Stephanie E. McClure

Identification of 12 or more lymph nodes in resected colon cancer specimens as an indicator of quality performance

Identification of ≥12 lymph nodes in resected colon cancer specimens has been endorsed as a quality indicator.

Surgical resection and long-term survival for octogenarians who undergo surgery for non-small-cell lung cancer.

PURPOSE An increasing proportion of newly diagnosed non-small-cell lung cancer (NSCLC) patients are octogenarians. It has been questioned whether older patients benefit from surgical resection of lung cancer to the same extent as younger patients. PATIENTS AND METHODS We conducted a single-institution, retrospective analysis of patients newly diagnosed with NSCLC from 2000-2006, who underwent surgical resection of their lung cancer in Hoag Hospital. We compared resection and survival rates for patients who were age 80 years or older to younger cohorts and determined their stage distribution, rates of surgery, and actuarial survival by age-defined cohort. Of 1293 total patients, 17.2% were age 80 years or older; 36.1%, age 70-79 years; 29.2%, age 60-69 years; 12.9%, age 50-59 years; and 4.6%, under age 50. Of these patients, 482 underwent surgical resection. Surgical procedures included 400 lobectomies, 23 pneumonectomies, and 59 wedge resections. RESULTS The proportion of patients who had local disease at diagnosis was higher for octogenarians compared with younger patients (33.6% vs. 26.6%; P = .021), but the resection rate for octogenarians was lower (64% vs. 83%; P = .0003). For patients determined to have local- or regional-stage disease, resection rates were 52% versus 67.9% (P = .0007). However, survival curves for patients who underwent surgical resection were similar for all five cohorts with 5-year survival rates of 62%, 53%, 63%, 63%, and 79% from oldest to youngest. CONCLUSION Non-small-cell lung cancer patients < 80 years of age were less likely to undergo potentially curative surgery, but survival for octogenarians who did undergo surgical resection was comparable to younger age groups. Such patients should not be denied potentially curative surgery simply because of age.

Overall survival benefit from postoperative radiation therapy for organ-confined, margin-positive prostate cancer.

PURPOSE Radical prostatectomy for invasive prostate cancer is associated with positive margin rates in 10% to 50% of resected specimens. Postoperative radiation therapy may benefit patients who have organ-confined prostate cancer with positive margins. METHODS AND MATERIALS We performed a retrospective analysis to examine whether adjunctive radiation therapy enhanced long-term survival for prostate cancer patients who underwent prostatectomy for localized prostate cancer but with positive margins. We used the Hoag Cancer Center database to identify patients diagnosed with invasive prostate cancer. Relative and overall survival rates were calculated. RESULTS Among 1,474 patients diagnosed with localized invasive prostate cancer during the years 1990 to 2006 and undergoing prostatectomy, 113 (7.7%) were identified who had positive margins and did not have local extension of disease, positive lymph nodes, or distant metastases. A total of 17 patients received adjunctive radiation therapy (Group A), whereas 96 did not (Group B; 3 received hormonal therapy). Both groups had a median age of 64 years and median follow-up of 7.5 years. In Group A, no patients have died as of last follow-up, but in Group B, 18 have died. Estimated 10-year and 15-year overall survival rates were both 100% for Group A compared with 85% and 57% respectively for Group B (p2=0.050, log rank). Relative 10- and 15 year survival rates were both 100% for Group A compared with 100% and 79% respectively for Group B. CONCLUSIONS This retrospective analysis suggests that prostate cancer patients with localized disease but positive margins do derive a survival benefit from adjuvant radiation therapy.

Steadily Improving Survival in Lung Cancer

BACKGROUND National data demonstrate minimal improvement in survival for patients diagnosed with lung cancer despite a number of apparent advances during the past 3 decades. We wished to know how demographic characteristics, staging, therapy, and survival have changed over time for patients with lung cancer who were accessioned to the cancer registry of a large community hospital in southern California. PATIENTS AND METHODS Clinical features and survival data were collected on patients diagnosed during each of the successive 6-year eras of 1986 to 1991 (n = 812), 1992 to 1997 (n = 1072), 1998 to 2003 (n = 1209), and 2004 to 2009 (n = 1365). RESULTS Median survival improved from 11 to 13 to 16 to 26 months and overall 5-year survival steadily improved from 16.5% to 19.1% to 24.0% to 31.1%. The proportion of patients with localized disease at diagnosis increased from 18.4% to 24.1% to 24.9% to 31.6%. Improvements in relative survival were much greater than have occurred nationally. Other obvious trends over time were increasing age of patients, increasing proportions with diagnoses of adenocarcinoma with concomitant decreases in squamous cell and small cell histologies, and decreases in the proportion of large cell carcinoma with reciprocal increases in neuroendocrine diagnoses. The use of chemotherapy for patients with local disease tripled in the most recent era. CONCLUSION Survival has steadily improved for patients in this community who were diagnosed with lung cancer. The explanations for this improvement are multifactorial, but include earlier stage at diagnosis, decreases in histologic types associated with active smoking, and increased use of systemic therapies.

Should High-Dose Interleukin-2 Still Be the Preferred Treatment for Patients with Metastatic Melanoma?

For more than 20 years interleukin-2 (IL2) was the preferred treatment for medically fit metastatic melanoma patients, but recently two new agents, ipilimumab and vemurafenib, were approved for stage IV disease. Single-institution data were used to determine the long-term survival rate for IL2-treated melanoma patients, and whether use of inpatient IL2 had declined recently. Between May 1987 and April 2010, 150 patients were hospitalized for high-dose, intravenous (i.v.) IL2. The average number of IL2 patients increased from 5.4 per year during 1987-1991 to 5.8 during 1992-1997 after regulatory approval of IL2, to 8.3 during 1998-2006 after a marketing indication in metastatic melanoma was granted, but dropped to 3.0 during 2007-2010. At the time of treatment, median age was 52 years; 27% were 60 years of age or older. At the time of analysis 122 patients were deceased. Median survival from the start date of IL2 treatment was 15.6 months, with a 20% 5-year survival. Among patients enrolled in clinical trials, there were as many nonresponders who survived 5 years as responders, which is consistent with a delayed immunotherapy benefit. In the absence of long-term survival data for these newer agents, IL2 probably should still be the preferred initial treatment for most patients with metastatic melanoma who are medically fit.

Should high-dose interleukin-2 still be the preferred treatment for patients with metastatic renal cell cancer?

Interleukin-2 (IL-2) was the preferred treatment for medically fit patients with advanced kidney cancer, but recently, several targeted therapies have been approved for metastatic renal cell carcinoma. We wished to determine the long-term survival rate for patients with kidney cancer treated with IL-2 and whether the use of intense inpatient IL-2 has declined since the introduction of targeted therapies. Patients who received IL-2 were identified from clinical trial enrollment, pharmacy logs, and financial billing records. Survival was determined from the earliest date of IL-2 therapy. There were 79 patients hospitalized for high-dose infusional IL-2 between March 1989 and March 2009. Median age was 58 years, and 27% were older than 65 years at the time of treatment. At the time of this analysis, 72 patients had deceased. Median survival was 9.9 months, but 5-year survival was 19.4%. The average number of patients with IL-2 increased from 2.2 per year during 1989-1992 to 5.6 during 1993-2001 after FDA approval, but dropped to 2.0 during 2002-2009. High-dose IL-2 is associated with a 5-year survival rate that is higher than objective response rates, suggesting a delayed immunotherapy benefit for some patients. The use of intensive IL-2 has declined dramatically in recent years, but unless a long-term survival benefit can be shown for these new targeted products, we feel that inpatient IL-2 remains the preferred initial treatment.

High-dose IL-2 in metastatic melanoma: better survival in patients who also received patient-specific autologous tumor cell vaccine

Treatment with high-dose Interleukin-2 (IL-2) has been associated with long-term survival in small proportion of metastatic melanoma patients. We recently reported a median survival of 15.6 months, and a 20% 5-year survival rate for 150 such patients who were hospitalized for high-dose i.v. IL-2 between May 1987 and April 2010. [1] A recent report showed a survival advantage for the addition of gp100 vaccine plus high-dose IL-2 compared to treatment with IL-2 alone [2]. We were aware that several of our IL-2 patients had also received patient-specific tumor cell vaccines derived from autologous tumor cell lines. We wished to determine whether this may have contributed to their high 5-year survival rate. Comparison of existing data bases revealed that 27 of the 150 IL-2 patients had also received a patient-specific vaccine; 123 had not. The table below (Table ​(Table1)1) summarizes survival data, which was calculated from the date IL-2 was initiated. Survival was much better in patients who received a patient-specific vaccine in addition to IL-2 (p age of 50 (NSD). Of the 27 vaccine patients, 7 started vaccine therapy an average of 8.7 mos. before receiving IL-2 (range 2.4 to 40 mos.) and 20 received vaccine a median of 14.2 months after starting IL-2 (range 1 to 42 mos.); 12 received injections of irradiated autologous tumor cells and 15 received injections of dendritic cells loaded with antigens from irradiated autologous tumor cells, and suspended in 500 microgram GM-CSF. Survival was longer in patients who received IL-2 first (5-yr survival 55% vs 14%), and in patients who received the dendritic cell vaccine (5-yr survival 53% vs 33%). This analysis suggests that receipt of high-dose IL-2 followed by a patient specific vaccine results in better survival than IL-2 alone, but the limitations of such a retrospective analysis, and the risk of confounding unintended bias, are significant. Table 1

Abstract P3-14-02: Should patients with comedo ductal carcinoma in situ (DCIS) be managed as if they have locally invasive breast cancer?

Withdrawn by Author Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-14-02.

Abstract 5027: Steadily improving survival in lung cancer

Background and Purpose: There have been many improvements in the diagnosis and management of lung cancer during the past 25 years, including better imaging and the potential for earlier diagnosis, better surgical staging and introduction of minimally invasive surgery, improved radiation technology, and introduction of several systemic cancer drugs, including targeted therapies, and acceptance of multidisciplinary approaches rather than focusing on single modalities of therapy. We examined how treatment has changed in successive eras and how this relates to survival. Patients and Methods: The Hoag Cancer Institute data base was used to identify patients with lung cancer diagnosed during 1986-2009, who were diagnosed and/or received some or all of their lung cancer treatment at Hoag Hospital within four months of diagnosis. For the four successive 5-year periods, data was summarized for patient demographics and treatment, and observed and relative 5-year survival rates were calculated. Results: Data is summarized in the table below. Conclusion: Over time there have been steady increases in median age, and in the proportion that have adenocarcinoma, are female, have local stage disease, undergo surgery alone as therapy, and receive systemic therapy with surgery as initial treatment. These changes have been associated with a 13.3 percentage point absolute increase in observed survival and an 81% relative increase. Relative 5-year survival increased from 18% to 34%, which contrasts with national data showing an increase from only 14% to 16% in the U.S. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5027. doi:10.1158/1538-7445.AM2011-5027