Clinical outcomes of patients with complicated post-operative course after gastrectomy for cancer: a GIRCG study using the GASTRODATA registry

Gastrectomy for gastric cancer is still performed in Western countries with high morbidity and mortality. Post-operative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. In 2015, a project was launched by the EGCA with the aim of building an agreement on list and definitions of post-operative complications specific for gastrectomy. In 2018, the platform www.gastrodata.org was launched for collecting cases by utilizing this new complication list. In the present paper, the Italian Research Group for Gastric Cancer endorsed a collection of complicated cases in the period 2015-2019, with the aim of investigating the clinical pictures, diagnostic modalities, and treatment approaches, as well as outcome measures of patients experiencing almost one post-operative complication. Fifteen centers across Italy provided 386 cases with a total of 538 complications (mean 1.4 complication/patient). The most frequent complications were non-surgical infections (gastrointestinal, pulmonary, and urinary) and anastomotic leaks, accounting for 29.2% and 17.3% of complicated patients, with a median Clavien-Dindo score of II and IIIB, respectively. Overall mortality of this series was 12.4%, while mortality of patients with anastomotic leak was 25.4%. The clinical presentation with systemic septic signs, the timing of diagnosis, and the hospital volume were the most relevant factors influencing outcome.

Abstract P3-12-06: Saving in clinical trials: A possible challenge for improving health care for breast cancer patients

Background: The economic crisis that has characterized recent years has required a careful spending review worldwide and particularly in Italy Health Care System. This resulted in substantial cuts in terms of services and drugs prescriptions.

For this reason, it becomes very important to adopt measures aimed to save health care costs, maintaining at the same time the highest standard of health care. The enrollment in clinical trials (CTs) may encourage this goal, making high-cost drugs available.

Methods: We compared the overall expenses for an oncology patient treated with standard therapy (reference: public hospital price list) to a similar patient enrolled in a CT. The cost comparison was made considering a patient affected by Her2 positive breast cancer in three different settings: neoadjuvant, adjuvant, and advanced/metastatic disease. We considered three categories of cost: diagnostic procedures; drug purchase; drug management. All analyses were performed considering an average treatment period and dose, calculated on a middleweight patient.

We take into account the absolute saving in Euro (€) and the percentage one.

Results: The data show a saving in all treatment lines, referring to the analyzed cost groups.

In neoadjuvant setting, the estimated patient standard cost is 92.829,00€; we calculated a saving of 92.451,00€ (93,74%), of which 1.226,00€ for diagnostic procedures charge (65%), 89.205,00€ for drug purchase (100%) and 2.020,00€ for drug management (116%).

In adjuvant setting, where the estimated standard cost is 25.527,00€, we observed a saving of 23.332,00€ (51%): 22.392,00€ (98% of drug purchase) and 940,00€ (54%) for drug management; no saving for diagnostic procedures.

Regarding the metastatic breast cancer treatment, we calculated a saving of 115.158,00€ (88%) compared to 115.571,00€, that means the estimated standard cost. In this case the saving is allocated as follows: 750,00€ for diagnostic procedures (64.5%), 113.508,00€ for drug purchase (100%) and 900,00€ for drug management (100%).

Conclusions: CTs are useful in order to save money in the overall patient management, allowing them to have access to expensive innovative drugs.

Moreover, we have to consider the additional fees provided by Sponsor for each enrolled patient.

This basic model of cost analysis could be used by Institutional Health Care stakeholders for spending review strategies.

The public institutes with the characteristics of Comprehensive Cancer Center are essential to recruiting the needed study population for Sponsorized CTs, and the cashed and saved money can be reinvested for improving Breast Cancer patients care.Background: The economic crisis that has characterized recent years has required a careful spending review worldwide and particularly in Italy Health Care System. This resulted in substantial cuts in terms of services and drugs prescriptions.

For this reason, it becomes very important to adopt measures aimed to save health care costs, maintaining at the same time the highest standard of health care. The enrollment in clinical trials (CTs) may encourage this goal, making high-cost drugs available.

Methods: We compared the overall expenses for an oncology patient treated with standard therapy (reference: public hospital price list) to a similar patient enrolled in a CT. The cost comparison was made considering a patient affected by Her2 positive breast cancer in three different settings: neoadjuvant, adjuvant, and advanced/metastatic disease. We considered three categories of cost: diagnostic procedures; drug purchase; drug management. All analyses were performed considering an average treatment period and dose, calculated on a middleweight patient.

We take into account the absolute saving in Euro (€) and the percentage one.

Results: The data show a saving in all treatment lines, referring to the analyzed cost groups.

In neoadjuvant setting, the estimated patient standard cost is 92.829,00€; we calculated a saving of 92.451,00€ (93,74%), of which 1.226,00€ for diagnostic procedures charge (65%), 89.205,00€ for drug purchase (100%) and 2.020,00€ for drug management (116%).

In adjuvant setting, where the estimated standard cost is 25.527,00€, we observed a saving of 23.332,00€ (51%): 22.392,00€ (98% of drug purchase) and 940,00€ (54%) for drug management; no saving for diagnostic procedures.

Regarding the metastatic breast cancer treatment, we calculated a saving of 115.158,00€ (88%) compared to 115.571,00€, that means the estimated standard cost. In this case the saving is allocated as follows: 750,00€ for diagnostic procedures (64.5%), 113.508,00€ for drug purchase (100%) and 900,00€ for drug management (100%).

Conclusions: CTs are useful in order to save money in the overall patient management, allowing them to have access to expensive innovative drugs.

Moreover, we have to consider the additional fees provided by Sponsor for each enrolled patient.

This basic model of cost analysis could be used by Institutional Health Care stakeholders for spending review strategies.

The public institutes with the characteristics of Comprehensive Cancer Center are essential to recruiting the needed study population for Sponsorized CTs, and the cashed and saved money can be reinvested for improving Breast Cancer patients care.

Citation Format: Taverniti C, Bonfadini C, Pradotto M, Cagnazzo C, Demartini P, Rossi L, Ignazzi G, Arizio F, Beano A. Saving in clinical trials: A possible challenge for improving health care for breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-12-06.

A novel 120-kDa antigen shared by immature human thymocytes and long-term-activated T cells

In this study we report the characterization of monoclonal antibody (mAb) 8B4/20, raised against immature human thymocytes, that identifies a novel leukocyte antigen. The molecular characterization of the antigen by immunoprecipitation and immunoblotting yields, under nonreducing conditions, a specific band of 120 kDa which, under reducing conditions, displays a slightly lower molecular mass (110 kDa. mAb 8B4/20 detects a molecule found on the majority of thymocytes with an inverted gradient of expression when compared to CD3. It appears at high density on the CD3-/low thymocytes, at reduced density on the CD3med and double-positive thymocytes, and is absent on CD3hi and single-positive thymocytes and on peripheral blood T cells. Immunohistochemistry on frozen sections demonstrates cortical staining of the thymic lobules. Flow cytometric analysis of the different subsets of peripheral blood mononuclear cells shows that mAb 8B4/20 detects an antigen expressed only on CD56+/CD16+ natural killer cells and on a fraction of CD14+ monocytes. T cells, B cells, erythrocytes, granulocytes and platelets are consistently negative. The expression of the molecule on tumor cell lines does not show lineage restriction. Analysis of phytohemagglutinin plus recombinant interleukin-2-activated peripheral blood lymphocytes shows that mAb 8B4/20 identifies an antigen expressed on CD3+ cells by week 3 of culture. Thus, it recognizes a very late activation antigen (VLA) on mature T cells. The cell distribution and the electrophoretic pattern of the molecule identified by mAb 8B4/20 is distinct from that of known CD and of integrin/VLA molecules. Its function on thymocytes is so far unknown; however, the binding of mAb 8B4/20 to tumor lines induces changes in the morphology and adhesive properties of the 8B4/20+ cells growing in suspension. We suggest that mAb 8B4/20 recognizes a molecule that may be involved in interactions between thymocytes and other thymic structures that may be relevant for the selection process.

Effects of sheep digoxin-specific antibodies and their Fab fragments on digoxin pharmacokinetics in dogs

Intact sheep antidigoxin antibodies and their Fab fragments have both been found to exert profound effects on digoxin pharmacokinetics in [3H] digoxin-treated dogs. Both classes of molecule remove digoxin from the extravascular space and sequester it in the circulation in protein-bound form, a form in which the digoxin is presumably inactive. These two classes of molecule differ, however, in that the intact antibody molecules interfere with digoxin excretion, thereby promoting the retention of the glycoside; this retained digoxin is eventually released in free, active form when the administered antibody is metabolically degraded. In contrast, urinary excretion of digoxin continues in Fab-treated dogs, with significant quantities of digoxin being excreted promptly in the urine in complex with Fab fragments. These differences in urinary excretion, together with the probable decreased immunogenicity of sheep antidigoxin Fab fragments, suggest that such fragments possess potential advantages over intact antibody molecules for use in the therapy of life-threatening digoxin intoxication in man.