Patients with early RA with persistent moderate disease activity during the first year had a worse outcome than patients who achieved sustained clinical remission. Persistent moderate disease activity affects long-term structure, remission rate and functional and work disability. Such patients may benefit from intensive treatment.

Alcohol abstinence before liver transplantation (LT) for alcohol-associated liver disease (ALD) is required for every candidate. Some listed patients might relapse, resulting in LT for patients nonabstinent during the pretransplant period. Long-term survival outcomes of these patients have never been studied. We sought to determine whether alcohol consumption on the day of the LT influenced long-term survival after LT. We conducted a retrospective case-control study among French LT centers. Cases were defined as recipients between January 1995 and December 2007 having positive blood and/or urine alcohol levels the day of LT. Each case was paired with 2 controls corresponding to patients transplanted for ALD during the same trimester. Patients were classified into 3 categories per alcohol consumption: abstainers, occasional or transitory excessive consumers, or patients with a sustained excessive consumption (daily consumption >20-30 g/day). During the study period, 3052 LTs for ALD were conducted in France. We identified 42 cases paired with 84 controls. Median blood alcohol level was 0.4 g/L (range 0.1-4.1 g/L) and median urine alcohol level was 0.2 g/L (range 0.1-2.0 g/L). Median follow-up period until death or censoring was 12.9 years (CI 95% = [12.3; 13.6]). Long-term survival was not different between the groups. Relapse to any alcohol consumption rate was higher in the case group (59.5%) than in the control group (38.1%, odds ratio 2.44; CI 95% = [1.13; 5.27]), but sustained excessive consumption was not significantly different between the groups (33.3% versus 29.8% in case and control groups respectively, χ 2 = 0.68). Rates of recurrent cirrhosis and cirrhosis-related deaths were more frequent in the case group. Liver transplantation for nonabstinent patients during the immediate pretransplant period does not result in impaired long-term survival despite higher relapse and recurrent cirrhosis rates.

ObjectiveAntitumour treatment in the last 2 weeks of death (ATT-W2) and a new regimen of ATT within 30 days of death (NATT-M1) are considered as aggressive end-of-life (EOL) care. We aimed to assess factors associated with inappropriate use of antitumour treatment (ATT) at EOL.MethodsData of patients with cancer who died in 2013, 2015, 2017 and 2019 in a single for-profit cancer centre were retrospectively analysed. ATT was divided into chemotherapy (CT), oral targeted therapy (OTT), hormonotherapy and immunotherapy (IMT).ResultsA total of 1282 patients were included. NATT-M1 was given to 197 (15.37%) patients, and 167 (13.03%) had an ATT-W2. Patients with a performance status of <2 and treated with CT had more both ATT- W2 (OR=2.45, 95% CI 1.65 to 3.65, and OR=10.29, 95% CI 4.70 to 22.6, respectively) and NATT-M1 (OR=2.01, 95% CI 1.40 to 2.90, and OR=8.41, 95% CI 4.46 to 15.86). Predictive factors of a higher rate of ATT-W2 were treatment with OTT (OR=19.08, 95% CI 7.12 to 51.07), follow-up by a medical oncologist (OR=1.49, 95% CI 1.03 to 2.17), miscellaneous cancer (OR=3.50, 95% CI 1.13 to 10.85) and length of hospital stay before death of <13 days (OR=1.92, 95% CI 1.32 to 2.79). Urinary tract and male genital cancers received less ATT-W2 (OR=0.38, 95% CI 0.16 to 0.89, and OR=0.40, 95% CI 0.16 to 0.99) and patients treated by IMT or with age <69 years more NATT-M1 (OR=19.21, 95% CI 7.55 to 48.8, and OR=1.69, 95% CI 1.20 to 2.37). Patients followed up by the palliative care team (PCT) had fewer ATT-W2 and NATT-M1 (OR=0.49, 95% CI 0.35 to 0.71, and OR=0.42, 95% CI 0.30 to 0.58).ConclusionsMost recent ATT and access to a PCT follow-up are the two most important potentially modifiable factors associated with aggressive EOL in patients with cancer. Early integrated palliative oncology care could help to decrease futile ATT at EOL.

In oncology, overall survival (OS) is the optimal endpoint for measuring the clinical benefit. However, and contrary to progression-free survival (PFS) which represents a potential surrogate endpoint of OS in clinical trials, OS often requires a long follow-up where the effect of the studied treatment may be diluted by subsequent therapies. In the literature, the relationship between PFS and OS was investigated more analytically than theoretically. We propose a new statistical modelling for OS based on the two survival times: PFS and post-progression survival (PPS) which we assumed to be linked using a conditional exponential distribution. This model allows us to test the existence of an association between PFS and PPS to better understand the process of improvement or decrement of OS. We found a closed form of the correlation coefficient between PFS and both PPS and OS. We expressed them as simple formulas in function of model parameters. One of the model parameters proved to be a correlation indicator between these survival times. We also defined the likelihood of the model in order to use the maximum likelihood estimator to estimate the model parameters from Phase III randomized clinical trial data, involving patients with locally advanced non-small cell lung cancer. The results showed a significant link between PFS and PPS and a strong association between improvements in PFS and OS.

Introduction: Perioperative chemotherapy is a standard treatment (Magic trial, fnclcc trial). The 5-year survival being 36% for patients treated with chemotherapy versus 23% for surgery alone. Progression-free survival was also significantly prolonged. The combination of Docetaxel-Cisplatin-5FU provides greater clinical benefit and induces to consider the triple combination as a reference treatment in metastatic gastric cancer in patients under 65 years with high response rate. Preoperative RTCT is expected to increase the rate of curative resections and complete histological response. Two studies evaluating the feasibility of preoperative RTCT in operable gastric adenocarcinoma with continuous 5FU (+ or -paclitaxel) and 45 Gy are available and the combination 5FU oxaliplatin has been assessed in the esophagus and rectum tumors. We investigate the efficacy of an optimal 2 cycles of chemotherapy with Docetaxel -Cisplatin -5FU + lenograstim then preoperative RTCT with oxaliplatin -5FU in gastric adenocarcinoma. Methods: Between 2009 and 2014, 33 patients with gastric adenocarcinoma were included. Inclusion criteria adenocarcinoma of the stomach, cardia, Siewert II, III, according to staging classification TNM Scannographic and ultrasonography: T2banyN, T3anyN, T4anyN M0) optional laparoscopy, loss of weight ≤ 15% and age ≤65 years. Treatment consisted of DCF docetaxel 75 mg/m 2 I.V. day 1, cisplatin 75 mg/ m 2 I.V. day 1, 5-FU 750 mg/m 2 continuous infusion for 120 h, every 3 weeks for 2 cycles and lenograstim 5 days followed by RTCT delivered in 25 daily fractions of 1.8 Gy in 5 weeks with 5Fu 250mg/m 2 continuous infusion per day on days 1 to 35 and oxaliplatin 85mg/m 2 day 1-14-28. Surgery was performed 4-6 weeks after RTCT. The primary endpoints were pathological response rate and secondary endpoint PFS, overall survival, quality of life, morbidity and post operative mortality, toxicity. Results: 34 patients were included, 29 were operated, 1 patient withdrew consent, 1 patient progressive disease after 2 cycles of DCF 32 patients received RTCT and 2 patients progressive disease after RTCT, 1 patient refused surgery (complete endoscopic response). 29 patients were operated and 3 non resected ( peritoneal metastasis). 26 patients underwent surgery after RTCT (total gastrectomy n = 12, total gastrectomy and diaphragm surgery n = 1 lewis santy n = 11, subtotal gastrectomy n = 1, Enlarged gastrectomy transverse colectomy and partial pancreatic n = 1 D1 (n = 5) and D2 (n = 20 and D2 with splenectomy n = 1) R0 resection rate was n = 26/26. Postoperative morbidity (n = 12) and mortality (n = 2), histology mean nodes examined and involved respectively 16 and 2,5. pT0pN0 23% pT1pN0 19% pTpN2N3 20% others 38%. <10% residual tumor 27% histologic complete response 23%. Conclusion: Promising results from trials involving preoperative chemoradiation followed by surgery in gastric cancer ( pathologic complete response 23%) need to be further evaluated in a Phase III setting and compared with perioperative chemotherapy but mo...

Background: Trifluridine/tipiracil hydrochloride has shown to improve progressionfree survival (PFS) and overall survival (OS) in patients with metastatic colorectal cancer (mCRC). Exploratory analysis suggested that patients with good prognostic characteristics GPC (18 months since first diagnosis) carry better prognosis vs. poor prognostic characteristics (PPC). We report the Greater Manchester experience of the use of TFT.Methods: All consecutive patients who received TFT between August 2016 and August 2019 were included. Data were collected from electronic records. Univariate survival analysis was performed with Kaplan-Meier curve and log-rank test. Cox regression was used for multivariable analysis. Conclusion:Capecitabine associated with mitomycin and SIB-IMRT is a treatment as effective and safer than 5-FU-based chemotherapy for locally SCCAC.

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