Improved survival of patients with metastatic breast cancer in routine care: results of a retrospective study in a community-based oncology group practice 1995-2005.

BACKGROUND: Little is known about the treatment reality in metastatic breast cancer (MBC) outside clinical trials. We undertook this analysis to evaluate the actual treatment reality for unselected patients with MBC in routine care. PATIENTS AND METHODS: All patients with MBC, who were treated in our community-based group practice between 1995 and 2005, were analyzed retrospectively concerning prognostic factors, treatment, and survival. RESULTS: 403 consecutive patients were evaluated with a median age of 60 years (range 32-93). Aromatase inhibitor therapy was used in 87% of all patients. 83% received chemotherapy with the median number of lines being 3 (1-15). An anthracycline was given to 49%, a taxane was used in 55%, vinorelbine in 42%, capecitabine in 36%, gemcitabine in 28%, and a platinum compound in 9%. 94% of patients with bone metastasis received a bisphosphonate, and 63% of HER-2/neu-positive patients were treated with trastuzumab. Median survival since the start of palliative therapy was 30 months. Statistical analysis revealed as major prognostic factors hormone receptor status and prevalence of only bone metastasis. CONCLUSIONS: Treatment reality of MBC in routine care reveals a prolonged median survival of 30 months which is probably due to the sequential use of the most effective treatment modalities.

CT-guided percutaneous core needle biopsy in oncology outpatients: sensitivity, specificity, complications.

BACKGROUND: Inpatient CT-guided core needle biopsies are an integral diagnostic method to obtain a histology from lesions of unknown dignity in oncology. The purpose of this study was to evaluate feasibility, sensitivity, specificity, and complication rate of diagnostic CT-guided percutaneous core needle biopsies in oncology outpatients. PATIENTS AND METHODS: We retrospectively analyzed data of all oncology outpatients who received CT-guided core needle biopsies between August 2001 and March 2005. RESULTS: 432 outpatients received 465 CT-guided core needle biopsies using a 14-, 16-, or 18-gauge coaxial cutting needle. 174 patients (37%) were biopsied for intra-abdominal lesions, 130 (28%) for intrathoracic lesions, 55 (12%) for bone lesions, 40 (9%) for peripheral tumors, 36 (8%) for peripheral lymph nodes, and 30 (7%) for central lymph nodes. 249 (53%) biopsies were performed in local anesthesia, 216 (47%) in general anesthesia. Sensitivity was 94%, specificity 92%, and effective accuracy 92%. Complications occurred after 23 biopsies (4.9%). A pneumothorax occurred after 17 thorax biopsies (13%). 7 patients (1.5%) had to be hospitalized after the biopsy. No patient died due to the procedure. CONCLUSION: CT-guided core needle biopsies are feasible and safe in oncology outpatients. The technique shows a high diagnostic sensitivity and specificity with a low complication rate in routine care.

[Stroke prevention in atrial fibrillation in Germany. Situational analysis of treatment reality based on retrospective data]. / Schlaganfallprophylaxe bei Vorhofflimmern in Deutschland : Eine Statusanalyse basierend auf retrospektiven Daten der Versorgungsrealität.

BACKGROUND: Guideline-based, risk-adjusted therapy with anticoagulants reduce thromboembolic stroke risk in patients with atrial fibrillation (AF). METHOD: This study analyzed use of oral anticoagulation in German AF-patients. Access to anonymized patient records was made via IMS Health Disease Analyzer database (sample size: 113,619 patients with ICD-10 Code I48.-; observation period: 11/2010-10/2013). Results were subsequently extrapolated to all general practitioners' (GPs) and cardiological practices in Germany. RESULTS: In 2011 12-month AF-prevalence was extrapolated to 2.1 million patients (first diagnosed: n = 537.548). In 2012 AF-prevalence gone up to 2.2 million cases (first diagnosed: n = 537.548) and in 2013 to 2.8 million (first diagnosed: n = 636.571). Commonly prescribed oral anticoagulants (OAC) were vitamin K antagonists (VKA). Unstable INR setting, private health insurance, hospital admission, heart failure or hypertension increased probability of change from VKA to non-vitamin K antagonist oral anticoagulants (NOAC). 17.3-36.5% of patients with CHA2DS2-VASc-score ≥ 2 did not receive any thromboembolism prophylaxis; 38.5% with CHA2DS2-VASc-score = 0 received unnecessarily OACs. For 2013 a potential of 29.749 ischemic strokes in GP practices was calculated, which possibly can be avoided by thromboembolism prophylaxis according to guidelines. CONCLUSIONS: Risk-based anticoagulation showed requirements for optimization. Use of OACs, according to guideline recommendations, would minimize bleeding risks, reduce ischemic strokes and could release resources.

Treatment of advanced non small cell lung cancer in routine care: a retrospective analysis of 212 consecutive patients treated in a community based oncology group practice.

Treatment outcome data generated in prospective trials are intrinsically biased due to necessary selection criteria. Therefore the results obtained may not reflect the actual impact of current treatment options for an unselected general population. We analysed the treatment modalities and the outcome in 212 consecutive patients with non small cell lung cancer stages IIIB and IV who were seen in a community based oncology group practice between 6/1995 and 6/2006. 93 presented with stage IIIB and 119 with stage IV. Chemotherapy was given to 194/212 patients (92%), 114 patients (54%) received palliative radiation at one point during treatment. Treatment consisted of chemotherapy only in 86 patients (40%) and radiation only in 6 patients. 12 patients received best supportive care only. Patients with stage IIIB have survival rates at 12, 24 and 36 months of 64%, 27% and 21% respectively and for patients with stage IV the survival rates at 12, 24 and 36 months are 40%, 19% and 11% respectively. The median survival for stages IIIB and IV is 16 and 11 months respectively. In a multivariate analysis incorporating the factors stage (IIIB vs. IV), age (<70 vs. >/=70 years) and performance status (WHO 0/1 vs. 2/3) only stage and performance status were independent factors for survival. These retrospective data concerning analysis of survival, response rates and toxicity in a community setting confirm published results of phase II-III studies and indicate that results generated in prospective trials can be transferred into routine care.

Bendamustine/mitoxantrone/rituximab: a short remission induction chemoimmunotherapy for elderly patients with relapsed or refractory chronic lymphocytic leukemia.

We have evaluated all outpatients with relapsed or refractory chronic lymphocytic leukemia (CLL) who were treated with bendamustine/mitoxantrone/rituximab (BMR) between May 1999 and December 2008. Treatment consisted of bendamustine 90 mg/m2 on day 1 + 2, Mitoxantrone 6 mg/m2 on day 1, and Rituximab 375 mg/m2 on day 8, 15, 22 + 29. Thirty-nine patients (19 males, 20 females) received BMR with a median age of 69 years (46­81). Nineteen patients (49%) were above 70 years and 13 patients (33%) were 75 years or above. Performance score ranged between 0 and 2. The median number of previous therapies was 2 (1­4). Therapy was tolerated well with two observed therapy-associated hospitalizations. A reversible grade 3 or 4 hematotoxicity was seen in 30 patients (77%). Other reversible grade 3 or 4 toxicities were seen in two patients (5%). The overall response rate was 92% (10% complete remission, 82% partial remission). Median time to next CLL-therapy was 13 months (0­69). We conclude that BMR is a short and effective outpatient chemoimmunotherapy for patients with relapsed or refractory CLL, which can be used safely in elderly patients.