Biweekly THP‐COP therapy for newly diagnosed peripheral T‐cell lymphoma patients

Pirarubicin tetrahydropyranyl adriamycin (THP‐ADR) is an analogue of doxorubicin. This agent exhibits activity against some doxorubicin‐resistant cell lines. We performed a phase II study of biweekly THP‐COP [50 mg/m² pirarubicin, 750 mg/m² cyclophosphamide, 1.4 mg/m² vincristine (2.0 mg maximum) on day 1, and 100 mg/body predonisolone on days 1–5] in patients with peripheral T‐cell lymphoma (PTCL). Seventeen patients with newly diagnosed PTCL were enrolled. Histological diagnoses were of PTCL, not otherwise specified (n = 5), or angioimmunoblastic T‐cell lymphoma (n = 12). All diagnostic specimens including those of the historical control group were centrally reviewed by hematological pathologists. All patients received six cycles of biweekly THP‐COP. The patient group included 13 male and 4 female patients, with a median age of 62 years. The median follow‐up time in surviving patients was 30 months. Overall response rate was 94% with 15 cases of complete remission (88%). The 3‐year progression‐free survival and overall survival rates were 57% and 75%, respectively. The most frequent adverse events associated with biweekly THP‐COP were leukocytopenia (100%), neutropenia (100%), and lymphopenia (100%), followed by alopecia (92%) and anaemia (88%). All of these occurred only transiently, and the patients subsequently recovered. Biweekly THP‐COP is a safe and promising therapy for patients with newly diagnosed PTCL. This study is registered in a public database (UMIN000010485). Copyright © 2014 John Wiley & Sons, Ltd.     

Socio‐demographic predictors of high support needs in newly diagnosed breast cancer patients

GRIESSER A.‐C., VLASTOS G., MOREL L., BEAUME C., SAPPINO A.‐P. & HALLER G. (2010) European Journal of Cancer Care
Socio‐demographic predictors of high support needs in newly diagnosed breast cancer patients This study aimed to identify high support needs and their socio‐demographic predictors to improve supportive care for newly diagnosed breast cancer patients. A cross‐sectional study measured patients' needs and unsatisfied support needs by the supportive care needs survey (SCNS‐34), administered after surgery, chemotherapy or radiotherapy. Socio‐demographic, disease and treatment characteristics completed data collection. A total of 308 questionnaires were completed with a response rate of 88%. The most frequent support needs (73.3% of patients) related to information and the highest unsatisfied support needs to the management of emotions and daily life (36.3–39.6% of patients). Younger age predicted high and dissatisfied support needs (P < 0.05). Patients born outside Switzerland or with a lower level of education had more needs in daily living and psychological domains (P < 0.05). Being born outside Switzerland also predicted dissatisfaction with information provided. Being parent was a predictor of significant needs in the daily living domain after adjusting for disease and treatment characteristics (P= 0.01). Therefore, information, psychological and daily living support for newly diagnosed breast cancer patients should be strongly reinforced, particularly in patients being born outside Switzerland, those with children or being younger. For the latter, support in sexuality domain should also be emphasised.     

Management of newly diagnosed myeloma

The treatment of multiple myeloma has changed dramatically in the last decade with the introduction of thalidomide, bortezomib, and lenalidomide. Patients eligible for autologous stem cell transplantation (ASCT) are treated with non-alkylating agent-containing regimens as initial therapy; typically thalidomide-dexamethasone or lenalidomide-dexamethasone. For patients not eligible for ASCT, the current standard of care is melphalan, prednisone, and thalidomide. Ongoing trials will soon assess if combinations including melphalan and prednisone plus bortezomib or MP plus lenalidomide may be considered an attractive option. Patients who have risk factors, such as deletion 13 or translocation t(4;14) or t(14;16), are candidates for novel, more aggressive treatments.     

A randomized,controlled study of Internet peer‐to‐peer interactions among women newly diagnosed with breast cancer

Objective: Peer‐to‐peer interactions are associated with enhanced psychosocial adjustment among women with breast cancer. Millions of women with cancer and others with various health conditions use the Internet to establish peer relationships, usually without professional moderation. This paper reports findings from the first randomized, controlled study of the benefits of these types of Internet‐based peer interactions. Methods: This pilot study involved seventy‐eight women who were recently diagnosed with breast cancer. Participants were randomly assigned to either an Internet peer support condition or Internet‐based educational control condition. Data were gathered at baseline and 4‐ and 12‐months. Primary outcomes of interest were psychological distress and quality of life. Results: Contrary to hypotheses, participants in the Internet peer support condition tended to do worse over time on primary outcome measures. There were no differences between groups on secondary outcomes of perceived social support, self‐efficacy, or hope. Paradoxically, many women in the Internet peer support condition actively participated and reported high levels of satisfaction, suggesting some self‐perceived benefits. Conclusions: These results suggest that Internet based peer‐to‐peer interactions may not necessarily be universally beneficial despite the positive experiences reported by many participants. Further research is needed to understand the magnitude of this effect with a larger sample. Moreover, these results raise questions about the need to understand the comparative effectiveness of Internet‐based communications by group structure (i.e., unstructured/structured; unmoderated/moderated) and the effect of content (i.e., expression of fear/anxiety, insightful disclosures, etc.) on outcomes. Copyright © 2009 John Wiley & Sons, Ltd.     

Treatment of newly diagnosed multiple myeloma

Multiple myeloma (MM) is the second most common oncohematologic disease. Most patients are older than 65 years at diagnosis, and different therapeutic options are available depending on the age of the patient. For those younger than 65 years, autologous stem cell transplantation is the standard of care, whereas in older patients the better choice is conventional chemotherapy. The introduction of thalidomide, bortezomib, and lenalidomide, which target MM cells and the bone marrow microenvironment, has changed the therapeutic options in newly diagnosed patients with MM.     

Improved long‐term survival in all Sanz risk patients of newly diagnosed acute promyelocytic leukemia treated with a combination of retinoic acid and arsenic trioxide‐based front‐line therapy

Limited data was available for long‐term follow‐up in newly diagnosed acute promyelocytic leukemia (APL) patients treated with all‐trans‐retinoic acid (ATRA) plus intravenously arsenic trioxide (ATO)‐based front‐line therapy. The aim of this work was to retrospectively analyze the long‐term survival rate and frequency of therapy‐related myeloid neoplasia (t‐MN) occurring in a large cohort of APL patients. A total of 760 newly diagnosed patients with APL between January 1999 and May 2016 were evaluated. The early death rate was 9.2% (70/760). Of the remaining 690 patients with complete remission, patients were grouped according to front‐line regimens: ATRA plus ATO with or without chemotherapy (ATO group) and ATRA with chemotherapy (non‐ATO group). The median duration of follow‐up was 7.5 years (1.0‐18.3 years). ATO group showed significant superior 10‐year estimated relapse‐free survival (RFS) up to 90.3% comparing with 65.5% in the non‐ATO group (P < 0.0001). In addition, the 10‐year estimated overall survival (OS) was 93.9% for patients in the ATO group and 89.1% for those in the non‐ATO group (P = 0.03). In the subgroup analysis, the RFS rate was also higher in ATO group comparing with non‐ATO group in both low‐to‐intermediate‐risk (94.2% vs 64.6%, P < 0.0001) and high‐risk subgroup (89.6% vs 74.7%, P = 0.04). Notably, the 3‐year RFS and OS rates in the chemotherapy‐free subgroup of the low‐to‐intermediate‐risk patients (n = 88) were 100% and 100%, respectively. In the entire cohort, a total of 10 patients developed secondary malignant neoplasms, including 7 patients with therapy‐related myeloid neoplasms (t‐MN). The estimated 5‐year cumulative incidence risk of t‐MN in the ATO and non‐ATO groups was 1.0% and 0.4%, respectively (P = 0.34). Thus, our data revealed that the long‐term outcome of patients treated with ATRA plus ATO‐based regimens was associated with continuing high efficacy in all Sanz risk patients with newly diagnosed APL.     

Help‐seeking behaviour in newly diagnosed lung cancer patients: Assessing the role of perceived stigma

Objective

This study explored help‐seeking behaviours, group identification, and perceived legitimacy of discrimination, and its potential relationship with perceived lung cancer stigma.

Methods

Consecutive consenting adults (n = 274) with a primary diagnosis of lung cancer within the previous 4 months were recruited at 31 outpatient clinics in Australia. A self‐report survey assessed help‐seeking, group identification, perceived legitimacy of discrimination, and perceived lung cancer stigma.

Results

Services providing assistance from health professionals (69.5%) and informational support (68.5%) were more frequently used than emotional‐based support. Only a small proportion (2.6%) of participants were unlikely to seek help from anyone, with the most popular sources of help being the general practitioner (91.0%), and oncologist/treating clinician (81.3%). One‐fifth (21.1%) indicated they identified with being a lung cancer patient, and most did not perceive discrimination against lung cancer patients. Higher perceived lung cancer stigma was significantly associated with greater perceived legitimacy of discrimination (P < 0.001), but not help‐seeking behaviours or group identification.

Conclusions

The relationship between lung cancer stigma and perceived legitimacy of discrimination may guide initiatives to reduce stigma for patients. It is encouraging that perceived stigma did not appear to inhibit help‐seeking behaviours. However, further research in this emerging field is needed to investigate patterns of perceived stigma and help‐seeking over time to identify how and when to offer support services most appropriate to the needs of lung cancer patients.

     

Long‐term efficacy and safety of arsenic trioxide for first‐line treatment of elderly patients with newly diagnosed acute promyelocytic leukemia

BACKGROUND:

The prognosis of acute promyelocytic leukemia (APL) in the elderly is poorer than that of younger patients after treatment with all‐trans retinoic acid plus chemotherapy, which is the current standard therapy for APL. A significantly higher mortality during consolidation therapy was found, which is mainly due to deaths from sepsis following chemotherapy‐induced myelosuppression.

METHODS:

A total of 33 patients aged 60 years or older with de novo APL were treated with single‐agent arsenic trioxide (ATO) for remission induction and postremission therapy. The postremission therapy continued for up to 4 years.

RESULTS:

Twenty‐nine patients (87.9%) achieved a hematologic complete remission, and the most common adverse event during remission induction was leukocytosis (63.6%). Definite differentiation syndrome was observed in 5 patients. Nonhematologic adverse events were all manageable and reversible. Twenty‐eight patients proceeded to postremission therapy. Adverse effects during postremission therapy were mild, transient, and no treatment was required. No patients died from ATO‐related toxicities. With a median follow‐up of 99 months, the 10‐year cumulative incidence of relapse, overall survival, disease‐free survival, and cause‐specific survival were 10.3%, 69.3%, 64.8%, and 84.8%, respectively, which are comparable with those in the younger APL partners. No significant risks for development of chronic arsenicosis or second malignancy were observed during the follow‐up period.

CONCLUSIONS:

The results indicate that the single‐agent ATO regimen is safe and effective with long‐term durable remission, and could be used as first‐line treatment for elderly patients with de novo APL. Cancer 2013. © 2012 American Cancer Society.     

Management of newly diagnosed high‐risk and intermediate‐risk follicular lymphoma with 90Y ibritumomab tiuxetan in a phase II study

Five‐year overall survival for high‐risk Follicular Lymphoma International Prognostic Index follicular lymphoma is only approximately 50% compared with 90% for low risk. To evaluate an approach to improve upon this poor outcome, we completed an exploratory phase II trial of intensified treatment for patients with intermediate and high‐risk follicular lymphoma. Front‐line treatment with chemo‐immunotherapy consisting of rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone was followed by radio‐ immunotherapy with 90‐Yttrium ibritumomab tiuxetan consolidation, and 2 years of rituximab maintenance. The 5‐year overall survival for intermediate and high‐risk patients was 88% and 83%, respectively. Of 33 enrolled patients, 3 were off study before receiving radio‐immunotherapy. Three months post radio‐immunotherapy, 28/33 (85%) patients had achieved complete response including 6 patients who had only a partial response to chemo‐immunotherapy and converted to complete response after radio‐immunotherapy. The 5‐year progression‐free survival for intermediate and high risk was 79% and 58%, respectively. Nine of 19 patients with molecular markers patients remain in molecular and clinical complete remission with a median follow‐up of 48 months (range 3‐84 months). Post radio‐immunotherapy, hematologic toxicities were mostly grade 1 and 2. However, asymptomatic grade 3 or 4 thrombocytopenia and neutropenia occurred in 11%‐36% and 10%‐24% of patients, respectively. Myelodysplastic syndrome occurred in 1 patient 4 years post treatment. Whereas many patients had prolonged B‐cell reduction and low immunoglobulin levels post treatment, previous immunities to rubella were maintained. More aggressive upfront approaches such as this may benefit higher risk follicular lymphoma, but confirmatory trials are required. http://www.clinicaltrials.gov : NCT01446562.