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Dores G.M.,Oklahoma City Veterans Affairs Health Care System | Dores G.M.,U.S. National Institutes of Health | Qubaiah O.,Hematology and Oncology Associates | Mody A.,Oklahoma City Veterans Affairs Health Care System | And 3 more authors.
BMC Cancer | Year: 2015

Background: In contrast to the well-described epidemiology and behavior of small cell lung carcinoma (SCLC), little is known about extrapulmonary small cell carcinoma (EPSCC). Methods: Using data from the Surveillance, Epidemiology and End Results (SEER) Program (1992-2010), we calculated age-adjusted incidence rates (IRs), IR ratios (IRRs), annual percent change (APC), relative survival (RS), RS ratios (RSRs), and the respective 95% confidence intervals (95% CI) of SCLC and EPSCC according to primary site. We used the SEER historic stage variable that includes localized (confined to the organ of origin), regional (direct extension to adjacent organ/tissue or regional lymph nodes), and distant (discontinuous metastases) stages and combined localized and regional stages into "limited" stage. Results: The incidence of SCLC (IR=76.3/million person-years; n=51,959) was 22-times that of EPSCC (IR=3.5; n=2,438). Of the EPSCC sites, urinary bladder, prostate, and uterine cervix had the highest incidence (IRs=0.7-0.8); urinary bladder (IRR=4.91) and stomach (IRR=3.46) had the greatest male/female disparities. Distant-to-limited stage site-specific IRRs of EPSCC were significantly elevated for pancreas (IRR=6.87; P<0.05), stomach, colon/rectum, ovary, and prostate (IRRs=1.62-2.42; P<0.05) and significantly decreased for salivary glands, female breast, uterine cervix, and urinary bladder (IRRs=0.32-0.46). During 1992-2010, significant changes in IRs were observed for EPSCC overall (APC=1.58), small cell carcinoma of the urinary bladder (APC=6.75), SCLC (APC=-2.74) and small cell carcinoma of unknown primary site (APC=-4.34). Three-year RS was significantly more favorable for patients with EPSCC than SCLC for both limited (RSR=2.06; 95% CI 1.88, 2.26) and distant stages (RSR=1.55; 95% CI 1.16, 2.07). Among limited stage small cell carcinoma, RS was most favorable for salivary glands, female breast, and uterine cervix (RS=52-68%), whereas RS for nearly all sites with distant stage disease was <10%. Conclusion: EPSCC comprises a heterogeneous group of diseases that appears, at least in part, etiologically distinct from SCLC and is associated with more favorable stage-specific patient survival. © Dores et al.; licensee BioMed Central. Source

Raje N.,Harvard University | Vescio R.,Cedars Sinai Samuel Oschin Comprehensive Cancer Center | Montgomery C.W.,Hematology and Oncology Associates | Badros A.,University of Maryland, Baltimore | And 7 more authors.
Clinical Cancer Research | Year: 2016

Purpose: Zoledronic acid (ZOL) given every 3 to 4 weeks can reduce skeletal-related events (SRE) in patients with bone lesions from multiple myeloma. This study evaluated efficacy and safety of less-frequent ZOL dosing based on bone turnover markers in patients with 1 to 2 years of prior bisphosphonate therapy. Experimental Design: Patients received ZOL (4 mg) every 4 or 12 weeks based on urinary N-telopeptide of type 1 collagen (uNTX) levels (every 4 weeks ifuNTX ≥50 nmol/mmol creatinine, every 12 weeks if uNTX < 50). Results: Of 121 patients enrolled (mean age, 63.8 years; median follow-up, 21 months), 4 patients started ZOL every 4 weeks and 117 received ZOL every 12 weeks based on uNTX at study entry. All 4 patients who initiated ZOL every 4 weeks switched to every 12 weeks due to decreased uNTX. Thirty-eight of 117 patients who initiated ZOL every 12 weeks switched to ZOL every 4 weeks due to disease progression (n = 20), increased uNTX (n = 14), and SREs (n = 4). Overall SRE incidence was low; 7 (5.8%) and 5 (4.9%) patients experienced an SRE during years 1 and 2, respectively. Mean (SD) SRE rate at year 2 was 0.01 (0.03) per person-year. The 2-year incidence rate for osteonecrosis of jaw was 3.3%. Four deaths were reported, none related to ZOL. Conclusions: Less frequent ZOL dosing (every 12 weeks over 2 years) maintains a low SRE rate and can be safely administered for up to 4 years. Clin Cancer Res; 22(6); 1378-84. © 2015 American Association for Cancer Research. Source

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