Tolerability Of Bevacizumab In Elderly Ovarian Cancer Patients Turbo Study A Case Control Study Of A Real Life Experience

Objective. Bevacizumab maintenance following platinum-based chemotherapy is an effective treatment for epithelial ovarian cancer (EOC), both in primary and recurrent disease. Our aim was to identify criteria to select elderly patients who can safely benefit from bevacizumab addition.Methods. This is a case-control study on patients with primary or recurrent EOC who received platinum-based chemotherapy plus bevacizumab, between January 2015 - December 2016. Patient characteristics, treatment details and adverse events were reviewed and analyzed in two setting: younger (65 years, group 1) and elderly (65 years, group 2). A binary logistic model was applied to correlate clinical variables and severe (grade u22653) toxicity risk. Results. Overall, 283 patients with EOC were included, with 72 (25.4%) older patients compared with 211 (74.6%) younger women. Bevacizumab had been administered to 234 patients (82.7%) as first-line treatment and in 49 (17.3%) with recurrent disease. At diagnosis, elderly patients presented with at least one comorbidity and were taking at least 1 medication in 84.7% and 80.6% of the cases respectively, compared with correspondingly 47.4% and 37.4% in group 1 (p0.001). Nonetheless, the occurrence of serous (G3/G4) adverse events did not increase among the older group. Creatinine serum levels 1.1 g/dl, estimated glomerular filtration rate (eGFR)

Background:Bevacizumab with chemotherapy followed by bevacizumab was approved in 2018 for the first-line (1L) treatment of patients with ovarian cancer (OC). However, little is known about the real-world experience of OC patients treated with bevacizumab.Methods: This SEER-Medicare retrospective cohort study included females u2265 66 years, OC (stage II-IV) diagnosis between 2009 and 2015, who continued bevacizumab or observation alone after 4 u2013 10 cycles of 1L platinum-based chemotherapy with or without bevacizumab. The primary outcome was overall survival (OS), measured from 1L treatment initiation to death. Safety events of interest included thrombosis, hemorrhage, stroke, and gastrointestinal perforation. Inverse probability of treatment weighting (IPTW) incorporated 32 demographic and prognostic characteristics. Cox proportional hazards models with IPTW were used to compare outcomes.Results:In this cohort (N=2262), 66 (3%) patients received bevacizumab maintenance. Mean age (u00b1SD) was 74.6 (6.2) years, 89% were Stage III or IV, and 26.9% of patients had u22651 co-morbidity. Patients treated (preapproval) with 1L maintenance bevacizumab increased from 0.3% in 2009 to 4.1% in 2015. Compared to observation alone, median OS in patients treated with bevacizumab maintenance was 43.6 vs 37.9 months (adjusted hazard ratio [HR]=0.83 [95% CI: 0.50 u2013 1.36]). Among those who received >7 cycles of bevacizumab, OS was longer, though not significantly, compared to observation alone (aHR = 0.62 [95% CI: 0.32-1.18]). Initiation of nonplatinum chemotherapy within 12 months occurred in 36.4% of observation only and 20.9% of bevacizumab maintenance patients. Compared to observation alone, specified safety events were not higher with bevacizumab maintenance, aHR: 0.94 [0.49 u2013 1.82].Conclusions: Survival among this small cohort of elderly OC patients in this real-world study is consistent with that observed in trials of 1L bevacizumab maintenance. First-line maintenance bevacizumab therapy appears to provide modest survival benefit.

This practical book provides up-to-date information on the particular features of ovarian cancer in older women and the best management approach. The full range of relevant topics is covered. Guidance is provided on geriatric assessment, screening, pathology, diagnosis, and follow-up. The various treatment options are carefully explained, covering surgical approaches, chemotherapy as a first-line strategy, the use of anti-angiogenic agents, and treatment of relapse. The cognitive problems that may arise in elderly women during and after treatment of ovarian cancer are documented, with advice on response. Guidance is also provided on the design of clinical trials, and current directions in biological research are reviewed. This book will be of value to both practitioners and researchers with an interest in ovarian cancer and the elderly.​

Background:Despite high response rates to initial treatment, high recurrence rates remain a persistent challenge among patients with ovarian cancer (OC). There is limited data on overall survival (OS) rates and burden of disease in terms of resource use with contemporary standard of care. We examined the treatment experience of real-world patients in the United States (U.S) at 1-, 2-, 3- and 4-year landmarks.Methods:Using a single-arm retrospective cohort study design, we identified OC patients from the Surveillance, Epidemiology and End Results (SEER)-Medicare database who were aged u226566 years and had completed 4 u2013 10 cycles of platinum-based first-line (1L) chemotherapy from January 2009 to December 2015. The descriptive outcomes were OS, rates of hospitalization, mean number of hospitalizations and length of hospital stay (LOS), receipt of bevacizumab and proportion of patients who initiated non-platinum therapies, and transition rates through lines of therapy at 1-, 2-, 3- and 4-year landmarks.Results:We identified a total of 2,262 patients (mean age was 74.6 u00b16.2 years). 29.9% of patients had u22651 non-cancer comorbidity. 90.2% of patients were white.At 1 year after initiating chemotherapy, 90.7% of patients were alive, 56.1% were hospitalized at least once with a mean LOS of 16 days; 10.2% had received bevacizumab and 20.5% had initiated a nonplatinum-based therapy. At 4 years, 44.1% of patients were alive, 72.6% were hospitalized at least once with a mean LOS of 22 days; 31% had received bevacizumab and 56.2% had initiated a nonplatinum-based therapy. The proportion of patients who had died, completed or were receiving 3 or more lines of therapy increased from 10.1% at 1 year to 74.2% at 4 years from initiating chemotherapy. Among 1,538 patients with known treatment or mortality status after 4 years post-treatment initiation.Conclusions:The increasing burden of therapy and hospitalizations over time demonstrate the need for more effective front-line therapies to delay progression in ovarian cancer. Less than a fifth of OC patients received no further treatment 4 years after the initial treatment with contemporary standard of care.

ObjectivesSerous ovarian cancer, despite optimum treatment, most patients will recur and follow a chronically relapsing course, requiring repeated systemic therapies. Recurrent diseases are incurable, and the standard treatment goals are active symptom control, disease burden reduction, prolong the treatmentu2010free period, and maintain quality of life. Bevacizumab, an anti-vascular endothelial growth factor antibody with chemotherapy improved the improved response rates, progression-free survival (PFS) significantly in platinumu2010sensitive and platinumu2010resistant disease There is a paucity of data regarding the use of bevacizumab in the Indian subcontinent Material & MethodsWe retrospectively reviewed the clinical data of patients with epithelial ovarian cancer (EOC) from the hospital database treated during 2016-2019. The progression-free survival (PFS), overall response rate (ORR) and toxicity profile analyzed using IBM SPSS software version 25.0 (IBM Corp., Armonk, NY)ResultsSixty-One women with relapsed ovarian cancer were treated with bevacizumab (15mg/kg) and chemotherapy. The median age was 60 years (IQR 36-64). Median follow up 20 months (IQR 6-36month ) Platinum sensitive (>6m platinum-free interval) relapse constitutes 38/61(62.3%) and platinum-resistant (

Introduction/Background:Low grade serous ovarian cancer (LGSOC) accounts for 10% of serous epithelial ovarian cancers. In contrast to high grade serous ovarian cancer (HGSOC), it is characterised by an early age of onset, indolent growth rate and relative resistance to cytotoxic chemotherapy. The use of Bevacizumab in ovarian cancer has mostly been investigated in HGSOC and is contra-indicated in patients with extensive disease associated with the bowel, due to risks of bowel perforation. Several single-institution studies have reported activity of Bevacizumab in LGSOC in the recurrent disease or adjuvant setting. We present a case series of two patients with advanced LGSOC and extensive serosal disease involving the bowel that were treated with Bevacizumab in the first-line setting.Methodology:Case notes, pathology results and CT scans were reviewed. Histology slides from initial biopsy and debulking surgery specimens were stained for H&E to assess chemotherapy-response scores.Results:Both patients had Stage IIIC disease, with extensive disease involving the bowel which prohibited surgery. No response was seen on CT scan or serum Ca125 levels after three cycles of Carboplatin and Paclitaxel in either case, but following the addition of Bevacizumab both patients had a marked reduction in disease volume enabling debulking surgery that was not previously feasible. Serum Ca125 levels reduced to near-normal values prior to surgery following three cycles of Bevacizumab in both cases (438 to 50 and 151 to 54). There were no adverse events associated with Bevacizumab use (18 cycles 7.5mg/kg). Conclusion:We propose that Bevacizumab is safe to use in our set of LGSOC patients with extensive bowel involvement, and can facilitate surgery in those patients that were previously inoperable. Further evaluation of its use in the first line setting, particularly in patients that have had no response to conventional chemotherapy agents, is recommended. We have commenced an observational study including all LGSOC patients receiving Bevacizumab.

Women aged u226565 represent nearly 50% of ovarian cancer (OC) patients (pts). However, elderly OC pts are less likely to receive the optimal treatment and multidimensional geriatric assessment is still underused. Furthermore, they are significantly under-represented in clinical trials. The present study aimed to provide an overview of real-life treatment strategies for elderly advanced-OC pts and to investigate clinico-pathological features that potentially drive clinical decision-making in first-line treatment.A retrospective analysis was conducted on a consecutive series of 45 OC pts u226569 years old treated with first-line chemotherapy (CT) from 2011 to 2018 at National Cancer Institute, IRCCS CRO Aviano (Italy). Factors associated with treatment choice and rate of adverse events were investigated through Fisher-exact test and Pearson's Chi-squared test; differences in progression free survival (PFS) and overall survival (OS) were tested by log-rank test.In the total series, 67% of pts received standard carboplatin-paclitaxel combination (CPC) first-line CT . Conversely, 33% received a monotherapy (MT) (31% with carboplatin, 2% with paclitaxel). PS ECOG u22651 was the only factor significantly associated with MT (P=0.021). No differences were observed between CPC and CPC with dose reductions (CPCdr), either in terms of PFS (HR=1,29 P=0,59) or OS (HR=1,40 P=0,56). On the other hand, MT was associated with shorter PFS (HR=4,35 P=0,001) and OS (HR=4,48 P=0,005). No differences in treatment discontinuation rate, neutropenia, thrombocytopenia, neuropathy, constipation, diarrhea and asthenia in CPC, CPCdr and MT were detected (P>0.05).CPC represents the first-line standard therapy in advanced OC, the present study suggests that, in elderly patients, a dose reduction could be considered rather than a single agent regimen. Clinical decision-making was, moreover, mainly driven by PS ECOG, emphasizing the value of multidimensional geriatric assessment. Notwithstanding the limitations due to the small sample size, the evaluated regimens showed a comparable toxicity profile. Further prospective studies are needed to investigate biomarkers, aiming to tailor treatment strategies and to improve clinical outcomes.

This book analyzes all aspects of metronomic chemotherapy, a new approach involving low-dose, long-term, and frequently administered therapy that has preclinical and clinical activity in various tumors. After an opening section on the pharmacological bases of metronomic chemotherapy, including its antiangiogenic effects and impact on immunity, preclinical studies on various classes of drug are discussed. Clinical applications of metronomic chemotherapy in a wide variety of tumors are then addressed in detail, with description of the results of all published studies. The clinical pharmacology of metronomic chemotherapy is also considered in depth, encompassing pharmacokinetics, pharmacogenetics, pharmacoeconomics, and adverse drug reactions. The book closes by describing the role of this therapy in the veterinarian clinic.

In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. However, more than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Care often is not patient-centered, many patients do not receive palliative care to manage their symptoms and side effects from treatment, and decisions about care often are not based on the latest scientific evidence. The cost of cancer care also is rising faster than many sectors of medicine--having increased to $125 billion in 2010 from $72 billion in 2004--and is projected to reach $173 billion by 2020. Rising costs are making cancer care less affordable for patients and their families and are creating disparities in patients' access to high-quality cancer care. There also are growing shortages of health professionals skilled in providing cancer care, and the number of adults age 65 and older--the group most susceptible to cancer--is expected to double by 2030, contributing to a 45 percent increase in the number of people developing cancer. The current care delivery system is poorly prepared to address the care needs of this population, which are complex due to altered physiology, functional and cognitive impairment, multiple coexisting diseases, increased side effects from treatment, and greater need for social support. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents a conceptual framework for improving the quality of cancer care. This study proposes improvements to six interconnected components of care: (1) engaged patients; (2) an adequately staffed, trained, and coordinated workforce; (3) evidence-based care; (4) learning health care information technology (IT); (5) translation of evidence into clinical practice, quality measurement and performance improvement; and (6) accessible and affordable care. This report recommends changes across the board in these areas to improve the quality of care. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis provides information for cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industry to reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality care delivery system. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.

Cell Surface Proteases provides a comprehensive overview of these important enzymes that catalyze the hydrolysis of a protein as it degrades to a simpler substance. In the 1990s, an explosion of new discoveries shed light on the role of cell surface proteases and extended it beyond degradation of extracellular matrix components to include its influence on growth factors, cell signaling, and other cellular events. This volume unites the scientific literature from across disciplines and teases out unified themes of interactions between cell surface proteases and interconnecting cell surface-related systems -- including integrins and other adhesion molecules. Scientists and students involved in developmental biology, cell biology and disease processes will find this an indispensable resource. * Provides an overview of the entire field of cell surface proteases in a single volume* Presents major issues and astonishing discoveries at the forefront of modern developmental biology and developmental medicine * A thematic volume in the longest-running forum for contemporary issues in developmental biology with over 30 years of coverage