The anti-PD-1 antibody cemiplimab has demonstrated effectiveness in the setting of locally advanced basal cell carcinoma (BCC) and squamous cell carcinoma. We describe a case of a large, locally invasive basosquamous carcinoma, an aggressive type of BCC, invading the left sternocleidomastoid muscle with near compression of the left internal jugular vein producing a severe anaemia secondary to ulceration and chronic blood loss. The patient was initially started on vismodegib monotherapy but failed to respond. He was then started on cemiplimab in addition to vismodegib. Improvement was noted after one cycle. After 21 cycles of cemiplimab, the left shoulder ulcerated lesion was completely re-epithelialised. He remains in complete remission after 31 cycles of cemiplimab in addition to vismodegib.
Purpose In the genomic era, more women with low-risk breast cancer will forego chemotherapy and rely on adjuvant endocrine therapy (AET) to prevent metastatic recurrence. However, some of these patients will unfortunately relapse. We sought to understand this outcome. Preliminary work suggested that early discontinuation of AET, also known as non-persistence, may play an important role. A retrospective analysis exploring factors related to our breast cancer patients’ non-persistence with AET was performed. Methods Women who underwent Oncotype-DX® testing between 2011 and 2014 with minimum 5 years follow-up were included. ‘Low risk’ was defined as Oncotype score < 26. Outcomes of recurrence and persistence were determined by chart review. Patient, tumor and treatment factors were collected, and persistent versus non-persistent groups compared using multivariable ANOVA and Fisher Chi square exact test. Results We identified six cases of distant recurrence among low-risk patients with a median follow-up of 7.7 years. Among them, five of six patients (83%) were non-persistent with AET. The non-persistence rate in our cohort regardless of recurrence was 57/228 (25%). Non-persistent patients reported more severe side effects compared with persistent patients (p = 0.002) and were more likely to be offered a switch in endocrine therapy, rather than symptom-relief (p = 0.006). In contrast, persistent patients were 10.3 times more likely to have been offered symptom-alleviating medications compared with non-persistent patients (p < 0.001). A subset analysis revealed that patients who persisted with therapy had a higher Oncotype-DX® score than patients who discontinued early (p = 0.028). Conclusion Metastatic recurrence in low-risk breast cancer patients may be primarily due to non-persistence with endocrine therapy. Further work is needed to optimize care for patients who struggle with side effects. To our knowledge, these are the first published data suggesting that Oncotype-DX® score may influence persistence with AET.
Purpose: In the genomic era, more women with low-risk breast cancer will forego chemotherapy and rely on adjuvant endocrine therapy (AET) to prevent metastatic recurrence. However, some of these patients will unfortunately relapse. We sought to understand this outcome. Preliminary work suggested that early discontinuation of AET, also known as non-persistence, may play an important role. A retrospective analysis exploring factors related to our breast cancer patients’ non-persistence with AET was performed. Methods: Women who underwent Oncotype DX® testing between 2011-2014 with minimum 5-year follow-up were included. ‘Low risk’ was defined as Oncotype score < 26. Outcomes of recurrence and persistence were determined by chart review. Patient, tumor and treatment factors were collected, and persistent vs non-persistent groups compared using multivariable ANOVA and Fisher Chi square exact test. Results: We identified 6 cases of distant recurrence among low-risk patients with a median follow-up of 7.7 years. Among them, 5 of 6 patients (83%) were non-persistent with AET. The non-persistence rate in our cohort regardless of recurrence was 57/228 (25%). Non-persistent patients reported more severe side effects compared with persistent patients (p=0.002) andwere more likely to be offered a switch in endocrine therapy, rather than symptom-relief (p=0.006). In contrast, persistent patients were 10.3 times more likely to have been offeredsymptom-alleviating medications compared with non-persistent patients (p<0.001). A subset analysis revealed that patients who persisted with therapy had a higher Oncotype-DX® score than patients who discontinued early (p=0.028). Conclusions: Metastatic recurrence in low-risk breast cancer patients may be primarily due to non-persistence with endocrine therapy. Further work is needed to optimize care for patients who struggle with side effects. To our knowledge, these are the first published data suggesting that Oncotype-DX® score may influence persistence with AET.
e13520 Background: Due to limited access to healthcare providers, lengthy travel times to clinics, and disadvantageous socioeconomic dynamics, patients in rural locations face significant challenges causing a low recruitment in clinical trials. However, there may be preconceived assumptions of a patient’s desire to participate in a trial leading to bias from healthcare organizations and thereby, decreased efforts in enrollment. Dartmouth Cancer Center is the smallest NCI designated comprehensive cancer center, serving rural New Hampshire and Vermont. In this study, we surveyed patients with cancer to assess their level of understanding of clinical trials, factors influencing patients’ willingness to enroll, and the difficulties faced after accrual in the trials. Methods: A 23 items anonymous questionnaire was distributed to the oncology patients at the outpatient clinic. The questions included demographics, socioeconomic status, time to travel, challenges faced in participating in the trials. Cox proportional regression analysis was done to identify factors influencing decision to participate in trials. Results: Among 93 respondents, 74% are within the age of 61 – 80 years, 64.45% are male and 74% are married, 51% are retired and 59.7% have household income of ≤$100,000. 32.2% of our respondents travelled over 1 hour to receive care. 73.3% of the respondents understood what it means to participate in a clinical trial. 91.8% are willing, yet only 40% were given an option to participate in a trial. Only 10.5% ever declined to participate. Additional cost, frequent travel, and possibility of receiving a placebo are the biggest factors in declining a participation. Up to 95% of the participants enrolled in a trial had positive experience and have the ultraistic motives. None of the socioeconomic or personal factors had any significant bearing on willingness to participate. Conclusions: Socioeconomic and regional factors have little bearing on a person's inclination to participate in clinical trials. There is a strong interest in understanding and enrolling in clinical studies. Cancer centers need to reduce the gap between patient interest in trials and actual trial participation.[Table: see text]
e19197 Background: Despite the low five-year expected survival of patients with advanced cancer, it has been suggested that up to 1.7% of patients aged 65 and older with advanced cancer may continue to undergo screening for colorectal cancer and up to 8.9% of female patients 65 and older with an advanced cancer may receive a screening mammography.1 The intent of our study was to determine the rate of colorectal and breast cancer screening in men ages 50-75 and women ages 40-75 after these patients were diagnosed with an advanced cancer. Methods: The medical records of 208 patients (median age 63.5, range 42-75) with a diagnosis of stage IV colorectal, prostate, breast, liver, gastroesophageal, skin, uterine, bladder, kidney and stage III-IV pancreatic and lung cancer were reviewed for documentation of a screening mammography, colonoscopy or FIT-DNA testing after the patient was diagnosed with an advanced cancer. Results: Overall, 4.8% of patients were screened for colorectal cancer and 10% of the females received at least one mammogram. The screening mammography rate in patients less than 64 years of age was 13.3% and the colorectal screening rate in this age group was 4.4%. In patients 65 and older, the screening mammography rate was 7% and the colorectal screening rate was 5.2%. Conclusions: Colorectal and breast cancer screening rates in patients with advanced cancer were higher within our fully integrated healthcare system in comparison to previously reported findings in patients 65 and older. In addition, the rate of screening with mammography may be more prevalent amongst patients 64 or younger with advanced cancer in comparison to patients 65 and older with a similar diagnosis. The next phase of this quality improvement project involves disabling health maintenance prompts within the electronic medical record of patients with advanced cancer. References: 1. Sima, C. S., Panageas, K. S., & Schrag, D. (2010). Cancer screening among patients with advanced cancer. Jama, 304(14), 1584-1591. doi:10.1001/jama.2010.1449 [doi].
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.