4083 Background: While gemcitabine plus cisplatin has demonstrated significant antitumor activity as 1st line therapy of BC, there is no effective treatment after failure of gemcitabine-based therapy. REG is an oral multi-kinase inhibitor that targets angiogenesis, oncogenesis and cancer proliferation/metastasis. We evaluated the efficacy of REG in BC. Methods: Patients (pts) with histologically proven BC who progressed on at least one line of systemic therapy received REG 160 mg daily 21 days on 7 days off, in 28 day cycles. The primary endpoint was 6-month (mo) overall survival (OS) and the secondary endpoints were median OS, progression free survival (PFS) and response rates (RR). Pre and post-treatment plasma were collected for cytokine evaluation. Results: A total of 39 pts received at least 1 dose of REG; 32 pts were evaluable for efficacy. Median age was 62 (range: 27-88) years and the primary sites of tumor were intrahepatic cholangiocarcinoma (68.8%), extrahepatic (18.8%), and gallbladder (12.5%). Pts were considered evaluable for efficacy if patients received more than 1 cycle of REG. For 32 evaluable pts, 6 mo OS was 52% with median PFS of 2.8 mo (95% CI: 1.1-4.5) and median OS of 7.9 mo (95% CI: 0-18.7). Median PFS and OS of the pts (n=20) failed 1 line of therapy were 3.7 mo (95% CI: 3.2-4.1) and 13.8 mo (95% CI: 1.8-25.8), respectively. Median PFS and OS of the pts (n=12) failed 2 lines were 1.8 mo (95% CI: 1.63-1.97) and 4.5 mo (95% CI: 2.6-6.3), respectively. RR was 9.4% (2 PR and 1 unconfirmed PR) and DCR was 62.5%. Total 71.8% of grade 3/4 adverse events (AE) were observed, and the most common AE were fatigue (56.4%) and hypertension (53.8%). Dose modification was required in 49% of the pts. Among the 23 cytokines analyzed, elevated baseline VEGF-A was associated with good prognosis (HR 0.62, p=0.01). Elevated baseline TIMP-1 (HR 1.79, p=0.04) and IL-6 (HR 1.33, p=0.05) were associated with poor prognosis. REG treatment decreased BMP-9, GP130, VEGF-R2 and VEGF-R3 and increased IL-6, PIGF, TIMP-1, VCAM-1 and VEGF-A significantly. Conclusions: The primary endpoint was met in this study. VEGF-A may be further evaluated as a predictive biomarker for REG in BC. Further randomized trials are warranted to confirm the efficacy and the correlative data. Clinical trial information: NCT02115542.
A leukemoid reaction is a hematological disorder in which the White Blood Cells (WBCs) count may rise more than 50,000 per micro liter (μL) accompanied by an increase in Neutrophil precursors. The incidence of this reaction is uncertain. This looks like blood cancer but it is caused by reasons outside bone marrow like severe infections, drug reactions, intoxication, ischemia, inflammation and stress. The WBCs count falls back to normal once this cause is eradicated so we present an unusual case of leukemoid reaction with very high WBCs in a COVID19 patient to create awareness among physicians dealing with such cases.
Introduction: Coronavirus disease (COVID-19) is a leading cause of acute hypoxemic respiratory failure which can progress to acute respiratory distress syndrome (ARDS). These patients are deeply sedated, paralyzed and ventilated and prone positioning is known to help in these cases. Prone positioning has been known to help in ARDS cases, but they are ventilated deeply sedated and paralyzed. The aim of the current study was to assess the safety and potential benefits of awake prone positioning in COVID-19 patients with moderate to severe hypoxemic respiratory failure. Methods: This is a retrospective cohort study, performed at Bahira International Hospital Lahore. Record of confirmed COVID-19 patients with hypoxic respiratory failure was reviewed thoroughly to collect data. The duration, timing, frequency, tolerability, beneficial effects and adverse events during prone positioning were recorded from the medical records before and after self-prone positioning. Results: The current analysis showed that prone positioning is supportive to maintain good saturation (92%) as compared to keeping patients in spine position (82%). Conclusion: It can be concluded from the current study that prone position is helpful to maintain normal oxygen saturation even on low oxygen supply, helping in quick recovery and preventing oxygen induced damage to the lungs.
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