e24016 Background: It is unclear whether older adults undergoing head and neck cancer (HNC) surgery have significant functional and mental health impairments perioperatively. We examined postoperative physical, nutritional and psychosocial service use among a cohort of older adults with HNC co-managed by geriatricians and surgeons. Methods: Our sample consisted of older adults who were referred to the Geriatrics Service at MSKCC between 2015-2019 and took a geriatric assessment (GA) prior to undergoing HNC surgery. Physical, nutritional and psychosocial service utilization during the patient’s stay was assessed. Physical services included a physical, occupational or rehabilitation consult. Nutritional services consisted of speech and swallow or nutritional consult. Psychosocial services consisted of a psychiatry, psychology, or social work consult. All patients were comanaged by geriatricians and surgeons. Relationships between each service use, all 12 geriatric deficits, demographic, and surgical characteristics were assessed using chi-squared analysis and t-test for continuous variables. Results: 159 patients (median age 81) were included. The median time in the OR was 342 min and the median length of stay (LOS) was 6 days. The most common GA impairments were major distress (61%), depression (59%), Social Activity Limitation (SAL) (53%) and deficits in Activities of Daily Living (ADL) (44%). Nutritional and physical services were used much more frequently than psychosocial services (79% and 85% vs 31%; p=.01 and p=.003, respectively). Lower ADL, increasing OR time and LOS were statistically associated with utilization of the three services and SAL was associated with a greater proportion of physical and psychosocial consults (Table). No demographic characteristics were associated with any of the services. Only 38% of patients with major distress and 40% of patients with depression had a mental health consult. In comparison, 93% of patients with an abnormal TUG had a physical consult and 92% of patients with weight loss greater than 10 pounds prior to surgery got a nutritional consult. Conclusions: Many older adults with head and neck cancer experience aging-related impairments. Physical impairments are more commonly addressed than psychosocial impairments. Future studies should aim to identify and overcome barriers to addressing psychosocial issues in HNC patients. [Table: see text]
In the version of this Article initially published, a versioning error led to a mistake in the third paragraph of the Discussion.In the text now reading "In our dataset, the most extreme and sustained increase in SARS-CoV-2 cases associated with school opening was in the South, where school opening was associated with a weekly increase in cases ranging from 9.8 to 21.3 per 100,000 people, " the range initially reported was "7.8 to 18.9 per 100,000." The results presented in the text and figures are unaffected.
The proportion of anal cancer cases that produce elevated carcinoembryonic antigen (CEA) levels is not well described in the medical literature. In this study, we used electronic health record data from a single urban cancer center to identify patients from 2004–2018 with anal cancer who have also had a pre-initial treatment CEA measurement. We identified 40 patients who met our eligibility criteria. Of those, 11 (27.5%) had an elevated pretreatment CEA. Elevated CEA was not associated with any of the clinical or demographic covariates; however, three out of five patients with a recurrence had an elevated CEA.
185 Background: Targeted radionucleotide therapy (TRT) has become a standard of care. α-emitters have a higher energy transfer over a shorter range than β-emitters. PSMA-targeting antibodies have different biodistribution than small molecules and may improve intracellular retention based on pre-clinical models. Here, we present mature follow up of a phase 1 dose-escalation trial of 225Ac-J591 plus 177Lu-PSMA-I&T (aka PNT2002). Methods: Inclusion criteria:progressive mCRPC with ≥1 prior AR pathway inhibitor (ARPI), prior chemo (or unfit/refused), and with ≥1 lesion on PSMA PET where SUVmax >liver. 177Lu-PSMA-I&T (6.8 GBq) and 225Ac-J591 (30, 35, or 40 KBq/kg) given up to 2 doses 8 weeks apart. Primary outcome was dose-limiting limiting toxicity and recommended phase 2 dose (RP2D). Preliminary efficacy outcomes examined were overall survival (OS), progression-free survival (PFS), PSA response, and circulating tumor cell (CTC) changes. Results: 18 patients (6 at each dose level) with median age 70, median PSA of 54.4 (2.43-9614). Previous therapies: 11 (61%) with >1 ARPI, 12 (67%) chemo, 5 (28%) sip-T, 3 (17%) radium-223. Baseline CTCs: 15 detectable, 9 unfavorable. The median SUVmax of the most avid lesion on PSMA-PET was 31.4 (95% CI 11-82.7). Metastatic sites: 13 bone, 9 lymph node, 4 visceral. 8 (44%) were Halabi high risk. Treatment emergent adverse events (AEs) included neutropenia in 3 patients (17%), all Grade <2; thrombocytopenia occurred in 12 (67%) (3 GR 3); anemia in 10 (56%, 3 GR 3); 12 (67%) xerostomia (one Gr2); one (6%) with acute renal failure. Other AEs: 10 (56%) pain flare (1 Gr3 in pt with cord compression), 11 (61%) nausea (all Gr 1), 9 (50%) fatigue (all Gr 1). The RP2D of 225Ac-J591 was 35 KGBq/kg. 17 (94%) patients experienced a decline in PSA levels, with 11 out of 17 (64%) achieving PSA50 response. 4/5 patients (80%) converted from unfavorable to favorable CTC count, 4/8 (50%) from detectable to undetectable, 1 of 2 (50%) remained undetectable. Median biochemical PFS was 7.3 months (95% CI 2.7-15.8), and median OS was 29.8 mo (95% CI 7.4-NR), with 10 patients still alive at time of submission. 5 were progression free at one year, including 3 of 6 treated at RP2D. With longer follow up, no new safety signals were identified. Conclusions: The combination of PSMA-targeted alpha (via antibody) plus beta (via small molecule) was feasible. High grade AEs were rare and no new safety signals emerged with longer term follow up. Nearly all patients had PSA decline, and 5 had durable disease control off therapy. Clinical trial information: NCT04886986 .
Background: Five-year survivors of cancer are at excess risk of non-cancer competing morbidity and mortality including cardiovascular disease (CVD). However, whether excess risk differs based on exposure to specific chemotherapy treatments is unclear. We compared risk of CVD among 5-year cancer survivors with or without prior chemotherapy exposure. Methods: Using a retrospective cohort design, we identified 25,535 pan-cancer survivors with ≥5 years follow-up at MSKCC. New onset CVD events (i.e., heart failure [HF], myocardial infarction [MI], stroke) were ascertained based upon administrative billing codes. Cumulative incidence rates (CIR) were estimated, accounting for the competing risk of death, and differences between groups with and without chemotherapy treatment were evaluated using Gray’s test. Multivariable Fine and Gray proportional hazard models estimated sub-distribution hazard ratios (sHR) and 95%CIs for survivors treated with versus without chemotherapy. Subgroups of survivors treated with an individual class of chemotherapy were also examined. Results: Median follow-up was 116.2 (IQR, 80.6-162.0) months (Table). Compared to survivors with no chemotherapy exposure, survivors with prior chemotherapy treatment had higher CIR of HF (7.62% vs. 2.77%, P<0.01) and stroke (5.44% vs. 3.06%, P<0.01), but not MI (3.92% vs 3.49%, P=0.20). In multivariable models, survivors who received chemotherapy had higher risk of HF (sHR: 4.08; 95% CI: 3.47-4.80), MI (sHR: 1.61; 95% CI: 1.36-1.91), and stroke (sHR: 2.64; 95% CI: 2.20-3.15). Risks of CVD varied based upon type of chemotherapy received (Figure 1). Conclusion: Cancer survivors who received chemotherapy had higher risks of CVD compared with survivors without chemotherapy exposure, with variation based upon type of chemotherapy. These findings underscore the need for aggressive CVD risk factor modification and prevention in cancer survivors, especially those who received chemotherapy associated with increased CVD risk.
