The American College of Surgeons (ACS) presented the 2017 Jacobson Innovation Award to Timothy A. M. Chuter, MB, BS, DM, FACS, at a dinner in his honor June 9 in Chicago. Dr. Chuter is professor of surgery at the University of California, San Francisco (UCSF), where he practices vascular surgery with a focus on the endovascular reconstruction of aneurysms involving the aortic arch and thoracoabdominal aorta.

The Jacobson Innovation Award honors living surgeons who have developed innovative devices or techniques in any field of surgery and is made possible through a gift from Julius H. Jacobson II, MD, FACS, and his wife Joan. Dr. Jacobson is a general vascular surgeon known for his pioneering work in the development of microsurgery.

Leading the way in endovascular aneurysm repair, Dr. Chuter was recognized for his role in the development of endovascular aneurysm repair. He was the first individual to design and implant bifurcated stent grafts to treat abdominal aortic aneurysms, based on the idea that if an aneurysm has branches—at the aortic arch or the bifurcation of the common iliac artery, for example—the endovascular prosthesis also should have branches. Because the most common site for aortic aneurysm involves the distal abdominal aorta, bifurcated endovascular repair has become the most accepted method of aneurysm repair worldwide.

In the years between 1993 and 2000, the scope of endovascular repair rapidly expanded, with several firsts in the field, such as the first bifurcated stent grafts in 1993, the first endovascular repair of a ruptured aortic aneurysm in 1994, the first fenestrated stent grafts for aneurysms of the pararenal aorta in 1998, and the first branched stent grafts for the thoracoabdominal aorta in 2000. Dr. Chuter played a role in many of these developments, though none was the work of a single inventor. Dr. Chuter has said that he is proud to have contributed to several advances in endovascular aneurysm repair, not only by inventing new forms of repair, but also by mentoring surgical residents, fellows, and faculty.

The American College of Surgeons (ACS) presented the 2017 Jacobson Innovation Award to Timothy A. M. Chuter, MB, BS, DM, FACS, at a dinner in his honor June 9 in Chicago. Dr. Chuter is professor of surgery at the University of California, San Francisco (UCSF), where he practices vascular surgery with a focus on the endovascular reconstruction of aneurysms involving the aortic arch and thoracoabdominal aorta.

The Jacobson Innovation Award honors living surgeons who have developed innovative devices or techniques in any field of surgery and is made possible through a gift from Julius H. Jacobson II, MD, FACS, and his wife Joan. Dr. Jacobson is a general vascular surgeon known for his pioneering work in the development of microsurgery.

Leading the way in endovascular aneurysm repair, Dr. Chuter was recognized for his role in the development of endovascular aneurysm repair. He was the first individual to design and implant bifurcated stent grafts to treat abdominal aortic aneurysms, based on the idea that if an aneurysm has branches—at the aortic arch or the bifurcation of the common iliac artery, for example—the endovascular prosthesis also should have branches. Because the most common site for aortic aneurysm involves the distal abdominal aorta, bifurcated endovascular repair has become the most accepted method of aneurysm repair worldwide.

In the years between 1993 and 2000, the scope of endovascular repair rapidly expanded, with several firsts in the field, such as the first bifurcated stent grafts in 1993, the first endovascular repair of a ruptured aortic aneurysm in 1994, the first fenestrated stent grafts for aneurysms of the pararenal aorta in 1998, and the first branched stent grafts for the thoracoabdominal aorta in 2000. Dr. Chuter played a role in many of these developments, though none was the work of a single inventor. Dr. Chuter has said that he is proud to have contributed to several advances in endovascular aneurysm repair, not only by inventing new forms of repair, but also by mentoring surgical residents, fellows, and faculty.

The American College of Surgeons (ACS) presented the 2017 Jacobson Innovation Award to Timothy A. M. Chuter, MB, BS, DM, FACS, at a dinner in his honor June 9 in Chicago. Dr. Chuter is professor of surgery at the University of California, San Francisco (UCSF), where he practices vascular surgery with a focus on the endovascular reconstruction of aneurysms involving the aortic arch and thoracoabdominal aorta.

The Jacobson Innovation Award honors living surgeons who have developed innovative devices or techniques in any field of surgery and is made possible through a gift from Julius H. Jacobson II, MD, FACS, and his wife Joan. Dr. Jacobson is a general vascular surgeon known for his pioneering work in the development of microsurgery.

Leading the way in endovascular aneurysm repair, Dr. Chuter was recognized for his role in the development of endovascular aneurysm repair. He was the first individual to design and implant bifurcated stent grafts to treat abdominal aortic aneurysms, based on the idea that if an aneurysm has branches—at the aortic arch or the bifurcation of the common iliac artery, for example—the endovascular prosthesis also should have branches. Because the most common site for aortic aneurysm involves the distal abdominal aorta, bifurcated endovascular repair has become the most accepted method of aneurysm repair worldwide.

In the years between 1993 and 2000, the scope of endovascular repair rapidly expanded, with several firsts in the field, such as the first bifurcated stent grafts in 1993, the first endovascular repair of a ruptured aortic aneurysm in 1994, the first fenestrated stent grafts for aneurysms of the pararenal aorta in 1998, and the first branched stent grafts for the thoracoabdominal aorta in 2000. Dr. Chuter played a role in many of these developments, though none was the work of a single inventor. Dr. Chuter has said that he is proud to have contributed to several advances in endovascular aneurysm repair, not only by inventing new forms of repair, but also by mentoring surgical residents, fellows, and faculty.

Surgeons are well familiar with the statistic from the Centers for Disease Control and Prevention (CDC) identifying trauma as the leading cause of death for children and adults under age 44. More Americans lose their lives each year to trauma than to AIDS and stroke combined. Unfortunately, nearly 45 million Americans live in areas more than an hour away from either a Level I or II trauma center. Ensuring access to trauma care requires many crucial components including trauma centers and appropriately trained physicians and nurses, all of which must dedicate extensive resources around the clock so that seriously injured patients have the best possible chance for survival.

It has long been a top legislative priority of the ACS to establish and maintain adequate funding for high-quality trauma systems throughout the United States, including those systems operated by our armed forces.The ACS was a sponsor of the National Academy of Medicine (NAM) report entitled, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. This report, released in June of 2016, outlines the steps necessary to secure a national trauma system and sets the goal of achieving zero preventable traumatic deaths.

In an effort to facilitate the achievement of the goals laid out in the report, The Mission Zero Act (H.R. 880) was introduced in the House of Representatives by Chairman of the House Energy and Commerce Health Subcommittee, Michael Burgess, MD (R-TX), Representatives Cathy Castor (D-FL), Gene Green (D-TX), and Richard Hudson (R-NC). Identical companion legislation was introduced in the Senate (S.1022) by Senators Johnny Isakson (R-GA), John Cornyn (R-TX), and Tammy Duckworth (D-IL). The Mission Zero Act creates a grant program to assist civilian trauma centers in partnering with military trauma professionals to establish a pathway to provide patients with the highest quality of trauma care in times of peace and war, thus taking a step in the direction of the NAM report recommendations.

Specifically, the legislation provides for:

• $40 million in grants to fund military trauma teams and providers to embed into civilian trauma facilities.

o Trauma centers are eligible for a $1 million grant to host military trauma teams at eligible high-acuity level 1 trauma centers

o Trauma centers are also eligible for grants to host individual providers ($100,000 for physician or $50,000 for non-physician providers) at eligible level I, II, or III trauma centers

As of today, the House and Senate versions of the Mission Zero Act have 25co-sponsors and 2 co-sponsors respectively. The ACS would very much like to build some momentum for the Mission Zero Act going into the fall when it is expected that there will be several large “must pass” pieces of legislation working their way through Congress to which the Mission Zero Act could potentially be attached. Accordingly, I respectfully ask all Fellows to take a few moments to visit the SurgeonsVoice website at www.surgeonsvoice.org, click on the Take Action tab on the right side of the page and send a message to their individual representatives and senators seeking support for this important legislation.

Until next month …

Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.

Surgeons are well familiar with the statistic from the Centers for Disease Control and Prevention (CDC) identifying trauma as the leading cause of death for children and adults under age 44. More Americans lose their lives each year to trauma than to AIDS and stroke combined. Unfortunately, nearly 45 million Americans live in areas more than an hour away from either a Level I or II trauma center. Ensuring access to trauma care requires many crucial components including trauma centers and appropriately trained physicians and nurses, all of which must dedicate extensive resources around the clock so that seriously injured patients have the best possible chance for survival.

It has long been a top legislative priority of the ACS to establish and maintain adequate funding for high-quality trauma systems throughout the United States, including those systems operated by our armed forces.The ACS was a sponsor of the National Academy of Medicine (NAM) report entitled, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. This report, released in June of 2016, outlines the steps necessary to secure a national trauma system and sets the goal of achieving zero preventable traumatic deaths.

In an effort to facilitate the achievement of the goals laid out in the report, The Mission Zero Act (H.R. 880) was introduced in the House of Representatives by Chairman of the House Energy and Commerce Health Subcommittee, Michael Burgess, MD (R-TX), Representatives Cathy Castor (D-FL), Gene Green (D-TX), and Richard Hudson (R-NC). Identical companion legislation was introduced in the Senate (S.1022) by Senators Johnny Isakson (R-GA), John Cornyn (R-TX), and Tammy Duckworth (D-IL). The Mission Zero Act creates a grant program to assist civilian trauma centers in partnering with military trauma professionals to establish a pathway to provide patients with the highest quality of trauma care in times of peace and war, thus taking a step in the direction of the NAM report recommendations.

Specifically, the legislation provides for:

• $40 million in grants to fund military trauma teams and providers to embed into civilian trauma facilities.

o Trauma centers are eligible for a $1 million grant to host military trauma teams at eligible high-acuity level 1 trauma centers

o Trauma centers are also eligible for grants to host individual providers ($100,000 for physician or $50,000 for non-physician providers) at eligible level I, II, or III trauma centers

As of today, the House and Senate versions of the Mission Zero Act have 25co-sponsors and 2 co-sponsors respectively. The ACS would very much like to build some momentum for the Mission Zero Act going into the fall when it is expected that there will be several large “must pass” pieces of legislation working their way through Congress to which the Mission Zero Act could potentially be attached. Accordingly, I respectfully ask all Fellows to take a few moments to visit the SurgeonsVoice website at www.surgeonsvoice.org, click on the Take Action tab on the right side of the page and send a message to their individual representatives and senators seeking support for this important legislation.

Until next month …

Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.

Surgeons are well familiar with the statistic from the Centers for Disease Control and Prevention (CDC) identifying trauma as the leading cause of death for children and adults under age 44. More Americans lose their lives each year to trauma than to AIDS and stroke combined. Unfortunately, nearly 45 million Americans live in areas more than an hour away from either a Level I or II trauma center. Ensuring access to trauma care requires many crucial components including trauma centers and appropriately trained physicians and nurses, all of which must dedicate extensive resources around the clock so that seriously injured patients have the best possible chance for survival.

It has long been a top legislative priority of the ACS to establish and maintain adequate funding for high-quality trauma systems throughout the United States, including those systems operated by our armed forces.The ACS was a sponsor of the National Academy of Medicine (NAM) report entitled, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. This report, released in June of 2016, outlines the steps necessary to secure a national trauma system and sets the goal of achieving zero preventable traumatic deaths.

In an effort to facilitate the achievement of the goals laid out in the report, The Mission Zero Act (H.R. 880) was introduced in the House of Representatives by Chairman of the House Energy and Commerce Health Subcommittee, Michael Burgess, MD (R-TX), Representatives Cathy Castor (D-FL), Gene Green (D-TX), and Richard Hudson (R-NC). Identical companion legislation was introduced in the Senate (S.1022) by Senators Johnny Isakson (R-GA), John Cornyn (R-TX), and Tammy Duckworth (D-IL). The Mission Zero Act creates a grant program to assist civilian trauma centers in partnering with military trauma professionals to establish a pathway to provide patients with the highest quality of trauma care in times of peace and war, thus taking a step in the direction of the NAM report recommendations.

Specifically, the legislation provides for:

• $40 million in grants to fund military trauma teams and providers to embed into civilian trauma facilities.

o Trauma centers are eligible for a $1 million grant to host military trauma teams at eligible high-acuity level 1 trauma centers

o Trauma centers are also eligible for grants to host individual providers ($100,000 for physician or $50,000 for non-physician providers) at eligible level I, II, or III trauma centers

As of today, the House and Senate versions of the Mission Zero Act have 25co-sponsors and 2 co-sponsors respectively. The ACS would very much like to build some momentum for the Mission Zero Act going into the fall when it is expected that there will be several large “must pass” pieces of legislation working their way through Congress to which the Mission Zero Act could potentially be attached. Accordingly, I respectfully ask all Fellows to take a few moments to visit the SurgeonsVoice website at www.surgeonsvoice.org, click on the Take Action tab on the right side of the page and send a message to their individual representatives and senators seeking support for this important legislation.

Until next month …

Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.

Today in America, more people survive serious injury than any time in the past. Yet trauma remains the leading killer of young people and military service members during combat. Trauma has been characterized as the “neglected epidemic of our time.”

A 2016 report by the National Academies of Science, Engineering and Medicine (NASEM) has added new momentum to the effort to complete the nation’s trauma system. It found one in five trauma deaths could be prevented through stronger Federal leadership, greater research funding to improve outcomes, strengthening prehospital care, distributing trauma centers based on need and integrating military and civilian trauma care into one national trauma system.

In a five-part series of stories, “Putting the Pieces Together: A National Effort to Complete the U.S. Trauma System,” the American College of Surgeons Committee on Trauma will share steps being taken to complete the nation’s trauma system. Stories will look at the history of trauma care and the trauma system in America, partnerships with the military to translate battlefield lessons to the home front and back again, the challenges facing America’s trauma systems, and the steps leading experts are taking to fill the gaps in the system and achieve the goal of zero preventable deaths and disability from injury.

Read the series online at www.facs.org/trauma or follow the ACS COT on Twitter @ACSTrauma.

Today in America, more people survive serious injury than any time in the past. Yet trauma remains the leading killer of young people and military service members during combat. Trauma has been characterized as the “neglected epidemic of our time.”

A 2016 report by the National Academies of Science, Engineering and Medicine (NASEM) has added new momentum to the effort to complete the nation’s trauma system. It found one in five trauma deaths could be prevented through stronger Federal leadership, greater research funding to improve outcomes, strengthening prehospital care, distributing trauma centers based on need and integrating military and civilian trauma care into one national trauma system.

In a five-part series of stories, “Putting the Pieces Together: A National Effort to Complete the U.S. Trauma System,” the American College of Surgeons Committee on Trauma will share steps being taken to complete the nation’s trauma system. Stories will look at the history of trauma care and the trauma system in America, partnerships with the military to translate battlefield lessons to the home front and back again, the challenges facing America’s trauma systems, and the steps leading experts are taking to fill the gaps in the system and achieve the goal of zero preventable deaths and disability from injury.

Read the series online at www.facs.org/trauma or follow the ACS COT on Twitter @ACSTrauma.

Today in America, more people survive serious injury than any time in the past. Yet trauma remains the leading killer of young people and military service members during combat. Trauma has been characterized as the “neglected epidemic of our time.”

A 2016 report by the National Academies of Science, Engineering and Medicine (NASEM) has added new momentum to the effort to complete the nation’s trauma system. It found one in five trauma deaths could be prevented through stronger Federal leadership, greater research funding to improve outcomes, strengthening prehospital care, distributing trauma centers based on need and integrating military and civilian trauma care into one national trauma system.

In a five-part series of stories, “Putting the Pieces Together: A National Effort to Complete the U.S. Trauma System,” the American College of Surgeons Committee on Trauma will share steps being taken to complete the nation’s trauma system. Stories will look at the history of trauma care and the trauma system in America, partnerships with the military to translate battlefield lessons to the home front and back again, the challenges facing America’s trauma systems, and the steps leading experts are taking to fill the gaps in the system and achieve the goal of zero preventable deaths and disability from injury.

Read the series online at www.facs.org/trauma or follow the ACS COT on Twitter @ACSTrauma.

Photo courtesy of the CDC

A study of residents in Ontario, Canada, showed that opioid prescription use was more common in cancer survivors than in individuals without a history of cancer.

This was true even among survivors who were 10 or more years past their cancer diagnosis.

Rinku Sutradhar, PhD, of the University of Toronto in Ontario, Canada, and her colleagues reported these findings in Cancer.

The researchers said little is known about prescribing opioids to relieve pain in individuals who have survived cancer.

To investigate, the team looked at opioid prescribing among residents of Ontario, Canada, with and without a history of cancer.

The study included 8601 adults who were at least 5 years past a cancer diagnosis. These subjects were were matched with 8601 individuals without a prior cancer diagnosis. The subjects were matched based on sex and calendar year of birth.

The researchers looked for opioid prescriptions filled at a pharmacy during the observation period. Follow-up was stopped at any indication of cancer recurrence, second malignancy, or new cancer diagnosis.

The rate of opioid prescribing was 1.22 times higher among cancer survivors than corresponding matched controls.

Over a 36-month period, the average number of opioid prescriptions filled by cancer survivors was 7.7, compared with 6.3 for controls.

This increased rate of opioid prescribing was also seen among survivors who were 10 or more years past their cancer diagnosis.

Individuals with lower income and those who were younger, from rural neighborhoods, and with more comorbidities had significantly higher prescribing rates. Sex was not associated with prescribing rates.

“Our research findings raise concerns about the diagnosis and management of chronic pain problems among survivors stemming from their cancer diagnosis or treatment,” Dr Sutradhar said. “Physicians providing primary care to cancer survivors should consider close examination of reasons for continued opioid use to differentiate chronic pain from dependency.”

Photo courtesy of the CDC

A study of residents in Ontario, Canada, showed that opioid prescription use was more common in cancer survivors than in individuals without a history of cancer.

This was true even among survivors who were 10 or more years past their cancer diagnosis.

Rinku Sutradhar, PhD, of the University of Toronto in Ontario, Canada, and her colleagues reported these findings in Cancer.

The researchers said little is known about prescribing opioids to relieve pain in individuals who have survived cancer.

To investigate, the team looked at opioid prescribing among residents of Ontario, Canada, with and without a history of cancer.

The study included 8601 adults who were at least 5 years past a cancer diagnosis. These subjects were were matched with 8601 individuals without a prior cancer diagnosis. The subjects were matched based on sex and calendar year of birth.

The researchers looked for opioid prescriptions filled at a pharmacy during the observation period. Follow-up was stopped at any indication of cancer recurrence, second malignancy, or new cancer diagnosis.

The rate of opioid prescribing was 1.22 times higher among cancer survivors than corresponding matched controls.

Over a 36-month period, the average number of opioid prescriptions filled by cancer survivors was 7.7, compared with 6.3 for controls.

This increased rate of opioid prescribing was also seen among survivors who were 10 or more years past their cancer diagnosis.

Individuals with lower income and those who were younger, from rural neighborhoods, and with more comorbidities had significantly higher prescribing rates. Sex was not associated with prescribing rates.

“Our research findings raise concerns about the diagnosis and management of chronic pain problems among survivors stemming from their cancer diagnosis or treatment,” Dr Sutradhar said. “Physicians providing primary care to cancer survivors should consider close examination of reasons for continued opioid use to differentiate chronic pain from dependency.”

Photo courtesy of the CDC

A study of residents in Ontario, Canada, showed that opioid prescription use was more common in cancer survivors than in individuals without a history of cancer.

This was true even among survivors who were 10 or more years past their cancer diagnosis.

Rinku Sutradhar, PhD, of the University of Toronto in Ontario, Canada, and her colleagues reported these findings in Cancer.

The researchers said little is known about prescribing opioids to relieve pain in individuals who have survived cancer.

To investigate, the team looked at opioid prescribing among residents of Ontario, Canada, with and without a history of cancer.

The study included 8601 adults who were at least 5 years past a cancer diagnosis. These subjects were were matched with 8601 individuals without a prior cancer diagnosis. The subjects were matched based on sex and calendar year of birth.

The researchers looked for opioid prescriptions filled at a pharmacy during the observation period. Follow-up was stopped at any indication of cancer recurrence, second malignancy, or new cancer diagnosis.

The rate of opioid prescribing was 1.22 times higher among cancer survivors than corresponding matched controls.

Over a 36-month period, the average number of opioid prescriptions filled by cancer survivors was 7.7, compared with 6.3 for controls.

This increased rate of opioid prescribing was also seen among survivors who were 10 or more years past their cancer diagnosis.

Individuals with lower income and those who were younger, from rural neighborhoods, and with more comorbidities had significantly higher prescribing rates. Sex was not associated with prescribing rates.

“Our research findings raise concerns about the diagnosis and management of chronic pain problems among survivors stemming from their cancer diagnosis or treatment,” Dr Sutradhar said. “Physicians providing primary care to cancer survivors should consider close examination of reasons for continued opioid use to differentiate chronic pain from dependency.”

Micrograph showing DLBCL

Results from the SCHOLAR-1 study revealed poor outcomes of salvage therapy in patients with refractory diffuse large B-cell lymphoma (DLBCL).

This retrospective study included data on patients enrolled in 2 randomized trials and 2 academic databases.

The patients had primary refractory disease, were refractory to second-line or later therapy, or had relapsed within 12 months of autologous stem cell transplant (ASCT).

Twenty-six percent of patients responded to salvage therapy, with 7% achieving a complete response (CR).

The median overall survival (OS) was 6.3 months, and 20% of patients were still alive at 2 years’ follow-up.

Christian Gisselbrecht, MD, of Saint Louis Hospital in Paris, France, and his colleagues reported these findings in Blood. SCHOLAR-1 was funded through an unrestricted grant from Kite Pharma.

“SCHOLAR-1 demonstrates the uniformly poor treatment outcomes for patients with aggressive non-Hodgkin lymphoma and emphasizes the need for breakthrough therapies for these refractory patients,” Dr Gisselbrecht said.

Patient characteristics

The study included pooled, patient-level data from 2 phase 3 trials and 2 databases:

• The Canadian Cancer Trials Group study LY.12 (n=219)
• The Lymphoma Academic Research Organization’s CORAL study  (n=170)
• A cohort from MD Anderson Cancer Center (n=165)
• A cohort from the Molecular Epidemiology Resource of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (n=82).

There were a total of 636 patients who met criteria for refractory DLBCL, which included primary mediastinal B-cell lymphoma and transformed follicular lymphoma.

Twenty-eight percent of patients were primary refractory, 50% were refractory to second-line or later therapy, and 22% had relapsed within 12 months of transplant.

The patients’ median age was 55 (range, 19-81), and 64% were male. Seventy-three percent had an ECOG performance status of 0-1, 14% had a status of 2-4, and 13% were missing this data. Seventy-two percent of patients had stage III-IV disease, 27% had stage I-II disease, and less than 1% were missing this data.

Treatments

The MD Anderson cohort included patients who were relapsed/refractory to initial rituximab-containing chemotherapy, had failed salvage platinum-containing chemotherapy, and received a second salvage therapy at MD Anderson.

The University of Iowa/Mayo Clinic cohort included unselected, newly diagnosed patients with lymphoma who entered prospective documentation of primary and subsequent treatments and outcomes.

In the LY.12 study, patients were enrolled upon relapse after anthracycline-containing therapy and randomized to 1 of 2 salvage regimens, with a goal of consolidative ASCT.

The CORAL study enrolled patients in their first relapse or whose lymphoma was refractory to first-line therapy. They were randomized to 1 of 2 salvage regimens, with a goal of consolidative ASCT.

In the LY.12 and CORAL studies, eligible patients with CD20+ lymphoma were randomized to rituximab maintenance or observation post-ASCT.

Response

In all, 523 patients were evaluated for response. The overall response rate (ORR) was 26%, with a 7% CR rate and an 18% partial response rate.

Among patients with primary refractory disease, the ORR was 20%, and the CR rate was 3%.

Among patients who were refractory to second-line or later therapy, the ORR was 26%, and the CR rate was 10%.

Among patients who relapsed after transplant, the ORR was 34%, and the CR rate was 15%.

Survival

A total of 603 patients were evaluated for survival.

The median OS from the start of salvage therapy was 6.3 months (range, 5.9-7.0). The 1-year OS rate was 28%, and the 2-year OS was 20%.

Among primary refractory patients, the median OS was 7.1 months (range, 6.0-8.1), 1-year OS was 29%, and 2-year OS was 24%.

Among patient who were refractory to second-line or later therapy, the median OS was 6.1 months (range, 5.2-7.0), 1-year OS was 26%, and 2-year OS was 17%.

Among patients who relapsed after transplant, the median OS was 6.2 months (range, 5.2-7.6), 1-year OS was 32%, and 2-year OS was 19%.

“Although 60% to 70% of non-Hodgkin lymphoma patients survive 5 years after rituximab-based chemotherapy and autologous stem cell transplant, nearly half of them either do not respond or relapse shortly after transplant,” Dr Gisselbrecht noted.

“SCHOLAR-1 provides a rigorous measure of outcomes for these patients who do not benefit from currently available therapies, and this landmark study will serve as an important historical control for evaluating new therapeutic candidates in the field of non-Hodgkin lymphoma.”

Micrograph showing DLBCL

Results from the SCHOLAR-1 study revealed poor outcomes of salvage therapy in patients with refractory diffuse large B-cell lymphoma (DLBCL).

This retrospective study included data on patients enrolled in 2 randomized trials and 2 academic databases.

The patients had primary refractory disease, were refractory to second-line or later therapy, or had relapsed within 12 months of autologous stem cell transplant (ASCT).

Twenty-six percent of patients responded to salvage therapy, with 7% achieving a complete response (CR).

The median overall survival (OS) was 6.3 months, and 20% of patients were still alive at 2 years’ follow-up.

Christian Gisselbrecht, MD, of Saint Louis Hospital in Paris, France, and his colleagues reported these findings in Blood. SCHOLAR-1 was funded through an unrestricted grant from Kite Pharma.

“SCHOLAR-1 demonstrates the uniformly poor treatment outcomes for patients with aggressive non-Hodgkin lymphoma and emphasizes the need for breakthrough therapies for these refractory patients,” Dr Gisselbrecht said.

Patient characteristics

The study included pooled, patient-level data from 2 phase 3 trials and 2 databases:

• The Canadian Cancer Trials Group study LY.12 (n=219)
• The Lymphoma Academic Research Organization’s CORAL study  (n=170)
• A cohort from MD Anderson Cancer Center (n=165)
• A cohort from the Molecular Epidemiology Resource of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (n=82).

There were a total of 636 patients who met criteria for refractory DLBCL, which included primary mediastinal B-cell lymphoma and transformed follicular lymphoma.

Twenty-eight percent of patients were primary refractory, 50% were refractory to second-line or later therapy, and 22% had relapsed within 12 months of transplant.

The patients’ median age was 55 (range, 19-81), and 64% were male. Seventy-three percent had an ECOG performance status of 0-1, 14% had a status of 2-4, and 13% were missing this data. Seventy-two percent of patients had stage III-IV disease, 27% had stage I-II disease, and less than 1% were missing this data.

Treatments

The MD Anderson cohort included patients who were relapsed/refractory to initial rituximab-containing chemotherapy, had failed salvage platinum-containing chemotherapy, and received a second salvage therapy at MD Anderson.

The University of Iowa/Mayo Clinic cohort included unselected, newly diagnosed patients with lymphoma who entered prospective documentation of primary and subsequent treatments and outcomes.

In the LY.12 study, patients were enrolled upon relapse after anthracycline-containing therapy and randomized to 1 of 2 salvage regimens, with a goal of consolidative ASCT.

The CORAL study enrolled patients in their first relapse or whose lymphoma was refractory to first-line therapy. They were randomized to 1 of 2 salvage regimens, with a goal of consolidative ASCT.

In the LY.12 and CORAL studies, eligible patients with CD20+ lymphoma were randomized to rituximab maintenance or observation post-ASCT.

Response

In all, 523 patients were evaluated for response. The overall response rate (ORR) was 26%, with a 7% CR rate and an 18% partial response rate.

Among patients with primary refractory disease, the ORR was 20%, and the CR rate was 3%.

Among patients who were refractory to second-line or later therapy, the ORR was 26%, and the CR rate was 10%.

Among patients who relapsed after transplant, the ORR was 34%, and the CR rate was 15%.

Survival

A total of 603 patients were evaluated for survival.

The median OS from the start of salvage therapy was 6.3 months (range, 5.9-7.0). The 1-year OS rate was 28%, and the 2-year OS was 20%.

Among primary refractory patients, the median OS was 7.1 months (range, 6.0-8.1), 1-year OS was 29%, and 2-year OS was 24%.

Among patient who were refractory to second-line or later therapy, the median OS was 6.1 months (range, 5.2-7.0), 1-year OS was 26%, and 2-year OS was 17%.

Among patients who relapsed after transplant, the median OS was 6.2 months (range, 5.2-7.6), 1-year OS was 32%, and 2-year OS was 19%.

“Although 60% to 70% of non-Hodgkin lymphoma patients survive 5 years after rituximab-based chemotherapy and autologous stem cell transplant, nearly half of them either do not respond or relapse shortly after transplant,” Dr Gisselbrecht noted.

“SCHOLAR-1 provides a rigorous measure of outcomes for these patients who do not benefit from currently available therapies, and this landmark study will serve as an important historical control for evaluating new therapeutic candidates in the field of non-Hodgkin lymphoma.”

Micrograph showing DLBCL

Results from the SCHOLAR-1 study revealed poor outcomes of salvage therapy in patients with refractory diffuse large B-cell lymphoma (DLBCL).

This retrospective study included data on patients enrolled in 2 randomized trials and 2 academic databases.

The patients had primary refractory disease, were refractory to second-line or later therapy, or had relapsed within 12 months of autologous stem cell transplant (ASCT).

Twenty-six percent of patients responded to salvage therapy, with 7% achieving a complete response (CR).

The median overall survival (OS) was 6.3 months, and 20% of patients were still alive at 2 years’ follow-up.

Christian Gisselbrecht, MD, of Saint Louis Hospital in Paris, France, and his colleagues reported these findings in Blood. SCHOLAR-1 was funded through an unrestricted grant from Kite Pharma.

“SCHOLAR-1 demonstrates the uniformly poor treatment outcomes for patients with aggressive non-Hodgkin lymphoma and emphasizes the need for breakthrough therapies for these refractory patients,” Dr Gisselbrecht said.

Patient characteristics

The study included pooled, patient-level data from 2 phase 3 trials and 2 databases:

• The Canadian Cancer Trials Group study LY.12 (n=219)
• The Lymphoma Academic Research Organization’s CORAL study  (n=170)
• A cohort from MD Anderson Cancer Center (n=165)
• A cohort from the Molecular Epidemiology Resource of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (n=82).

There were a total of 636 patients who met criteria for refractory DLBCL, which included primary mediastinal B-cell lymphoma and transformed follicular lymphoma.

Twenty-eight percent of patients were primary refractory, 50% were refractory to second-line or later therapy, and 22% had relapsed within 12 months of transplant.

The patients’ median age was 55 (range, 19-81), and 64% were male. Seventy-three percent had an ECOG performance status of 0-1, 14% had a status of 2-4, and 13% were missing this data. Seventy-two percent of patients had stage III-IV disease, 27% had stage I-II disease, and less than 1% were missing this data.

Treatments

The MD Anderson cohort included patients who were relapsed/refractory to initial rituximab-containing chemotherapy, had failed salvage platinum-containing chemotherapy, and received a second salvage therapy at MD Anderson.

The University of Iowa/Mayo Clinic cohort included unselected, newly diagnosed patients with lymphoma who entered prospective documentation of primary and subsequent treatments and outcomes.

In the LY.12 study, patients were enrolled upon relapse after anthracycline-containing therapy and randomized to 1 of 2 salvage regimens, with a goal of consolidative ASCT.

The CORAL study enrolled patients in their first relapse or whose lymphoma was refractory to first-line therapy. They were randomized to 1 of 2 salvage regimens, with a goal of consolidative ASCT.

In the LY.12 and CORAL studies, eligible patients with CD20+ lymphoma were randomized to rituximab maintenance or observation post-ASCT.

Response

In all, 523 patients were evaluated for response. The overall response rate (ORR) was 26%, with a 7% CR rate and an 18% partial response rate.

Among patients with primary refractory disease, the ORR was 20%, and the CR rate was 3%.

Among patients who were refractory to second-line or later therapy, the ORR was 26%, and the CR rate was 10%.

Among patients who relapsed after transplant, the ORR was 34%, and the CR rate was 15%.

Survival

A total of 603 patients were evaluated for survival.

The median OS from the start of salvage therapy was 6.3 months (range, 5.9-7.0). The 1-year OS rate was 28%, and the 2-year OS was 20%.

Among primary refractory patients, the median OS was 7.1 months (range, 6.0-8.1), 1-year OS was 29%, and 2-year OS was 24%.

Among patient who were refractory to second-line or later therapy, the median OS was 6.1 months (range, 5.2-7.0), 1-year OS was 26%, and 2-year OS was 17%.

Among patients who relapsed after transplant, the median OS was 6.2 months (range, 5.2-7.6), 1-year OS was 32%, and 2-year OS was 19%.

“Although 60% to 70% of non-Hodgkin lymphoma patients survive 5 years after rituximab-based chemotherapy and autologous stem cell transplant, nearly half of them either do not respond or relapse shortly after transplant,” Dr Gisselbrecht noted.

“SCHOLAR-1 provides a rigorous measure of outcomes for these patients who do not benefit from currently available therapies, and this landmark study will serve as an important historical control for evaluating new therapeutic candidates in the field of non-Hodgkin lymphoma.”

More than a quarter of the patients in palliative care have a primary diagnosis of cancer, according to the Center to Advance Palliative Care.

A survey of 351 palliative care programs showed that 27% of their patients had been diagnosed with cancer in 2016, more than twice as many patients who had a cardiac (13%) or pulmonary (12%) diagnosis. The next most common primary diagnosis category in 2016 was neurologic at 8%, with a tie at 6% between diagnoses classified as infectious or complex chronic, followed by patients with dementia at 5%, Maggie Rogers and Tamara Dumanovsky, PhD, of the CAPC reported.

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More than a quarter of the patients in palliative care have a primary diagnosis of cancer, according to the Center to Advance Palliative Care.

A survey of 351 palliative care programs showed that 27% of their patients had been diagnosed with cancer in 2016, more than twice as many patients who had a cardiac (13%) or pulmonary (12%) diagnosis. The next most common primary diagnosis category in 2016 was neurologic at 8%, with a tie at 6% between diagnoses classified as infectious or complex chronic, followed by patients with dementia at 5%, Maggie Rogers and Tamara Dumanovsky, PhD, of the CAPC reported.

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More than a quarter of the patients in palliative care have a primary diagnosis of cancer, according to the Center to Advance Palliative Care.

A survey of 351 palliative care programs showed that 27% of their patients had been diagnosed with cancer in 2016, more than twice as many patients who had a cardiac (13%) or pulmonary (12%) diagnosis. The next most common primary diagnosis category in 2016 was neurologic at 8%, with a tie at 6% between diagnoses classified as infectious or complex chronic, followed by patients with dementia at 5%, Maggie Rogers and Tamara Dumanovsky, PhD, of the CAPC reported.

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The Food and Drug Administration announced a safety alert on Aug. 10, 2017, for liquid-filled intragastric balloon systems, as they have caused five reports of unanticipated deaths that occurred from 2016 to present in patients.

The cause or incidence of patient death is still unknown, and the FDA has not been able to definitively attribute the deaths to the devices or the insertion procedures for these devices. All five reports show that patient deaths occurred within a month or less of balloon placement. In three of the reports, death occurred as soon as 1-3 days after balloon placement. The FDA has also received two additional reports of deaths in the same time period related to potential complications associated with balloon treatment.

[email protected]

The Food and Drug Administration announced a safety alert on Aug. 10, 2017, for liquid-filled intragastric balloon systems, as they have caused five reports of unanticipated deaths that occurred from 2016 to present in patients.

The cause or incidence of patient death is still unknown, and the FDA has not been able to definitively attribute the deaths to the devices or the insertion procedures for these devices. All five reports show that patient deaths occurred within a month or less of balloon placement. In three of the reports, death occurred as soon as 1-3 days after balloon placement. The FDA has also received two additional reports of deaths in the same time period related to potential complications associated with balloon treatment.

[email protected]

The Food and Drug Administration announced a safety alert on Aug. 10, 2017, for liquid-filled intragastric balloon systems, as they have caused five reports of unanticipated deaths that occurred from 2016 to present in patients.

The cause or incidence of patient death is still unknown, and the FDA has not been able to definitively attribute the deaths to the devices or the insertion procedures for these devices. All five reports show that patient deaths occurred within a month or less of balloon placement. In three of the reports, death occurred as soon as 1-3 days after balloon placement. The FDA has also received two additional reports of deaths in the same time period related to potential complications associated with balloon treatment.

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