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Ehab Y Hanna - One of the best experts on this subject based on the ideXlab platform.
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Identification of markers predictive for response to Induction Chemotherapy in patients with sinonasal undifferentiated carcinoma.
Oral oncology, 2019Co-Authors: Yoko Takahashi, Diana Bell, Jeffrey N. Myers, Ahmed S. Abdelmeguid, Dianna B. Roberts, Frederico O. Gleber-netto, Tong Xin Xie, Curtis R. Pickering, Ehab Y HannaAbstract:Abstract Objectives Sinonasal undifferentiated carcinoma (SNUC) is a rare, highly aggressive cancer. Despite aggressive multimodal therapy, its prognosis remains poor. Because of its locally advanced nature and high propensity for distant metastasis, we frequently use Induction Chemotherapy before definitive therapy in patients with SNUC. However, about 30% of patients do not respond to Induction Chemotherapy, and lack of response is associated with a poor survival rate. Therefore, in this study, we performed gene expression analysis of SNUC samples to identify prognostic markers for Induction Chemotherapy response. Materials and methods Formalin-fixed, paraffin-embedded SNUC tumor samples from previously untreated patients harvested before Induction Chemotherapy were used. Gene expression was performed using an oncology gene expression panel. Results We identified 34 differentially expressed genes that distinguish the responders from the non-responders. Pathway analysis using these genes revealed alteration of multiple pathways between the two groups. Of these 34 genes, 24 distinguished between these two groups. Additionally, 16 gene pairs were associated with response to Induction therapy. Conclusion We identified genes predictive of SNUC response to Induction Chemotherapy and pathways potentially associated with treatment outcome. This is the first report of identification of predictive biomarkers for response of SNUC to Induction Chemotherapy, and it may help us develop therapeutic strategies to improve the treatment outcomes of non-responders.
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Induction Chemotherapy for advanced squamous cell carcinoma of the paranasal sinuses.
Archives of otolaryngology--head & neck surgery, 2011Co-Authors: Ehab Y Hanna, Dianna B. Roberts, Alvaro Diaz Cardenas, Franco Demonte, Michael E. Kupferman, Randal S. Weber, David I. Rosenthal, Merrill S. KiesAbstract:Objective To review the oncologic outcomes in patients with advanced (stage III-IV) squamous cell carcinoma of the paranasal sinuses treated with Induction Chemotherapy prior to definitive local therapy. Methods The medical records of 46 consecutive patients with previously untreated, biopsy-proved squamous cell carcinoma of the paranasal sinuses who received Induction Chemotherapy during the course of their treatment were reviewed for demographics, tumor types and stages, treatment details, and oncologic outcomes. Results Of the 46 patients (median age, 59 years), the tumor epicenter was in the maxillary sinus in 31 (67%), ethmoid sinus in 9 (20%), nasal cavity in 4 (9%), and sphenoid sinus in 2 (4%). All patients had T3 or T4 tumors, and 12 (26%) patients had clinical evidence of nodal metastasis, with an overall stage of III (20%) or IV (80%). Induction Chemotherapy regimens consisted of a combination of a taxane and platinum in 80% of patients, by themselves (14 patients) or in combination with a third agent, such as ifosfamide (14 patients) or 5-fluorouracil (9 patients). The combination of a taxane and 5-fluorouracil was used in the remaining 9 patients. More than two-thirds (67%) of the patients achieved at least a partial response to Induction Chemotherapy, 24% had progressive disease, and 9% had stable disease. Subsequent treatment after Induction Chemotherapy consisted of surgery, usually followed by radiation or chemoradiation or by definitive radiation or chemoradiation with surgical salvage of any residual disease. Overall, surgical resection was performed in only 24 of 46 patients (52%) treated with Induction Chemotherapy. The 2-year survival for patients with at least a partial response or stable disease after Induction Chemotherapy was 77% in contrast to only 36% for patients with progressive disease. Conclusions Tumor response to Induction Chemotherapy in patients with advanced squamous cell carcinoma of the paranasal sinuses may be predictive of treatment outcome and prognosis. Favorable response to Induction Chemotherapy is associated with better survival and a reasonable chance of organ preservation.
Thomas A Damico - One of the best experts on this subject based on the ideXlab platform.
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adding radiation to Induction Chemotherapy does not improve survival of patients with operable clinical n2 non small cell lung cancer
The Journal of Thoracic and Cardiovascular Surgery, 2015Co-Authors: Chifu Jeffrey Yang, Brian C Gulack, Paul J Speicher, Xiaofei Wang, David H Harpole, Mark W Onaitis, Thomas A Damico, Mark F Berry, Matthew G HartwigAbstract:Abstract Objective Radiotherapy is commonly used in Induction regimens for patients with non–small cell lung cancer with operable mediastinal nodal disease, although evidence has not shown a benefit over Induction Chemotherapy alone. We compared outcomes between Induction Chemotherapy and Induction chemoradiation using the National Cancer Data Base. Methods Induction radiation use and survival of patients who underwent lobectomy or pneumonectomy after Induction Chemotherapy for clinical T1-3N2M0 non–small cell lung cancer in the National Cancer Data Base from 2003 to 2006 were assessed using logistic regression, general linear regression, Kaplan–Meier, and Cox proportional hazard analysis. Results Of 1362 patients who met study criteria, 834 (61%) underwent Induction chemoradiation and 528 (39%) underwent Induction Chemotherapy. Lobectomy was performed in 82% of patients (n = 1111), and pneumonectomy was performed in 18% of patients (n = 251). Pneumonectomy was performed more often after Induction chemoradiation than after Induction Chemotherapy (20% vs 16%, P = .04). Downstaging from N2 to N0/N1 was more common with Induction chemoradiation compared with Induction Chemotherapy (58% vs 46%, P P = .41). In multivariable analysis, the addition of radiation to Induction Chemotherapy also was not associated with a survival benefit (hazard ratio, 1.03; 95% confidence interval, 0.89-1.18; P = .73). Conclusions Induction chemoradiation is used in the majority of patients with non–small cell lung cancer with N2 disease who undergo Induction therapy before surgical resection, but it is not associated with improved survival compared with Induction Chemotherapy.
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Induction chemoradiation is not superior to Induction Chemotherapy alone in stage iiia lung cancer
The Annals of Thoracic Surgery, 2012Co-Authors: Asad A Shah, Mark F Berry, Ching Tzao, Mihir Gandhi, Mathias Worni, Ricardo Pietrobon, Thomas A DamicoAbstract:Background The optimal treatment strategy for patients with operable stage IIIA (N2) non-small cell lung cancer is uncertain. We performed a systematic review and meta-analysis to test the hypothesis that the addition of radiotherapy to Induction Chemotherapy prior to surgical resection does not improve survival compared with Induction Chemotherapy alone. Methods A comprehensive search of PubMed for relevant studies comparing patients with stage IIIA (N2) non-small cell lung cancer undergoing resection after treatment with Induction Chemotherapy alone or Induction chemoradiotherapy was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. Hazard ratios were extracted from these studies to give pooled estimates of the effect of Induction therapy on overall survival. Results There were 7 studies that met criteria for analysis, including 1 randomized control trial, 1 phase II study, 3 retrospective reviews, and 2 published abstracts of randomized controlled trials. None of the studies demonstrated a survival benefit to adding Induction radiation to Induction Chemotherapy versus Induction Chemotherapy alone. The meta-analysis performed on randomized studies (n = 156 patients) demonstrated no benefit in survival from adding radiation (hazard ratio 0.93, 95% confidence interval 0.54 to 1.62, p = 0.81), nor did the meta-analysis performed on retrospective studies (n = 183 patients, hazard ratio 0.77, 95% confidence interval 0.50 to 1.19, p = 0.24). Conclusions Published evidence is sparse but does not support the use of radiation therapy in Induction regimens for stage IIIA (N2). Given the potential disadvantages of adding radiation preoperatively, clinicians should consider using this treatment strategy only in the context of a clinical trial to allow better assessment of its effectiveness.
Fangyun Xie - One of the best experts on this subject based on the ideXlab platform.
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Effect of Induction Chemotherapy in Nasopharyngeal Carcinoma: An Updated Meta-Analysis
Frontiers in oncology, 2021Co-Authors: Shan-shan Yang, Jian-gui Guo, Jia-ni Liu, Zhi-qiao Liu, En-ni Chen, Chun-yan Chen, Pu-yun Ouyang, Fei Han, Fangyun XieAbstract:Background: Previous meta-analysis had evaluated the effect of Induction Chemotherapy in nasopharyngeal carcinoma. But two trials with opposite findings were not included and the long-term result of another trial significantly differed from the preliminary report. This updated meta-analysis was thus warranted. Methods: Literature search was conducted to identify randomized controlled trials focusing on the additional efficacy of Induction Chemotherapy in nasopharyngeal carcinoma. Trial-level pooled analysis of hazard ratio (HR) for progression free survival and overall survival and risk ratio (RR) for locoregional control rate and distant control rate were performed. Results: Twelve trials were eligible. The addition of Induction Chemotherapy significantly prolonged both progression free survival (HR=0.68, 95% confidence interval [CI] 0.60-0.76, p
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A Pairwise Meta-Analysis of Induction Chemotherapy in Nasopharyngeal Carcinoma.
The oncologist, 2019Co-Authors: Pu-yun Ouyang, Zhi-qiao Liu, Xiao-min Zhang, Xing-sheng Qiu, Yuan-hong Gao, Fangyun XieAbstract:BACKGROUND Locoregionally advanced nasopharyngeal carcinoma has high risk of distant metastasis and mortality. Induction Chemotherapy is commonly administrated in clinical practice, but the efficacy was quite controversial in and out of randomized controlled trials. We thus conducted this pairwise meta-analysis. MATERIALS AND METHODS Trials that randomized patients to receive radiotherapy or concurrent chemoradiotherapy with or without Induction Chemotherapy were identified via searches of PubMed, MEDLINE, and ClinicalTrials.gov. RESULTS A total of ten trials (2,627 patients) were included. The pooled hazard ratios (HRs) based on fixed effect model were 0.68 (95% confidence interval [CI] 0.56-0.80, p
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Retrospective Analysis of the Survival Benefit of Induction Chemotherapy in Stage IVa-b Nasopharyngeal Carcinoma
PloS one, 2016Co-Authors: Xiao-wen Lan, Pu-yun Ouyang, Xue-bin Zou, Yao Xiao, Jie Tang, Fangyun XieAbstract:Purpose The value of adding Induction Chemotherapy to chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma (LA-NPC) remains controversial, yet high-risk patients with LA-NPC have poor outcomes after chemoradiotherapy. We aimed to assess the survival benefits of Induction Chemotherapy in stage IVa-b NPC. Patients and methods A total of 602 patients with stage IVa-b NPC treated with intensity-modulated radiation therapy (IMRT) and concurrent Chemotherapy with or without Induction Chemotherapy were retrospectively analyzed. Overall survival (OS), locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS) and progression-free survival (PFS) were evaluated using the Kaplan-Meier method, log-rank test and Cox regression analysis. Results In univariate analysis, 5-year OS was 83.2% for Induction Chemotherapy plus concurrent Chemotherapy and 74.8% for concurrent Chemotherapy alone, corresponding to an absolute risk reduction of 8.4% (P = 0.022). Compared to concurrent Chemotherapy alone, addition of Induction Chemotherapy improved 5-year DMFS (83.2% vs. 74.4%, P = 0.018) but not 5-year LRFS (83.7% vs. 83.0%, P = 0.848) or PFS (71.9% vs. 66.0%, P = 0.12). Age, T category, N category, Chemotherapy strategy and clinical stage were associated with 5-year OS (P = 0.017, P = 0.031, P = 0.007, P = 0.022, P = 0.001, respectively). In multivariate analysis, Induction Chemotherapy plus concurrent Chemotherapy was an independent favorable prognostic factor for OS (HR, 0.62; 95% CI, 0.43-0.90, P = 0.012) and DMFS (HR, 0.57; 95% CI, 0.38-0.83, P = 0.004). In subgroup analysis, Induction Chemotherapy significantly improved 5-year DMFS in stage IVa (86.8% vs. 77.3%, P = 0.008), but provided no significant benefit in stage IVb. Conclusions In patients with stage IVa-b NPC treated with IMRT, addition of Induction Chemotherapy to concurrent Chemotherapy significantly improved 5-year OS and 5-year DMFS. This study provides a basis for selection of high risk patients in future clinical therapeutic trials.
Merrill S. Kies - One of the best experts on this subject based on the ideXlab platform.
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Outcomes for olfactory neuroblastoma treated with Induction Chemotherapy
Head & neck, 2017Co-Authors: Diana Bell, Dianna B. Roberts, Michael E. Kupferman, Renata Ferrarotto, Jack Phan, Steven J. Frank, C. David Fuller, G. Brandon Gunn, Merrill S. KiesAbstract:Background Oncologic outcomes for Induction Chemotherapy and its role in patients with advanced olfactory neuroblastoma (ONB) remain unclear. Methods A retrospective review of 15 consecutive patients with extensive local invasion and/or nodal disease treated with Induction Chemotherapy with curative intent followed by definitive local therapy. Results The majority of patients were treated with cisplatin and etoposide. The response to Chemotherapy was 68% (10/15). Response was 78% (7/9) in the high Hyams high-grade group and 50% (3/6) in the Hyams low-grade group. Seven patients had complete response (CR) and 3 patients were able to avoid orbital exenteration. The 5-year disease-free survival (DFS) and overall survival (OS) were 71% and 78%, respectively, with a trend toward improved survival in patients with CR. Conclusion ONB is a chemosensitive tumor and Induction Chemotherapy is an acceptable strategy for aggressive and locoregional advanced disease. Hyams grade may predict chemosensitivity and CR may be associated with improved survival.
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Induction Chemotherapy for advanced squamous cell carcinoma of the paranasal sinuses.
Archives of otolaryngology--head & neck surgery, 2011Co-Authors: Ehab Y Hanna, Dianna B. Roberts, Alvaro Diaz Cardenas, Franco Demonte, Michael E. Kupferman, Randal S. Weber, David I. Rosenthal, Merrill S. KiesAbstract:Objective To review the oncologic outcomes in patients with advanced (stage III-IV) squamous cell carcinoma of the paranasal sinuses treated with Induction Chemotherapy prior to definitive local therapy. Methods The medical records of 46 consecutive patients with previously untreated, biopsy-proved squamous cell carcinoma of the paranasal sinuses who received Induction Chemotherapy during the course of their treatment were reviewed for demographics, tumor types and stages, treatment details, and oncologic outcomes. Results Of the 46 patients (median age, 59 years), the tumor epicenter was in the maxillary sinus in 31 (67%), ethmoid sinus in 9 (20%), nasal cavity in 4 (9%), and sphenoid sinus in 2 (4%). All patients had T3 or T4 tumors, and 12 (26%) patients had clinical evidence of nodal metastasis, with an overall stage of III (20%) or IV (80%). Induction Chemotherapy regimens consisted of a combination of a taxane and platinum in 80% of patients, by themselves (14 patients) or in combination with a third agent, such as ifosfamide (14 patients) or 5-fluorouracil (9 patients). The combination of a taxane and 5-fluorouracil was used in the remaining 9 patients. More than two-thirds (67%) of the patients achieved at least a partial response to Induction Chemotherapy, 24% had progressive disease, and 9% had stable disease. Subsequent treatment after Induction Chemotherapy consisted of surgery, usually followed by radiation or chemoradiation or by definitive radiation or chemoradiation with surgical salvage of any residual disease. Overall, surgical resection was performed in only 24 of 46 patients (52%) treated with Induction Chemotherapy. The 2-year survival for patients with at least a partial response or stable disease after Induction Chemotherapy was 77% in contrast to only 36% for patients with progressive disease. Conclusions Tumor response to Induction Chemotherapy in patients with advanced squamous cell carcinoma of the paranasal sinuses may be predictive of treatment outcome and prognosis. Favorable response to Induction Chemotherapy is associated with better survival and a reasonable chance of organ preservation.
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Effect of Induction Chemotherapy on speech and swallowing function in patients with oral tongue cancer
Head & neck, 2009Co-Authors: Denise A. Barringer, Merrill S. Kies, Katherine A. Hutcheson, Erich M. Sturgis, Jan S. LewinAbstract:Background. Swallowing physiology, diet, and patient-reported outcomes were evaluated after Induction Chemotherapy for oral tongue cancer. Methods. Fifteen of 23 patients enrolled in a phase II clinical trial of Induction Chemotherapy followed by surgical resection for oral tongue cancer underwent instrumental and perceptual analysis of speech and swallowing. Oropharyngeal swallow efficiency (OPSE) was calculated. Patient-reported outcomes were collected. We compared pre- and postChemotherapy results. Results. OPSE scores were not significantly different (p > .05) after Induction Chemotherapy; however, patient-reported swallowing and diet levels were significantly higher (p < .001 and p = .015, respectively). Diet levels improved from soft-chewable to full diet in most patients. Speech intelligibility did not change (p = .328). Conclusion. It appears that Induction Chemotherapy has a negligible effect on speech and swallowing physiology but may provide symptomatic improvement of pain and swallowing after treatment. Further investigations are needed to corroborate these findings. © 2008 Wiley Periodicals, Inc. Head Neck, 2009
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Induction Chemotherapy for head and neck squamous cell carcinomas (SCCHN)
Current treatment options in oncology, 2007Co-Authors: Merrill S. KiesAbstract:Induction Chemotherapy for squamous cell carcinoma of the head and neck has long been known to be highly active with tumor responses observed in a high percentage of patients. More recent studies have added taxane to traditional platin and infusional fluorouracil regimens. Docetaxel, cisplatin and 5-fluorouracil (TPF) is presently studied in prospective controlled trials to better define the efficacy and potential toxicity of sequential treatment with TPF followed by concomitant chemoradiotherapy. We await the results of these trials before we accept Induction Chemotherapy as a standard treatment and to best identify the subgroups of patients who may be most likely to benefit from the approach.
Wan Beom Park - One of the best experts on this subject based on the ideXlab platform.
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Micafungin prophylaxis for acute leukemia patients undergoing Induction Chemotherapy.
BMC Cancer, 2019Co-Authors: Hyunkyung Park, Jeonghwan Youk, Dong Yeop Shin, Junshik Hong, Inho Kim, Nam Joong Kim, Jeong Ok Lee, Soo Mee Bang, Sung-soo Yoon, Wan Beom ParkAbstract:Micafungin is a well-tolerated and effective prophylactic antifungal agent used in hematologic diseases. In this prospective trial, we evaluated the efficacy and safety of prophylactic micafungin during first Induction Chemotherapy in patients with acute leukemia. We also compared outcomes of prophylactic micafungin with those of prophylactic posaconazole in acute myeloid leukemia (AML). Medically fit patients with newly diagnosed acute leukemia received 50 mg micafungin intravenously once daily from the initiation of first Induction Chemotherapy to recovery of neutrophil count, suspected fungal infection, or unacceptable drug-related toxicity ( Clinicaltrials.gov number, NCT02440178). The primary end point was incidence of invasive fungal infection, and the secondary end points were adverse events of prophylactic micafungin and mortality during Induction therapy. The 65 patients (median age = 51 years, male:female = 34:31) enrolled in this study had diagnoses of AML (33, 50.8%), acute lymphoblastic leukemia (31, 47.7%), and acute biphenotypic leukemia (1, 1.5%). Median duration of micafungin treatment was 24 days (range 1–68), with proven invasive fungal disease in one patient (1.5%) and possible fungal infection in two patients (3.1%). Three of the patients (4.6%) experienced the following adverse events, but all events were tolerable: liver function abnormality (Grade 2, n = 1; Grade 3, n = 1) and allergic reaction (Grade 2, n = 1). Three patients died during Induction therapy, and invasive aspergillosis pneumonia was the cause of death for one of those patients. Overall, 19 patients (29.2%) discontinued prophylactic micafungin, and 18 (27.7%) patients switched to another antifungal agent. We observed no fungal infections caused by amphotericin B-resistant organisms. In AML patients, outcomes of prophylactic micafungin during Induction Chemotherapy did not differ significantly with those of prophylactic posaconazole with regard to incidence of fungal infections, rate of discontinuation, or safety. Our study demonstrates that prophylactic micafungin is safe and effective in patients with acute leukemia undergoing Induction Chemotherapy. Outcomes in patients with AML were similar to those of prophylactic posaconazole, indicating the usefulness of micafungin as a prophylactic antifungal agent during Induction Chemotherapy for AML. Clinicaltrials.gov NCT02440178, registered May 12th 2015.
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Micafungin prophylaxis for acute leukemia patients undergoing Induction Chemotherapy
BMC, 2019Co-Authors: Hyunkyung Park, Jeonghwan Youk, Dong Yeop Shin, Junshik Hong, Inho Kim, Nam Joong Kim, Jeong Ok Lee, Soo Mee Bang, Sung-soo Yoon, Wan Beom ParkAbstract:Abstract Background Micafungin is a well-tolerated and effective prophylactic antifungal agent used in hematologic diseases. In this prospective trial, we evaluated the efficacy and safety of prophylactic micafungin during first Induction Chemotherapy in patients with acute leukemia. We also compared outcomes of prophylactic micafungin with those of prophylactic posaconazole in acute myeloid leukemia (AML). Methods Medically fit patients with newly diagnosed acute leukemia received 50 mg micafungin intravenously once daily from the initiation of first Induction Chemotherapy to recovery of neutrophil count, suspected fungal infection, or unacceptable drug-related toxicity (Clinicaltrials.gov number, NCT02440178). The primary end point was incidence of invasive fungal infection, and the secondary end points were adverse events of prophylactic micafungin and mortality during Induction therapy. Results The 65 patients (median age = 51 years, male:female = 34:31) enrolled in this study had diagnoses of AML (33, 50.8%), acute lymphoblastic leukemia (31, 47.7%), and acute biphenotypic leukemia (1, 1.5%). Median duration of micafungin treatment was 24 days (range 1–68), with proven invasive fungal disease in one patient (1.5%) and possible fungal infection in two patients (3.1%). Three of the patients (4.6%) experienced the following adverse events, but all events were tolerable: liver function abnormality (Grade 2, n = 1; Grade 3, n = 1) and allergic reaction (Grade 2, n = 1). Three patients died during Induction therapy, and invasive aspergillosis pneumonia was the cause of death for one of those patients. Overall, 19 patients (29.2%) discontinued prophylactic micafungin, and 18 (27.7%) patients switched to another antifungal agent. We observed no fungal infections caused by amphotericin B-resistant organisms. In AML patients, outcomes of prophylactic micafungin during Induction Chemotherapy did not differ significantly with those of prophylactic posaconazole with regard to incidence of fungal infections, rate of discontinuation, or safety. Conclusions Our study demonstrates that prophylactic micafungin is safe and effective in patients with acute leukemia undergoing Induction Chemotherapy. Outcomes in patients with AML were similar to those of prophylactic posaconazole, indicating the usefulness of micafungin as a prophylactic antifungal agent during Induction Chemotherapy for AML. Trial registration Clinicaltrials.gov NCT02440178, registered May 12th 2015
