAL trials ,COMBINED modality therapy ,IMMUNOTHERAPY ,HEAD tumors ,RESEARCH funding ,NECK tumors ,TUMOR classification ,TREATMENT effectiveness ,PATIENT selection ,DIAGNOSIS ,TUMOR treatment ,THERAPEUTICS - Abstract
Recent advances have permitted successful therapeutic targeting of the immune system in head and neck squamous cell carcinoma (HNSCC). These new immunotherapeutic targets and agents are being rapidly adopted by the oncologic community and hold considerable promise. The National Cancer Institute sponsored a Clinical Trials Planning Meeting to address the issue of how to further investigate the use of immunotherapy in patients with HNSCC. The goals of the meeting were to consider phase 2 or 3 trial designs primarily in 3 different patient populations: those with previously untreated, human papillomavirus-initiated oropharyngeal cancers; those with previously untreated, human papillomavirus-negative HNSCC; and those with recurrent/metastatic HNSCC. In addition, a separate committee was formed to develop integrative biomarkers for the clinical trials. The meeting started with an overview of key immune components and principles related to HNSCC, including immunosurveillance and immune escape. Four clinical trial concepts were developed at the meeting integrating different immunotherapies with existing standards of care. These designs were presented for implementation by the head and neck committees of the National Cancer Institute-funded National Clinical Trials Network. This article summarizes the proceedings of this Clinical Trials Planning Meeting, the purpose of which was to facilitate the rigorous development and design of randomized phase 2 and 3 immunotherapeutic trials in patients with HNSCC. Although reviews usually are published immediately after the meeting is held, this report is unique because there are now tangible clinical trial designs that have been funded and put into practice and the studies are being activated to accrual. Cancer 2017;123:1259-1271. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]
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- 2016
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3. Clinical Factors Associated With Cost in Head and Neck Cancer: Implications for a Bundled Payment Model.
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Tom MC, Ross RB, Koyfman SA, Adelstein DJ, Lorenz RR, Burkey BB, Shah C, Suh JH, Bolwell BJ, Savage C, Platz S, and Ward MC
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- Adult, Aged, Aged, 80 and over, Chemoradiotherapy economics, Chemoradiotherapy methods, Combined Modality Therapy, Female, General Surgery economics, General Surgery methods, Head and Neck Neoplasms pathology, Humans, Male, Middle Aged, Radiotherapy economics, Radiotherapy methods, United States, Head and Neck Neoplasms economics, Head and Neck Neoplasms therapy, Health Care Costs statistics & numerical data, Patient Care Bundles economics
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Purpose: To determine which factors influence cost in head and neck cancer (HNC) to inform the development of a bundled payment model (BPM)., Methods: Patients with stages 0 to IVB (by American Joint Commission on Cancer, 7th edition) HNC of various sites and histology treated definitively at a single tertiary care center during 2013 were included. Clinical variables and direct cost data were obtained, and their associations were investigated using χ
2 , t , Wilcoxon rank sum, and analysis of variance testing. Results were used to develop a BPM., Results: One hundred fifty patients were included; 87% were white, 74% were men, 48% had oropharyngeal cancer, and 58% had stage IVA disease. Treatment consisted of surgery alone (17%), radiation alone (11%), surgery plus radiation (14%), chemoradiation (45%), and surgery plus chemoradiation (13%). On multivariable analysis, both increasing group stage and number of treatment modalities used were significantly associated with higher cost. Given that stage often dictates treatment, we developed three cost tiers that were based on overall treatment modality. Tier A, the least costly, consisted of single-modality therapy with either surgery alone or radiation alone (median cost divided by the median overall cost of treatment, 0.54; 25th to 75th percentile range, 0.29 to 1.02), followed by tier B, which consisted of bimodality therapy with either chemoradiation or surgery plus radiation (1.03; range, 0.81 to 1.35), followed by tier C, which consisted of trimodality therapy with surgery plus chemoradiation (1.43; range, 1.10 to 1.96)., Conclusion: The number of treatment modalities required is the primary driver of cost in HNC. These data can simplify development of a comprehensive HNC BPM.- Published
- 2019
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4. Risk of Hematologic Malignancies After Radioiodine Treatment of Well-Differentiated Thyroid Cancer.
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Molenaar RJ, Sidana S, Radivoyevitch T, Advani AS, Gerds AT, Carraway HE, Angelini D, Kalaycio M, Nazha A, Adelstein DJ, Nasr C, Maciejewski JP, Majhail NS, Sekeres MA, and Mukherjee S
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- Adult, Cohort Studies, Female, Hematologic Neoplasms etiology, Humans, Iodine Radioisotopes adverse effects, Male, Middle Aged, Neoplasms, Radiation-Induced etiology, Registries, Risk, SEER Program, Thyroid Neoplasms surgery, Thyroidectomy, United States epidemiology, Hematologic Neoplasms epidemiology, Iodine Radioisotopes administration & dosage, Neoplasms, Radiation-Induced epidemiology, Thyroid Neoplasms epidemiology, Thyroid Neoplasms radiotherapy
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Purpose To investigate the risk and outcomes of second hematologic malignancies (SHMs) in a population-based cohort of patients with well-differentiated thyroid cancer (WDTC) treated or not with radioactive iodine (RAI). Methods Patients with WDTC were identified from SEER registries. Competing risk regression analysis was performed to calculate the risks of SHMs that occurred after WDTC treatment and outcomes after SHM development were assessed. Results Of 148,215 patients with WDTC, 53% received surgery alone and 47% received RAI. In total, 783 patients developed an SHM after a median interval of 6.5 years (interquartile range, 3.3 to 11.2 years) from WDTC diagnosis. In multivariable analysis, compared with those undergoing thyroidectomy alone, RAI treatment was associated with an increased early risk of developing acute myeloid leukemia (AML; hazard ratio, 1.79; 95% CI, 1.13 to 2.82; P = .01) and chronic myeloid leukemia (CML; hazard ratio, 3.44; 95% CI, 1.87 to 6.36; P < .001). This increased risk of AML and CML after RAI treatment was seen even in low-risk and intermediate-risk WDTC tumors. Occurrence of AML but not CML in patients with WDTC was associated with shorter median overall survival compared with matched controls (8.0 years v 31.0 years; P = .001). In addition, AML developing after RAI trended toward inferior survival compared with matched controls with de novo AML (median overall survival, 1.2 years v 2.9 years; P = .06). Conclusion Patients with WDTC treated with RAI had an increased early risk of developing AML and CML but no other hematologic malignancies. AML that arises after RAI treatment has a poor prognosis. RAI use in patients with WDTC should be limited to patients with high-risk disease features, and patients with WDTC treated with adjuvant RAI should be monitored for myeloid malignancies as part of cancer surveillance.
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- 2018
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5. Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update.
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Forastiere AA, Ismaila N, Lewin JS, Nathan CA, Adelstein DJ, Eisbruch A, Fass G, Fisher SG, Laurie SA, Le QT, O'Malley B, Mendenhall WM, Patel S, Pfister DG, Provenzano AF, Weber R, Weinstein GS, and Wolf GT
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- Clinical Decision-Making, Consensus, Evidence-Based Medicine standards, Humans, Laryngeal Neoplasms mortality, Laryngeal Neoplasms pathology, Laryngectomy adverse effects, Laryngectomy mortality, Neoplasm Staging, Organ Sparing Treatments adverse effects, Organ Sparing Treatments mortality, Patient Selection, Treatment Outcome, United States, Laryngeal Neoplasms therapy, Laryngectomy methods, Organ Sparing Treatments methods
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Purpose To update the guideline recommendations on the use of larynx-preservation strategies in the treatment of laryngeal cancer. Methods An Expert Panel updated the systematic review of the literature for the period from January 2005 to May 2017. Results The panel confirmed that the use of a larynx-preservation approach for appropriately selected patients does not compromise survival. No larynx-preservation approach offered a survival advantage compared with total laryngectomy and adjuvant therapy as indicated. Changes were supported for the use of endoscopic surgical resection in patients with limited disease (T1, T2) and for initial total laryngectomy in patients with T4a disease or with severe pretreatment laryngeal dysfunction. New recommendations for positron emission tomography imaging for the evaluation of regional nodes after treatment and best measures for evaluating voice and swallowing function were added. Recommendations Patients with T1, T2 laryngeal cancer should be treated initially with intent to preserve the larynx by using endoscopic resection or radiation therapy, with either leading to similar outcomes. For patients with locally advanced (T3, T4) disease, organ-preservation surgery, combined chemotherapy and radiation, or radiation alone offer the potential for larynx preservation without compromising overall survival. For selected patients with extensive T3 or large T4a lesions and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy. Patients with clinically involved regional cervical nodes (N+) who have a complete clinical and radiologic imaging response after chemoradiation do not require elective neck dissection. All patients should undergo a pretreatment baseline assessment of voice and swallowing function and receive counseling with regard to the potential impact of treatment options on voice, swallowing, and quality of life. Additional information is available at www.asco.org/head-neck-cancer-guidelines and www.asco.org/guidelineswiki .
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- 2018
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6. Adjuvant Chemoradiation After Surgical Resection in Elderly Patients With High-Risk Squamous Cell Carcinoma of the Head and Neck: A National Cancer Database Analysis.
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Woody NM, Ward MC, Koyfman SA, Reddy CA, Geiger J, Joshi N, Burkey B, Scharpf J, Lamarre E, Prendes B, and Adelstein DJ
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- Aged, Aged, 80 and over, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell surgery, Databases, Factual statistics & numerical data, Female, Head and Neck Neoplasms mortality, Head and Neck Neoplasms pathology, Head and Neck Neoplasms surgery, Humans, Hypopharyngeal Neoplasms mortality, Hypopharyngeal Neoplasms pathology, Hypopharyngeal Neoplasms surgery, Hypopharyngeal Neoplasms therapy, Laryngeal Neoplasms mortality, Laryngeal Neoplasms pathology, Laryngeal Neoplasms surgery, Laryngeal Neoplasms therapy, Male, Mouth Neoplasms mortality, Mouth Neoplasms pathology, Mouth Neoplasms surgery, Mouth Neoplasms therapy, Oropharyngeal Neoplasms mortality, Oropharyngeal Neoplasms pathology, Oropharyngeal Neoplasms surgery, Oropharyngeal Neoplasms therapy, Practice Patterns, Physicians', Propensity Score, Proportional Hazards Models, Radiotherapy, Intensity-Modulated statistics & numerical data, Squamous Cell Carcinoma of Head and Neck, United States, Carcinoma, Squamous Cell therapy, Chemoradiotherapy, Adjuvant statistics & numerical data, Head and Neck Neoplasms therapy
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Purpose: To determine the patterns of adjuvant chemoradiotherapy use in elderly patients treated with definitive surgical resection for squamous cell carcinoma of the head and neck with extracapsular extension (ECE) or positive margins and determine whether an association with overall survival (OS) exists with adjuvant concurrent chemoradiotherapy (CRT)., Methods and Materials: The National Cancer Database was queried to identify patients with SCC of the oral cavity, oropharynx, larynx, and hypopharynx who were treated with primary definitive surgery and adjuvant radiation therapy between 2004 and 2012. For elderly patients (aged >70 years) with pathology revealing ECE or positive margin, the benefit of concurrent chemotherapy was explored using multivariable Cox proportional hazards modeling., Results: A total of 7349 patients were identified meeting study criteria, of whom 1187 were elderly (aged >70 years) with a median follow-up of 30.6 months. Of these elderly patients, 445 had ECE or positive margin and represent the study population, of whom 187 (42%) received CRT. Delivery of CRT in this cohort increased over the study period, and intensity modulated radiation therapy was associated with increased use of CRT (odds ratio 2.07; P=.004). Increasing age was associated with reduced use of CRT (odds ratio 0.88; P<.001). Chemoradiotherapy was associated with a significant improvement in OS on multivariable analysis (hazard ratio 0.74; P=.04) and a trend toward significance on inverse propensity score analysis (hazard ratio 0.78; P=.051). Three-year OS was 53.8% in the CRT group, compared with 44.6% in the adjuvant radiation therapy-alone patients., Conclusions: The use of adjuvant CRT is increasing among elderly patients with resected squamous cell carcinoma of the head and neck exhibiting ECE or positive margins. Chemoradiotherapy was associated with an improvement in OS on multivariable analysis but not propensity-weighted analysis. Among fit elderly patients with ECE or positive margins after definitive surgical resection, concurrent chemotherapy can be carefully considered., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
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