Oncology Hematology Care Inc

Cincinnati, OH, United States

Oncology Hematology Care Inc

Cincinnati, OH, United States

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PubMed | Netherlands Cancer Institute, Dana-Farber Cancer Institute, Rocky Research, Yale Cancer Center and 10 more.
Type: Journal Article | Journal: European urology | Year: 2016

Elevated circulating tumor cell (CTC) blood levels (5 cells/7.5ml) convey a negative prognosis in metastatic castration-resistant prostate cancer but their prognostic significance in patients receiving chemotherapy is uncertain. The association between CTC counts (at baseline or after treatment), overall survival (OS), and response to docetaxel with lenalidomide was evaluated in a 208-patient subset from the MAINSAIL trial, which compared docetaxel-prednisone-lenalidomide and docetaxel-prednisone-placebo in metastatic castration-resistant prostate cancer patients. Baseline CTCs were <5 cells/7.5ml blood in 87 (42%) patients and 5 cells/7.5ml in 121 (58%) patients. Neither tumor response nor prostate-specific antigen response correlated with baseline CTCs. However, CTC count 5 cells/7.5ml was significantly associated with lower OS (hazard ratio: 3.23, p = 0.0028). Increases in CTCs from <5 cells/7.5ml to 5 cells/7.5ml after three cycles were associated with significantly shorter OS (hazard ratio: 5.24, p=0.025), whereas CTC reductions from 5 cells/7.5ml to <5 cells/7.5ml were associated with the best prognosis (p=0.003).Our study in metastatic castration-resistant prostate cancer patients treated with docetaxel chemotherapy, with or without lenalidomide, showed that patient survival was best predicted by circulating tumor cell count at the start of treatment. A rising circulating tumor cell count after three cycles of therapy predicted poor survival, while a decline predicted good survival.


Extermann M.,University of South Florida | Extermann M.,Moffitt Cancer Center | Crane E.J.,Oncology Hematology Care Inc. | Boulware D.,University of South Florida
Critical Reviews in Oncology/Hematology | Year: 2010

An increasing number of nonagenarians are treated for cancer. However, very few data are available to guide treatment choices in this often frail population. The charts of all patients registered at Moffitt Cancer Center between 1993 and 2006 who were aged 90 or older at the time of treatment/evaluation were reviewed, and those treated for an active cancer (n=177) were included in the analysis. For 23.5% of patients, the index cancer was a second malignancy. Initial treatments were: surgery 41%, chemotherapy 9%, radiation therapy 15%, concomitant chemo-radiation therapy 2%, hormonal therapy 12%, targeted therapy 8%, photodynamic therapy 1%, observation/supportive care 3%, hospice 9%. The median survival was 1.69 years [95% CI. =1.34, 2.17, range 0.1-6.21]. For early stage cancer it was 2.02 years [95% CI. =1.56, 2.87], and for advanced stage cancer, 1.06 years [95% CI. =0.58, 1.63] (p=0.02 by log-rank). Treatment related mortality was low (1.1%). In conclusion, our nonagenarians underwent a broad range of treatments with low treatment related mortality. Advanced cancer still limits the survival of nonagenarians. Second cancers are frequent in older cancer survivors. © 2010.


Hainsworth J.D.,Sarah Cannon Research Institute | Hainsworth J.D.,Tennessee Oncology PLLC | Rubin M.S.,Florida Cancer Specialists | Arrowsmith E.R.,Chattanooga Oncology Hematology Associates | And 3 more authors.
Clinical Genitourinary Cancer | Year: 2013

Background: This phase II trial examined the activity and toxicity of second-line treatment with pazopanib after failure of first-line single-agent treatment with sunitinib or bevacizumab in patients with advanced clear cell renal carcinoma. Patients and Methods: Fifty-five patients with metastatic clear cell renal carcinoma who had previously received first-line treatment with sunitinib (39 patients) or bevacizumab (16 patients) were enrolled. Patients received pazopanib 800 mg orally daily and were evaluated for response after 8 weeks of treatment. Responses were measured using Response Evaluation Criteria in Solid Tumors (RECIST), version 1.0, and confirmed with repeated scans after 8 weeks. Patients with objective response or stable disease continued treatment until disease progression or unacceptable toxicity occurred. Results: Fifteen of 55 patients (27%) had objective response to pazopanib. An additional 27 patients (49%) had stable disease, for a disease control rate of 76%. After a median follow-up of 16.7 months, the median progression-free survival for the entire group was 7.5 months (95% confidence interval, 5.4-9.4 months). Similar progression-free survival was observed regardless of whether previous treatment was with sunitinib or bevacizumab. The estimated overall survival rate for the entire group at 24 months was 43%. Conclusion: Pazopanib is an active agent for the treatment of advanced clear cell renal carcinoma, even after failure of sunitinib or bevacizumab. Treatment with pazopanib should be considered early in the sequence of therapy for patients with advanced renal cell carcinoma. © 2013 Elsevier Inc.


Spigel D.R.,Sarah Cannon Research Institute | Spigel D.R.,Tennessee Oncology PLLC | Waterhouse D.M.,Sarah Cannon Research Institute | Waterhouse D.M.,Oncology Hematology Care Inc | And 3 more authors.
Clinical Lung Cancer | Year: 2013

Background: Topotecan is currently the only US Federal Drug Administration (FDA)-approved drug for second-line treatment of relapsed small-cell lung cancer (SCLC). We investigated the efficacy and safety of a novel topotecan- bevacizumab combination in treating relapsed SCLC. Patients and Methods: Each 21-day treatment cycle consisted of bevacizumab (15 mg/kg) administration on day 1 and oral topotecan (2.3 mg/m2/d) administration on days 1 to 5. Treatment was continued for 8 cycles or until disease progression/toxicity. The primary objective was evaluation of 3-month progression-free survival (PFS). Overall response rate (ORR), duration of response, time to response (TTR), and overall survival (OS) were secondary objectives. Results: The study enrolled 50 patients between July 2008 and May 2010. The 3-month PFS was 65% (95% confidence interval [CI], 49.3%-76.9%), which was promising compared with the historical control of 50% (P =.017) but did not meet the predefined criteria for clinically meaningful improvement. Median PFS was 6.24 months for the sensitive subgroup (progression time from end of previous chemotherapy > 90 days; n = 27) and 2.91 months for the resistant subgroup (progression time ≤ 90 days; n = 23). No patient achieved complete response (CR), and the ORR was 16%. Twenty (40%) patients had stable disease (SD) and 13 (26%) had progressive disease (PD). Median OS, TTR, and duration of response were 7.4, 1.3, and 4.7 months, respectively. The worst reported adverse events (AEs) were grade 1/2 in 11 (22%) patients and grade 3/4/5 in 39 (78%) patients. Conclusion: Improvement in the 3-month PFS after treatment with topotecan-bevacizumab was promising compared with the historical control and justifies additional studies with this regimen.


Drent M.,Hospital Gelderse Vallei | Drent M.,Maastricht University | Lower E.E.,University of Cincinnati | Lower E.E.,Oncology Hematology Care Inc. | De Vries J.,University of Tilburg
European Respiratory Journal | Year: 2012

Sarcoidosis-associated fatigue is globally recognised as a disabling symptom. Fatigue has been reported in up to 50-70% of sarcoidosis patients, causing impaired quality of life. The aetiology of this troublesome problem remains elusive and is usually multifactorial. Fatigue can be a consequence of treatment itself, including as a complication of corticosteroid therapy. The diagnosis of sarcoidosis-associated fatigue requires an extensive evaluation to identify and treat potentially reversible causes. Granuloma formation and cytokine release may be involved in its aetiology. However, despite adequate sarcoidosis treatment, many patients continue to experience fatigue. Comorbidities associated with sarcoidosis, including depression, anxiety, hypothyroidism and altered sleep patterns, may all contribute to fatigue. Despite an exhaustive search for treatable clinical causes of fatigue, most patients' complaints of fatigue are not correlated with clinical parameters of disease activity. Recent studies have demonstrated the effectiveness of various neurostimulants, including methylphenidate, for the treatment of sarcoidosis-associated fatigue. These and other agents may be useful adjuncts for the treatment of sarcoidosis-associated fatigue. Obviously, there is a need for studies evaluating the causes and new therapeutic options of sarcoidosis-associated fatigue. Psychological interventions should also be examined. Copyright©ERS 2012.


Bendell J.C.,Sarah Cannon Research Institute SCRI | Bendell J.C.,Tennessee Oncology PLLC | Meluch A.,Tennessee Oncology | Peyton J.,Tennessee Oncology | And 4 more authors.
Clinical Advances in Hematology and Oncology | Year: 2012

Purpose: To evaluate the efficacy of bevacizumab (Avastin, Genentech) and erlotinib (Tarceva, Genentech/Roche) when added to preoperative chemoradiation therapy with paclitaxel, carboplatin, and infusional 5-fluorouracil (5-FU) in the treatment of localized cancers of the esophagus or gastroesophageal (GE) junction. The primary endpoint was the pathologic complete response (pCR) rate. Methods: Eligible patients had previously untreated localized squamous cell, adenocarcinoma, or adenosquamous carcinoma of the esophagus or GE junction, and were considered surgical candidates at enrollment. Daily erlotinib (100 mg orally) was administered on days 1-42 of preoperative treatment. Patients received paclitaxel (200 mg/m2 intravenously [IV]), carboplatin (area under the curve [AUC] 5.0 IV), and bevacizumab (15 mg/kg IV) on days 1 and 22, and 5-FU by continuous infusion (225 mg/m2/day IV) on days 1-35, with radiation therapy in 1.8-Gy single fractions, Monday-Friday (to a total of 45 Gy). Those who were deemed surgical candidates proceeded to resection during weeks 12-14. Results: Between February 2007 and September 2009, 62 patients (median age, 64 years; 92% male; 94% adenocarcinoma) were enrolled; 44 patients (71%) completed neoadjuvant treatment and proceeded to surgery. Eighteen patients (29%) achieved pCR, with partial pathologic remission in an additional 22 patients (35%). Common grade 3/4 toxicities included leukopenia (64%), neutropenia (44%), mucositis/stomatitis (42%), diarrhea (27%), and esophagitis (27%). There were 40 instances of treatment-related hospitalization, and 2 postoperative deaths. Conclusions: The addition of bevacizumab and erlotinib to neoadjuvant chemoradiation did not demonstrate survival benefit or improved pCR rate over similar regimens. While the overall rates of toxicity were not increased, targeted agent-specific toxicity was evident. Further study of this specific regimen is not warranted.


PubMed | Oncology Hematology Care Inc.
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

1090 Background: Imatinib mesylate (G) is a potent tyrosine kinase inhibitor of platelet derived growth factor receptor (PDGFR), c-KIT, and bcr/abl. PDGFR signaling regulates interstitial tumor pressure enhancing tumor drug delivery and effects. This phase II pilot evaluates the feasibility, toxicity, and efficacy of imatinib with weekly docetaxel as a strategy to potentiate docetaxel in metastatic breast cancer (MBC).Eligibility: 0-1 regimens for MBC, > 6 months from prior adjuvant taxanes, measurable disease, ECOG PS 0-2, adequate organ function, < G2 neuropathy.Docetaxel 30 mg/m33 pts are evaluable for toxicity. Median age 58 (38-82), ECOG PS 0-18, PS 1-14 pts. 49% ER-/PR- and 79% HER2 neg. 61% had metastases in > 2 visceral sites with lung predominating 42%. 55% received therapy 1Imatinib with docetaxel is associated with significant GI toxicity, despite G dose modification to 400 mg daily. No therapeutic advantage for the addition of imatinib to weekly docetaxel in MBC was evident. [Table: see text].


PubMed | Oncology Hematology Care Inc.
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

4629 Background: Sorafenib and everolimus are standard agents with different targets (VEGFR and m-TOR, respectively) for the treatment of advanced RCC. Combined use of these agents may improve efficacy. This phase I/II trial established the maximum tolerated dose (MTD) for these agents when used in combination, and then evaluated this combination in advanced RCC.Eligible patients had metastatic or unresectable recurrent clear cell RCC, and had received 0 or 1 previous regimen for advanced RCC. Additional entry criteria: ECOG PS 0-1, prior nephrectomy (unless medically inappropriate), no active CNS metastasis, adequate liver/kidney/marrow function, informed consent. Sorafenib was given PO daily; everolimus PO once weekly. Patients were evaluated for response every 8 weeks; treatment continued until progression.10 patients entered the phase I portion; the MTDs were sorafenib 400mg PO qd and everolimus 35mg PO weekly (DLTs: rash, hand-foot syndrome). 50 patients enrolled in the phase II portion (total 56 treated at MTD dosing). Efficacy results after median 9.6 months follow-up (Table). Median treatment duration was 5 months (range 0.3-25.4+). Grade 3/4 toxicity: fatigue (21%), pain (18%), proteinuria (9%), hypophosphatemia (7%). Six patients (11%) stopped treatment due to toxicity.Concurrent use of sorafenib and everolimus required use of 50% of the single agent doses. The regimen was active and tolerable; however, benefit versus sequential single agents is not suggested. [Table: see text].


PubMed | Oncology Hematology Care Inc.
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017

274 Background: The 2013 Community Oncology Practice Impact Report notes an increase of 20% in the number of community clinics closing since 2011. The objective of this study was to examine trends in location and reimbursement of chemotherapy in office-based (OBS) and outpatient hospital settings (OHS).Using the MarketScan Research Databases, first administrations of bevacizumab and trastuzumab were identified from 1/1/2005 through 12/31/2012 for patients with commercial or employer-sponsored supplemental Medicare insurance. Bevacizumab claims were excluded if the claim had a diagnosis related to macular degeneration or other eye disease. Claims for both drugs were excluded if the reimbursed amount was less than $100. Chemotherapy administration reimbursements were identified through CPT codes on the same day as the day as the drug charge. All claims were identified as occurring in OB or OHS.The percent of bevacizumab claims occurring in OHS increased from 6 to 34% among Medicare claims, and from 15 to 42% among commercial claims from 2005 to 2012. For trastuzumab, the increases were 4 to 35%, and 10 to 35% in Medicare and commercial claims, respectively. OHS reimbursements were consistently higher than OBS reimbursements for chemotherapy administration and drug for both drugs across both payers.Although the differential in reimbursements between OHS and OBS declined in the most recent two years, OHS reimbursements remained substantially higher while the shift in chemotherapy administration from OBS to OHS has continued through 2012. Continued attention to reimbursement differences between OHS and OBS is warranted and additional research is needed to more fully document the impact on patients, providers, and payers. [Table: see text].


PubMed | Oncology Hematology Care Inc.
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017

260 Background: With the growing shift towards chemotherapy administration in outpatient hospital settings (OHS) versus office-based settings (OBS), we sought to characterize the percent of patients with a copay and the mean copayment by setting and insurance type over time.Using the MarketScan Research Databases, first administrations of bevacizumab and trastuzumab were identified from 1/1/2005 through 12/31/2012 for patients with commercial or employer-sponsored supplemental Medicare insurance. Bevacizumab claims were excluded if the claim had a diagnosis related to macular degeneration or other eye disease. All claims were identified in OHS, OBS, or other setting.The percent of patients with a copayment varied by insurer and setting but within each group remained fairly consistent over time. The average percent with a copay was 14% OHS and 19% OBS for commercial and 17% OHS and 28% OBS for Medicare patients. Per administration copayment amounts varied over time, with peaks of $978 OHS and $631 OBS for commercial in 2012 and $721 OHS and $464 OBS in 2011 for Medicare with 2012 Medicare copayments declining somewhat for bevacizumab. For herceptin peak mean copayments were $886 and $439 in 2012 for OHS and OBS commercial patients, respectively, and $458 and $474 in 2010 with declines in 2011 and 2012 for Medicare, respectively. Commercial patients receiving care in OHS settings consistently faced copayments that were 50 to 100% higher those paid by patients receiving chemotherapy in OBS. Copayment differentials were smaller for Medicare patients.As more patients are receiving care in OHS, these data imply significant financial burdens on patients, especially for those with commercial health insurance. Additional research is necessary to understand the overall cost burden on patients and whether the shift to OHS-based care has negatively impacted patient adherence or quality of life due to financial burden. [Table: see text].

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