Mediastinal Presentation of Testicular Embryonal Carcinoma.

Testicular embryonal carcinoma is a type of nonseminomatous germ cell tumor (NSGCT) that commonly presents with scrotal swelling due to testicular mass. About half of patients with NSGCTs will present with metastases at initial diagnosis. Rarely, testicular embryonal carcinoma can present primarily in the mediastinum. Treatment is well-studied and effective: chemotherapy with bleomycin, etoposide, and cisplatin. Post-chemotherapy retroperitoneal lymph node dissection (RPLND) is common adjuvant therapy. In this report we present a case of testicular embryonal carcinoma in a 32-year-old Caucasian man. The rarity of the case resides in its presentation: supraclavicular lymphadenopathy and no testicular mass on palpation or scrotal ultrasound.

A Case Presentation of Metastatic Hepatic Epithelioid Hemangioendothelioma: A Rare Vascular Tumor.

Epithelioid hemangioendothelioma (EHE) is an uncommon vascular tumor that can present in various organs, including the liver. Hepatic EHE (HEHE) may showcase with metastases at initial presentation, as patients have vague symptoms such as right upper quadrant pain leading to the risk of delayed diagnosis. There is no standard treatment. Fortunately, prognosis is good. This remains true for some patients with metastatic disease who are not being actively treated. In this report, we present a unique case of metastatic HEHE in a 65-year-old Caucasian male who has not received treatment and continues to remain in stable condition after his initial diagnosis three years ago.

A Case of Metastatic Uveal Melanoma: From Diagnosis to Survival Four Years Later.

Uveal melanoma includes melanoma of the choroid, ciliary body or the iris of the eye and is a rare malignancy that accounts for about 1,500 new cases in the U.S. every year. Of the choroid, ciliary body or the iris, the choroid is most often affected. Local treatment is well-studied; however, this cancer tends to metastasize in nearly 50% of patients, even if the primary melanoma is treated appropriately. There are limited approved treatments for metastatic uveal melanoma and thus, survival rates are low. However, emerging clinical trials demonstrate promising results and play a prominent role in survival of patients with uveal melanoma.

Safety and efficacy of first-line nivolumab plus ipilimumab alternating with nivolumab monotherapy in patients with advanced renal cell carcinoma: the non-randomised, open-label, phase IIIb/IV CheckMate 920 trial.

OBJECTIVES: The non-randomised, open-label, phase IIIb/IV multicohort CheckMate 920 trial explored the safety and efficacy with a less frequent, but continual nivolumab plus ipilimumab (NIVO+IPI) dosing regimen (cohort 1) to determine whether this modification could potentially retain efficacy benefits while improving on the manageable safety profile previously observed with this combination in patients with advanced renal cell carcinoma (aRCC). SETTING: Patients were enrolled from 48 largely community-based sites in the USA. PARTICIPANTS: 106 patients with previously untreated, predominantly clear cell aRCC received treatment. INTERVENTIONS: Patients received NIVO 6 mg/kg plus IPI 1 mg/kg on day 1 of the first week of each 8-week cycle; the combination alternated with NIVO 480 mg monotherapy on day 1 of the fifth week of each 8-week cycle. Treatment continued until disease progression, unacceptable toxicity, withdrawal of consent or study end. The maximum treatment duration was 2 years. The primary endpoint was the incidence of high-grade (grade 3/4 and grade 5) immune-mediated adverse events (IMAEs) within 100 days of the last dose. Select secondary endpoints included time to onset and resolution of high-grade IMAEs, progression-free survival (PFS) and objective response rate (ORR). The incidence of treatment-related adverse events and the overall survival (OS) were the exploratory endpoints. RESULTS: The most common grade 3/4 IMAEs were diarrhoea/colitis (7.5%) and rash (6.6%) and no grade 5 IMAEs occurred, with a minimum follow-up of 28.5 months. The median PFS was 4.8 (95% CI 3.0 to 8.3) months, the ORR in evaluable patients (n=96) was 34.4% (95% CI 25.0 to 44.8), and the median OS was not reached (95% CI 24.8 months to not estimable). CONCLUSIONS: While no new safety signals were reported with less frequent, but continual NIVO+IPI dosing in CheckMate 920, the modified regimen was not associated with clinical benefits relative to the approved NIVO+IPI dose. These results support the continued use of the currently approved NIVO+IPI combination dosing schedule for patients with aRCC. TRIAL REGISTRATION NUMBER: NCT02982954.

Patient-Defined Treatment Success: Perspectives of Patients With Advanced-Stage Lung Cancer.

PURPOSE: In the United States, lung cancer accounts for 14% of cancer diagnoses and 28% of cancer deaths annually. Because no cure exists for advanced lung cancer, the primary treatment goal is to prolong survival. OBJECTIVES: The study aim was to determine whether individual preferences, characteristics, and treatment experiences affect the meaning of treatment success. MATERIALS AND METHODS: A quantitative study using an observational, longitudinal cohort of patients with advanced stage non-small-cell lung cancer was conducted. Data sources included medical records and patient interviews. Data were analyzed using χ2, Fisher's exact, and McNemar's tests, as well as logistic regressions. RESULTS: At the first interview of 235 individuals, 12% considered survival alone as their definition of treatment success; others defined treatment success as survival plus other aspects, such as quality of life and reaching an important personal goal. As they moved through chemotherapy, 47% of the patients changed their definition of treatment success. Bivariate analysis showed that patients with lower incomes tended to be more likely to change their definition of treatment success compared with their counterparts with higher income (P = .0245). CONCLUSION: By taking chemotherapy, patients expect to increase their odds of survival and want to maintain the quality of life and functionality. A patient's definition of treatment success is often changing as treatment continues, making it appropriate to ensure patient-provider communication throughout their clinical care. The study results are limited to patients with advanced non-small-cell lung cancer and drawn from a predominantly white patient population, mainly from the US Midwest.

Quitting the smoke break: a successful partnership with the construction industry.

SETTING: The Conference Board of Canada cites that 77% of employees want to receive health information in the workplace. From 2014 to 2016, Ottawa Public Health (OPH) partnered with 25 construction companies, to implement smoking cessation programs on 41 construction sites. INTERVENTION: OPH partnered with local construction companies, unions, and workers to design, deliver, and evaluate a tailored initiative to build smoke-free culture and encourage quit attempts. Workers received group and one on one counseling and nicotine replacement therapy (NRT) from OPH staff. Client satisfaction was assessed and used to inform ongoing quality improvement. OUTCOMES: Since 2014, this project has expanded from one pilot site to 41 sites and has engaged two of the largest construction companies in Canada. A participant's survey (N = 62) found that at 1 month, 40% remained smoke-free and 38% had reduced the amount tobacco smoked. At 6 months, 34% remained smoke-free and 45% had reduced their consumption of tobacco. IMPLICATIONS: Construction workers typically have high smoking rates and low engagement with cessation programs. Public health practitioners working with the construction industry must understand the culture, engage on-site champions, and articulate the added value of tobacco cessation to the business. Using this information on partnering with the construction industry, this innovative program, first of its kind in Canada, could be duplicated in other communities.

Evaluating Symptom Distress in Cancer Patients.

BACKGROUND: Distress in cancer patients negatively affects emotions and coping abilities and can reduce treatment adherence, quality of life, and survival rates. The prevalence of distress in cancer patients has been reported at 35.1 percent and 37.8 percent, but is frequently undiagnosed. Previous studies have produced conflicting results regarding reported symptoms.This study aims to help health care providers identify symptoms correlated with distress to improve recognition and treatment. METHODS: A cross-sectional study was performed via medical record review of 40 adult cancer patients at the Avera Cancer Institute. Responses were compared using Pearson's chi-square test and the t-test. RESULTS: The average age of participants was 56.8 ± 12.0, and 65 percent had breast cancer. The mean overall score for distress was 4.6 ± 2.7 points on a 0-10 scale (95 percent CI 3.71 - 5.45). Twenty-four patients (60 percent) reported clinically significant distress. Females were more likely to report sadness. Specific symptoms with a statistically significant association with a higher overall distress included: fears, depression, sleep, worry, fatigue, nervousness, eating, and loss of interest in normal activities. CONCLUSIONS: Although our sample size was small and homogeneous, the results demonstrated statistically significant associations between overall distress and the symptoms of fears, depression, sleep, worry, fatigue, nervousness, eating, and loss of interest in normal activities. These findings can increase awareness of symptoms associated with distress and allow clinicians to recommend specific interventions. Though many oncology clinics screen for distress, distress remains an important factor affecting quality of life and warrants further investigation.

A metastatic colon adenocarcinoma harboring BRAF V600E has a durable major response to dabrafenib/trametinib and chemotherapy.

The subset of metastatic colorectal adenocarcinomas that harbor BRAF V600E mutations are aggressive tumors with significantly shortened survival and limited treatment options. Here we present a colorectal cancer patient whose disease progressed through standard chemotherapy and who developed liver metastasis. Comprehensive genomic profiling (FoundationOne(®)) identified a BRAF V600E mutation in the liver lesion, as well as other genomic alterations consistent with colorectal cancers. Combination therapy of dabrafenib and trametinib with standard cytotoxic chemotherapy resulted in a durable major ongoing response for the patient. This report illustrates the utility of comprehensive genomic profiling with personalized targeted therapy for aggressive metastatic colorectal adenocarcinomas.

UGT1A1 genotype-guided phase I study of irinotecan, oxaliplatin, and capecitabine.

PURPOSE: We performed a UGT1A1 genotype-guided study to determine the maximum tolerated dose (MTD) and evaluate the toxicities and pharmacokinetics of the combination of capecitabine (CAP), oxaliplatin (OX), and irinotecan (IRIN). EXPERIMENTAL DESIGN: Patients were screened for UGT1A1 *28 genotype prior to treatment. The starting dose (mg/m(2)) was IRIN (150), OX (85) and CAP (400), days 2-15. Doses were escalated or de-escalated within each genotype group (*28/*28, *1/*28 and *1/*1). IRIN pharmacokinetics was performed at the MTD. RESULTS: 50 patients were evaluable for toxicity [11 (*28/*28); 18 (*1/*28); 21 (*1/*1)]. UGT1A1 *28/*28 patients experienced hematologic dose limiting toxicity (DLT), requiring dose-de-escalation. The UGT1A1 *28/*28 recommended phase 2 dose (RP2D) was IRIN (75), OX (85), and CAP (400). In contrast, both UGT1A1 *1/*28 and *1/*1 tolerated higher doses of IRIN and non-hematologic toxicity was dose limiting for UGT1A1 *1/*1. The RP2D was IRIN (150), OX (85), and CAP (400) for UGT1A1*1/*28 and IRIN (150), OX (100), and CAP (1600) for UGT1A1 *1/*1. UGT1A1 *1/*28 and *1/*1 patients treated with IRIN (150) had similar AUCs for the active irinotecan metabolite, SN38 (366 +/- 278 and 350 +/- 159 ng/ml*hr, respectively). UGT1A1 *28/*28 patients (n = 3) treated with a lower IRIN dose (100) had non-significantly higher mean SN38 exposures (604 +/- 289 ng/ml*hr, p = 0.14). Antitumor activity was observed in all genotype groups. CONCLUSIONS: UGT1A1 genotype affects the dose and pharmacokinetics of the CAPIRINOX regimen and UGT1A1 genotype-guided dosing of CAPIRINOX is ongoing in a phase II study of small bowel cancer (NCT00433550).

Are cancer survivors/patients knowledgeable about osteoporosis? Results from a survey of 285 chemotherapy-treated cancer patients and their companions.

OBJECTIVE: This study assessed osteoporosis knowledge deficits among cancer patients and their spouses/partners. DESIGN: Single-institution survey (modified version of the Osteoporosis Knowledge Assessment Tool). SETTING: The Mayo Clinic in Rochester, Minnesota. PARTICIPANTS: Consecutive chemotherapy-treated cancer patients (n = 285) with their spouses/partners (n = 101). OUTCOME MEASURES: The main outcome was the percentage of cancer patients who incorrectly conveyed that 1) cancer treatment strengthens bones (or did not know) and/or 2) male cancer patients are not at risk for osteoporosis (or did not know). ANALYSES: Test scores and 95% confidence intervals (CI) as well as the correlation between patient and spouse/partner scores, are reported. RESULTS: 39% of patients (95% CI, 32% - 48%) thought cancer treatment strengthened bones or did not know, and 39% (95% CI, 32% - 48%) either answered that osteoporosis almost never occurred in men or did not know. The mean correct score on the modified Osteoporosis Knowledge Assessment Tool was 6.7 (95% CI, 6.7, 7.9), and scores from patients correlated with companion scores (r = 0.42; P < .001). CONCLUSIONS AND IMPLICATIONS: Chemotherapy-treated cancer patients and their companions have knowledge deficits concerning osteoporosis. Educational initiatives to increase awareness may be of value.