The Experts below are selected from a list of 16113 Experts worldwide ranked by ideXlab platform
Lee M. Krug - One of the best experts on this subject based on the ideXlab platform.
-
Local Therapy with continued egfr tyrosine kinase inhibitor Therapy as a treatment strategy in egfr mutant advanced lung cancers that have developed acquired resistance to egfr tyrosine kinase inhibitors
Journal of Thoracic Oncology, 2013Co-Authors: Helena Alexandra Yu, Camelia S. Sima, Christopher G. Azzoli, Naiyer A. Rizvi, James Huang, Stephen B Solomon, Andreas Rimner, Paul K Paik, Catherine M Pietanza, Lee M. KrugAbstract:Background Development of acquired resistance limits the utility of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) for the treatment of EGFR -mutant lung cancers. There are no accepted targeted therapies for use after acquired resistance develops. Metastasectomy is used in other cancers to manage oligometastatic disease. We hypothesized that Local Therapy is associated with improved outcomes in patients with EGFR -mutant lung cancers with acquired resistance to EGFR TKI. Methods Patients who received non–central nervous system Local Therapy were identified by a review of data from a prospective biopsy protocol for patients with EGFR -mutant lung cancers with acquired resistance to EGFR TKI Therapy and other institutional biospecimen registry protocols. Results Eighteen patients were identified, who received elective Local Therapy (surgical resection, radiofrequency ablation, or radiation). Local Therapy was well tolerated, with 85% of patients restarting TKI Therapy within 1 month of Local Therapy. The median time to progression after Local Therapy was 10 months (95% confidence interval [CI]: 2–27 months). The median time until a subsequent change in systemic Therapy was 22 months (95% CI: 6–30 months). The median overall survival from Local Therapy was 41 months (95% CI: 26–not reached). Conclusions EGFR- mutant lung cancers with acquired resistance to EGFR TKI Therapy are amenable to Local Therapy to treat oligometastatic disease when used in conjunction with continued EGFR inhibition. Local Therapy followed by continued treatment with an EGFR TKI is well tolerated and associated with long PFS and OS. Further study in selected individuals in the context of other systemic options is required.
-
Local Therapy as a treatment strategy in EGFR-mutant advanced lung cancers that have developed acquired resistance to EGFR tyrosine kinase inhibitors.
Journal of Clinical Oncology, 2012Co-Authors: Helena Alexandra Yu, Camelia S. Sima, Alexander Drilon, Anna M. Varghese, Maria Catherine Pietanza, Christopher G. Azzoli, Naiyer A. Rizvi, Lee M. Krug, Mark G. Kris, Vincent A. MillerAbstract:7527 Background: The utility of EGFR directed Therapy for the treatment of EGFR mutant lung cancer is limited by the development of acquired resistance (AR) to EGFR tyrosine kinase inhibitor (TKI) Therapy, which occurs after a median of 16 months (mos). There are no approved targeted therapies after disease progression on EGFR TKI Therapy. Local Therapy for oligometastatic disease is used with regularity in other solid tumors, and can lead to long term survival in selected individuals. EGFR mutant lung cancers with AR to TKI Therapy can follow an indolent course that is amenable to Local Therapy to treat progression of disease when used in conjunction with continued EGFR inhibition. Outcomes following Local Therapy in this setting have not been assessed. Methods: Patients (pts) with AR to EGFR TKI’s who received Local Therapy excluding treatment of CNS metastases or Local Therapy prior to AR were identified in an IRB-approved prospective registry of 184 pts with AR enrolled from August 2004- November 2011...
Monica Morrow - One of the best experts on this subject based on the ideXlab platform.
-
Local Therapy and survival in breast cancer
The New England Journal of Medicine, 2007Co-Authors: Rinaa S Punglia, Monica Morrow, Eric P Winer, Jay R HarrisAbstract:Some investigators have viewed breast cancer as a Local disease that then spreads; others have seen it as a systemic disease from the start. This review argues for another view, since the failure to achieve initial Local control allows some tumors to disseminate later, reducing a patient's chance of long-term survival. Recent evidence supports a larger role for aggressive, Local Therapy for breast cancer.
-
Surgeon Perspectives about Local Therapy for Breast Carcinoma
Cancer, 2005Co-Authors: Steven J. Katz, Paula M. Lantz, Nancy K. Janz, Angela Fagerlin, Kendra Schwartz, Dennis Deapen, Barbara Salem, Indu Lakhani, Monica MorrowAbstract:BACKGROUND Geographic variations in the use of mastectomy and the use of radiation Therapy (RT) after breast-conserving surgery (BCS) have motivated concerns that surgeons are not uniformly adhering to treatment standards. METHODS The authors surveyed attending surgeons of a population-based sample of patients with breast carcinoma diagnosed in Detroit and Los Angeles from December 2001 to January 2003 (n = 365; response rate, 80.0%). Clinical scenarios were used to evaluate opinions about Local Therapy. RESULTS On average, surgeons reported that they devoted 31.3% of their total practice to breast carcinoma. Approximately one-half of surgeons practiced in a community hospital setting, whereas 18.8% practiced in a cancer center. Compared to low volume surgeons, high volume surgeons were more likely to favor BCS with RT for invasive breast carcinoma (60.8%, 74.0%, and 87.2% for low, moderate, and high volume surgeons, respectively, P < 0.001). Surgeons who favored BCS were more likely to perceive greater quality of life (QOL) benefits for BCS than mastectomy (85.9%) compared with surgeons who favored mastectomy (28.6%) and those who did not favor 1 procedure over the other (60.0%, P < 0.001). In a ductal carcinoma in situ scenario, 35.0% of surgeons favored BCS without RT and 61.0% favored BCS with RT. Opinions regarding the role of RT after BCS varied by geographic site, surgeon volume, and patient age. CONCLUSIONS Variation in surgeon opinion concerning Local Therapy reflected clinical uncertainty about the benefits of alternative treatments. High volume surgeons more frequently endorsed current clinical guidelines that favor BCS compared with mastectomy. This may partly be explained by the greater belief that BCS confers a better patient QOL than mastectomy. Cancer 2005. © 2005 American Cancer Society.
-
patterns and correlates of Local Therapy for women with ductal carcinoma in situ
Journal of Clinical Oncology, 2005Co-Authors: Steven J. Katz, Paula M. Lantz, Nancy K. Janz, Angela Fagerlin, Kendra Schwartz, Dennis Deapen, Barbara Salem, Indu Lakhani, Monica MorrowAbstract:Purpose Concerns have been raised about the quality of treatment for women with ductal carcinomain-situ (DCIS) because persistent high rates of mastectomy suggest overtreatment, whereas lower than expected rates of radiation Therapy after breast-conserving surgery (BCS) suggest undertreatment. Patients and Methods All women with DCIS diagnosed in 2002 and who reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results (SEER) registries were identified and surveyed shortly after receipt of surgery (response rate, 79.7%; n 817). Analyses were restricted to patients with DCIS (n 659) indicated by SEER stage data. Results Only 14.0% of patients at lowest risk of recurrence (based on tumor size and histologic grade) received a mastectomy compared with 22.8% and 52.6% of patients at intermediate and highest risk (P .001). Only 13.1% of patients who were not influenced or slightly influenced by concerns about recurrence received mastectomy compared with 48.8% of women who were greatly influenced by this concern (P .001). A between-geographic site difference in receipt of radiation after BCS was observed for the lowest risk group (38.9% in Los Angeles v 70.5% in Detroit) but not for the highest risk group (80.2% in Los Angeles v 85.9% in Detroit, P .006 for site and risk group differences). Between-site differences in receipt of radiation after BCS were consistent with patient recall of surgeon discussions about treatment. Conclusion Surgeons are tailoring their recommendations for Local Therapy options for DCIS based on important clinical factors. Patient attitudes also play an important role in treatment decisions. The substantial influence of both surgeon opinion and patient attitudes should temper concerns about the quality of treatment for women with DCIS. J Clin Oncol 23:3001-3007. © 2005 by American Society of Clinical Oncology
-
does aggressive Local Therapy improve survival in metastatic breast cancer
Surgery, 2002Co-Authors: Seema A Khan, Andrew K Stewart, Monica MorrowAbstract:Abstract Background. Women with metastatic breast cancer and an intact primary tumor are currently treated with systemic Therapy. Local Therapy of the primary tumor is considered irrelevant to the outcome, and is recommended only for palliation of symptoms. Methods. We have examined the use of Local Therapy, and its impact on survival in patients presenting with stage IV breast cancer at initial diagnosis, who were reported to the National Cancer Data Base (NCDB) between 1990 and 1993. Results. A total of 16,023 patients with stage IV disease were identified in the NCDB during this period, of whom 6861 (42.8%) received either no operation or a variety of diagnostic or palliative procedures, and 9162 (57.2%) underwent partial (3513) or total (5649) mastectomy. The presence of free surgical margins was associated with an improvement in 3-year survival in partial or total mastectomy groups (26% vs 35%, respectively). A multivariate proportional hazards model identified the number of metastatic sites, the type of metastatic burden, and the extent of resection of the primary tumor as significant independent prognostic covariates. Women treated with surgical resection with free margins, when compared with those not surgically treated, had superior prognosis, with a hazard ratio of 0.61 (95% confidence interval 0.58,0.65). Conclusions. These data suggest that the role of Local Therapy in women with stage IV breast cancer needs to be re-evaluated, and Local Therapy plus systemic Therapy should be compared with systemic Therapy alone in a randomized trial. Surgery 2002;132:620-7.
-
Breast cancer in young women: issues in Local Therapy.
Journal of The National Cancer Institute Monographs, 1994Co-Authors: Monica Morrow, Cathy HassettAbstract:Although age has been studied as a prognostic factor in breast cancer, little attention has been paid to its role in the selection and outcome of Local Therapy. A review of 42 breast cancer patients less than 40 years of age treated at the University of Chicago from 1989 to 1992 demonstrated that of women with stage 0, I, or II disease, 37% had medical contraindications to breast preservation compared with 25% of women over 40. Twenty-one percent of young women eligible for conservation opted for mastectomy and reconstruction compared with 9% of their older counterparts. Only 4% of women in either age group selected mastectomy alone as Therapy. The literature on the relationship of age to Local failure after breast conservation and the long-term morbidity of the Local Therapy of breast cancer is reviewed. Further research to clarify issues in Local Therapy in young patients is proposed.
Brian D Kavanagh - One of the best experts on this subject based on the ideXlab platform.
-
the impact of definitive Local Therapy for lymph node positive prostate cancer a population based study
International Journal of Radiation Oncology Biology Physics, 2014Co-Authors: Chad G Rusthoven, Julie A Carlson, Timothy V Waxweiler, David Raben, Peter E Dewitt, David E Crawford, Paul Maroni, Brian D KavanaghAbstract:Purpose To evaluate the survival outcomes for patients with lymph node-positive, nonmetastatic prostate cancer undergoing definitive Local Therapy (radical prostatectomy [RP], external beam radiation Therapy [EBRT], or both) versus no Local Therapy (NLT) in the US population in the modern prostate specific antigen (PSA) era. Methods and Materials The Surveillance, Epidemiology, and End Results database was queried for patients with T1-4N1M0 prostate cancer diagnosed from 1995 through 2005. To allow comparisons of equivalent datasets, patients were analyzed in separate clinical (cN+) and pathologically confirmed (pN+) lymph node-positive cohorts. Kaplan-Meier overall survival (OS) and prostate cancer-specific survival (PCSS) estimates were generated, with accompanying univariate log-rank and multivariate Cox proportional hazards comparisons. Results A total of 796 cN+ and 2991 pN+ patients were evaluable. Among cN+ patients, 43% underwent EBRT and 57% had NLT. Outcomes for cN+ patients favored EBRT, with 10-year OS rates of 45% versus 29% ( P P P P P Conclusions In this large, population-based cohort, definitive Local Therapy was associated with significantly improved survival in patients with lymph node-positive prostate cancer.
Helena Alexandra Yu - One of the best experts on this subject based on the ideXlab platform.
-
Local Therapy with continued egfr tyrosine kinase inhibitor Therapy as a treatment strategy in egfr mutant advanced lung cancers that have developed acquired resistance to egfr tyrosine kinase inhibitors
Journal of Thoracic Oncology, 2013Co-Authors: Helena Alexandra Yu, Camelia S. Sima, Christopher G. Azzoli, Naiyer A. Rizvi, James Huang, Stephen B Solomon, Andreas Rimner, Paul K Paik, Catherine M Pietanza, Lee M. KrugAbstract:Background Development of acquired resistance limits the utility of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) for the treatment of EGFR -mutant lung cancers. There are no accepted targeted therapies for use after acquired resistance develops. Metastasectomy is used in other cancers to manage oligometastatic disease. We hypothesized that Local Therapy is associated with improved outcomes in patients with EGFR -mutant lung cancers with acquired resistance to EGFR TKI. Methods Patients who received non–central nervous system Local Therapy were identified by a review of data from a prospective biopsy protocol for patients with EGFR -mutant lung cancers with acquired resistance to EGFR TKI Therapy and other institutional biospecimen registry protocols. Results Eighteen patients were identified, who received elective Local Therapy (surgical resection, radiofrequency ablation, or radiation). Local Therapy was well tolerated, with 85% of patients restarting TKI Therapy within 1 month of Local Therapy. The median time to progression after Local Therapy was 10 months (95% confidence interval [CI]: 2–27 months). The median time until a subsequent change in systemic Therapy was 22 months (95% CI: 6–30 months). The median overall survival from Local Therapy was 41 months (95% CI: 26–not reached). Conclusions EGFR- mutant lung cancers with acquired resistance to EGFR TKI Therapy are amenable to Local Therapy to treat oligometastatic disease when used in conjunction with continued EGFR inhibition. Local Therapy followed by continued treatment with an EGFR TKI is well tolerated and associated with long PFS and OS. Further study in selected individuals in the context of other systemic options is required.
-
Local Therapy as a treatment strategy in EGFR-mutant advanced lung cancers that have developed acquired resistance to EGFR tyrosine kinase inhibitors.
Journal of Clinical Oncology, 2012Co-Authors: Helena Alexandra Yu, Camelia S. Sima, Alexander Drilon, Anna M. Varghese, Maria Catherine Pietanza, Christopher G. Azzoli, Naiyer A. Rizvi, Lee M. Krug, Mark G. Kris, Vincent A. MillerAbstract:7527 Background: The utility of EGFR directed Therapy for the treatment of EGFR mutant lung cancer is limited by the development of acquired resistance (AR) to EGFR tyrosine kinase inhibitor (TKI) Therapy, which occurs after a median of 16 months (mos). There are no approved targeted therapies after disease progression on EGFR TKI Therapy. Local Therapy for oligometastatic disease is used with regularity in other solid tumors, and can lead to long term survival in selected individuals. EGFR mutant lung cancers with AR to TKI Therapy can follow an indolent course that is amenable to Local Therapy to treat progression of disease when used in conjunction with continued EGFR inhibition. Outcomes following Local Therapy in this setting have not been assessed. Methods: Patients (pts) with AR to EGFR TKI’s who received Local Therapy excluding treatment of CNS metastases or Local Therapy prior to AR were identified in an IRB-approved prospective registry of 184 pts with AR enrolled from August 2004- November 2011...
Sami Ramzi Leyhbannurah - One of the best experts on this subject based on the ideXlab platform.
-
Local Therapy improves survival in metastatic prostate cancer
European Urology, 2017Co-Authors: Sami Ramzi Leyhbannurah, Stephanie Gazdovich, Lars Budaus, Emanuele Zaffuto, Alberto Briganti, Firas Abdollah, Francesco Montorsi, Jonas Schiffmann, Mani MenonAbstract:Abstract Background Treatment of the primary, termed Local Therapy (LT), may improve survival in metastatic prostate cancer (mPCa) versus no Local Therapy (NLT). Objective To assess cancer-specific mortality (CSM) after LT versus NLT in mPCa. Design, setting, and participants Within the Surveillance, Epidemiology and End Results database (2004–2013), 13 692 mPCa patients were treated with LT (radical prostatectomy [RP] or radiation Therapy [RT]) or NLT. Outcome measurements and statistical analysis Multivariable competing risk regression analyses (MVA CRR) tested CSM after propensity score matching (PSM) in two analyses, (1) NLT versus LT and (2) RP versus RT, and were complemented with interaction, sensitivity, unmeasured confounder, and landmark analyses. Results and limitations Of 13 692 mPCa patients, 474 received LT: 313 underwent RP and 161 RT. In MVA CRR, after PSM, LT ( n =474) results in lower CSM (subhazard ratio [SHR] 0.40, 95% confidence interval [CI] 0.32–0.50) versus NLT ( n =1896). In MVA CRR after PSM, RP ( n =161) results in lower CSM (SHR 0.59, 95% CI 0.35–0.99) versus RT ( n =161). Invariably, lowest CSM rates were recorded for Gleason ≤7, ≤cT3, and M1a substage. Interaction and sensitivity analyses confirmed the robustness of results, and landmark analyses rejected the bias favouring LT. A strong unmeasured confounder (HR=5), affecting 30% of NLT patients, could obliterate LT benefit. Data were retrospective. Conclusions In mPCa, LT results in lower mortality relative to NLT. Within LT, lower mortality is recorded after RP than RT. Patients with most favourable grade, Local stage, and metastatic substage derive most benefit from LT. They also derive most benefit from RP, when LT types are compared (RP vs RT). It is important to consider study limitations until ongoing clinical trials confirm the proposed benefits. Patient summary Individuals with prostate cancer that spreads outside of the prostate might still benefit from prostate-directed treatments, such as radiation or surgery, in addition to receiving androgen deprivation Therapy.
