Most patients with early-stage classical Hodgkin lymphoma (cHL) are treated with doxorubicin, bleomycin, vinblastine, and dacarbazine with or without radiation therapy, although studies are now evaluating the incorporation of novel agents paired with abbreviated chemotherapy. We present the efficacy and safety of brentuximab vedotin (BV) and nivolumab in combination with doxorubicin and dacarbazine (AN+AD) in patients with early-stage cHL. In this phase 2 study, patients with non-bulky (<10 cm) Ann Arbor stage I or II cHL received 4 cycles of AN+AD. The primary endpoint was complete response (CR) rate at end of treatment (EOT) by investigator. At the time of this analysis, 154 patients received ≥1 dose of AN+AD. The objective response rate at EOT was 96% (95% CI, 91.7-98.6), and the CR rate was 92% (95% CI, 86.0-95.4). In the favorable (n=56) and unfavorable (n=97) subgroups, CR rates were 95% (95% CI, 85.1-98.9) and 91% (95% CI, 83.1-95.7), respectively. The proportion of patients with duration of CR of at least 2 years was 96% (95% CI, 90.9-98.4). At a median follow-up of 27.9 months, the estimated 2-year PFS rate was 97% (95% CI, 92.0-98.8). Any-grade and grade ≥3 treatment-emergent adverse events occurred in 99% and 44% of patients, respectively; no events of febrile neutropenia were reported. Any-grade treatment-emergent immune-mediated adverse events occurred in 22% of patients. One disease-related death was reported after the safety reporting period. Results from this study support the use of BV and nivolumab in combination with limited chemotherapy in patients with non-bulky, early-stage cHL. ClinicalTrials.gov: NCT03646123
BACKGROUND:Adults with advanced cancer often experience low engagement with advance care planning (ACP) and high levels of depression, anxiety, and fear of death/dying. Access to specialist palliative care is limited. This study tests Valued Living, a novel online acceptance-based group intervention designed to increase ACP and improve psychological/spiritual well-being among adults with advanced cancer screening positive for depression or anxiety. Valued Living was delivered online by social workers in community oncology settings. METHODS:Adults with advanced solid tumor cancer (N = 240) and significant depression or anxiety symptoms were randomized 1:1 within cohorts to Valued Living or usual care (UC). Valued Living provided five weekly group sessions by videoconference plus self-paced online modules. Primary outcome was the total number of ACP behavioral steps completed of 12 potential steps (e.g., selecting health care proxy, advanced directives) by 3.5-month follow-up. Secondary outcomes included fear of death, rigid cognitive avoidance of death, depression, anxiety, and spiritual well-being. RESULTS:Valued Living participants completed 1.27 more ACP steps (95% CI, 0.36-2.18; d = 0.36; p = .006) than UC. Largest condition differences were identifying (97.4% vs. 84.2%) and documenting a health care proxy (83.3% vs. 64.9%). Valued Living participants improved more in cognitive avoidance of death (d = 0.36; p = .005), and spiritual well-being (d = 0.42; p < .001) but not fear of death or anxiety. CONCLUSION:The online Valued Living intervention, implemented by social workers in community oncology clinics, increased ACP and well-being among depressed and anxious adults with advanced cancer. Findings support this supportive care approach for the growing population living with advanced cancer. TRIAL REGISTRATION:The trial registration is ClinicalTrials.gov NCT04773639.
BACKGROUND Pancreatic acinar cell carcinoma (PACC) and pancreatoblastoma (Pb) are rare exocrine pancreatic malignancies with liver-dominant metastatic patterns and poor prognosis. Limited treatment options exist beyond the extrapolated pancreatic ductal adenocarcinoma regimens. Yttrium-90 (Y-90) radioembolization has demonstrated efficacy in various hepatic malignancies but remains understudied in these rare pancreatic tumors. These cases illustrate the potential role of Y-90 radioembolization in achieving durable hepatic disease control in PACC and Pb patients. CASE SUMMARY Case 1: A 62-year-old man with metastatic PACC underwent four Y-90 radioembolizations over 46 months, achieving partial responses after each treatment with sustained disease control exceeding one year without systemic therapy. Case 2: A 78-year-old woman with metastatic Pb following radical pancreaticoduodenectomy received four sequential Y-90 treatments targeting hepatic metastases, demonstrating partial responses to the treated metastases which established ongoing local disease control. Both patients tolerated multiple Y-90 sessions well with minimal complications. The treatments were successfully integrated with systemic therapies and provided meaningful symptom relief. These cases demonstrate the radiosensitivity of these rare malignancies and the feasibility of repeated Y-90 administrations over extended intervals in selected patients. CONCLUSION Y-90 radioembolization achieves durable hepatic response in rare pancreatic exocrine malignancies with a favorable safety profile.
Background Histotripsy is a novel, noninvasive, nonionizing focused ultrasound technology that mechanically destroys tissue via cavitation. Neuroendocrine tumors, which frequently metastasize to the liver and follow an indolent course, may be particularly well-suited for histotripsy, and we report an early experience. Methods This retrospective analysis summarizes the first 32 patients consecutively treated with histotripsy in a neuroendocrine practice. Intraoperative targeting and cavitation were performed with the EDISON system. Clinical outcomes, postprocedural imaging, and adverse events were assessed. Results Of 36 patients consecutively evaluated, 32 underwent histotripsy to at least 1 liver tumor. Twenty-seven patients had neuroendocrine tumors. Neuroendocrine tumor primary sites include the small intestine (16), pancreas (8), lung (2), and cecum (1). The treatment intent for patients with neuroendocrine tumors was full coverage of all known liver disease in 2 patients, with partial treatment in the remaining patients. Of the 19 tumors with full treatment intent, 100% showed a complete response. Partial treatments showed stable disease. Minor adverse events included skin irritation and transient pain. Major adverse events included acute kidney injury in 3 patients and 1 death post-treatment related to respiratory distress in the setting of underlying respiratory compromise. Conclusion Histotripsy is a promising noninvasive treatment for metastatic neuroendocrine tumors, offering effective tumor control when full coverage is achieved. Tumor histolysis may induce acute kidney injury, suggesting a need to appropriately select patients based on acute kidney injury risk, limit treated volume per session, and closely monitor urine output and color during treatment. These early findings support further study across broader patient populations.
