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Demographic, Clinical and Laboratory...
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Paydary, Koosha.
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Demographic, Clinical and Laboratory Correlates of Overall Survival Among Patients Treated with Immune-checkpoint Blockers: A Single Institution Report.
紀錄類型:
書目-電子資源 : Monograph/item
正題名/作者:
Demographic, Clinical and Laboratory Correlates of Overall Survival Among Patients Treated with Immune-checkpoint Blockers: A Single Institution Report./
作者:
Paydary, Koosha.
出版者:
Ann Arbor : ProQuest Dissertations & Theses, : 2020,
面頁冊數:
34 p.
附註:
Source: Masters Abstracts International, Volume: 81-11.
Contained By:
Masters Abstracts International81-11.
標題:
Oncology. -
電子資源:
http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=27739686
ISBN:
9798645454418
Demographic, Clinical and Laboratory Correlates of Overall Survival Among Patients Treated with Immune-checkpoint Blockers: A Single Institution Report.
Paydary, Koosha.
Demographic, Clinical and Laboratory Correlates of Overall Survival Among Patients Treated with Immune-checkpoint Blockers: A Single Institution Report.
- Ann Arbor : ProQuest Dissertations & Theses, 2020 - 34 p.
Source: Masters Abstracts International, Volume: 81-11.
Thesis (M.S.)--Rush University, 2020.
This item must not be sold to any third party vendors.
Objective: We retrospectively investigated the Overall Survival (OS) and incidence of Hyper-progressive disease (HPD) of patients who were treated with Immune-checkpoint blockers (ICBs) including Nivolumab, Pembrolizumab, Atezolizumab, Ipilimumab at our institution, John H Stroger Jr Hospital of Cook County, Chicago, IL. We also evaluated the demographic, clinical and laboratory variables associated with OS and HPD. We hypothesized that higher plasma lactate dehydrogenase (LDH) levels at baseline, increasing plasma LDH levels while on ICB and documentation of HPD while on ICB are associated with shorter OS. Methods: This was a single institution retrospective study that obtained data of patients who were treated with ICBs including Nivolumab, Pembrolizumab, Atezolizumab or Ipilimumab, as different lines of treatment from 4/1/2011 to 6/30/2018, at John H. Stroger Jr. Hospital of Cook County, Chicago, IL. These patients were treated with ICBs for a diverse group of solid tumors including head and neck squamous cell cancers (HNSCC), lung adenocarcinoma, lung squamous cell carcinoma, lung small cell carcinoma, melanoma, renal cell carcinoma (RCC), GE (gastro-esophageal junction) adenocarcinoma, bladder cancer, Markel cell carcinoma, Kaposi sarcoma and breast adenocarcinoma. Results: After excluding patients with incomplete medical records, we reviewed the clinical records of a total of 104 patients from tumor registry of our institution, out of which 66 (63.5%) patients were male and 38 (36.5%) were female. Most common diagnosis was non-small cell lung cancer (28.7%) followed by squamous cell cancer of head and neck (14.4%), renal cell cancer (8.5%) and melanoma (5.9%). Among the total sample, 91.4% patients were treated in metastatic setting. Majority of patients were treated with either Nivolumab (71.1%) or Pembrolizumab (21.2%) in the 2nd (50%) or 3rd line (29.8%) setting. The mean ± SD of OS for total of 104 patients was 35.39 ± 22.81 months, with minimum and maximum OS of 6 and 109 months, respectively. Patients with RCC (13 patients) followed by HNSCC (22 patients), had longer OS compared to patients with lung adenocarcinoma (38 patients), squamous cell lung cancer (6 patients) and small cell lung cancer (9 patients) (mean square =982.23, F= 2.08, P value= 0.03). Furthermore, OS was shorter among patients with raising levels of LDH before the final CT scan was obtained while on ICB, compared to those whose LDH was stable/not raising, although the difference was borderline/non-significant (23.09 ±21.37 versus 37.59± 23.21 respectively, P value=0.07). In fact, patients with persistently high LDH levels while on ICB had shorter OS, although this difference was not significant. Patients who had evidence of HPD on the final CT scan had significantly shorter OS (14 patients with HPD, 22.21±16.23 months versus 37.52±230.8 months, P value=0.01). Out of 104 patients, 13 were lost-to-follow-up (LFUP) during the course of study. Out of the remaining 91 patients, 40 were alive while 51 died by the end of the course of study. Significant associations were observed between mortality and LDH trend while on ICB, LDH levels rising before final CT was obtained on ICB: 23 out of 30 patients with rising LDH levels vs. 28 out of 61 patients with stable/improving LDH levels died; P value=0.003). Thirteen out of 18 patients with persistently rising LDH levels and four out of five patients with occurrence of rising LDH after an initial improvement died. The incidence of death was thus significantly higher among these groups compared to those with stable LDH levels, or those with an initial increase and later improvement or persistently decreasing levels of LDH (Pearson Chi squared= 9.80, P value=0.04). Patients with HPD or persistently worsening imaging findings had higher incidence of death (Pearson Chi squared= 23.97, P value=0.002). Also, ICB being the last line of therapy was associated with higher incidence of death (Pearson Chi squared= 8.19, P value= 0.004). Of the remaining 102 patients, 14 (13.7%) had HPD during the course of study. With respect to laboratory values, LDH trend while on ICB was associated with HPD among patients with persistently increasing LDH levels, since nine out of 20 patients with persistently rising LDH levels developed HPD, whereas only three out of 64 patients with stable LDH levels developed HPD (Pearson Chi squared= 21.41; P value < 0.001). Also, 14 out of 35 patients with rising LDH levels before their last CT scan had HPD, versus zero out of the 67 patients without rising LDH levels before their last CT scan, which was significantly different (Pearson Chi squared= 32.45, P value<0.001). Additionally, LDH levels remaining persistently high during ICB was associated with HPD (Pearson Chi squared= 16.85, P value < 0.001). Finally, HPD was significantly associated with mortality (P value=0.047). After entering the variables that were significantly associated with HPD into a multivariable logistic regression, the only variable that could significantly predict HPD was rising LDH levels before last CT scan was obtained (adjusted OR=13.87, P value=0.009). Finally, a Kaplan-Meier survival analysis was performed to compare the survival time of patients who had HPD with those who did not; the mean survival time for patients who had HPD and those who did not have HPD was 26.7 months (95% CI: 17.11-36.37) and 55.91 months (95% CI: 46.44-65.38), respectively. Defining the cumulative survival as the survival time (months) since time of diagnosis and occurrence of death in both groups, the cumulative survival decreased rapidly among patients with HPD compared to those who did not have HPD over the course of study (Log-Rank Chi squared= 11.52, P value < 0.001). Conclusion: Our results show that rising or persistently high LDH levels among patients who are on ICBs can be a predictor of HPD and shorter OS. HPD itself is a predictor of shorter OS. The correlation of HPD to LDH levels as a possible marker is intriguing and warrants further prospective studies to delineate this relationship.
ISBN: 9798645454418Subjects--Topical Terms:
751006
Oncology.
Subjects--Index Terms:
Immune-checkpoint blockers
Demographic, Clinical and Laboratory Correlates of Overall Survival Among Patients Treated with Immune-checkpoint Blockers: A Single Institution Report.
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Objective: We retrospectively investigated the Overall Survival (OS) and incidence of Hyper-progressive disease (HPD) of patients who were treated with Immune-checkpoint blockers (ICBs) including Nivolumab, Pembrolizumab, Atezolizumab, Ipilimumab at our institution, John H Stroger Jr Hospital of Cook County, Chicago, IL. We also evaluated the demographic, clinical and laboratory variables associated with OS and HPD. We hypothesized that higher plasma lactate dehydrogenase (LDH) levels at baseline, increasing plasma LDH levels while on ICB and documentation of HPD while on ICB are associated with shorter OS. Methods: This was a single institution retrospective study that obtained data of patients who were treated with ICBs including Nivolumab, Pembrolizumab, Atezolizumab or Ipilimumab, as different lines of treatment from 4/1/2011 to 6/30/2018, at John H. Stroger Jr. Hospital of Cook County, Chicago, IL. These patients were treated with ICBs for a diverse group of solid tumors including head and neck squamous cell cancers (HNSCC), lung adenocarcinoma, lung squamous cell carcinoma, lung small cell carcinoma, melanoma, renal cell carcinoma (RCC), GE (gastro-esophageal junction) adenocarcinoma, bladder cancer, Markel cell carcinoma, Kaposi sarcoma and breast adenocarcinoma. Results: After excluding patients with incomplete medical records, we reviewed the clinical records of a total of 104 patients from tumor registry of our institution, out of which 66 (63.5%) patients were male and 38 (36.5%) were female. Most common diagnosis was non-small cell lung cancer (28.7%) followed by squamous cell cancer of head and neck (14.4%), renal cell cancer (8.5%) and melanoma (5.9%). Among the total sample, 91.4% patients were treated in metastatic setting. Majority of patients were treated with either Nivolumab (71.1%) or Pembrolizumab (21.2%) in the 2nd (50%) or 3rd line (29.8%) setting. The mean ± SD of OS for total of 104 patients was 35.39 ± 22.81 months, with minimum and maximum OS of 6 and 109 months, respectively. Patients with RCC (13 patients) followed by HNSCC (22 patients), had longer OS compared to patients with lung adenocarcinoma (38 patients), squamous cell lung cancer (6 patients) and small cell lung cancer (9 patients) (mean square =982.23, F= 2.08, P value= 0.03). Furthermore, OS was shorter among patients with raising levels of LDH before the final CT scan was obtained while on ICB, compared to those whose LDH was stable/not raising, although the difference was borderline/non-significant (23.09 ±21.37 versus 37.59± 23.21 respectively, P value=0.07). In fact, patients with persistently high LDH levels while on ICB had shorter OS, although this difference was not significant. Patients who had evidence of HPD on the final CT scan had significantly shorter OS (14 patients with HPD, 22.21±16.23 months versus 37.52±230.8 months, P value=0.01). Out of 104 patients, 13 were lost-to-follow-up (LFUP) during the course of study. Out of the remaining 91 patients, 40 were alive while 51 died by the end of the course of study. Significant associations were observed between mortality and LDH trend while on ICB, LDH levels rising before final CT was obtained on ICB: 23 out of 30 patients with rising LDH levels vs. 28 out of 61 patients with stable/improving LDH levels died; P value=0.003). Thirteen out of 18 patients with persistently rising LDH levels and four out of five patients with occurrence of rising LDH after an initial improvement died. The incidence of death was thus significantly higher among these groups compared to those with stable LDH levels, or those with an initial increase and later improvement or persistently decreasing levels of LDH (Pearson Chi squared= 9.80, P value=0.04). Patients with HPD or persistently worsening imaging findings had higher incidence of death (Pearson Chi squared= 23.97, P value=0.002). Also, ICB being the last line of therapy was associated with higher incidence of death (Pearson Chi squared= 8.19, P value= 0.004). Of the remaining 102 patients, 14 (13.7%) had HPD during the course of study. With respect to laboratory values, LDH trend while on ICB was associated with HPD among patients with persistently increasing LDH levels, since nine out of 20 patients with persistently rising LDH levels developed HPD, whereas only three out of 64 patients with stable LDH levels developed HPD (Pearson Chi squared= 21.41; P value < 0.001). Also, 14 out of 35 patients with rising LDH levels before their last CT scan had HPD, versus zero out of the 67 patients without rising LDH levels before their last CT scan, which was significantly different (Pearson Chi squared= 32.45, P value<0.001). Additionally, LDH levels remaining persistently high during ICB was associated with HPD (Pearson Chi squared= 16.85, P value < 0.001). Finally, HPD was significantly associated with mortality (P value=0.047). After entering the variables that were significantly associated with HPD into a multivariable logistic regression, the only variable that could significantly predict HPD was rising LDH levels before last CT scan was obtained (adjusted OR=13.87, P value=0.009). Finally, a Kaplan-Meier survival analysis was performed to compare the survival time of patients who had HPD with those who did not; the mean survival time for patients who had HPD and those who did not have HPD was 26.7 months (95% CI: 17.11-36.37) and 55.91 months (95% CI: 46.44-65.38), respectively. Defining the cumulative survival as the survival time (months) since time of diagnosis and occurrence of death in both groups, the cumulative survival decreased rapidly among patients with HPD compared to those who did not have HPD over the course of study (Log-Rank Chi squared= 11.52, P value < 0.001). Conclusion: Our results show that rising or persistently high LDH levels among patients who are on ICBs can be a predictor of HPD and shorter OS. HPD itself is a predictor of shorter OS. The correlation of HPD to LDH levels as a possible marker is intriguing and warrants further prospective studies to delineate this relationship.
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