Using an Atrial Fibrillation Decision Support Tool (AFDST), investigators determined that 45% of women and 39% of men in the study population were not being treated according to the tool’s recommended treatments to prevent stroke resulting from atrial fibrillation (AF).

Investigators wanted to achieve a better understanding of the appropriateness of antithrombotic therapy for thromboprophylaxis in women and elderly adults.

So they studied a cohort of individuals with AF to determine whether they were treated according to recommendations.

According to lead author Mark Eckman, MD, of the University of Cincinnati in Ohio, under treatment of patients with AF is a national problem.

And ironically, “[W]omen have a higher risk of AF-related stroke,” he said, “controlling for other risk factors such as hypertension, diabetes, congestive heart failure, yet women are being under treated.”

The team retrospectively studied 1585 adults aged 28 to 93 with nonvalvular AF or flutter cared for in an ambulatory setting in the University of Cincinnati Health primary care network.

The primary care doctors were testing the computerized AFDST, which uses patient information and characteristics to help with decisions about anticoagulant therapy to prevent stroke in AF patients.

The AFDST calculates for the individual patient the risk of AF-related stroke and major bleeding while taking blood thinning therapy. Based on this information, the AFDST makes suggestions for the best treatment to prevent AF-related stroke.

Demographics

Of the 1585 study participants, 46% were women.

Half of the participants were receiving some form of oral anticoagulant, primarily warfarin (39%), 36% were on aspirin only, and 11% were receiving other oral anticoagulants.

The investigators noted a trend in the study population toward lower levels of oral anticoagulant use in women (48%) as compared to men (52%), but the trend was not statistically significant (P=0.06).

Results

The AFDST recommended oral anticoagulation for 87% of the participants, aspirin for 4%,  and no antithrombitic therapy for 9%.

Patients' antithrombotic therapy was concordant with the AFDST recommendation in 58% of the participants.

Of the 42% for whom therapy was discordant with the AFDST, 37% were receiving aspirin only or no antithrombotic therapy when the tool recommended oral anticoagulation; 2% were receiving no antithrombotic therapy when the tool recommended aspirin; and 3% were receiving aspirin or oral anticoagulation when the tool recommended no antithrombotic therapy.

And as mentioned above, current treatment was discordant from recommended treatment in 45% of women and 39% of men (P=0.02).

Forty-four percent of women were under treated, receiving aspirin only when oral anticoagulation was recommended, compared with 31% of men who were under treated (P<0.001). Women were 1.8 times as likely to be under treated as men.

"Doctors need to realize we have mental biases that women are healthier and at lower risk of stroke,” Dr Eckman said. 

“We think women are at lower risk and we ignore warning signs,” he continued. “Thus, when we are making decisions for blood thinning therapy for patients with atrial fibrillation, we need to remember that women are at higher risk and we need to make sure we treat them aggressively enough to prevent stroke."

Overall, the use of oral anticoagulants did not differ significantly by age, with 55% of the patients 85 years and older receiving anticoagulation and 49% of the patients younger than 85 receiving it (P=0.13).

In 35% of the older population, treatment was discordant with recommendations compared with 43% in the younger (P = 0.009). Similar proportions in the younger and older groups were undertreated (P=0.30).

According to investigators, one surprising finding was that the proportion of patients receiving discordant treatment was larger in the younger group than in the over-85 group. They attributed this largely to overtreatment in the 31 to 50 age group.

Dr Eckman and colleagues published these findings in Journal of the American Geriatrics Society.

The research was supported in part by grants from Bristol-Myers Squibb/Pfizer Education Consortium, Pfizer Medical Education Group, Informed Medical Decisions Foundation, and the National Institutes of Health/National Center for Advancing Translational Sciences.

Using an Atrial Fibrillation Decision Support Tool (AFDST), investigators determined that 45% of women and 39% of men in the study population were not being treated according to the tool’s recommended treatments to prevent stroke resulting from atrial fibrillation (AF).

Investigators wanted to achieve a better understanding of the appropriateness of antithrombotic therapy for thromboprophylaxis in women and elderly adults.

So they studied a cohort of individuals with AF to determine whether they were treated according to recommendations.

According to lead author Mark Eckman, MD, of the University of Cincinnati in Ohio, under treatment of patients with AF is a national problem.

And ironically, “[W]omen have a higher risk of AF-related stroke,” he said, “controlling for other risk factors such as hypertension, diabetes, congestive heart failure, yet women are being under treated.”

The team retrospectively studied 1585 adults aged 28 to 93 with nonvalvular AF or flutter cared for in an ambulatory setting in the University of Cincinnati Health primary care network.

The primary care doctors were testing the computerized AFDST, which uses patient information and characteristics to help with decisions about anticoagulant therapy to prevent stroke in AF patients.

The AFDST calculates for the individual patient the risk of AF-related stroke and major bleeding while taking blood thinning therapy. Based on this information, the AFDST makes suggestions for the best treatment to prevent AF-related stroke.

Demographics

Of the 1585 study participants, 46% were women.

Half of the participants were receiving some form of oral anticoagulant, primarily warfarin (39%), 36% were on aspirin only, and 11% were receiving other oral anticoagulants.

The investigators noted a trend in the study population toward lower levels of oral anticoagulant use in women (48%) as compared to men (52%), but the trend was not statistically significant (P=0.06).

Results

The AFDST recommended oral anticoagulation for 87% of the participants, aspirin for 4%,  and no antithrombitic therapy for 9%.

Patients' antithrombotic therapy was concordant with the AFDST recommendation in 58% of the participants.

Of the 42% for whom therapy was discordant with the AFDST, 37% were receiving aspirin only or no antithrombotic therapy when the tool recommended oral anticoagulation; 2% were receiving no antithrombotic therapy when the tool recommended aspirin; and 3% were receiving aspirin or oral anticoagulation when the tool recommended no antithrombotic therapy.

And as mentioned above, current treatment was discordant from recommended treatment in 45% of women and 39% of men (P=0.02).

Forty-four percent of women were under treated, receiving aspirin only when oral anticoagulation was recommended, compared with 31% of men who were under treated (P<0.001). Women were 1.8 times as likely to be under treated as men.

"Doctors need to realize we have mental biases that women are healthier and at lower risk of stroke,” Dr Eckman said. 

“We think women are at lower risk and we ignore warning signs,” he continued. “Thus, when we are making decisions for blood thinning therapy for patients with atrial fibrillation, we need to remember that women are at higher risk and we need to make sure we treat them aggressively enough to prevent stroke."

Overall, the use of oral anticoagulants did not differ significantly by age, with 55% of the patients 85 years and older receiving anticoagulation and 49% of the patients younger than 85 receiving it (P=0.13).

In 35% of the older population, treatment was discordant with recommendations compared with 43% in the younger (P = 0.009). Similar proportions in the younger and older groups were undertreated (P=0.30).

According to investigators, one surprising finding was that the proportion of patients receiving discordant treatment was larger in the younger group than in the over-85 group. They attributed this largely to overtreatment in the 31 to 50 age group.

Dr Eckman and colleagues published these findings in Journal of the American Geriatrics Society.

The research was supported in part by grants from Bristol-Myers Squibb/Pfizer Education Consortium, Pfizer Medical Education Group, Informed Medical Decisions Foundation, and the National Institutes of Health/National Center for Advancing Translational Sciences.

Using an Atrial Fibrillation Decision Support Tool (AFDST), investigators determined that 45% of women and 39% of men in the study population were not being treated according to the tool’s recommended treatments to prevent stroke resulting from atrial fibrillation (AF).

Investigators wanted to achieve a better understanding of the appropriateness of antithrombotic therapy for thromboprophylaxis in women and elderly adults.

So they studied a cohort of individuals with AF to determine whether they were treated according to recommendations.

According to lead author Mark Eckman, MD, of the University of Cincinnati in Ohio, under treatment of patients with AF is a national problem.

And ironically, “[W]omen have a higher risk of AF-related stroke,” he said, “controlling for other risk factors such as hypertension, diabetes, congestive heart failure, yet women are being under treated.”

The team retrospectively studied 1585 adults aged 28 to 93 with nonvalvular AF or flutter cared for in an ambulatory setting in the University of Cincinnati Health primary care network.

The primary care doctors were testing the computerized AFDST, which uses patient information and characteristics to help with decisions about anticoagulant therapy to prevent stroke in AF patients.

The AFDST calculates for the individual patient the risk of AF-related stroke and major bleeding while taking blood thinning therapy. Based on this information, the AFDST makes suggestions for the best treatment to prevent AF-related stroke.

Demographics

Of the 1585 study participants, 46% were women.

Half of the participants were receiving some form of oral anticoagulant, primarily warfarin (39%), 36% were on aspirin only, and 11% were receiving other oral anticoagulants.

The investigators noted a trend in the study population toward lower levels of oral anticoagulant use in women (48%) as compared to men (52%), but the trend was not statistically significant (P=0.06).

Results

The AFDST recommended oral anticoagulation for 87% of the participants, aspirin for 4%,  and no antithrombitic therapy for 9%.

Patients' antithrombotic therapy was concordant with the AFDST recommendation in 58% of the participants.

Of the 42% for whom therapy was discordant with the AFDST, 37% were receiving aspirin only or no antithrombotic therapy when the tool recommended oral anticoagulation; 2% were receiving no antithrombotic therapy when the tool recommended aspirin; and 3% were receiving aspirin or oral anticoagulation when the tool recommended no antithrombotic therapy.

And as mentioned above, current treatment was discordant from recommended treatment in 45% of women and 39% of men (P=0.02).

Forty-four percent of women were under treated, receiving aspirin only when oral anticoagulation was recommended, compared with 31% of men who were under treated (P<0.001). Women were 1.8 times as likely to be under treated as men.

"Doctors need to realize we have mental biases that women are healthier and at lower risk of stroke,” Dr Eckman said. 

“We think women are at lower risk and we ignore warning signs,” he continued. “Thus, when we are making decisions for blood thinning therapy for patients with atrial fibrillation, we need to remember that women are at higher risk and we need to make sure we treat them aggressively enough to prevent stroke."

Overall, the use of oral anticoagulants did not differ significantly by age, with 55% of the patients 85 years and older receiving anticoagulation and 49% of the patients younger than 85 receiving it (P=0.13).

In 35% of the older population, treatment was discordant with recommendations compared with 43% in the younger (P = 0.009). Similar proportions in the younger and older groups were undertreated (P=0.30).

According to investigators, one surprising finding was that the proportion of patients receiving discordant treatment was larger in the younger group than in the over-85 group. They attributed this largely to overtreatment in the 31 to 50 age group.

Dr Eckman and colleagues published these findings in Journal of the American Geriatrics Society.

The research was supported in part by grants from Bristol-Myers Squibb/Pfizer Education Consortium, Pfizer Medical Education Group, Informed Medical Decisions Foundation, and the National Institutes of Health/National Center for Advancing Translational Sciences.

CHICAGO – Lenalidomide maintenance therapy significantly prolonged overall survival after autologous stem cell transplant in newly diagnosed multiple myeloma patients, including patients who had a complete response to ASCT, based on a meta-analysis presented at the annual meeting of the American Society of Clinical Oncology.

While several studies have indicated that lenalidomide maintenance reduces the risk of disease progression or death compared to a control group, none of the individual studies were powered to detect a significant improvement in overall survival, said Dr. Philip L. McCarthy, director of the Blood and Marrow Transplant Center at Roswell Park Cancer Institute, Buffalo, N.Y., who is a co-author of the meta-analysis and reported the results on behalf of Dr. Michel Attal of University Hospital, Toulouse, France.

The researchers found that three randomized controlled trials using lenalidomide post-ASCT (IFM 2005-02, CALGB 100104 [Alliance], GIMEMA RV-209) met the criteria of having patient-level data, a control arm, and primary efficacy data for newly-diagnosed patients with multiple myeloma.

After induction and single (82%) or tandem (18%) ASCT, 55% of patients in the meta-analysis had complete or very good partial responses.

From 2005 to 2009, 605 patients received lenalidomide either 10 mg/day on days 1-21 of a 28-day cycle (GIMEMA) or on days 1-28 of a 28-day cycle (IFM and CALGB); 604 patients were in a control group. With a median follow-up of 6.6 years, 491 patients (41%) had died.

Median overall survival was not reached in the lenolidamide group and was 86 months in the control group (HR = 0.74; 95% CI, 0.62-0.89; log-rank P = .001). Survival was longer in the lenolidamine group as compared to the control group at 5 years (71% vs 66%), 6 years (65% vs 58%), and 7 years (62% vs 50%), reported Dr. McCarthy.

Dr. McCarthy receives research funding from Celgene, the maker of Revlimid (lenalidomide); and is a consultant or advisor to and receives honoraria from Binding Site; Bristol-Myers Squibb; Celgene; Janssen; Karyopharm Therapeutics; and Sanofi. Dr. Attal had no disclosures.

[email protected]

On Twitter @maryjodales

CHICAGO – Lenalidomide maintenance therapy significantly prolonged overall survival after autologous stem cell transplant in newly diagnosed multiple myeloma patients, including patients who had a complete response to ASCT, based on a meta-analysis presented at the annual meeting of the American Society of Clinical Oncology.

While several studies have indicated that lenalidomide maintenance reduces the risk of disease progression or death compared to a control group, none of the individual studies were powered to detect a significant improvement in overall survival, said Dr. Philip L. McCarthy, director of the Blood and Marrow Transplant Center at Roswell Park Cancer Institute, Buffalo, N.Y., who is a co-author of the meta-analysis and reported the results on behalf of Dr. Michel Attal of University Hospital, Toulouse, France.

The researchers found that three randomized controlled trials using lenalidomide post-ASCT (IFM 2005-02, CALGB 100104 [Alliance], GIMEMA RV-209) met the criteria of having patient-level data, a control arm, and primary efficacy data for newly-diagnosed patients with multiple myeloma.

After induction and single (82%) or tandem (18%) ASCT, 55% of patients in the meta-analysis had complete or very good partial responses.

From 2005 to 2009, 605 patients received lenalidomide either 10 mg/day on days 1-21 of a 28-day cycle (GIMEMA) or on days 1-28 of a 28-day cycle (IFM and CALGB); 604 patients were in a control group. With a median follow-up of 6.6 years, 491 patients (41%) had died.

Median overall survival was not reached in the lenolidamide group and was 86 months in the control group (HR = 0.74; 95% CI, 0.62-0.89; log-rank P = .001). Survival was longer in the lenolidamine group as compared to the control group at 5 years (71% vs 66%), 6 years (65% vs 58%), and 7 years (62% vs 50%), reported Dr. McCarthy.

Dr. McCarthy receives research funding from Celgene, the maker of Revlimid (lenalidomide); and is a consultant or advisor to and receives honoraria from Binding Site; Bristol-Myers Squibb; Celgene; Janssen; Karyopharm Therapeutics; and Sanofi. Dr. Attal had no disclosures.

[email protected]

On Twitter @maryjodales

CHICAGO – Lenalidomide maintenance therapy significantly prolonged overall survival after autologous stem cell transplant in newly diagnosed multiple myeloma patients, including patients who had a complete response to ASCT, based on a meta-analysis presented at the annual meeting of the American Society of Clinical Oncology.

While several studies have indicated that lenalidomide maintenance reduces the risk of disease progression or death compared to a control group, none of the individual studies were powered to detect a significant improvement in overall survival, said Dr. Philip L. McCarthy, director of the Blood and Marrow Transplant Center at Roswell Park Cancer Institute, Buffalo, N.Y., who is a co-author of the meta-analysis and reported the results on behalf of Dr. Michel Attal of University Hospital, Toulouse, France.

The researchers found that three randomized controlled trials using lenalidomide post-ASCT (IFM 2005-02, CALGB 100104 [Alliance], GIMEMA RV-209) met the criteria of having patient-level data, a control arm, and primary efficacy data for newly-diagnosed patients with multiple myeloma.

After induction and single (82%) or tandem (18%) ASCT, 55% of patients in the meta-analysis had complete or very good partial responses.

From 2005 to 2009, 605 patients received lenalidomide either 10 mg/day on days 1-21 of a 28-day cycle (GIMEMA) or on days 1-28 of a 28-day cycle (IFM and CALGB); 604 patients were in a control group. With a median follow-up of 6.6 years, 491 patients (41%) had died.

Median overall survival was not reached in the lenolidamide group and was 86 months in the control group (HR = 0.74; 95% CI, 0.62-0.89; log-rank P = .001). Survival was longer in the lenolidamine group as compared to the control group at 5 years (71% vs 66%), 6 years (65% vs 58%), and 7 years (62% vs 50%), reported Dr. McCarthy.

Dr. McCarthy receives research funding from Celgene, the maker of Revlimid (lenalidomide); and is a consultant or advisor to and receives honoraria from Binding Site; Bristol-Myers Squibb; Celgene; Janssen; Karyopharm Therapeutics; and Sanofi. Dr. Attal had no disclosures.

[email protected]

On Twitter @maryjodales

After implementation of surgical safety checklists in a tertiary care hospital, researchers observed a 27% reduction of risk-adjusted all-cause 90-day mortality, but adjusted all-cause 30-day mortality remained unchanged.

In addition, length of stay was reduced but 30-day readmission rate was not, according to the study published online in JAMA Surgery. Those key findings are from an effort to assess the association between the implementation of surgical safety checklists (SSCs) and rates of all-cause 90- and 30-day mortality.

©PixelEmbargo/Thinkstock

Previous studies have analyzed in-hospital mortality or 30-day mortality “but not intermediate-term outcome variables,” said lead author Dr. Matthias Bock of the department of anesthesiology and intensive care medicine at Merano Hospital, Merano, Italy. “Almost one-quarter (23.6%) of the deaths within 30 days after surgery occurred after discharge, and 39.7% of patients undergoing surgery experienced only post-discharge complications. Ninety-day mortality often doubles 30-day mortality. In-hospital mortality and 30-day mortality might therefore underreport the real risk to these patients, especially after tumor surgery or among the elderly. Studies of the effect or the association of the implementation of surgical safety checklists (SSCs) on 90-day mortality are lacking.”

Dr. Bock and his associates retrospectively evaluated the outcomes of surgical procedures performed during the six months before and six months after implementation of SSCs at the 715-bed Central Hospital of Bolzano (CHB) in Italy (Jan. 1-June 30, 2010, and Jan. 1-June 30, 2013, respectively). The key outcome measures were risk-adjusted rates of 90- and 30-day mortality, readmission rate, and LOS (JAMA Surg. 2016 Feb 3. doi:10.1001/jamasurg.2015.5490).

The study sample consisted of 10,741 patients, including 5,444 pre-intervention and 5,297 post-intervention patients. Of these, 53% were female and their mean age was 53 years.

The researchers reported that 90-day all-cause mortality was 2.4% before SSC implementation, compared with 2.2% after implementation, for an adjusted odds ratio (AOR) of 0.73 (P = .02). However, 30-day all-cause mortality was 1.36% before SSC implementation, compared with 1.32% after implementation, for an AOR of 0.79 (P = .17), remaining essentially unchanged.

Dr. Bock and his associates also found that 30-day readmission rates were similar in the pre-implementation and post-implementation groups (14.6% vs. 14.5%, respectively: P = .90), but the adjusted length of stay favored the post-implementation group (a mean of 9.6 days, compared with a mean of 10.4 days in the in the pre-implementation group; P less than .001).

The researchers acknowledged certain limitations of the study, including its single-center design and the lack of a control group. “The study design highly reduces the risk for observation bias (Hawthorne effect),” they wrote. “Furthermore, we did not inform the staff about the purpose of our study. We analyzed only objective outcome data to reduce reporting bias as much as possible.”

The finding of a decline in LOS “suggests potential cost savings after the implementation of SSCs,” they concluded. “Further trials should address this hypothesis and the effect on quality of care owing to a reduction of the costs of complications or unplanned reoperations.”

The study was supported by the Public Health Care Company of South Tyrol, Italy, and by the Autonomous Province of Bolzano, Italy. The researchers reported having no financial disclosures.

[email protected]

After implementation of surgical safety checklists in a tertiary care hospital, researchers observed a 27% reduction of risk-adjusted all-cause 90-day mortality, but adjusted all-cause 30-day mortality remained unchanged.

In addition, length of stay was reduced but 30-day readmission rate was not, according to the study published online in JAMA Surgery. Those key findings are from an effort to assess the association between the implementation of surgical safety checklists (SSCs) and rates of all-cause 90- and 30-day mortality.

©PixelEmbargo/Thinkstock

Previous studies have analyzed in-hospital mortality or 30-day mortality “but not intermediate-term outcome variables,” said lead author Dr. Matthias Bock of the department of anesthesiology and intensive care medicine at Merano Hospital, Merano, Italy. “Almost one-quarter (23.6%) of the deaths within 30 days after surgery occurred after discharge, and 39.7% of patients undergoing surgery experienced only post-discharge complications. Ninety-day mortality often doubles 30-day mortality. In-hospital mortality and 30-day mortality might therefore underreport the real risk to these patients, especially after tumor surgery or among the elderly. Studies of the effect or the association of the implementation of surgical safety checklists (SSCs) on 90-day mortality are lacking.”

Dr. Bock and his associates retrospectively evaluated the outcomes of surgical procedures performed during the six months before and six months after implementation of SSCs at the 715-bed Central Hospital of Bolzano (CHB) in Italy (Jan. 1-June 30, 2010, and Jan. 1-June 30, 2013, respectively). The key outcome measures were risk-adjusted rates of 90- and 30-day mortality, readmission rate, and LOS (JAMA Surg. 2016 Feb 3. doi:10.1001/jamasurg.2015.5490).

The study sample consisted of 10,741 patients, including 5,444 pre-intervention and 5,297 post-intervention patients. Of these, 53% were female and their mean age was 53 years.

The researchers reported that 90-day all-cause mortality was 2.4% before SSC implementation, compared with 2.2% after implementation, for an adjusted odds ratio (AOR) of 0.73 (P = .02). However, 30-day all-cause mortality was 1.36% before SSC implementation, compared with 1.32% after implementation, for an AOR of 0.79 (P = .17), remaining essentially unchanged.

Dr. Bock and his associates also found that 30-day readmission rates were similar in the pre-implementation and post-implementation groups (14.6% vs. 14.5%, respectively: P = .90), but the adjusted length of stay favored the post-implementation group (a mean of 9.6 days, compared with a mean of 10.4 days in the in the pre-implementation group; P less than .001).

The researchers acknowledged certain limitations of the study, including its single-center design and the lack of a control group. “The study design highly reduces the risk for observation bias (Hawthorne effect),” they wrote. “Furthermore, we did not inform the staff about the purpose of our study. We analyzed only objective outcome data to reduce reporting bias as much as possible.”

The finding of a decline in LOS “suggests potential cost savings after the implementation of SSCs,” they concluded. “Further trials should address this hypothesis and the effect on quality of care owing to a reduction of the costs of complications or unplanned reoperations.”

The study was supported by the Public Health Care Company of South Tyrol, Italy, and by the Autonomous Province of Bolzano, Italy. The researchers reported having no financial disclosures.

[email protected]

After implementation of surgical safety checklists in a tertiary care hospital, researchers observed a 27% reduction of risk-adjusted all-cause 90-day mortality, but adjusted all-cause 30-day mortality remained unchanged.

In addition, length of stay was reduced but 30-day readmission rate was not, according to the study published online in JAMA Surgery. Those key findings are from an effort to assess the association between the implementation of surgical safety checklists (SSCs) and rates of all-cause 90- and 30-day mortality.

©PixelEmbargo/Thinkstock

Previous studies have analyzed in-hospital mortality or 30-day mortality “but not intermediate-term outcome variables,” said lead author Dr. Matthias Bock of the department of anesthesiology and intensive care medicine at Merano Hospital, Merano, Italy. “Almost one-quarter (23.6%) of the deaths within 30 days after surgery occurred after discharge, and 39.7% of patients undergoing surgery experienced only post-discharge complications. Ninety-day mortality often doubles 30-day mortality. In-hospital mortality and 30-day mortality might therefore underreport the real risk to these patients, especially after tumor surgery or among the elderly. Studies of the effect or the association of the implementation of surgical safety checklists (SSCs) on 90-day mortality are lacking.”

Dr. Bock and his associates retrospectively evaluated the outcomes of surgical procedures performed during the six months before and six months after implementation of SSCs at the 715-bed Central Hospital of Bolzano (CHB) in Italy (Jan. 1-June 30, 2010, and Jan. 1-June 30, 2013, respectively). The key outcome measures were risk-adjusted rates of 90- and 30-day mortality, readmission rate, and LOS (JAMA Surg. 2016 Feb 3. doi:10.1001/jamasurg.2015.5490).

The study sample consisted of 10,741 patients, including 5,444 pre-intervention and 5,297 post-intervention patients. Of these, 53% were female and their mean age was 53 years.

The researchers reported that 90-day all-cause mortality was 2.4% before SSC implementation, compared with 2.2% after implementation, for an adjusted odds ratio (AOR) of 0.73 (P = .02). However, 30-day all-cause mortality was 1.36% before SSC implementation, compared with 1.32% after implementation, for an AOR of 0.79 (P = .17), remaining essentially unchanged.

Dr. Bock and his associates also found that 30-day readmission rates were similar in the pre-implementation and post-implementation groups (14.6% vs. 14.5%, respectively: P = .90), but the adjusted length of stay favored the post-implementation group (a mean of 9.6 days, compared with a mean of 10.4 days in the in the pre-implementation group; P less than .001).

The researchers acknowledged certain limitations of the study, including its single-center design and the lack of a control group. “The study design highly reduces the risk for observation bias (Hawthorne effect),” they wrote. “Furthermore, we did not inform the staff about the purpose of our study. We analyzed only objective outcome data to reduce reporting bias as much as possible.”

The finding of a decline in LOS “suggests potential cost savings after the implementation of SSCs,” they concluded. “Further trials should address this hypothesis and the effect on quality of care owing to a reduction of the costs of complications or unplanned reoperations.”

The study was supported by the Public Health Care Company of South Tyrol, Italy, and by the Autonomous Province of Bolzano, Italy. The researchers reported having no financial disclosures.

[email protected]

LOS ANGELES – Treatment with neoadjuvant chemotherapy leads to significant downstaging in a selected group of patients with advanced colon cancer, results from a large registry study showed.

“Neoadjuvant chemotherapy is already established as a treatment strategy in several other types of cancers, such as breast cancer, gastric cancer, and rectal cancer,” lead study author Dr. Moniek Verstegen said at the annual meeting of the American Society of Colon and Rectal Surgeons. “It reduces tumor size and promotes resectability. In colon cancer, however, this treatment strategy is relatively new and not applied very often.”

©BluePlanetEarth/thinkstockphotos.com

Preliminary results from the ongoing FOxTROT trial in the United Kingdom showed that preoperative chemotherapy for radiologically staged, locally advanced, operable primary colon cancer is feasible, with acceptable toxicity and perioperative morbidity, but long-term results are not yet available. The aim of the current study was to see how often neoadjuvant chemotherapy is used in the Netherlands for stage II and III colon cancer and to assess the tumor and nodal downsizing effects. Moreover, perioperative results and long-term outcomes were compared between those treated with neoadjuvant chemotherapy and those who were treated with adjuvant chemotherapy for locally advanced colon cancer.

The researchers searched the Netherlands Cancer Registry from 2008-2012 to identify 24,944 patients diagnosed with stage II and III colon cancer. Dr. Verstegen, a researcher in the department of surgery at Radboud University Medical Center, Nijmegen, Netherlands, reported results from 85 patients who received neoadjuvant chemotherapy and 2,216 who received adjuvant chemotherapy (the control group). Both groups were similar in terms of age (a median of about 65 years), gender, localization of the primary tumor, differentiation grade, morphology, and clinical T and N stage. Multivisceral resections were performed significantly more often in the neoadjuvant group, compared with the control group (21% vs. 5%, respectively; P less than .001). There were no differences between groups in the number of complete resections, nor in the rate of complications. Furthermore, no patient died within 30 days of neoadjuvant chemotherapy after surgery.

Tumor downstaging was observed in 47% of patients treated with neoadjuvant chemotherapy and there were three complete responses. At the same time, nodal downstaging was observed in 50% of patients treated with neoadjuvant chemotherapy. The 3-year overall survival was 73% in both groups.

Dr. Verstegen acknowledged certain limitations of the study, including its retrospective design and the lack of data on recurrences and disease-free survival. “Neoadjuvant chemotherapy seems to be a safe treatment strategy, since we have low postoperative morbidity and mortality rates,” she concluded. “We see comparable outcomes compared to the control group. Prospective trials are needed to confirm the safety and value of neoadjuvant chemotherapy.”

Dr. Verstegen reported having no financial disclosures.

[email protected]

LOS ANGELES – Treatment with neoadjuvant chemotherapy leads to significant downstaging in a selected group of patients with advanced colon cancer, results from a large registry study showed.

“Neoadjuvant chemotherapy is already established as a treatment strategy in several other types of cancers, such as breast cancer, gastric cancer, and rectal cancer,” lead study author Dr. Moniek Verstegen said at the annual meeting of the American Society of Colon and Rectal Surgeons. “It reduces tumor size and promotes resectability. In colon cancer, however, this treatment strategy is relatively new and not applied very often.”

©BluePlanetEarth/thinkstockphotos.com

Preliminary results from the ongoing FOxTROT trial in the United Kingdom showed that preoperative chemotherapy for radiologically staged, locally advanced, operable primary colon cancer is feasible, with acceptable toxicity and perioperative morbidity, but long-term results are not yet available. The aim of the current study was to see how often neoadjuvant chemotherapy is used in the Netherlands for stage II and III colon cancer and to assess the tumor and nodal downsizing effects. Moreover, perioperative results and long-term outcomes were compared between those treated with neoadjuvant chemotherapy and those who were treated with adjuvant chemotherapy for locally advanced colon cancer.

The researchers searched the Netherlands Cancer Registry from 2008-2012 to identify 24,944 patients diagnosed with stage II and III colon cancer. Dr. Verstegen, a researcher in the department of surgery at Radboud University Medical Center, Nijmegen, Netherlands, reported results from 85 patients who received neoadjuvant chemotherapy and 2,216 who received adjuvant chemotherapy (the control group). Both groups were similar in terms of age (a median of about 65 years), gender, localization of the primary tumor, differentiation grade, morphology, and clinical T and N stage. Multivisceral resections were performed significantly more often in the neoadjuvant group, compared with the control group (21% vs. 5%, respectively; P less than .001). There were no differences between groups in the number of complete resections, nor in the rate of complications. Furthermore, no patient died within 30 days of neoadjuvant chemotherapy after surgery.

Tumor downstaging was observed in 47% of patients treated with neoadjuvant chemotherapy and there were three complete responses. At the same time, nodal downstaging was observed in 50% of patients treated with neoadjuvant chemotherapy. The 3-year overall survival was 73% in both groups.

Dr. Verstegen acknowledged certain limitations of the study, including its retrospective design and the lack of data on recurrences and disease-free survival. “Neoadjuvant chemotherapy seems to be a safe treatment strategy, since we have low postoperative morbidity and mortality rates,” she concluded. “We see comparable outcomes compared to the control group. Prospective trials are needed to confirm the safety and value of neoadjuvant chemotherapy.”

Dr. Verstegen reported having no financial disclosures.

[email protected]

LOS ANGELES – Treatment with neoadjuvant chemotherapy leads to significant downstaging in a selected group of patients with advanced colon cancer, results from a large registry study showed.

“Neoadjuvant chemotherapy is already established as a treatment strategy in several other types of cancers, such as breast cancer, gastric cancer, and rectal cancer,” lead study author Dr. Moniek Verstegen said at the annual meeting of the American Society of Colon and Rectal Surgeons. “It reduces tumor size and promotes resectability. In colon cancer, however, this treatment strategy is relatively new and not applied very often.”

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Preliminary results from the ongoing FOxTROT trial in the United Kingdom showed that preoperative chemotherapy for radiologically staged, locally advanced, operable primary colon cancer is feasible, with acceptable toxicity and perioperative morbidity, but long-term results are not yet available. The aim of the current study was to see how often neoadjuvant chemotherapy is used in the Netherlands for stage II and III colon cancer and to assess the tumor and nodal downsizing effects. Moreover, perioperative results and long-term outcomes were compared between those treated with neoadjuvant chemotherapy and those who were treated with adjuvant chemotherapy for locally advanced colon cancer.

The researchers searched the Netherlands Cancer Registry from 2008-2012 to identify 24,944 patients diagnosed with stage II and III colon cancer. Dr. Verstegen, a researcher in the department of surgery at Radboud University Medical Center, Nijmegen, Netherlands, reported results from 85 patients who received neoadjuvant chemotherapy and 2,216 who received adjuvant chemotherapy (the control group). Both groups were similar in terms of age (a median of about 65 years), gender, localization of the primary tumor, differentiation grade, morphology, and clinical T and N stage. Multivisceral resections were performed significantly more often in the neoadjuvant group, compared with the control group (21% vs. 5%, respectively; P less than .001). There were no differences between groups in the number of complete resections, nor in the rate of complications. Furthermore, no patient died within 30 days of neoadjuvant chemotherapy after surgery.

Tumor downstaging was observed in 47% of patients treated with neoadjuvant chemotherapy and there were three complete responses. At the same time, nodal downstaging was observed in 50% of patients treated with neoadjuvant chemotherapy. The 3-year overall survival was 73% in both groups.

Dr. Verstegen acknowledged certain limitations of the study, including its retrospective design and the lack of data on recurrences and disease-free survival. “Neoadjuvant chemotherapy seems to be a safe treatment strategy, since we have low postoperative morbidity and mortality rates,” she concluded. “We see comparable outcomes compared to the control group. Prospective trials are needed to confirm the safety and value of neoadjuvant chemotherapy.”

Dr. Verstegen reported having no financial disclosures.

[email protected]

There was an outdoor equipment designer for a well-known Maine-based outfitter who was fond of saying that there was no such thing as bad weather, just bad or inappropriate clothing. The origin of this pearl is claimed by the Norwegians, the Germans, and the English – all nations that have some experience with inclement weather.

The folks who continue to go about their business regardless of the weather usually place a high value on the benefits of being outdoors. They often claim that they simply feel healthier when they are breathing fresh air. It is likely they have grown up in a place, in a family, and in a culture in which waiting for good weather to get something done means it’s not going to get done.

For example, my daughter-in-law’s visual impairment prevents her from driving a car. As a result, she and my two grandchildren get to almost all of their in-town destinations here in Brunswick, Maine, by bicycle or on foot ... 12 months a year ... rain or shine. They can afford appropriate clothing, but they still get wet and cold from time to time. I have never heard them complain. They accept bad weather as a given just as much as they accept a sunny day as something to enjoy.

While my grandchildren’s attitude toward the weather may not be typical of most 9- and 11-year-olds, they may not be alone in a few decades. Preschools are popping up around the country that not only accept the vagaries in the weather, but embrace the outdoors as an educational tool (“Preschool Without Walls,” by Lillian Mongeau, the New York Times, Dec. 29, 2015). The Natural Start Alliance, founded in 2013, has a membership of 92 preschools whose students spend a significant portion of their school day playing and exploring outdoors rain or shine. While most of these schools emphasize the value of learning from the natural environment, one of my granddaughters attended an outdoors-rain-or-shine preschool in urban San Francisco.

At the other end of the spectrum are the schools that feel obligated to shield their students from the realities of meteorological variability. While excessive sun exposure and tissue-freezing wind chills are to be avoided, a crisp calm sunny day with temperatures in the middle teens can be fun, particularly if there is some dry snow to tromp around in. However, during the months from November 2014 to March 2015, the children who attended Public School 126 in New York City were not given the opportunity to play outside on more than 40 school days. The situation is complicated because their school, which lacks its own playground, must rely on nearby parks (“A Casualty of a Frigid New York Winter: Outdoor School Recess,” by Ginia Bellafante, the New York Times, March 6, 2015). But we aren’t talking Siberia. It was a colder-than-usual winter, but I suspect there must have been more than a few missed opportunities to go outside and enjoy the snow. I wonder how often the decision to stay inside was influenced by teachers and administrators who hadn’t come prepared to spend any more time outside than it took them to walk from the parking lot or bus stop.

The data are accumulating that adding physical activity to the school day improves student behavior and even promotes learning. The evidence that being outside is beneficial is a bit more difficult to find. Early in the last century, when indoor air was saturated with smoke from cooking and open combustion heating sources, many physicians recommended that even for infants, raising a healthy child meant having the child spend a large part of the day outdoors.

It’s time for pediatricians to spread the word to parents that their little darlings won’t catch pneumonia from playing outdoors on a cool damp day. Nor will they shrink if they get a little wet on a rainy day ... but they will run ... and the running will be good for them.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.”

There was an outdoor equipment designer for a well-known Maine-based outfitter who was fond of saying that there was no such thing as bad weather, just bad or inappropriate clothing. The origin of this pearl is claimed by the Norwegians, the Germans, and the English – all nations that have some experience with inclement weather.

The folks who continue to go about their business regardless of the weather usually place a high value on the benefits of being outdoors. They often claim that they simply feel healthier when they are breathing fresh air. It is likely they have grown up in a place, in a family, and in a culture in which waiting for good weather to get something done means it’s not going to get done.

For example, my daughter-in-law’s visual impairment prevents her from driving a car. As a result, she and my two grandchildren get to almost all of their in-town destinations here in Brunswick, Maine, by bicycle or on foot ... 12 months a year ... rain or shine. They can afford appropriate clothing, but they still get wet and cold from time to time. I have never heard them complain. They accept bad weather as a given just as much as they accept a sunny day as something to enjoy.

While my grandchildren’s attitude toward the weather may not be typical of most 9- and 11-year-olds, they may not be alone in a few decades. Preschools are popping up around the country that not only accept the vagaries in the weather, but embrace the outdoors as an educational tool (“Preschool Without Walls,” by Lillian Mongeau, the New York Times, Dec. 29, 2015). The Natural Start Alliance, founded in 2013, has a membership of 92 preschools whose students spend a significant portion of their school day playing and exploring outdoors rain or shine. While most of these schools emphasize the value of learning from the natural environment, one of my granddaughters attended an outdoors-rain-or-shine preschool in urban San Francisco.

At the other end of the spectrum are the schools that feel obligated to shield their students from the realities of meteorological variability. While excessive sun exposure and tissue-freezing wind chills are to be avoided, a crisp calm sunny day with temperatures in the middle teens can be fun, particularly if there is some dry snow to tromp around in. However, during the months from November 2014 to March 2015, the children who attended Public School 126 in New York City were not given the opportunity to play outside on more than 40 school days. The situation is complicated because their school, which lacks its own playground, must rely on nearby parks (“A Casualty of a Frigid New York Winter: Outdoor School Recess,” by Ginia Bellafante, the New York Times, March 6, 2015). But we aren’t talking Siberia. It was a colder-than-usual winter, but I suspect there must have been more than a few missed opportunities to go outside and enjoy the snow. I wonder how often the decision to stay inside was influenced by teachers and administrators who hadn’t come prepared to spend any more time outside than it took them to walk from the parking lot or bus stop.

The data are accumulating that adding physical activity to the school day improves student behavior and even promotes learning. The evidence that being outside is beneficial is a bit more difficult to find. Early in the last century, when indoor air was saturated with smoke from cooking and open combustion heating sources, many physicians recommended that even for infants, raising a healthy child meant having the child spend a large part of the day outdoors.

It’s time for pediatricians to spread the word to parents that their little darlings won’t catch pneumonia from playing outdoors on a cool damp day. Nor will they shrink if they get a little wet on a rainy day ... but they will run ... and the running will be good for them.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.”

There was an outdoor equipment designer for a well-known Maine-based outfitter who was fond of saying that there was no such thing as bad weather, just bad or inappropriate clothing. The origin of this pearl is claimed by the Norwegians, the Germans, and the English – all nations that have some experience with inclement weather.

The folks who continue to go about their business regardless of the weather usually place a high value on the benefits of being outdoors. They often claim that they simply feel healthier when they are breathing fresh air. It is likely they have grown up in a place, in a family, and in a culture in which waiting for good weather to get something done means it’s not going to get done.

For example, my daughter-in-law’s visual impairment prevents her from driving a car. As a result, she and my two grandchildren get to almost all of their in-town destinations here in Brunswick, Maine, by bicycle or on foot ... 12 months a year ... rain or shine. They can afford appropriate clothing, but they still get wet and cold from time to time. I have never heard them complain. They accept bad weather as a given just as much as they accept a sunny day as something to enjoy.

While my grandchildren’s attitude toward the weather may not be typical of most 9- and 11-year-olds, they may not be alone in a few decades. Preschools are popping up around the country that not only accept the vagaries in the weather, but embrace the outdoors as an educational tool (“Preschool Without Walls,” by Lillian Mongeau, the New York Times, Dec. 29, 2015). The Natural Start Alliance, founded in 2013, has a membership of 92 preschools whose students spend a significant portion of their school day playing and exploring outdoors rain or shine. While most of these schools emphasize the value of learning from the natural environment, one of my granddaughters attended an outdoors-rain-or-shine preschool in urban San Francisco.

At the other end of the spectrum are the schools that feel obligated to shield their students from the realities of meteorological variability. While excessive sun exposure and tissue-freezing wind chills are to be avoided, a crisp calm sunny day with temperatures in the middle teens can be fun, particularly if there is some dry snow to tromp around in. However, during the months from November 2014 to March 2015, the children who attended Public School 126 in New York City were not given the opportunity to play outside on more than 40 school days. The situation is complicated because their school, which lacks its own playground, must rely on nearby parks (“A Casualty of a Frigid New York Winter: Outdoor School Recess,” by Ginia Bellafante, the New York Times, March 6, 2015). But we aren’t talking Siberia. It was a colder-than-usual winter, but I suspect there must have been more than a few missed opportunities to go outside and enjoy the snow. I wonder how often the decision to stay inside was influenced by teachers and administrators who hadn’t come prepared to spend any more time outside than it took them to walk from the parking lot or bus stop.

The data are accumulating that adding physical activity to the school day improves student behavior and even promotes learning. The evidence that being outside is beneficial is a bit more difficult to find. Early in the last century, when indoor air was saturated with smoke from cooking and open combustion heating sources, many physicians recommended that even for infants, raising a healthy child meant having the child spend a large part of the day outdoors.

It’s time for pediatricians to spread the word to parents that their little darlings won’t catch pneumonia from playing outdoors on a cool damp day. Nor will they shrink if they get a little wet on a rainy day ... but they will run ... and the running will be good for them.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.”

CHICAGO – Adjuvant temozolomide given after radiation therapy improves survival of patients with a form of anaplastic glioma, a rare brain tumor. The patients had anaplastic glioma without 1p/19q co-deletion.

This co-deletion – the short arm of chromosome 1 and the long arm of chromosome 19 – is a favorable marker in the tumor, and patients without the deletion have traditionally done worse than those with the deletion. Until this study, no one knew if temozolomide would improve outcomes of patients without the co-deletion.

The four-arm, Phase III Trial on Concurrent and Adjuvant Temozolomide [TMZ] Chemotherapy in NON-1p/19q Deleted Anaplastic Glioma: The CATNON Intergroup Trial (EORTC 26053-22054), still ongoing, is testing radiotherapy, radiotherapy plus concurrent TMZ, radiotherapy plus 12 months of adjuvant TMZ, or radiotherapy plus concurrent TMZ plus 12 months of adjuvant TMZ. Adjuvant TMZ was given in 12 cycles.

Given the rarity of the tumor, the trial involved 118 institutions on three continents and ran for eight years between 2007 and 2015. From 1407 patients 18 years or older with World Health Organization performance status 0-2 screened, 751 were confirmed to have grade III anaplastic gliomas that were intact for 1p/19q (ie, no deletions). After radiation therapy with 59.4 Gy in 33 fractions, these patients were randomly assigned to one of the four treatment arms.

The trial asked two questions: Does adjuvant chemotherapy after radiotherapy improve outcome, and does chemotherapy concurrent with radiotherapy improve outcomes?

Just after enrollment was completed, a data monitoring committee recommended, based on an interim analysis in October 2015, that the data for the adjuvant arm be released, reported Dr. Martin van den Bent, professor of neuro-oncology at Erasmus MC Cancer Center in Rotterdam, The Netherlands. “It completely came as a surprise,” he said at a press conference at the annual meeting of the American Society of Clinical Oncology.

Comparing radiation with or without concurrent TMZ followed by adjuvant TMZ to treatment without adjuvant therapy, the overall survival at five years increased from 44% without any TMZ or with TMZ concurrent with radiation (n = 372) to 56% with adjuvant temozolomide (n = 373). “This corresponds to a hazard ratio of 0.67, a highly statistically significant increment,” Dr. van den Bent said.

Adjuvant TMZ was also associated with a statistically significant increase in median progression free survival from 19 months without adjuvant therapy to almost 43 months with it.

When patients were stratified by O6-methyl-guanine DNA methyltransferase (MGMT) promoter methylation status, the researchers found that MGMT methylation was prognostic for overall survival but not predictive of improved outcome to adjuvant TMZ.

For the nonadjuvant group, the median overall survival was 41 months (95% CI, 37-61 months), but the groups receiving adjuvant TMZ had not yet reached a median overall survival. “We know now that temozolomide given after radiation therapy improves survival in this disease,” Dr. van den Bent said.

A trial of such a rare disease requires many collaborating centers and oncology groups and a long duration to show improvements in outcome. Collaborating oncology groups across many countries “have shown the capacity to answer important clinical questions in orphan diseases,” he said.

Press conference moderator Dr. Don Dizon of Massachusetts General Hospital, Boston, said, “I think this illustrates… the theme of this year’s meeting, which is Collective Wisdom, and even more than that it illustrates that even with a rare tumor type and using standard chemotherapy it’s very important, and we can select patients who are most likely to benefit from treatment and at the same time potentially spare patients from the toxicities of therapy that they’re unlikely to benefit from.”

Results from the arm of the trial testing temozolomide given only at the time of radiation therapy are not yet available and are expected in 2020. In addition, investigators plan to assess genetic abnormalities that are known to affect prognosis in the disease, specifically MGMT promoter methylation and IDH (isocitrate dehydrogenase) mutation.

Common toxicities with temozolomide were mainly low platelet and white cell counts with severe toxicity in 5-10% of patients.

CHICAGO – Adjuvant temozolomide given after radiation therapy improves survival of patients with a form of anaplastic glioma, a rare brain tumor. The patients had anaplastic glioma without 1p/19q co-deletion.

This co-deletion – the short arm of chromosome 1 and the long arm of chromosome 19 – is a favorable marker in the tumor, and patients without the deletion have traditionally done worse than those with the deletion. Until this study, no one knew if temozolomide would improve outcomes of patients without the co-deletion.

The four-arm, Phase III Trial on Concurrent and Adjuvant Temozolomide [TMZ] Chemotherapy in NON-1p/19q Deleted Anaplastic Glioma: The CATNON Intergroup Trial (EORTC 26053-22054), still ongoing, is testing radiotherapy, radiotherapy plus concurrent TMZ, radiotherapy plus 12 months of adjuvant TMZ, or radiotherapy plus concurrent TMZ plus 12 months of adjuvant TMZ. Adjuvant TMZ was given in 12 cycles.

Given the rarity of the tumor, the trial involved 118 institutions on three continents and ran for eight years between 2007 and 2015. From 1407 patients 18 years or older with World Health Organization performance status 0-2 screened, 751 were confirmed to have grade III anaplastic gliomas that were intact for 1p/19q (ie, no deletions). After radiation therapy with 59.4 Gy in 33 fractions, these patients were randomly assigned to one of the four treatment arms.

The trial asked two questions: Does adjuvant chemotherapy after radiotherapy improve outcome, and does chemotherapy concurrent with radiotherapy improve outcomes?

Just after enrollment was completed, a data monitoring committee recommended, based on an interim analysis in October 2015, that the data for the adjuvant arm be released, reported Dr. Martin van den Bent, professor of neuro-oncology at Erasmus MC Cancer Center in Rotterdam, The Netherlands. “It completely came as a surprise,” he said at a press conference at the annual meeting of the American Society of Clinical Oncology.

Comparing radiation with or without concurrent TMZ followed by adjuvant TMZ to treatment without adjuvant therapy, the overall survival at five years increased from 44% without any TMZ or with TMZ concurrent with radiation (n = 372) to 56% with adjuvant temozolomide (n = 373). “This corresponds to a hazard ratio of 0.67, a highly statistically significant increment,” Dr. van den Bent said.

Adjuvant TMZ was also associated with a statistically significant increase in median progression free survival from 19 months without adjuvant therapy to almost 43 months with it.

When patients were stratified by O6-methyl-guanine DNA methyltransferase (MGMT) promoter methylation status, the researchers found that MGMT methylation was prognostic for overall survival but not predictive of improved outcome to adjuvant TMZ.

For the nonadjuvant group, the median overall survival was 41 months (95% CI, 37-61 months), but the groups receiving adjuvant TMZ had not yet reached a median overall survival. “We know now that temozolomide given after radiation therapy improves survival in this disease,” Dr. van den Bent said.

A trial of such a rare disease requires many collaborating centers and oncology groups and a long duration to show improvements in outcome. Collaborating oncology groups across many countries “have shown the capacity to answer important clinical questions in orphan diseases,” he said.

Press conference moderator Dr. Don Dizon of Massachusetts General Hospital, Boston, said, “I think this illustrates… the theme of this year’s meeting, which is Collective Wisdom, and even more than that it illustrates that even with a rare tumor type and using standard chemotherapy it’s very important, and we can select patients who are most likely to benefit from treatment and at the same time potentially spare patients from the toxicities of therapy that they’re unlikely to benefit from.”

Results from the arm of the trial testing temozolomide given only at the time of radiation therapy are not yet available and are expected in 2020. In addition, investigators plan to assess genetic abnormalities that are known to affect prognosis in the disease, specifically MGMT promoter methylation and IDH (isocitrate dehydrogenase) mutation.

Common toxicities with temozolomide were mainly low platelet and white cell counts with severe toxicity in 5-10% of patients.

CHICAGO – Adjuvant temozolomide given after radiation therapy improves survival of patients with a form of anaplastic glioma, a rare brain tumor. The patients had anaplastic glioma without 1p/19q co-deletion.

This co-deletion – the short arm of chromosome 1 and the long arm of chromosome 19 – is a favorable marker in the tumor, and patients without the deletion have traditionally done worse than those with the deletion. Until this study, no one knew if temozolomide would improve outcomes of patients without the co-deletion.

The four-arm, Phase III Trial on Concurrent and Adjuvant Temozolomide [TMZ] Chemotherapy in NON-1p/19q Deleted Anaplastic Glioma: The CATNON Intergroup Trial (EORTC 26053-22054), still ongoing, is testing radiotherapy, radiotherapy plus concurrent TMZ, radiotherapy plus 12 months of adjuvant TMZ, or radiotherapy plus concurrent TMZ plus 12 months of adjuvant TMZ. Adjuvant TMZ was given in 12 cycles.

Given the rarity of the tumor, the trial involved 118 institutions on three continents and ran for eight years between 2007 and 2015. From 1407 patients 18 years or older with World Health Organization performance status 0-2 screened, 751 were confirmed to have grade III anaplastic gliomas that were intact for 1p/19q (ie, no deletions). After radiation therapy with 59.4 Gy in 33 fractions, these patients were randomly assigned to one of the four treatment arms.

The trial asked two questions: Does adjuvant chemotherapy after radiotherapy improve outcome, and does chemotherapy concurrent with radiotherapy improve outcomes?

Just after enrollment was completed, a data monitoring committee recommended, based on an interim analysis in October 2015, that the data for the adjuvant arm be released, reported Dr. Martin van den Bent, professor of neuro-oncology at Erasmus MC Cancer Center in Rotterdam, The Netherlands. “It completely came as a surprise,” he said at a press conference at the annual meeting of the American Society of Clinical Oncology.

Comparing radiation with or without concurrent TMZ followed by adjuvant TMZ to treatment without adjuvant therapy, the overall survival at five years increased from 44% without any TMZ or with TMZ concurrent with radiation (n = 372) to 56% with adjuvant temozolomide (n = 373). “This corresponds to a hazard ratio of 0.67, a highly statistically significant increment,” Dr. van den Bent said.

Adjuvant TMZ was also associated with a statistically significant increase in median progression free survival from 19 months without adjuvant therapy to almost 43 months with it.

When patients were stratified by O6-methyl-guanine DNA methyltransferase (MGMT) promoter methylation status, the researchers found that MGMT methylation was prognostic for overall survival but not predictive of improved outcome to adjuvant TMZ.

For the nonadjuvant group, the median overall survival was 41 months (95% CI, 37-61 months), but the groups receiving adjuvant TMZ had not yet reached a median overall survival. “We know now that temozolomide given after radiation therapy improves survival in this disease,” Dr. van den Bent said.

A trial of such a rare disease requires many collaborating centers and oncology groups and a long duration to show improvements in outcome. Collaborating oncology groups across many countries “have shown the capacity to answer important clinical questions in orphan diseases,” he said.

Press conference moderator Dr. Don Dizon of Massachusetts General Hospital, Boston, said, “I think this illustrates… the theme of this year’s meeting, which is Collective Wisdom, and even more than that it illustrates that even with a rare tumor type and using standard chemotherapy it’s very important, and we can select patients who are most likely to benefit from treatment and at the same time potentially spare patients from the toxicities of therapy that they’re unlikely to benefit from.”

Results from the arm of the trial testing temozolomide given only at the time of radiation therapy are not yet available and are expected in 2020. In addition, investigators plan to assess genetic abnormalities that are known to affect prognosis in the disease, specifically MGMT promoter methylation and IDH (isocitrate dehydrogenase) mutation.

Common toxicities with temozolomide were mainly low platelet and white cell counts with severe toxicity in 5-10% of patients.

CHICAGO – Up-front high-dose melphalan and autologous stem cell transplantation (ASCT) was superior to bortezomib-melphalan-prednisone (VMP) for fit patients younger than age 65 years with newly diagnosed multiple myeloma, based on the interim results from a randomized study of the European Myeloma Network.

With more than 1,200 patients, the study is the largest trial yet to show superior progression-free survival for ASCT. Follow-up has been too short to show significance for overall survival.

“Up-front ASCT was associated with a significant improvement in progression-free survival as compared to bortezomib-melphalan-prednisone in the overall patient population, (and the advantage) was retained across prespecified subgroups of patients at low and high risk … (as well as) in a multivariate analysis” of the overall population, Dr. Michele Cavo of the University of Bologna, Italy, reported at the annual meeting of the American Society of Clinical Oncology. “Up-front high-dose melphalan and ASCT continue to be the reference treatment choice for fit patients with newly diagnosed multiple myeloma, even in the novel agent era.”

ASCT was associated with higher rates of grade 3 or more adverse events in nearly every category, however, with the exception of peripheral nephropathy.

For the study, 1,266 patients, stratified by International Staging System stage and FISH (fluorescence in situ hybridization) analysis, were randomized to either VMP (512 pts) or to high-dose melphalan and ASCT (754 pts). At the meeting, Dr. Cavo reported on the study’s interim outcome results in 695 patients who had ASCT and 497 newly diagnosed patients who received VMP.

At 3 years, progression-free survival rates were 66.1% in the ASCT patients and 57.5% in the VMP patients. The median progression-free survival had not yet been reached in the ASCT patients and was 44 months in the bortezomib-melphalan-prednisone patients. (hazard ratio, 95% confidence interval, 0.73 [0.59-0.90]; P = .003).

Stringent complete responses were seen in 18.2% of patients in the VMP group and 17% of the ASCT group; Complete responses occurred in 25.3% of both groups. The main difference observed was in the number of very good partial responses, seen in 30.4% of the VMP group and in 43.2% of the ASCT group. Also, 11.2% of those in the VMP group had less than a partial response while that was the case for only 3.3% of the ASCT group.

Alternatively, the rate of grade 3 or more adverse events was higher in the ASCT group, with 17.5% experiencing febrile neutropenia, 15.6% mucositis, 3.2% sepsis, and 2.6% respiratory infections. The rates of these side effects in the VMP group were 0.2%, 0%, 0%, and 1.7%, respectively. The only grade 3 or more adverse event seen with greater frequency in the VMP group was peripheral neuropathy, seen in 13.8% as compared with 1.6% in the ASCT group.

Dr. Cavo receives honoraria from Amgen, Bristol-Myers Squibb, Celgene, Janssen, and Takeda. He serves as a consultant or advisor to and is on the speakers bureau for Amgen. Celgene, Janssen.

Abstract 8000

[email protected]

On Twitter @maryjodales

This story was updated on June 10, 2016.

CHICAGO – Up-front high-dose melphalan and autologous stem cell transplantation (ASCT) was superior to bortezomib-melphalan-prednisone (VMP) for fit patients younger than age 65 years with newly diagnosed multiple myeloma, based on the interim results from a randomized study of the European Myeloma Network.

With more than 1,200 patients, the study is the largest trial yet to show superior progression-free survival for ASCT. Follow-up has been too short to show significance for overall survival.

“Up-front ASCT was associated with a significant improvement in progression-free survival as compared to bortezomib-melphalan-prednisone in the overall patient population, (and the advantage) was retained across prespecified subgroups of patients at low and high risk … (as well as) in a multivariate analysis” of the overall population, Dr. Michele Cavo of the University of Bologna, Italy, reported at the annual meeting of the American Society of Clinical Oncology. “Up-front high-dose melphalan and ASCT continue to be the reference treatment choice for fit patients with newly diagnosed multiple myeloma, even in the novel agent era.”

ASCT was associated with higher rates of grade 3 or more adverse events in nearly every category, however, with the exception of peripheral nephropathy.

For the study, 1,266 patients, stratified by International Staging System stage and FISH (fluorescence in situ hybridization) analysis, were randomized to either VMP (512 pts) or to high-dose melphalan and ASCT (754 pts). At the meeting, Dr. Cavo reported on the study’s interim outcome results in 695 patients who had ASCT and 497 newly diagnosed patients who received VMP.

At 3 years, progression-free survival rates were 66.1% in the ASCT patients and 57.5% in the VMP patients. The median progression-free survival had not yet been reached in the ASCT patients and was 44 months in the bortezomib-melphalan-prednisone patients. (hazard ratio, 95% confidence interval, 0.73 [0.59-0.90]; P = .003).

Stringent complete responses were seen in 18.2% of patients in the VMP group and 17% of the ASCT group; Complete responses occurred in 25.3% of both groups. The main difference observed was in the number of very good partial responses, seen in 30.4% of the VMP group and in 43.2% of the ASCT group. Also, 11.2% of those in the VMP group had less than a partial response while that was the case for only 3.3% of the ASCT group.

Alternatively, the rate of grade 3 or more adverse events was higher in the ASCT group, with 17.5% experiencing febrile neutropenia, 15.6% mucositis, 3.2% sepsis, and 2.6% respiratory infections. The rates of these side effects in the VMP group were 0.2%, 0%, 0%, and 1.7%, respectively. The only grade 3 or more adverse event seen with greater frequency in the VMP group was peripheral neuropathy, seen in 13.8% as compared with 1.6% in the ASCT group.

Dr. Cavo receives honoraria from Amgen, Bristol-Myers Squibb, Celgene, Janssen, and Takeda. He serves as a consultant or advisor to and is on the speakers bureau for Amgen. Celgene, Janssen.

Abstract 8000

[email protected]

On Twitter @maryjodales

This story was updated on June 10, 2016.

CHICAGO – Up-front high-dose melphalan and autologous stem cell transplantation (ASCT) was superior to bortezomib-melphalan-prednisone (VMP) for fit patients younger than age 65 years with newly diagnosed multiple myeloma, based on the interim results from a randomized study of the European Myeloma Network.

With more than 1,200 patients, the study is the largest trial yet to show superior progression-free survival for ASCT. Follow-up has been too short to show significance for overall survival.

“Up-front ASCT was associated with a significant improvement in progression-free survival as compared to bortezomib-melphalan-prednisone in the overall patient population, (and the advantage) was retained across prespecified subgroups of patients at low and high risk … (as well as) in a multivariate analysis” of the overall population, Dr. Michele Cavo of the University of Bologna, Italy, reported at the annual meeting of the American Society of Clinical Oncology. “Up-front high-dose melphalan and ASCT continue to be the reference treatment choice for fit patients with newly diagnosed multiple myeloma, even in the novel agent era.”

ASCT was associated with higher rates of grade 3 or more adverse events in nearly every category, however, with the exception of peripheral nephropathy.

For the study, 1,266 patients, stratified by International Staging System stage and FISH (fluorescence in situ hybridization) analysis, were randomized to either VMP (512 pts) or to high-dose melphalan and ASCT (754 pts). At the meeting, Dr. Cavo reported on the study’s interim outcome results in 695 patients who had ASCT and 497 newly diagnosed patients who received VMP.

At 3 years, progression-free survival rates were 66.1% in the ASCT patients and 57.5% in the VMP patients. The median progression-free survival had not yet been reached in the ASCT patients and was 44 months in the bortezomib-melphalan-prednisone patients. (hazard ratio, 95% confidence interval, 0.73 [0.59-0.90]; P = .003).

Stringent complete responses were seen in 18.2% of patients in the VMP group and 17% of the ASCT group; Complete responses occurred in 25.3% of both groups. The main difference observed was in the number of very good partial responses, seen in 30.4% of the VMP group and in 43.2% of the ASCT group. Also, 11.2% of those in the VMP group had less than a partial response while that was the case for only 3.3% of the ASCT group.

Alternatively, the rate of grade 3 or more adverse events was higher in the ASCT group, with 17.5% experiencing febrile neutropenia, 15.6% mucositis, 3.2% sepsis, and 2.6% respiratory infections. The rates of these side effects in the VMP group were 0.2%, 0%, 0%, and 1.7%, respectively. The only grade 3 or more adverse event seen with greater frequency in the VMP group was peripheral neuropathy, seen in 13.8% as compared with 1.6% in the ASCT group.

Dr. Cavo receives honoraria from Amgen, Bristol-Myers Squibb, Celgene, Janssen, and Takeda. He serves as a consultant or advisor to and is on the speakers bureau for Amgen. Celgene, Janssen.

Abstract 8000

[email protected]

On Twitter @maryjodales

This story was updated on June 10, 2016.

SHM’s implementation toolkits provide hospitalists with the resources they need to lead quality improvement projects on a variety of clinical topics, including a new toolkit on venous thromboembolism (VTE) released in May. The new toolkit features a literature review, an implementation guide, and additional reference materials, such as discharge instructions and checklists. Be on the lookout for information about an upcoming webinar series on the treatment of patients with VTE with free CME.

Don’t miss other online toolkits and implementation guides from SHM, covering:

• COPD
• Acute coronary syndrome
• Pain management
• Glycemic control

Check out all available toolkits at www.hospitalmedicine.org/qi.

---

Brett Radler is SHM’s communications coordinator.

SHM’s implementation toolkits provide hospitalists with the resources they need to lead quality improvement projects on a variety of clinical topics, including a new toolkit on venous thromboembolism (VTE) released in May. The new toolkit features a literature review, an implementation guide, and additional reference materials, such as discharge instructions and checklists. Be on the lookout for information about an upcoming webinar series on the treatment of patients with VTE with free CME.

Don’t miss other online toolkits and implementation guides from SHM, covering:

• COPD
• Acute coronary syndrome
• Pain management
• Glycemic control

Check out all available toolkits at www.hospitalmedicine.org/qi.

---

Brett Radler is SHM’s communications coordinator.

SHM’s implementation toolkits provide hospitalists with the resources they need to lead quality improvement projects on a variety of clinical topics, including a new toolkit on venous thromboembolism (VTE) released in May. The new toolkit features a literature review, an implementation guide, and additional reference materials, such as discharge instructions and checklists. Be on the lookout for information about an upcoming webinar series on the treatment of patients with VTE with free CME.

Don’t miss other online toolkits and implementation guides from SHM, covering:

• COPD
• Acute coronary syndrome
• Pain management
• Glycemic control

Check out all available toolkits at www.hospitalmedicine.org/qi.

---

Brett Radler is SHM’s communications coordinator.

The Society of Hospital Medicine and the Journal of Hospital Medicine (JHM) are excited to announce the fourth installment in our #JHMChat Twitter chat series, which brings the latest hospital medicine research from JHM to Twitter and the bedside. We invite you to join us on Twitter on Monday, July 11, at 9 p.m. EDT.

During the chat, we invite you to join the conversation with Robert Mahoney, MD, associate professor of medicine at the Washington University School of Medicine, and Vinny Arora, MD, #JHMChat moderator and JHM deputy editor, to discuss the recent JHM publication “As-Needed Intravenous Antihypertensive Therapy and Blood Pressure Control.”

Participating in a #JHMChat allows you to have a dialogue with experts in the field conducting research with implications for your daily practice, network with fellow hospital medicine professionals, and lend your expertise to help others improve patient care. As you get ready for the chat, follow us and our Twitter partners:

• @JHospMedicine (Journal of Hospital Medicine)
• @SHMLive (Society of Hospital Medicine)
• @mahoneyr (Dr. Mahoney)
• @FutureDocs (Dr. Arora)
• @CostsofCare and @ABIMFoundation (#JHMChat partners)

On chat day, don’t forget to include #JHMChat in each of your tweets related to the chat to make sure all participants see them and are able to respond. To learn more, read the featured paper, and check out transcripts from our first three chats, visit www.hospitalmedicine.org/jhmchat.

See you on Twitter!

---

Brett Radler is SHM’s communications coordinator.

The Society of Hospital Medicine and the Journal of Hospital Medicine (JHM) are excited to announce the fourth installment in our #JHMChat Twitter chat series, which brings the latest hospital medicine research from JHM to Twitter and the bedside. We invite you to join us on Twitter on Monday, July 11, at 9 p.m. EDT.

During the chat, we invite you to join the conversation with Robert Mahoney, MD, associate professor of medicine at the Washington University School of Medicine, and Vinny Arora, MD, #JHMChat moderator and JHM deputy editor, to discuss the recent JHM publication “As-Needed Intravenous Antihypertensive Therapy and Blood Pressure Control.”

Participating in a #JHMChat allows you to have a dialogue with experts in the field conducting research with implications for your daily practice, network with fellow hospital medicine professionals, and lend your expertise to help others improve patient care. As you get ready for the chat, follow us and our Twitter partners:

• @JHospMedicine (Journal of Hospital Medicine)
• @SHMLive (Society of Hospital Medicine)
• @mahoneyr (Dr. Mahoney)
• @FutureDocs (Dr. Arora)
• @CostsofCare and @ABIMFoundation (#JHMChat partners)

On chat day, don’t forget to include #JHMChat in each of your tweets related to the chat to make sure all participants see them and are able to respond. To learn more, read the featured paper, and check out transcripts from our first three chats, visit www.hospitalmedicine.org/jhmchat.

See you on Twitter!

---

Brett Radler is SHM’s communications coordinator.

The Society of Hospital Medicine and the Journal of Hospital Medicine (JHM) are excited to announce the fourth installment in our #JHMChat Twitter chat series, which brings the latest hospital medicine research from JHM to Twitter and the bedside. We invite you to join us on Twitter on Monday, July 11, at 9 p.m. EDT.

During the chat, we invite you to join the conversation with Robert Mahoney, MD, associate professor of medicine at the Washington University School of Medicine, and Vinny Arora, MD, #JHMChat moderator and JHM deputy editor, to discuss the recent JHM publication “As-Needed Intravenous Antihypertensive Therapy and Blood Pressure Control.”

Participating in a #JHMChat allows you to have a dialogue with experts in the field conducting research with implications for your daily practice, network with fellow hospital medicine professionals, and lend your expertise to help others improve patient care. As you get ready for the chat, follow us and our Twitter partners:

• @JHospMedicine (Journal of Hospital Medicine)
• @SHMLive (Society of Hospital Medicine)
• @mahoneyr (Dr. Mahoney)
• @FutureDocs (Dr. Arora)
• @CostsofCare and @ABIMFoundation (#JHMChat partners)

On chat day, don’t forget to include #JHMChat in each of your tweets related to the chat to make sure all participants see them and are able to respond. To learn more, read the featured paper, and check out transcripts from our first three chats, visit www.hospitalmedicine.org/jhmchat.

See you on Twitter!

---

Brett Radler is SHM’s communications coordinator.

Researchers say they may have found a new use for an ancient anti-inflammatory drug, salicylate, which was first described by the Greek physician Hippocrates.

“Salicylic acid is one of the oldest drugs on the planet,” said senior author Eric Verdin, MD, of the Gladstone Institutes/UCSF, “dating back to the Egyptians and the Greeks, but we're still discovering new things about it.”

Its derivatives, acetylsalicylic acid, or aspirin, and diflunisal suppress 2 key proteins, CREB-binding protein (CBP) and p300, which control levels of proteins that cause inflammation or are involved in cell growth.

By inhibiting p300 and CBP, salicylic acid and diflunisal block the activation of these proteins and prevent cellular damage caused by inflammation. The research team believes that both p300 and CBP can be targeted by drugs, which would have important clinical implications.

Earlier research conducted by coauthor Stephen D. Nimer, MD, of the University of Miami Miller School of Medicine in Florida, and colleagues found a link between p300 and the leukemia-promoting protein AML1-ETO.

In the current study, published in eLife, researchers tested whether suppressing p300 with diflunisal would suppress leukemia growth in mice.

The research team inoculated SCID mice with Kasumi-1 cells, an AML cell line with the t(8;21) translocation, which represents one of the subtypes of CBF leukemia.

Three weeks later, they started treating the mice with diflunisal. Diflunisal reduced tumor size in a dose-dependent manner, and after 3 weeks of treatment, the tumors were significantly smaller than in the vehicle-treated control mice.

In fact, the researchers noted most tumors disappeared in mice treated with higher doses of diflunisal. The researchers also pointed out that diflunisal, an FDA-approved drug containing a salicylic acid substructure, inhibited CBP/p300 more potently than salicylate.

The researchers concluded that diflunisal and salicylate have promise as an oral therapy for AML patients with a t(8;21) translocation, and called it “an exciting potential application” for this new characterization of older drugs.

“Uncovering this pathway of inflammation that salicylic acid acts upon opens up a host of new clinical possibilities for these drugs,” Dr Verdin added.

The scientists are now pursuing a clinical trial to test whether salicylic acid can treat patients with leukemia as part of novel combination therapies.

Researchers say they may have found a new use for an ancient anti-inflammatory drug, salicylate, which was first described by the Greek physician Hippocrates.

“Salicylic acid is one of the oldest drugs on the planet,” said senior author Eric Verdin, MD, of the Gladstone Institutes/UCSF, “dating back to the Egyptians and the Greeks, but we're still discovering new things about it.”

Its derivatives, acetylsalicylic acid, or aspirin, and diflunisal suppress 2 key proteins, CREB-binding protein (CBP) and p300, which control levels of proteins that cause inflammation or are involved in cell growth.

By inhibiting p300 and CBP, salicylic acid and diflunisal block the activation of these proteins and prevent cellular damage caused by inflammation. The research team believes that both p300 and CBP can be targeted by drugs, which would have important clinical implications.

Earlier research conducted by coauthor Stephen D. Nimer, MD, of the University of Miami Miller School of Medicine in Florida, and colleagues found a link between p300 and the leukemia-promoting protein AML1-ETO.

In the current study, published in eLife, researchers tested whether suppressing p300 with diflunisal would suppress leukemia growth in mice.

The research team inoculated SCID mice with Kasumi-1 cells, an AML cell line with the t(8;21) translocation, which represents one of the subtypes of CBF leukemia.

Three weeks later, they started treating the mice with diflunisal. Diflunisal reduced tumor size in a dose-dependent manner, and after 3 weeks of treatment, the tumors were significantly smaller than in the vehicle-treated control mice.

In fact, the researchers noted most tumors disappeared in mice treated with higher doses of diflunisal. The researchers also pointed out that diflunisal, an FDA-approved drug containing a salicylic acid substructure, inhibited CBP/p300 more potently than salicylate.

The researchers concluded that diflunisal and salicylate have promise as an oral therapy for AML patients with a t(8;21) translocation, and called it “an exciting potential application” for this new characterization of older drugs.

“Uncovering this pathway of inflammation that salicylic acid acts upon opens up a host of new clinical possibilities for these drugs,” Dr Verdin added.

The scientists are now pursuing a clinical trial to test whether salicylic acid can treat patients with leukemia as part of novel combination therapies.

Researchers say they may have found a new use for an ancient anti-inflammatory drug, salicylate, which was first described by the Greek physician Hippocrates.

“Salicylic acid is one of the oldest drugs on the planet,” said senior author Eric Verdin, MD, of the Gladstone Institutes/UCSF, “dating back to the Egyptians and the Greeks, but we're still discovering new things about it.”

Its derivatives, acetylsalicylic acid, or aspirin, and diflunisal suppress 2 key proteins, CREB-binding protein (CBP) and p300, which control levels of proteins that cause inflammation or are involved in cell growth.

By inhibiting p300 and CBP, salicylic acid and diflunisal block the activation of these proteins and prevent cellular damage caused by inflammation. The research team believes that both p300 and CBP can be targeted by drugs, which would have important clinical implications.

Earlier research conducted by coauthor Stephen D. Nimer, MD, of the University of Miami Miller School of Medicine in Florida, and colleagues found a link between p300 and the leukemia-promoting protein AML1-ETO.

In the current study, published in eLife, researchers tested whether suppressing p300 with diflunisal would suppress leukemia growth in mice.

The research team inoculated SCID mice with Kasumi-1 cells, an AML cell line with the t(8;21) translocation, which represents one of the subtypes of CBF leukemia.

Three weeks later, they started treating the mice with diflunisal. Diflunisal reduced tumor size in a dose-dependent manner, and after 3 weeks of treatment, the tumors were significantly smaller than in the vehicle-treated control mice.

In fact, the researchers noted most tumors disappeared in mice treated with higher doses of diflunisal. The researchers also pointed out that diflunisal, an FDA-approved drug containing a salicylic acid substructure, inhibited CBP/p300 more potently than salicylate.

The researchers concluded that diflunisal and salicylate have promise as an oral therapy for AML patients with a t(8;21) translocation, and called it “an exciting potential application” for this new characterization of older drugs.

“Uncovering this pathway of inflammation that salicylic acid acts upon opens up a host of new clinical possibilities for these drugs,” Dr Verdin added.

The scientists are now pursuing a clinical trial to test whether salicylic acid can treat patients with leukemia as part of novel combination therapies.