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Objective Big Data is widely seen as a major opportunity for progress in the practice of personalized medicine, attracting the attention from medical societies and presidential teams alike as it offers a unique opportunity to enlarge the base of evidence, especially for older patients underrepresented in clinical trials. This study prospectively assessed the real-time availability of clinical cases in the Health & Research Informatics Total Cancer Care™ (TCC) database matching community patients with cancer, and the impact of such a consultation on treatment. Materials and Methods Patients aged 70 and older seen at the Lynn Cancer Institute (LCI) with a documented malignancy were eligible. Geriatric screening information and the oncologist's pre-consultation treatment plan were sent to Moffitt. A search for similar patients was done in TCC and additional information retrieved from Electronic Medical Records. A report summarizing the data was sent and the utility of such a consultation was assessed per email after the treatment decision. Results Thirty one patients were included. The geriatric screening was positive in 87.1% (27) of them. The oncogeriatric consultation took on average 2.2 working days. It influenced treatment in 38.7% (12), and modified it in 19.4% (6). The consultation was perceived as “somewhat” to “very useful” in 83.9% (26). Conclusion This study establishes a proof of concept of the feasibility of real time use of Big Data for clinical practice. The geriatric screening and the consultation report influenced treatment in 38.7% of cases and modified it in 19.4%, which compares very well with oncogeriatric literature. Additional steps are needed to render it financially and clinically viable.

The emergence of immunotherapy has generated great enthusiasm in oncology improving the prognosis of pathologies such as melanoma, lung cancer, kidney cancer, bladder and head and neck cancers. This enthusiasm concerns also older patients in view of the good tolerance of immunotherapy in young people. However, advanced age is linked to changes in the immune system, called immunosenescence, which could have a negative impact on the efficacy and toxicity of immunotherapy treatment. Knowledge in terms of efficacy and tolerance is limited for geriatric patients, few being included in clinical studies. This article summarizes the experience of immunotherapy in large clinical trials. It appears that the immune checkpoint inhibitors are effective and well tolerated in the elderly.L’émergence de l’immunothérapie a engendré un grand enthousiasme en oncologie en améliorant le pronostic de pathologies telles que le mélanome et les cancers pulmonaires, rénaux, vésicaux et de la sphère ORL. Cet enthousiasme concerne aussi les patients âgés au vu de la bonne tolérance de l’immunothérapie chez les jeunes. Cependant, l’âge avancé est lié à des modifications du système immunitaire, appelées immunosénescence, qui pourraient avoir un impact négatif sur l’efficacité et la toxicité du traitement par immunothérapie. Les connaissances en termes d’efficacité et de tolérance restent limitées pour les patients gériatriques, inclus en petit nombre dans les études cliniques. Cet article résume l’expérience de l’immunothérapie dans les grands essais cliniques. Il apparaît que les inhibiteurs de points de contrôle immunitaire soient efficaces et bien tolérés chez le sujet âgé.

Background/Aims: Heschl’s gyrus (HG) is functionally involved in the genesis of auditory verbal hallucinations (AVH). This dysfunction seems to be structurally facilitated. The aim of the study was to analyze macrostructural features of HG in a group of patients reporting AVH who demonstrated white matter diffusion tensor imaging abnormalities reported previously. Methods: 3-D anatomical MR scans were obtained (patients with and without history of AVH, controls). HG was delineated by manual segmentation. Cortical folding, absolute and relative volumes, laterality were analyzed. Results: According to the literature, in the collapsed group of patients, the normal left-greater-than-right laterality of HG was attenuated. We found a trend towards a higher number of duplicated HG in hallucinating patients. We also found a bigger volume of HG in the right hemisphere in hallucinating patients. This effect was caused by gray and white matter increase. Conclusions: This is the first study on manual volumetry of HG in a group of schizophrenia patients with AVH compared to patients without AVH. In a previous analysis of the diffusion tensor imaging data of the here presented sample, we found higher directionality of the arcuate fasciculus in patients with AVH, facilitating abnormal co-activation in the auditory cortices in the hallucinating brain. As these abnormal activations are frequent in hallucinating patients, the here described volume increase of HG might be interpreted as compensatory plastic adaptations of the contralateral regions. We suggest that this volume increase of HG is caused by the symptomatology and not by the underlying disorder of schizophrenia.

Introduction: The treatment of choice for newly diagnosed patients with advanced diffuse large B-cell lymphoma (DLBCL) is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) [Feugier P, Van Hoof A, Sebban C et al. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol 2005; 23: 4117-4126]. Anthracycline-based treatment is also superior to other drugs in controlling disease and prolonging survival in elderly patients [Hershman DL, McBride RB, Eisenberger A et al. Doxorubicin, cardiac risk factors, and cardiac toxicity in elderly patients with diffuse B-cell non-Hodgkin's lymphoma. J Clin Oncol 2008; 26: 3159-3165], however these individuals frequently have concomitant cardiac comorbidities such as congestive heart failure (CHF) that preclude the use of these agents. Methods: A search of the Moffitt Total Cancer Care™ database between January 1st 2008 and December 31st 2014 identified a cohort of 854 adult patients with a diagnosis of DLBCL. We performed a retrospective chart review of these patients and identified 40 individuals with documented CHF prior to the initiation of chemotherapy, due to either systolic (ejection fraction less than 50%) or diastolic dysfunction. The primary aim was to determine the chemotherapy regimens given to patients with DLBCL and CHF at Moffitt Cancer Center, and their related cardiovascular and oncologic outcomes. The study was approved by the University of South Florida Institutional Review Board. Results: 3 out of the 40 patients did not receive any chemotherapy and were excluded from the analysis. The median age was 71 years (range 21-93) with a median follow-up time of 19 months. Baseline characteristics are represented on table 1. Table 1.NPercentage (%)Sex1129.7FM2670.3Race38.1African AmericanAsian12.7White3389.2ECOG PS924.3011643.22821.6NA410.8Baseline Ejection fraction2156.8=50%1643.2Systolic Heart Failure1540.5NoYes1848.7UNK410.8Diastolic Heart Failure616.2NoYes1643.2UNK1540.5Ann Harbor Stage616.2III513.5III924.3IV1745.9 25 patients (67%) received R-CHOP or R-CHOP like (R-EPOCH) chemotherapy. The remaining patients received non R-CHOP regimens, being R-ICE (n=3), R-Hyper-CVAD (n=1), R-MTX (n=2), R-Bendamustine (n=2), R-CVP (n=2), R-CEOP (n=3). We observed an association between the type of treatment (R-CHOP vs non R-CHOP) and the type of heart failure, with diastolic CHF patients being more likely to receive a R-CHOP chemotherapy. (Table 2) Table 2.R-CHOPnon R-CHOPp-valueOR95% CINPercentage (%)NPercentage (%)Diastolic HFYes1588.2120.00.00530(2.14, 421.12)No211.8480.0Systolic HFYes731.811100 There was a trend toward better response to chemotherapy among patients with diastolic heart failure compared to systolic heart failure. We observed a larger number of cardiac events, defined as hospitalization for CHF, for cerebrovascular insult, for chest pain, for ischemic or non-ischemic cardiac events or cardiac-related deaths, in the group treated with R-CHOP, but this was not statistically significant, given low patients numbers. Although patients treated with a R-CHOP regimen demonstrated higher complete remission rates compared to non R-CHOP regimens (73.7% vs. 55.5% respectively), this result was not statistically significant (p=0.37), and there was no significant difference in overall survival or 2-year relapse free survival. Conclusion: To our knowledge, this is the largest series evaluating DLBCL treatment regimens in elderly patients with baseline cardiac dysfunction. This study demonstrated that elderly patients with DLBCL and baseline systolic CHF were more likely to receive non R-CHOP based regimens compared to patients with diastolic dysfunction. Non R-CHOP treatments seem to be better tolerated with fewer adverse cardiac events. The major limitations of this study are the small sample size from one center and the retrospective design. Future studies examining larger patient populations in a prospective fashion will provide more information about how to best treat DLBCL patients with heart failure. Disclosures No relevant conflicts of interest to declare.