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Petah Tikva, Israel

Brodowicz T.,Medical University of Vienna | Lang I.,National Institute of Oncology | Kahan Z.,University of Szeged | Greil R.,Paracelsus Medical University | And 15 more authors.
British Journal of Cancer | Year: 2014

Background: The randomised phase III TURANDOT trial compared first-line bevacizumab-paclitaxel (BEV-PAC) vs bevacizumab-capecitabine (BEV-CAP) in HER2-negative locally recurrent/metastatic breast cancer (LR/mBC). The interim analysis revealed no difference in overall survival (OS; primary end point) between treatment arms; however, progression-free survival (PFS) and objective response rate were significantly superior with BEV-PAC. We sought to identify patient populations that may be most appropriately treated with one or other regimen.Methods:Patients with HER2-negative LR/mBC who had received no prior chemotherapy for advanced disease were randomised to either BEV-PAC (bevacizumab 10 mg kg-1 days 1 and 15 plus paclitaxel 90 mg m-2 days 1, 8 and 15 q4w) or BEV-CAP (bevacizumab 15 mg kg-1 day 1 plus capecitabine 1000 mg m-2 bid days 1-14 q3w). The study population was categorised into three cohorts: triple-negative breast cancer (TNBC), high-risk hormone receptor-positive (HR+) and low-risk HR+. High-and low-risk HR+ were defined, respectively, as having ≥2 vs ≤1 of the following four risk factors: disease-free interval ≤24 months; visceral metastases; prior (neo)adjuvant anthracycline and/or taxane; and metastases in ≥3 organs. Results: The treatment effect on OS differed between cohorts. Non-significant OS trends favoured BEV-PAC in the TNBC cohort and BEV-CAP in the low-risk HR+ cohort. In all three cohorts, there was a non-significant PFS trend favouring BEV-PAC. Grade ≥3 adverse events were consistently less common with BEV-CAP. Conclusions: A simple risk factor index may help in selecting bevacizumab-containing regimens, balancing outcome, safety profile and patient preference. Final OS results are expected in 2015 (ClinicalTrials.gov NCT00600340). © 2014 Cancer Research UK.

Caglar H.B.,Brigham and Womens Hospital | Othus M.,Dana-Farber Cancer Institute | Allen A.M.,Brigham and Womens Hospital | Allen A.M.,Davidoff Center
Radiotherapy and Oncology | Year: 2010

Purpose: To define optimization parameters for limiting esophageal toxicity with concurrent chemoradiation (CRT) for non-small cell lung cancer (NSCLC). Materials and methods: A retrospective analysis of patients treated with concurrent chemoradiation at the Dana-Farber/Brigham and Women's Hospital Cancer Center was done with IRB approval. All patients were treated with concurrent CRT. All patients underwent 3-D conformal radiotherapy planned with ECLIPSE (Varian, Palo Alto, CA) treatment planning system. Patients had their esophagus contoured in two ways: the entire esophagus (Esoph) and esophagus in-field (Esophin). Together with clinical variables, dose volume metrics including mean dose, V5-V60 of both structures (Esoph and Esophin) were analyzed for correlation with acute esophagitis (≥grade 3) and late esophageal stricture. The analyses and graphics were completed using R (R Development Core Team, 2006). Logistic regression analysis was used to assess the relationships between dosimetric factors and swallowing complications while controlling for non-dosimetric variables. Results: 109 patients were studied between 2000 and 2006. 25% of patients had grade 3 or greater acute esophagitis. 5/109 (5.5%) had late esophageal stricture with a six-month actuarial risk of stricture of 6.5% (95% CI = 1-11%). Mean dose and V45-V60 for both Esoph and Esophin significantly correlated with development of acute esophagitis. V55 and V60 for both Esoph and Esophin significantly correlated with development of stricture. On Multivariate analysis V55 of the Esoph and Esophin was most predictive of toxicity. Limiting the V55 Esophin to 50% was the best cut-point for acute esophagitis. Conclusions: In the setting of concurrent CRT, V55 of the Esoph or Esoph in is the best predictor of acute esophagitis. © 2010 Elsevier Ireland Ltd. All rights reserved.

Wein S.,Davidoff Center
Journal of Pain and Palliative Care Pharmacotherapy | Year: 2012

Opioid-induced constipation is described, including features, mechanism, and management of the disorder. The role of various categories of laxatives including suppositories and the use of a peripherally acting μ-opioid receptor antagonist are discussed. Copyright © 2012 Informa Healthcare USA, Inc.

Shimoni A.,Chaim Sheba Medical Center | Avivi I.,Rambam Medical Center | Rowe J.M.,Rambam Medical Center | Yeshurun M.,Davidoff Center | And 6 more authors.
Cancer | Year: 2012

BACKGROUND: High-dose chemotherapy combined with autologous stem-cell transplantation (ASCT) is the standard therapy for refractory/relapsed aggressive lymphoma. In the era of rituximab-containing frontline regimens, it is becoming more challenging to salvage patients in this setting, and novel approaches are required. This is a randomized study evaluating the safety and efficacy of standard-dose ibritumomab tiuxetan (Zevalin) combined with high-dose BEAM chemotherapy (Z-BEAM) and ASCT in refractory/relapsed aggressive lymphoma. METHODS: Forty-Three patients with CD20+-aggressive lymphoma were randomized to a treatment arm (Z-BEAM, n = 22) or control arm (BEAM alone, n = 21). Ibritumomab tiuxetan was given at 0.4 mCi/kg on day -14 before ASCT. RESULTS: Patient characteristics, engraftment kinetics, and toxicity profile were similar between the 2 groups. Two-year progression-free survival (PFS) for all patients was 48% (95% confidence interval, 32%-64%): 59% and 37% after Z-BEAM and BEAM alone, respectively (P =.2). Multivariate analysis identified advanced age (hazard ratio [HR], 8.3; P =.001), high-risk disease (relapse within 12 months of diagnosis and/or secondary International Prognostic Index >2; HR, 2.8; P =.04), positive positron emission tomography-computed tomography pretransplant (HR, 2.4; P =.07), and BEAM alone (HR, 2.8; P =.03) as poor prognostic factors. Intermediate-risk patients with 1 or 2 risk factors had better PFS with Z-BEAM compared with BEAM: 69% and 29%, respectively (P =.07). Two-year overall survival was 91% and 62% after Z-BEAM and BEAM, respectively (P =.05). Similar prognostic factors determined survival. The HR for BEAM alone in the multivariate analysis was 8.1 (P =.01). CONCLUSIONS: Standard-dose ibritumomab tiuxetan combined with BEAM high-dose chemotherapy is safe and possibly more effective than BEAM alone as a conditioning regimen for ASCT in the era of rituximab-containing chemotherapy regimens. © 2012 American Cancer Society.

Limon D.,Tel Aviv University | Perry S.,Tel Aviv University | Granot T.,Tel Aviv University | Gordon N.,Tel Aviv University | And 2 more authors.
Journal of Oncology Practice | Year: 2016

Purpose Encounters between patients and medical staff are the foundation for building the patient-medical staff relationship, which is a keystone of care. We investigated perspectives of patients, caregivers, and medical staff related to greetings in oncology practice. Methods A total of 186 patients (median age, 62 years) and 104 caregivers (median age, 54 years) visiting the outpatient clinics at the Davidoff Cancer Institute completed a questionnaire about greeting-related preferences. Similar questionnaires were completed by 93 staff members (physicians, nurses, secretaries, and psychosocial team). Results Overall, patients preferred to be addressed informally (ie, by their given name) during first and subsequent meetings with their physician (59% and 75% of patients, respectively). However, most physicians (79%) addressed patients more formally (using surname or full name). Overall, 53% of patients wanted the physician to shake their hand. Physicians reported shaking hands with their patients at the beginning (46%) or end (71%) of the first meeting. Most patients (76%) wanted physicians to formally introduce themselves (by their full name) and mention their academic degree (65%). For other oncology professionals, a majority of patients (63%) preferred an informal introduction (by given name only). No major differences were observed between patients' and caregivers' perspectives. Conclusion This survey provides insights that may help oncology professionals in building relationships with their patients. Specifically, ourfindings suggest that patients with cancer in Israel prefer a casual environment; yet, they prefer that physicians introduce themselves in a more formal manner. © 2016 by American Society of Clinical Oncology.

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