4 results on '"Emil Lou"'
Search Results
2. Locally Advanced Rectal Cancer-Precision Therapy in a Time of Moving Targets and Competing Goals
- Author
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Emil Lou and Robert D. Madoff
- Subjects
Cancer Research ,medicine.medical_specialty ,Colorectal cancer ,business.industry ,Rectal Neoplasms ,Brief Report ,Locally advanced ,MEDLINE ,medicine.disease ,Treatment Adherence and Compliance ,Oncology ,Rectal carcinoma ,medicine ,Humans ,Radiology ,Neoplasm Recurrence, Local ,business ,Goals - Abstract
IMPORTANCE: Despite numerous published phase 3 trials, the association of treatment adherence with outcomes for patients with rectal cancer remains largely unexplored. OBJECTIVE: To analyze the association of treatment adherence with disease-free survival (DFS) among patients with rectal cancer in the CAO/ARO/AIO-04 trial. DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis of a phase 3 randomized clinical trial was conducted from July 25, 2006, to February 26, 2010, among 1232 patients from 80 centers with T3 to T4 or node-positive rectal adenocarcinoma. Statistical analysis was performed from May 5, 2019, to February 2, 2020. INTERVENTIONS: A total of 625 patients received neoadjuvant fluorouracil-based chemoradiotherapy (nCRT), and a total of 607 patients received fluorouracil-based nCRT with addition of oxaliplatin. Of the 1126 patients who underwent curative surgery, 439 started fluorouracil-based adjuvant chemotherapy and 419 started fluorouracil-based adjuvant chemotherapy with oxaliplatin. MAIN OUTCOMES AND MEASURES: The association of adherence with nCRT and adjuvant chemotherapy with DFS was assessed in both groups in the as-treated population. RESULTS: Among the 625 patients (442 men; mean age, 63.0 years) who received fluorouracil nCRT and the 607 patients (430 men; mean age, 63.0 years) who received fluorouracil-based nCRT with addition of oxaliplatin, after a median follow-up of 50 months (interquartile range, 38-61 months), 3-year DFS in the as-treated population was 71.1% in the fluorouracil group and 75.8% in the fluorouracil-oxaliplatin group (hazard ratio [HR], 0.803; 95% CI, 0.651-0.990; P = .04). Overall, 419 patients in the fluorouracil nCRT group (67.0%) and 434 patients in the fluorouracil-oxaliplatin nCRT group (71.5%) received full doses of preoperative nCRT. Likewise, 253 of 439 patients in the fluorouracil group (57.6%) and 134 of 419 patients in the fluorouracil-oxaliplatin group (32.0%) received full doses of adjuvant chemotherapy. Adherence to nCRT was associated with 3-year DFS in both the fluorouracil group (complete vs near complete: HR, 1.325; 95% CI, 0.959-1.832; P = .09; complete vs reduced: HR, 1.877; 95% CI, 1.147-3.072; P = .01) and the fluorouracil-oxaliplatin group (complete vs near complete: HR, 1.501; 95% CI, 0.980-2.299; P = .06; complete vs reduced: HR, 1.724; 95% CI, 1.144-2.596; P = .009) in multivariable analyses. In contrast, adjuvant chemotherapy was not associated with DFS in both the fluorouracil group (complete vs near complete: HR, 0.900; 95% CI, 0.559-1.448; P = .66; complete vs incomplete: HR, 1.057; 95% CI, 0.807-1.386; P = .69) and the fluorouracil-oxaliplatin group (complete vs near complete: HR, 1.155; 95% CI, 0.716-1.866; P = .56; complete vs incomplete: HR, 1.073; 95% CI, 0.790-1,457; P = .65). CONCLUSIONS AND RELEVANCE: To our knowledge, this is the first analysis of a phase 3 trial to assess the association of treatment adherence with some clinical outcomes for patients with rectal cancer. The findings emphasize the need for appropriate trial design with optimized nCRT dose and schedule and supportive strategies to facilitate good adherence and precision delivery, especially for intensified nCRT. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00349076
- Published
- 2020
3. Tumor-Stroma Proportion as a Predictive Biomarker of Resistance to Platinum-Based Chemotherapy in Patients With Ovarian Cancer
- Author
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Deanna Teoh, Emil Lou, Rachel Isaksson Vogel, Melissa A. Geller, Molly Klein, Spencer Hoostal, and Michael A. Linden
- Subjects
Oncology ,Cancer Research ,Chemotherapy ,medicine.medical_specialty ,endocrine system diseases ,business.industry ,medicine.medical_treatment ,Newly diagnosed ,medicine.disease ,Chemotherapy regimen ,female genital diseases and pregnancy complications ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Ovarian carcinoma ,Research Letter ,medicine ,In patient ,030212 general & internal medicine ,business ,Ovarian cancer ,Tumor stroma ,Predictive biomarker - Abstract
This study assesses tumor-stroma proportion and compares this finding with the development of resistance to platinum-based chemotherapy in women newly diagnosed with ovarian carcinoma.
- Published
- 2019
4. Estimating Survival in Patients With Lung Cancer and Brain Metastases
- Author
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William Sperduto, Brian M. Alexander, David Roberge, Alex Engelman, John P. Kirkpatrick, Kimberley S. Mak, Nils D. Arvold, Hubert Y. Pan, Penny K. Sneed, Norman Yeh, Daniel J. Ma, T. Jonathan Yang, Laurie E. Gaspar, Emil Lou, Mark M. Awad, Kathryn Beal, Helen A. Shih, John M Boyle, Joseph N. Contessa, Ryan Shanley, Paul D. Brown, Minesh P. Mehta, Paul W. Sperduto, J.G. Hardie, Ananta S Bangdiwala, Steve Braunstein, and Veronica Chiang
- Subjects
0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,Proportional hazards model ,business.industry ,Hazard ratio ,Retrospective cohort study ,medicine.disease ,Clinical trial ,Log-rank test ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Carcinoma ,Adenocarcinoma ,business ,Lung cancer - Abstract
Importance Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. As systemic therapies improve, patients with lung cancer live longer and thus are at increased risk for brain metastases. Understanding how prognosis varies across this heterogeneous patient population is essential to individualize care and design future clinical trials. Objective To update the current Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) for patients with non–small-cell lung cancer (NSCLC) and brain metastases. The DS-GPA is based on data from patients diagnosed between 1985 and 2005, and we set out to update it by incorporating more recently reported gene and molecular alteration data for patients with NSCLC and brain metastases. This new index is called the Lung-molGPA. Design, Setting, and Participants This is a multi-institutional retrospective database analysis of 2186 patients diagnosed between 2006 and 2014 with NSCLC and newly diagnosed brain metastases. The multivariable analyses took place between December 2015 and May 2016, and all prognostic factors were weighted for significance by hazard ratios. Significant factors were included in the updated Lung-molGPA prognostic index. Main Outcomes and Measures The main outcome was survival. Multiple Cox regression was used to select and weight prognostic factors in proportion to their hazard ratios. Log rank tests were used to compare adjacent classes and to compare overall survival for adenocarcinoma vs nonadenocarcinoma groups. Results The original DS-GPA was based on 4 factors found in 1833 patients with NSCLC and brain metastases diagnosed between 1985 and 2005: patient age, Karnofsky Performance Status, extracranial metastases, and number of brain metastases. The patients studied for the creation of the DS-GPA had a median survival of 7 months from the time of initial treatment of brain metastases. To design the updated Lung-molGPA, we analyzed data from 2186 patients from 2006 through 2014 with NSCLC and newly diagnosed brain metastases (1521 adenocarcinoma and 665 nonadenocarcinoma). Significant prognostic factors included the original 4 factors used in the DS-GPA index plus 2 new factors: EGFR and ALK alterations in patients with adenocarcinoma (mutation status was not routinely tested for nonadenocarcinoma). The overall median survival for the cohort in the present study was 12 months, and those with NSCLC-adenocarcinoma and Lung-molGPA scores of 3.5 to 4.0 had a median survival of nearly 4 years. Conclusions and Relevance In recent years, patient survival and physicians’ ability to predict survival in NSCLC with brain metastases has improved significantly. The updated Lung-molGPA incorporating gene alteration data into the DS-GPA is a user-friendly tool that may facilitate clinical decision making and appropriate stratification of future clinical trials.
- Published
- 2017
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