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  • 1
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 30 ( 2015-10-20), p. 3467-3474
    Abstract: Obinutuzumab (GA101), a novel glycoengineered type II anti-CD20 monoclonal antibody, demonstrated responses in single-arm studies of patients with relapsed/refractory non-Hodgkin lymphoma. This is the first prospective, randomized study comparing safety and efficacy of obinutuzumab with rituximab in relapsed indolent lymphoma. The primary end point of this study was the overall response rate (ORR) in patients with follicular lymphoma after induction and safety in patients with indolent lymphoma. Patients and Methods A total of 175 patients with relapsed CD20 + indolent lymphoma requiring therapy and with previous response to a rituximab-containing regimen were randomly assigned (1:1) to four once-per-week infusions of either obinutuzumab (1,000 mg) or rituximab (375 mg/m 2 ). Patients without evidence of disease progression after induction therapy received obinutuzumab or rituximab maintenance therapy every 2 months for up to 2 years. Results Among patients with follicular lymphoma (n = 149), ORR seemed higher for obinutuzumab than rituximab (44.6% v 33.3%; P = .08). This observation was also demonstrated by a blinded independent review panel that measured a higher ORR for obinutuzumab (44.6% v 26.7%; P = .01). However, this difference did not translate into an improvement in progression-free survival. No new safety signals were observed for obinutuzumab, and the incidence of adverse events was balanced between arms, with the exception of infusion-related reactions and cough, which were higher in the obinutuzumab arm. Conclusion Obinutuzumab demonstrated a higher ORR without appreciable differences in safety compared with rituximab. However, the clinical benefit of obinutuzumab in this setting remains unclear and should be evaluated within phase III trials.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
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  • 2
    Online Resource
    Online Resource
    SAGE Publications ; 2018
    In:  Journal of Cutaneous Medicine and Surgery Vol. 22, No. 5 ( 2018-09), p. 476-478
    In: Journal of Cutaneous Medicine and Surgery, SAGE Publications, Vol. 22, No. 5 ( 2018-09), p. 476-478
    Abstract: Melanoma is a serious, potentially lethal disease. It is one of very few common cancers whose incidence is rising in North America. Objectives: The objective of this study was to examine trends in melanoma incidence in Ontario, Canada’s most populous province, over the past 20 years. Methods: Using data from the Ontario Cancer Registry (OCR), this retrospective cohort examined all incident cases of melanoma in Ontario from 1990 to 2012. Generalized linear modeling was used to evaluate changes in melanoma incidence over time, adjusting for age and sex using direct standardization with the 1991 Canadian census population. Tests for trend for changes in the distribution of cases by age, sex, socioeconomic status, and rurality status were also calculated. Results: Our results show a statistically significant increasing incidence of melanoma in Ontario from 9.3 cases per 100 000 in 1990 to 18.0 cases per 100 000 in 2012 ( P for trend 〈 .001, adjusted for age and sex). Incidence rates show stabilization from 2010 to 2012. Conclusion: Our study reveals a marked increase in melanoma incidence in Ontario, more than doubling over the past 20 years but with a stabilization more recently. Adequate availability of dermatology services may be important to ensure satisfactory care for the increased caseload and to ensure that cases may detected at an early stage with a good prognosis.
    Type of Medium: Online Resource
    ISSN: 1203-4754 , 1615-7109
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2038674-6
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  • 3
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2022
    In:  Journal of Clinical Oncology Vol. 40, No. 16_suppl ( 2022-06-01), p. e21549-e21549
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 40, No. 16_suppl ( 2022-06-01), p. e21549-e21549
    Abstract: e21549 Background: The incorporation of ICI into the treatment of melanoma has greatly improved patient outcomes, but this benefit has come at the cost of exposing patients to immune-related adverse events (irAEs). A wide spectrum of irAE types has been described, and severity is known to vary from minor to life-threatening; however, the literature to date on the chronicity of irAEs is limited. Objectives: To characterize the long-term and permanent irAEs associated with ICI treatment in patients with melanoma, the treatment of irAEs and the association with survival outcomes. Methods: We performed a retrospective chart review of 161 adult patients with melanoma treated with at least one cycle of ICI regimen in the adjuvant or metastatic setting: 129 patients received PD-1 inhibitor monotherapy and 32 received dual immunotherapy. Patients were grouped by duration of irAE: permanent (no complete resolution), long-term (resolution over a period ≥6 months), transient (resolution over a period 〈 6 months), or no irAEs. Overall survival was evaluated for those patients that were treated in the metastatic setting with PD1 inhibitor monotherapy. Results: Thirty-eight patients were treated in the adjuvant setting and 123 patients were treated in the metastatic setting. A total of 279 irAEs were reported in the whole patient population. Sixty-six (41.0%) patients developed permanent irAEs, 15 (9.3%) experienced long-term irAEs as their longest-lasting toxicity, 34 (21.1%) developed transient irAEs only, and 46 (28.6%) experienced no irAEs. Permanent irAEs occurred in 21 (65.6%) patients treated with dual immunotherapy and in 45 (34.9%) patients treated with monotherapy. The majority of permanent irAEs were endocrine-related (35.5%) or skin-related (32.7%). Grade ≥3 permanent irAEs occurred in 20 (12.4%) patients and included toxicities such as adrenal insufficiency, myocarditis, and myelitis. Fifty-three (32.9%) patients were still on treatment for long-term or permanent irAEs 6 months or more following completion of ICI therapy, including 23 patients on thyroid replacement and 22 on oral steroids. ICI treatment was temporarily interrupted for 63 (22.6%) irAEs and permanently discontinued due to irAE in 38 (13.6%) patients. Subgroup analysis of patients who received single-agent ICI in the first-line palliative setting reveals that those with longer-duration irAEs had a significantly longer median overall survival. Conclusions: Despite the significant benefits, treatment with ICIs in melanoma is associated with a wide range of toxicities that can be permanent and may have long-lasting impacts on patients. The risk of long-term toxicity should therefore be discussed when obtaining consent for treatment. As these treatments are being used more commonly in the adjuvant setting, the impact of survivorship and the long-term management of these toxicities is increasingly important.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2022
    detail.hit.zdb_id: 2005181-5
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  • 4
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2018
    In:  Journal of Clinical Oncology Vol. 36, No. 15_suppl ( 2018-05-20), p. e15137-e15137
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 36, No. 15_suppl ( 2018-05-20), p. e15137-e15137
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2018
    detail.hit.zdb_id: 2005181-5
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  • 5
    In: Leukemia & Lymphoma, Informa UK Limited, Vol. 58, No. 2 ( 2017-02-01), p. 372-381
    Type of Medium: Online Resource
    ISSN: 1042-8194 , 1029-2403
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2017
    detail.hit.zdb_id: 2030637-4
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  • 6
    In: Leukemia & Lymphoma, Informa UK Limited, Vol. 58, No. 1 ( 2017-01-02), p. 64-69
    Type of Medium: Online Resource
    ISSN: 1042-8194 , 1029-2403
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2017
    detail.hit.zdb_id: 2030637-4
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  • 7
    Online Resource
    Online Resource
    Informa UK Limited ; 2018
    In:  Leukemia & Lymphoma Vol. 59, No. 9 ( 2018-09-02), p. 2211-2219
    In: Leukemia & Lymphoma, Informa UK Limited, Vol. 59, No. 9 ( 2018-09-02), p. 2211-2219
    Type of Medium: Online Resource
    ISSN: 1042-8194 , 1029-2403
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2018
    detail.hit.zdb_id: 2030637-4
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  • 8
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 8_suppl ( 2017-03-10), p. 31-31
    Abstract: 31 Background: While High-Dose Interferon (HDIFN) is the sole approved adjuvant systemic treatment for melanoma in Ontario and many other jurisdictions, it is toxic, of modest benefit, and costly. We sought to assess the population-level impact of toxicity, particularly neuro-psychiatric toxicity. This can inform value assessment for the adjuvant treatment of melanoma. Methods: This was a retrospective population-based registry study of all patients with melanoma receiving adjuvant HDIFN in Ontario 2008-2012. HDIFN receipt was determined from provincial drug-funding data. Toxicity was investigated through health services use compatible with HDIFN toxicity (e.g. mental health physician billings). Associations between early HDIFN discontinuation and health services use were examined. Using stage data reported from cancer centers on a subset of patients, propensity matched analysis compared utilization in stage IIB-IIIC patients that did and did not receive HDIFN. Results: Of 718 patients receiving HDIFN, 12% were ≥65 years, 83% had little or no comorbidity. One third had ≥1 toxicity-associated utilization within one year of starting HDIFN. 364/420 (87%) of utilization was mental health-related: 54% were family practitioner visits, 39% psychiatrist visits. Early drug discontinuation was more likely with pre-existing mental health issues in multivariable analysis (OR 2.0 (1.1,3.4)). In propensity matched analysis, HDIFN patients were more likely than untreated matched controls to have mental health utilization (51% vs. 42%, p=0.01) between 1 year pre-melanoma diagnosis to 2 years post. Conclusions: Mental health services use is common among stage IIB-IIIC patients with melanoma, especially with HDIFN. This emphasizes an important survivorship issue for these patients, and for those receiving HDIFN, and impacts the value of care. Pre-treatment mental health services use is associated with treatment discontinuation. This is important when contemplating the value of HDIFN use for individual patients. For those receiving HDIFN, optimal support must include mental health care.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2017
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  • 9
    In: Blood, American Society of Hematology, Vol. 126, No. 6 ( 2015-08-06), p. 733-738
    Abstract: Patients with relapsed or refractory transformed indolent lymphoma and DLBCL have similar outcomes with salvage therapy and ASCT. This therapy should be considered the standard of care for previously treated transformed indolent lymphoma.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2015
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 10
    In: Blood, American Society of Hematology, Vol. 116, No. 21 ( 2010-11-19), p. 800-800
    Abstract: Abstract 800 Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma (NHL) accounting for ~6% of all NHL. It is sensitive to combination chemotherapy, but remission durations are short without approaches such as stem cell transplantation (SCT). Most patients are incurable, but the clinical course is variable, with some patients succumbing quickly, while others survive 〉 10 years. MicroRNAs (miRs) are small, non-coding RNAs that regulate gene expression by inhibiting mRNA translation. miRs are useful in the prognostic assessment of tumors, but work to date examining differences between MCL and normal lymphoid tissues, have only identified 2 miRs involved in MCL prognosis (Zhao JJ, Blood, 2010; Di Lisio L, Leukemia, 2010). We used a novel approach to identify a prognostic miR signature in MCL. We hypothesized that a miR signature defining aggressiveness can be obtained by comparing miR expression profiles of aggressive NHL with indolent NHL, and that this signature when applied to a set of MCL cases, may aid in MCL prognosis. Total RNA was extracted from 135 formalin-fixed paraffin-embedded samples obtained at primary diagnosis (Table 1). RNA from a training set of 19 indolent and 20 aggressive NHL cases was analyzed on a high-throughput quantitative real-time PCR (qRT-PCR) platform assessing the expression of 365 miRs and 3 endogenous controls (TaqMan Human MicroRNA Array v1.0: TLDA, ABI) using the DDCt method. A two-sample Wilcoxon Rank sum test corrected for false discovery rate was used to assess the significance of differential expression for each miR between aggressive and indolent NHL. The 14 most significantly differentially expressed miRs (p 〈 0.001, FDR 〈 0.02) were validated on an independent set of 25 indolent NHL and 19 aggressive NHL by qRT-PCR, and analyzed using the DDCt method. Univariate analysis using a one-sided t-test yielded 9 miRs that validated on the independent NHL set. Multivariable analysis demonstrated the ability of this 9 miR signature to distinguish between aggressive and indolent NHL (p 〈 0.0001). Applying this signature to a set of 32 MCL patients with complete outcome data (Table 2) separated a poor prognosis group (median OS: 15 months, range: 4–40 months) from a good prognosis group (median OS: 88 months, range: 41–131 months) (Fig. 1). Among the 9 miRs were miR-29c, shown to have some prognostic value in MCL by Zhao et al., and miR-26a, shown to be important in MCL pathogenesis by Di Lisio et al. In light of the overlap with such recent studies, we believe the 9 miR prognostic signature we have identified may be of clinical utility. We are currently identifying mRNA targets for this miR signature and validating both the signature and the deregulated expression of these targets on a larger set of 200 MCL samples with known outcome data. Fig. 1. Psrincipal component analysis demonstrating separation of MCL cases into a good prognosis group in red (median OS: 88 months, range: 41–131 months) and a poor prognosis group in blue (median OS: 15 months, range: 4–40 months) based on expression of a 9 miR aggressiveness signature. Fig. 1. Psrincipal component analysis demonstrating separation of MCL cases into a good prognosis group in red (median OS: 88 months, range: 41–131 months) and a poor prognosis group in blue (median OS: 15 months, range: 4–40 months) based on expression of a 9 miR aggressiveness signature. Table 1. Sample breakdown Training set Number Aggressive cases Diffuse large B-cell lymphoma 5 Primary mediastinal B-cell lymphoma 5 Burkitt lymphoma 5 Atypical Burkitt 5 Indolent cases Small lymphocytic lymphoma/CLL 5 Extranodal marginal zone lymphoma 5 Follicular lymphoma Grade 1 3 Grade 2 3 Grade 3a 3 Validation set Aggressive cases Diffuse large B-cell lymphoma 7 Primary mediastinal B-cell lymphoma 5 Burkitt lymphoma 3 Atypical Burkitt 4 Indolent cases Small lymphocytic lymphoma/CLL 5 Extranodal marginal zone lymphoma 5 Follicular lymphoma Grade 1 5 Grade 2 5 Grade 3a 5 MCL cases Conventional 19 Blastoid/pleomorphic 11 Prolymphocytoid 1 Multiple lymphomatoid polyposis 1 Normal benign lymph nodes 20 TOTAL 135 Table 2. MCL clinical data Features Total % Gender Male 23 72 Female 9 28 ECOG 0 12 38 1 17 53 2-3 3 9 Stage 1 2 6 2 8 25 3 7 22 4 15 47 B symptoms 9 28 Extranodal sites 5 16 Lines of therapy 0 2 6 1 14 44 2 3 9 3 6 19 4 3 9 〉 4 4 13 Types of therapy Observation alone 2 6 Anthracycline-based 18 56 Rituximab 14 44 SCT 3 9 Bortezomib 3 9 Radiation 14 44 Median Range Age (yrs) 69 37–90 M-IPI score 6.6 5.3–8.7 Ki-67 (%) 25 7.5–90 Time to 1st treatment (months) 0.8 0.1–99.1 Overall survival (months) 34 4–131 Disclosures: Kuruvilla: Hoffman LaRoche: Honoraria, Research Funding; Celgene: Research Funding; Amgen: Honoraria; Otsuka: Honoraria; Genzyme: Honoraria.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2010
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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