P. Czaykowski - Academia.edu (original) (raw)

Papers by P. Czaykowski

Annals of Oncology, 2012

ABSTRACT Background Cabazitaxel/Prednisone (CbzP) improves survival in docetaxel resistant mCRPC.... more ABSTRACT Background Cabazitaxel/Prednisone (CbzP) improves survival in docetaxel resistant mCRPC. Canadian investigators collected safety and QoL data for patients (pts) participating in a global single-arm multicenter EAP. Methods Between May 2011 and Feb 2012, 61 evaluable pts were enrolled at 9 centers. Safety and QoL data were collected at baseline and at each cycle. QoL was assessed using the FACT-P and its subscales, EQ 5D-3L, and ESAS questionnaires. Utility values were derived from the EQ 5D-3L. Present pain intensity (PPI) and analgesic scores were assessed using the McGill-Melzack questionnaire. The change from baseline QoL in individual patients was analyzed. Results At the time of analysis, baseline characteristics and safety data were available for the first 33 pts. Median age was 65; 94% were ECOG 0/1; 85% had bone metastases; and 76% had progressed within 3 months of prior docetaxel. Over half (56%) received at least 5 cycles of CbzP. Main grade 3+ toxicities were anemia 3%, leukopenia 3%, and febrile neutropenia 3% (prophylactic and therapeutic G-CSF use was permitted). Incidence of diarrhea (all grades) was 52%, and grade 3+ diarrhea was 3%. No treatment related deaths were reported. Preliminary analyses showed stable QoL and derived utility values over time. A pain subscale of FACT-P, showed improvements in the first 4 cycles; PPI scores improved despite stable analgesic use. Conclusions In this EAP, reflecting routine clinical practice, the main toxicities of CbzP were similar to the TROPIC trial (neutropenia and diarrhea) emphasizing the need for close toxicity monitoring. Preliminary QoL and PPI data support a palliative benefit of CbzP not reported in TROPIC. Updated data with all evaluable pts and percentages of pts meeting important response thresholds will be presented. Disclosure S.S. Sridhar: Dr. Sridhar has served on the advisory board for and is involved in research projects with Sanofi Aventis Canada. E. Winquist: Dr Winquist has received travel funding and consultant's honoraria from Sanofi Canada. He is involved in research projects with Sanofi Canada. C. St.-Laurent Thibault: Catherine Saint-Laurent Thibault is an employee of Sanofi Canada Inc. H. Assi: Membership on an Advisory board, S. Berry: Membership on an advisory board, N. Aucoin: Membership on an advisory board, F. Saad: Dr Fred Saad sits on the advisory board for Sanofi Aventis Canada and has received consultant\\'s honoraria from Sanofi Canada. He is involved in research projects with Sanofi Canada. All other authors have declared no conflicts of interest.

Current Oncology, 2018

Background Baseline symptom burden as measured using the Edmonton Symptom Assessment System (esas... more Background Baseline symptom burden as measured using the Edmonton Symptom Assessment System (esas), a patient-reported, validated, and reliable tool measuring symptom severity in 9 separate domains, might yield prognostic information in patients receiving treatment for metastatic renal cell carcinoma (mrcc) and might add to the existing prognostic models.Methods In this retrospective single-centre cohort study, we included patients receiving first-line sunitinib therapy for mrcc between 2008 and 2012. Baseline variables included information relevant to the pre-existing prognostic models and pre-treatment esas summation scores (added together across all 9 domains), with higher scores representing greater symptom burden. We used Kaplan–Meier curves and Cox regression modelling to determine if symptom burden can provide prognostic information with respect to overall survival.Results We identified 68 patients receiving first-line therapy for mrcc. Most had intermediate- or poor-risk dis...

Journal of Clinical Oncology, 2008

5002 Background: There is no standard of care when pts with metastatic HRPC manifest disease prog... more 5002 Background: There is no standard of care when pts with metastatic HRPC manifest disease progression (PD) after 1st-line docetaxel. Custirsen is an antisense oligonucleotide targeting clusterin which in preclinical studies increased response of taxane-resistant cell lines to chemotherapy. This study evaluated the safety and efficacy of custirsen in combination with either docetaxel or mitoxantrone as 2nd-line therapy (Rx). Methods: Pts were eligible if they had PD while receiving or within 6 mo of discontinuing 1st-line docetaxel. All pts received 640 mg of weekly IV custirsen following 3 loading doses. Pts were randomized to standard doses of docetaxel/prednisone (DPC) or mitoxantrone/prednisone (MPC) on a 21-day cycle for up to 9 cycles. Protocol defined PD was based on RECIST, pain and performance score but not solely on PSA. Results: Analysis as of 03Jan08; median follow-up:13.3 (8.4- 17.1) mo. 42 pts received at least 1 cycle of combined therapy (DPC-20, MPC-22). Prior outcomes with 1st-line doce...

Journal of Clinical Oncology, 2009

LBA5019 Background: Bevacizumab (BEV) plus interferon alpha (IFN) demonstrated a superior objecti... more LBA5019 Background: Bevacizumab (BEV) plus interferon alpha (IFN) demonstrated a superior objective response rate and progression-free survival (PFS) versus IFN monotherapy in renal cell carcinoma (RCC) patients in 2 phase III trials. The primary objective of CALGB 90206 was to compare overall survival (OS) for advanced RCC patients receiving BEV plus IFN or IFN alone. Methods: Patients with previously-untreated, metastatic RCC with a clear cell component and Karnofsky performance status of ≥ 70% were eligible. Patients were prospectively randomized to receive BEV (10 mg/kg intravenously every 2 weeks) plus IFN (9 million units subcutaneously three times weekly) or the same dose and schedule of IFN as monotherapy. Randomization was stratified by nephrectomy status and number of MSKCC adverse features. The primary endpoint was OS, defined as the time from randomization to death due to any cause. The trial was designed with 86% power to detect a hazard ratio (HR) of 0.76, assuming a t...

Journal of Clinical Oncology, 2010

e15152 Background: Androgen deprivation therapy (ADT) is the mainstay therapy for men with advanc... more e15152 Background: Androgen deprivation therapy (ADT) is the mainstay therapy for men with advanced prostate cancer. However, there are a number of side effects of ADT that negatively impact the he...

Canadian Journal of Cardiology, 2016

Current Oncology, 2016

Adolescents and young adults (AYAS) with cancer in active treatment face a number of barriers to ... more Adolescents and young adults (AYAS) with cancer in active treatment face a number of barriers to optimal care. In the present article, we focus on the 3 critical domains of care for ayas—medical, psychosocial, and research—and how changes to the system could overcome barriers. We summarize the current literature, outline recommended principles of care, raise awareness of barriers to optimal care, and suggest specific changes to the system to overcome those barriers in the Canadian context. Many of the recommendations can nevertheless be applied universally. These recommendations are endorsed by the Canadian Task Force on Adolescents and Young Adults with Cancer and build on outcomes from two international workshops held by that group.

Journal of Applied Clinical Medical Physics, 2003

To assess the impact of CT slice index and thickness ͑3 mm versus 5 mm͒ on ͑i͒ prostate volume, d... more To assess the impact of CT slice index and thickness ͑3 mm versus 5 mm͒ on ͑i͒ prostate volume, dimensions, and isocenter coordinates, ͑ii͒ bladder and rectal volumes, and ͑iii͒ DRR quality, in the treatment of prostate cancer. Methods: 16 patients with prostate cancer underwent two planning CT-scans using 3 and 5 mm slice index/thickness. Prostate, bladder, and rectum were outlined on all scans. Prostate isocenter coordinates, maximum dimensions, and volumes were compared along with bladder and rectal volumes. Bladder volumes and maximum diameters were further investigated using a second observer. A comparative analysis of DRR quality was conducted as well as a dosimetric analysis using DVH. Results: The differences in measurements of prostate volume, isocenter coordinates and maximum dimensions between the 3 and 5 mm scans, were small and not statistically significant. Similar finding was seen for rectal volume. However, bladder volume was always larger on the 3 mm scan ͑mean differenceϭ27.9 cc; SEϭ4.8 cc; 95% CI: 17.7-38.2 cc; pϽ0.001) and the findings were reproduced with the second observer ͑mean differenceϭ31.9 cc; SEϭ4.7 cc; 95% CI: 21.9-41.9 cc; p Ͻ0.001). The differences in volume are caused by a slight increase in ͑1͒ the measurement of the longitudinal dimensions on the 3 mm scans, and ͑2͒ the slice by slice measured bladder area on the 3 mm scans. The latter is due to partial volume effect. The 3 mm DRR were slightly better than the 5 mm DRR. The bladder DVH differed significantly in some patients. Conclusion: Bladder volume is significantly larger on the 3 mm scans. Differences in contoured areas may be accounted for, in part, by the partial volume effect.

Current oncology (Toronto, Ont.), 2015

Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation thera... more Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation therapy has been shown to prevent vte; however, unique clinical circumstances in patients with cancer can often complicate the decisions surrounding the administration of prophylactic anticoagulation. No national Canadian guidelines on the prevention of cancer-associated thrombosis have been published. We therefore aimed to develop a consensus-based, evidence-informed guideline on the topic. PubMed was searched for clinical trials and meta-analyses published between 2002 and 2013. Reference lists of key articles were hand-searched for additional publications. Content experts from across Canada were assembled to review the evidence and make recommendations. Low molecular weight heparin can be used prophylactically in cancer patients at high risk of developing vte. Direct oral anticoagulants are not recommended for vte prophylaxis at this time. Specific clinical scenarios, including renal insuf...

Current Oncology, 2011

Objectives: Febrile neutropenia is considered an oncologic emergency, for which prompt initiation... more Objectives: Febrile neutropenia is considered an oncologic emergency, for which prompt initiation of antibiotics is essential. Methods: We conducted a retrospective cohort study for the 2006 calendar year involving all adult oncology patients presenting with febrile neutropenia to a regional health authority’s emergency departments. The objective was to determine the time from triage to antibiotic administration and its impact on patient outcomes. Results: We identified 68 patients presenting with febrile neutropenia, most of whom (76%) were seen in tertiary care centers. Of those patients, 65% were triaged to be seen within 15 minutes of arrival in the emergency room; however, the median time to reassessment was 57 minutes. The median time from triage to antibiotic administration was 5 hours (range: 1.23–22.8 hours). No increased risk of death or increased length of hospital stay was associated with delayed antibiotic administration. Older patients and patients without caregiver su...

Current Oncology, 2011

For advanced and metastatic prostate cancer, androgen deprivation therapy (adt) is the mainstay o... more For advanced and metastatic prostate cancer, androgen deprivation therapy (adt) is the mainstay of treatment. Awareness of the potential bone-health complications consequent to adt use is increasing. Many studies have shown that prolonged adt leads to significant bone loss and increased fracture risk that negatively affect quality of life. Clinical practice guidelines for preserving bone health in men with prostate cancer on adt vary across Canada. This paper reviews recent studies on bone health in men with prostate cancer receiving adt and the current evidence regarding bone-health monitoring and management in reference to Canadian provincial guidelines. Based on this narrative review, we provide general bone-health management recommendations for men with prostate cancer receiving adt.

Oncology Reports, 1997

Oligodendrogliomas appear to be the most chemoresponsive subtype of gliomas. PCV (procarbazine, C... more Oligodendrogliomas appear to be the most chemoresponsive subtype of gliomas. PCV (procarbazine, CCNU, vincristine) chemotherapy produces significant response rates and probable prolongation of survival. Unfortunately there is no well-defined second line chemotherapy. There is evidence that the purine analogue cladribine has activity in astrocytomas, which are much less sensitive to chemotherapy than oligodendrogliomas, but the use of cladribine in oligodendrogliomas has never been reported. We describe the unsuccessful use of cladribine as third line chemotherapy in a young man with an aggressive oligodendroglioma. The literature pertaining to chemotherapy for oligodendrogliomas is reviewed.

Leukemia & Lymphoma, 2006

Aggressive non-Hodgkin's lymphoma (NHL), such as diffuse large B-cell lymphoma, can be cu... more Aggressive non-Hodgkin's lymphoma (NHL), such as diffuse large B-cell lymphoma, can be cured in approximately 50% of cases, but those cases that recur and are not amenable to high-dose chemotherapy rely on palliative chemotherapy to improve symptoms and prolong life. Anthracyclines are associated with a high response rate in aggressive NHL but extended treatment results in cardiotoxicity. Liposomal encapsulated doxorubicin has been shown in other tumor types to allow for extended treatment with doxorubicin, but is associated with a low cardiac risk. The present study aimed to assess the response rate, survival and cardiac risk of patients with relapsed aggressive NHL treated with liposomal encapsulated doxorubicin. Eighteen patients with relapsed aggressive NHL were treated with liposomal encapsulated doxorubicin (40 - 50 mg/m2) for a planned six cycles. Some 83% of patients had diffuse large B-cell or mantle cell NHL. Four patients had a partial response (23%), whereas five patients had stable disease. None had a complete response. Eight patients progressed when receiving the liposomal encapsulated doxorubicin therapy. The median survival time was 34 weeks, and the median progression-free survival was 15.7 weeks. Overall survival was 50% at 6 months and 39% at 12 months. Progression-free survival was 33% at 6 months and was 28% at 12 months. The mean ejection fraction pre- and post-liposomal encapsulated doxorubicin treatment remained the same. Only one patient had a drop in ejection fraction to <50%. Liposomal encapsulated doxorubicin offers another choice to patients seeking palliation from their lymphoma recurrence with a response rate of 23% that was well tolerated and had a minimal cardiotoxic risk.

Journal of Oncology Practice, 2012

Completion of recommended liver imaging and carcinoembryonic antigen testing falls well below gui... more Completion of recommended liver imaging and carcinoembryonic antigen testing falls well below guidelines in Manitoba, whereas colonoscopy is better provided. Addressing this gap should improve outcomes for colorectal cancer survivors.

Journal of Clinical Oncology, 2008

Purpose Bevacizumab is an antibody that binds to vascular endothelial growth factor (VEGF) and ha... more Purpose Bevacizumab is an antibody that binds to vascular endothelial growth factor (VEGF) and has activity in metastatic renal cell carcinoma (RCC). Interferon alfa (IFN) is a historic standard first-line treatment for RCC. A prospective, randomized phase III trial of bevacizumab plus IFN versus IFN monotherapy was conducted. Patients and Methods Patients with previously untreated, metastatic clear-cell RCC were randomly assigned to receive either bevacizumab (10 mg/kg intravenously every 2 weeks) plus IFN (9 million U subcutaneously three times weekly) or the same dose and schedule of IFN monotherapy in a multicenter phase III trial. The primary end point was overall survival (OS). Secondary end points were progression-free survival (PFS), objective response rate (ORR), and safety. Results Between October 2003 and July 2005, 732 patients were enrolled. The prespecified stopping rule for OS has not yet been reached. The median PFS was 8.5 months in patients receiving bevacizumab pl...

Journal of Clinical Oncology, 2010

Purpose Bevacizumab is an antibody that binds vascular endothelial growth factor and has activity... more Purpose Bevacizumab is an antibody that binds vascular endothelial growth factor and has activity in metastatic renal cell carcinoma (RCC). Interferon alfa (IFN-α) is the historic standard initial treatment for RCC. A prospective, randomized, phase III trial of bevacizumab plus IFN-α versus IFN-α monotherapy was conducted. Patients and Methods Patients with previously untreated, metastatic clear cell RCC were randomly assigned to receive either bevacizumab (10 mg/kg intravenously every 2 weeks) plus IFN-α (9 million units subcutaneously three times weekly) or the same dose and schedule of IFN-α monotherapy in a multicenter phase III trial. The primary end point was overall survival (OS). Secondary end points were progression-free survival (PFS), objective response rate, and safety. Results Seven hundred thirty-two patients were enrolled. The median OS time was 18.3 months (95% CI, 16.5 to 22.5 months) for bevacizumab plus IFN-α and 17.4 months (95% CI, 14.4 to 20.0 months) for IFN-α...

Annals of Oncology, 2012

ABSTRACT Background Cabazitaxel/Prednisone (CbzP) improves survival in docetaxel resistant mCRPC.... more ABSTRACT Background Cabazitaxel/Prednisone (CbzP) improves survival in docetaxel resistant mCRPC. Canadian investigators collected safety and QoL data for patients (pts) participating in a global single-arm multicenter EAP. Methods Between May 2011 and Feb 2012, 61 evaluable pts were enrolled at 9 centers. Safety and QoL data were collected at baseline and at each cycle. QoL was assessed using the FACT-P and its subscales, EQ 5D-3L, and ESAS questionnaires. Utility values were derived from the EQ 5D-3L. Present pain intensity (PPI) and analgesic scores were assessed using the McGill-Melzack questionnaire. The change from baseline QoL in individual patients was analyzed. Results At the time of analysis, baseline characteristics and safety data were available for the first 33 pts. Median age was 65; 94% were ECOG 0/1; 85% had bone metastases; and 76% had progressed within 3 months of prior docetaxel. Over half (56%) received at least 5 cycles of CbzP. Main grade 3+ toxicities were anemia 3%, leukopenia 3%, and febrile neutropenia 3% (prophylactic and therapeutic G-CSF use was permitted). Incidence of diarrhea (all grades) was 52%, and grade 3+ diarrhea was 3%. No treatment related deaths were reported. Preliminary analyses showed stable QoL and derived utility values over time. A pain subscale of FACT-P, showed improvements in the first 4 cycles; PPI scores improved despite stable analgesic use. Conclusions In this EAP, reflecting routine clinical practice, the main toxicities of CbzP were similar to the TROPIC trial (neutropenia and diarrhea) emphasizing the need for close toxicity monitoring. Preliminary QoL and PPI data support a palliative benefit of CbzP not reported in TROPIC. Updated data with all evaluable pts and percentages of pts meeting important response thresholds will be presented. Disclosure S.S. Sridhar: Dr. Sridhar has served on the advisory board for and is involved in research projects with Sanofi Aventis Canada. E. Winquist: Dr Winquist has received travel funding and consultant's honoraria from Sanofi Canada. He is involved in research projects with Sanofi Canada. C. St.-Laurent Thibault: Catherine Saint-Laurent Thibault is an employee of Sanofi Canada Inc. H. Assi: Membership on an Advisory board, S. Berry: Membership on an advisory board, N. Aucoin: Membership on an advisory board, F. Saad: Dr Fred Saad sits on the advisory board for Sanofi Aventis Canada and has received consultant\\'s honoraria from Sanofi Canada. He is involved in research projects with Sanofi Canada. All other authors have declared no conflicts of interest.

Current Oncology, 2018

Background Baseline symptom burden as measured using the Edmonton Symptom Assessment System (esas... more Background Baseline symptom burden as measured using the Edmonton Symptom Assessment System (esas), a patient-reported, validated, and reliable tool measuring symptom severity in 9 separate domains, might yield prognostic information in patients receiving treatment for metastatic renal cell carcinoma (mrcc) and might add to the existing prognostic models.Methods In this retrospective single-centre cohort study, we included patients receiving first-line sunitinib therapy for mrcc between 2008 and 2012. Baseline variables included information relevant to the pre-existing prognostic models and pre-treatment esas summation scores (added together across all 9 domains), with higher scores representing greater symptom burden. We used Kaplan–Meier curves and Cox regression modelling to determine if symptom burden can provide prognostic information with respect to overall survival.Results We identified 68 patients receiving first-line therapy for mrcc. Most had intermediate- or poor-risk dis...

Journal of Clinical Oncology, 2008

5002 Background: There is no standard of care when pts with metastatic HRPC manifest disease prog... more 5002 Background: There is no standard of care when pts with metastatic HRPC manifest disease progression (PD) after 1st-line docetaxel. Custirsen is an antisense oligonucleotide targeting clusterin which in preclinical studies increased response of taxane-resistant cell lines to chemotherapy. This study evaluated the safety and efficacy of custirsen in combination with either docetaxel or mitoxantrone as 2nd-line therapy (Rx). Methods: Pts were eligible if they had PD while receiving or within 6 mo of discontinuing 1st-line docetaxel. All pts received 640 mg of weekly IV custirsen following 3 loading doses. Pts were randomized to standard doses of docetaxel/prednisone (DPC) or mitoxantrone/prednisone (MPC) on a 21-day cycle for up to 9 cycles. Protocol defined PD was based on RECIST, pain and performance score but not solely on PSA. Results: Analysis as of 03Jan08; median follow-up:13.3 (8.4- 17.1) mo. 42 pts received at least 1 cycle of combined therapy (DPC-20, MPC-22). Prior outcomes with 1st-line doce...

Journal of Clinical Oncology, 2009

LBA5019 Background: Bevacizumab (BEV) plus interferon alpha (IFN) demonstrated a superior objecti... more LBA5019 Background: Bevacizumab (BEV) plus interferon alpha (IFN) demonstrated a superior objective response rate and progression-free survival (PFS) versus IFN monotherapy in renal cell carcinoma (RCC) patients in 2 phase III trials. The primary objective of CALGB 90206 was to compare overall survival (OS) for advanced RCC patients receiving BEV plus IFN or IFN alone. Methods: Patients with previously-untreated, metastatic RCC with a clear cell component and Karnofsky performance status of ≥ 70% were eligible. Patients were prospectively randomized to receive BEV (10 mg/kg intravenously every 2 weeks) plus IFN (9 million units subcutaneously three times weekly) or the same dose and schedule of IFN as monotherapy. Randomization was stratified by nephrectomy status and number of MSKCC adverse features. The primary endpoint was OS, defined as the time from randomization to death due to any cause. The trial was designed with 86% power to detect a hazard ratio (HR) of 0.76, assuming a t...

Journal of Clinical Oncology, 2010

e15152 Background: Androgen deprivation therapy (ADT) is the mainstay therapy for men with advanc... more e15152 Background: Androgen deprivation therapy (ADT) is the mainstay therapy for men with advanced prostate cancer. However, there are a number of side effects of ADT that negatively impact the he...

Canadian Journal of Cardiology, 2016

Current Oncology, 2016

Adolescents and young adults (AYAS) with cancer in active treatment face a number of barriers to ... more Adolescents and young adults (AYAS) with cancer in active treatment face a number of barriers to optimal care. In the present article, we focus on the 3 critical domains of care for ayas—medical, psychosocial, and research—and how changes to the system could overcome barriers. We summarize the current literature, outline recommended principles of care, raise awareness of barriers to optimal care, and suggest specific changes to the system to overcome those barriers in the Canadian context. Many of the recommendations can nevertheless be applied universally. These recommendations are endorsed by the Canadian Task Force on Adolescents and Young Adults with Cancer and build on outcomes from two international workshops held by that group.

Journal of Applied Clinical Medical Physics, 2003

To assess the impact of CT slice index and thickness ͑3 mm versus 5 mm͒ on ͑i͒ prostate volume, d... more To assess the impact of CT slice index and thickness ͑3 mm versus 5 mm͒ on ͑i͒ prostate volume, dimensions, and isocenter coordinates, ͑ii͒ bladder and rectal volumes, and ͑iii͒ DRR quality, in the treatment of prostate cancer. Methods: 16 patients with prostate cancer underwent two planning CT-scans using 3 and 5 mm slice index/thickness. Prostate, bladder, and rectum were outlined on all scans. Prostate isocenter coordinates, maximum dimensions, and volumes were compared along with bladder and rectal volumes. Bladder volumes and maximum diameters were further investigated using a second observer. A comparative analysis of DRR quality was conducted as well as a dosimetric analysis using DVH. Results: The differences in measurements of prostate volume, isocenter coordinates and maximum dimensions between the 3 and 5 mm scans, were small and not statistically significant. Similar finding was seen for rectal volume. However, bladder volume was always larger on the 3 mm scan ͑mean differenceϭ27.9 cc; SEϭ4.8 cc; 95% CI: 17.7-38.2 cc; pϽ0.001) and the findings were reproduced with the second observer ͑mean differenceϭ31.9 cc; SEϭ4.7 cc; 95% CI: 21.9-41.9 cc; p Ͻ0.001). The differences in volume are caused by a slight increase in ͑1͒ the measurement of the longitudinal dimensions on the 3 mm scans, and ͑2͒ the slice by slice measured bladder area on the 3 mm scans. The latter is due to partial volume effect. The 3 mm DRR were slightly better than the 5 mm DRR. The bladder DVH differed significantly in some patients. Conclusion: Bladder volume is significantly larger on the 3 mm scans. Differences in contoured areas may be accounted for, in part, by the partial volume effect.

Current oncology (Toronto, Ont.), 2015

Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation thera... more Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation therapy has been shown to prevent vte; however, unique clinical circumstances in patients with cancer can often complicate the decisions surrounding the administration of prophylactic anticoagulation. No national Canadian guidelines on the prevention of cancer-associated thrombosis have been published. We therefore aimed to develop a consensus-based, evidence-informed guideline on the topic. PubMed was searched for clinical trials and meta-analyses published between 2002 and 2013. Reference lists of key articles were hand-searched for additional publications. Content experts from across Canada were assembled to review the evidence and make recommendations. Low molecular weight heparin can be used prophylactically in cancer patients at high risk of developing vte. Direct oral anticoagulants are not recommended for vte prophylaxis at this time. Specific clinical scenarios, including renal insuf...

Current Oncology, 2011

Objectives: Febrile neutropenia is considered an oncologic emergency, for which prompt initiation... more Objectives: Febrile neutropenia is considered an oncologic emergency, for which prompt initiation of antibiotics is essential. Methods: We conducted a retrospective cohort study for the 2006 calendar year involving all adult oncology patients presenting with febrile neutropenia to a regional health authority’s emergency departments. The objective was to determine the time from triage to antibiotic administration and its impact on patient outcomes. Results: We identified 68 patients presenting with febrile neutropenia, most of whom (76%) were seen in tertiary care centers. Of those patients, 65% were triaged to be seen within 15 minutes of arrival in the emergency room; however, the median time to reassessment was 57 minutes. The median time from triage to antibiotic administration was 5 hours (range: 1.23–22.8 hours). No increased risk of death or increased length of hospital stay was associated with delayed antibiotic administration. Older patients and patients without caregiver su...

Current Oncology, 2011

For advanced and metastatic prostate cancer, androgen deprivation therapy (adt) is the mainstay o... more For advanced and metastatic prostate cancer, androgen deprivation therapy (adt) is the mainstay of treatment. Awareness of the potential bone-health complications consequent to adt use is increasing. Many studies have shown that prolonged adt leads to significant bone loss and increased fracture risk that negatively affect quality of life. Clinical practice guidelines for preserving bone health in men with prostate cancer on adt vary across Canada. This paper reviews recent studies on bone health in men with prostate cancer receiving adt and the current evidence regarding bone-health monitoring and management in reference to Canadian provincial guidelines. Based on this narrative review, we provide general bone-health management recommendations for men with prostate cancer receiving adt.

Oncology Reports, 1997

Oligodendrogliomas appear to be the most chemoresponsive subtype of gliomas. PCV (procarbazine, C... more Oligodendrogliomas appear to be the most chemoresponsive subtype of gliomas. PCV (procarbazine, CCNU, vincristine) chemotherapy produces significant response rates and probable prolongation of survival. Unfortunately there is no well-defined second line chemotherapy. There is evidence that the purine analogue cladribine has activity in astrocytomas, which are much less sensitive to chemotherapy than oligodendrogliomas, but the use of cladribine in oligodendrogliomas has never been reported. We describe the unsuccessful use of cladribine as third line chemotherapy in a young man with an aggressive oligodendroglioma. The literature pertaining to chemotherapy for oligodendrogliomas is reviewed.

Leukemia & Lymphoma, 2006

Aggressive non-Hodgkin's lymphoma (NHL), such as diffuse large B-cell lymphoma, can be cu... more Aggressive non-Hodgkin's lymphoma (NHL), such as diffuse large B-cell lymphoma, can be cured in approximately 50% of cases, but those cases that recur and are not amenable to high-dose chemotherapy rely on palliative chemotherapy to improve symptoms and prolong life. Anthracyclines are associated with a high response rate in aggressive NHL but extended treatment results in cardiotoxicity. Liposomal encapsulated doxorubicin has been shown in other tumor types to allow for extended treatment with doxorubicin, but is associated with a low cardiac risk. The present study aimed to assess the response rate, survival and cardiac risk of patients with relapsed aggressive NHL treated with liposomal encapsulated doxorubicin. Eighteen patients with relapsed aggressive NHL were treated with liposomal encapsulated doxorubicin (40 - 50 mg/m2) for a planned six cycles. Some 83% of patients had diffuse large B-cell or mantle cell NHL. Four patients had a partial response (23%), whereas five patients had stable disease. None had a complete response. Eight patients progressed when receiving the liposomal encapsulated doxorubicin therapy. The median survival time was 34 weeks, and the median progression-free survival was 15.7 weeks. Overall survival was 50% at 6 months and 39% at 12 months. Progression-free survival was 33% at 6 months and was 28% at 12 months. The mean ejection fraction pre- and post-liposomal encapsulated doxorubicin treatment remained the same. Only one patient had a drop in ejection fraction to <50%. Liposomal encapsulated doxorubicin offers another choice to patients seeking palliation from their lymphoma recurrence with a response rate of 23% that was well tolerated and had a minimal cardiotoxic risk.

Journal of Oncology Practice, 2012

Completion of recommended liver imaging and carcinoembryonic antigen testing falls well below gui... more Completion of recommended liver imaging and carcinoembryonic antigen testing falls well below guidelines in Manitoba, whereas colonoscopy is better provided. Addressing this gap should improve outcomes for colorectal cancer survivors.

Journal of Clinical Oncology, 2008

Purpose Bevacizumab is an antibody that binds to vascular endothelial growth factor (VEGF) and ha... more Purpose Bevacizumab is an antibody that binds to vascular endothelial growth factor (VEGF) and has activity in metastatic renal cell carcinoma (RCC). Interferon alfa (IFN) is a historic standard first-line treatment for RCC. A prospective, randomized phase III trial of bevacizumab plus IFN versus IFN monotherapy was conducted. Patients and Methods Patients with previously untreated, metastatic clear-cell RCC were randomly assigned to receive either bevacizumab (10 mg/kg intravenously every 2 weeks) plus IFN (9 million U subcutaneously three times weekly) or the same dose and schedule of IFN monotherapy in a multicenter phase III trial. The primary end point was overall survival (OS). Secondary end points were progression-free survival (PFS), objective response rate (ORR), and safety. Results Between October 2003 and July 2005, 732 patients were enrolled. The prespecified stopping rule for OS has not yet been reached. The median PFS was 8.5 months in patients receiving bevacizumab pl...

Journal of Clinical Oncology, 2010

Purpose Bevacizumab is an antibody that binds vascular endothelial growth factor and has activity... more Purpose Bevacizumab is an antibody that binds vascular endothelial growth factor and has activity in metastatic renal cell carcinoma (RCC). Interferon alfa (IFN-α) is the historic standard initial treatment for RCC. A prospective, randomized, phase III trial of bevacizumab plus IFN-α versus IFN-α monotherapy was conducted. Patients and Methods Patients with previously untreated, metastatic clear cell RCC were randomly assigned to receive either bevacizumab (10 mg/kg intravenously every 2 weeks) plus IFN-α (9 million units subcutaneously three times weekly) or the same dose and schedule of IFN-α monotherapy in a multicenter phase III trial. The primary end point was overall survival (OS). Secondary end points were progression-free survival (PFS), objective response rate, and safety. Results Seven hundred thirty-two patients were enrolled. The median OS time was 18.3 months (95% CI, 16.5 to 22.5 months) for bevacizumab plus IFN-α and 17.4 months (95% CI, 14.4 to 20.0 months) for IFN-α...