tbuckley/cabot-search huggingface dataset:
Outcomes of elderly patients receiving neoadjuvant chemoradiation and adjuvant chemotherapy for locally advanced rectal cancer in a retrospective cohort.
Authors: Pablo Reguera Puertas, Vanessa Pachón Olmos, Reyes Ferreiro Monteagudo, Federico Longo, Carmen Guillen, Mercedes Rodríguez Garrote, María Ángeles Vaz Salgado, Maria Gion Cortés, Ainhoa Madariaga Urrutia, Alfonso Cortés Salgado, Silvia Patricia Cortez Castedo, Jacobo Muñoz del Toro, Cristina Saavedra Serrano, Asunción Hervás Morón, Cayetano Sempere Ortega, Javier Die Trill, Juan Carlos García Pérez, Juan Diego Pina, María Alejandra Caminoa-Lizarralde Aiza, Alfredo Carrato
Journal: Journal of Clinical Oncology (2016)

e15145 Background: Data of outcomes of elderly patients ( ≥ 70) with stage II and III rectal cancer treated with multimodal treatment (neoadjuvant chemoradiotherapy, surgery and adjuvant chemotherapy) are limited. Our objective is to evaluate the impact of age on the clinical outcomes in our institution. Methods: Data on170 patients diagnosed from January 2003 to December 2011 with stage II and III rectal adenocarcinoma were collected retrospectively from the Pathology Department data base. 82 patients were ≥ 70 and 11 ≥ 80 years old. Results: Characteristics of patients in terms of staging, ECOG and location of tumor were well balanced between < 70, ≥ 70, ≥ 80. Grade 3 and 4 hematological and non hematological toxicities during chemoradiotherapy were similar in the three groups, as was percentage of pathological complete response (12.5, 12.2 and 9.1% respectively). We observe a non significant trend of more anterior abdominal amputation in elderly (37.5, 43.9 and 54.5%). However, there are clear differences in the percentages receiving adjuvant chemotherapy (86.4, 57.3 and 36.4, p < 0.005). Patients < 70 had a median overall survival (OS) of 114.5 months versus 86.5 in the ≥ 70 cohort (p 0.063) and 59.552 in the ≥ 80 cohort (p 0.056). However these differences disappear between < and ≥ 70 if we examine cancer specific survival (121.8 vs 96.5 m p 0.25) but not with ≥ 80 (64 m p 0.038). Median disease free survival (DFS) is 100.6 m, 68.6 (p 0.033) and 47.6 (p 0.240) respectively. Conclusions: Elderly patients ( ≥ 70) with stage II and III rectal cancer present significantly lower DFS. This could be related with the lower percentage of them receiving adjuvant chemotherapy. This trend is also observed in OS but not confirmed in cancer specific survival except in ≥ 80. Results suggest that we should offer multimodal treatment to elderly people. More studies are needed with this population being sufficiently represented.
Abstract 13816: Prediction of Risk for Cardiovascular Events in Patients with Preserved Left Ventricular Ejection Fraction: Incremental Value of Diastolic Wall Strain
Authors: Satoshi Tsujimoto, Yoko Miyasaka, Yoshinobu Suwa, Hirofumi Maeba, Kazuhiro Yamamoto, Ichiro Shiojima
Journal: Circulation (2014)

Background: Diastolic wall strain (DWS) was recently reported as a simple and feasible echocardiographic index in assessing left ventricular diastolic stiffness. We sought to evaluate whether DWS independently predicts cardiovascular (CV) events in patients with preserved ejection fraction (EF), and whether it is incremental to conventional risk factors for identifying patients at increased risk for future CV events. Methods: Consecutive patients referred for clinically-indicated echocardiogram, those with preserved EF and no clinical heart failure or cardiac structural abnormalities were studied. CV events were ascertained using Framingham criteria (myocardial infarction, coronary insufficiency, stroke, transient ischemic attack, congestive heart failure, or CV death). DWS was calculated with a validated formula. Cox proportional hazards modeling was used to assess risk of CV events. Results: Of a total number of 962 patients (61 ± 15 year-old, 48% men, 50% hypertension, 18% diabetes), 69 (7.2%) develope...
Evaluation of topoisomerase II, Ki-67 and P53 expression in non-muscle invasive urothelial carcinoma and their clinical significance
Authors: E.A. Elkhouly, N. Alkady, M.F. Soltan
Journal: Annals of Oncology (2018)

Background: Trans-urethral resection of tumor (TURT) is the main treatment of non-muscle invasive urothelial carcinoma, but it is associated with high rate of recurrence and or progression, this arouses the need for adjuvant therapy. Topoisomerase II, KI67 and P53 are proliferation and cell cycle regulator markers that may predict tumor response to therapy. This study aimed to assess Top II, KI67 and P53 expression on clinical outcome and response to therapy of non-muscle invasive urothelial carcinoma. Methods: Fifty cases of non-muscle invasive urothelial carcinoma were collected; Top II, KI67, and P53 expression were evaluated. Patients received treatment then recurrence was correlated with the expression of previous markers. Results: There was a significant association between high Top II score, P53 and Ki67 and high grade (P = 0.0001, 0.001, 0.0001), submucosal infiltration (P = 0.0001, 0.01) and recurrence (P = 0.01, 0.001, 0.001). Conclusions: Top II, P53, and Ki-67 may predict response to therapy and the clinical outcome in non-muscle invasive urothelial carcinoma. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
TCT-668 Thirty-Day Readmissions After Transcatheter Mitral Valve Repair vs Surgical Mitral Valve Repair: Analysis of the 2014-2015 Nationwide Readmissions Databases
Authors: Fabio Lima, Dhaval Kolte, Zheng Zhang, Valerie Langberg, Igor Palacios
Journal: Journal of the American College of Cardiology (2018)
Pembrolizumab (Pembro) plus lenalidomide (Len) and low-dose dexamethasone (Dex) for relapsed/refractory multiple myeloma (RRMM): Efficacy and biomarker analyses.
Authors: Enrique M. Ocio, Maria-Victoria Mateos, Robert Z. Orlowski, David Siegel, Donna Ellen Reece, Philippe Moreau, Paula Rodriguez-Otero, Nikhil C. Munshi, David Avigan, Razi Ghori, Richard Wnek, Robin Mogg, Patricia Maria Marinello, Jesus San Miguel
Journal: Journal of Clinical Oncology (2017)

8015 Background: The PD-1 inhibitor pembro blocks interaction of PD-1 with its ligands PD-L1/PD-L2, activating antitumor immunity. Combination of pembro, len, and dex may provide synergistic antitumor activity in RRMM. Methods: Theopen-label, phase 1 KEYNOTE-023 (NCT02036502) study of pembro + len + low-dose dex enrolled patients (pts) with RRMM treated with ≥2 prior therapies (tx). Pts received pembro 200 mg IV Q2W, len 25 mg PO on d1-21, and dex 40 mg PO weekly on each 28-d cycle. Primary end point was safety. ORR was assessed by IMWG 2006. Exploratory biomarker analyses included flow cytometry (FC) (PD-L1, PD-L2 on CD38 + CD138 + cells) at screening or predose cycle 1, d 1 bone marrow (BM) aspirate. Absolute and/or relative numbers of circulating immune cells (by FC) and gene expression profile (GEP) (by Nanostring) were evaluated in predose cycle 1, d1 and cycle 2, d1 blood. Results: Median age was 61 y; median (range) prior lines of tx was 4 (1-10); 38 (75%) pts were len-refractory and 27 (53%) pts were double refractory. Most common grade ≥3 tx-related AEs (TRAEs) were neutropenia (33%), thrombocytopenia (18%), and anemia (12%). 2 (4%) pts died (hepatic failure, ischemic stroke) because of TRAEs. Immune-related AEs occurred in 5 (10%) pts. No pneumonitis was reported. For response-evaluable pts, ORR was 50% (20/40; 1 sCR, 14 PR, 5 VGPR); 1 had PD. ORR was 38% (11/29) for len-refractory pts. In 16/32 pts with FC-evaluable BM aspirate with &gt;100 CD38 + CD138 + cells, all were PD-L1 + , while PD-L2 expression was variable. At cycle 2, d1, frequency of circulating HLA-DR + , central (CD45RO + CCR7 - ), and effector memory (CD45O + CCR7 + ) CD8 + T cells significantly increased and naive (CD45RA + ) CD8 + T cells significantly decreased; all with multiplicity adjusted P values ≤ 0.01. Conclusions: Pembro + len + low-dose dex has an acceptable safety profile and antitumor activity in pts with RRMM, including len-refractory pts. PD-L1 was expressed in all pts evaluated by FC, whereas PD-L2 expression was variable. Among the pool of circulating T cells in peripheral blood, HLA-DR + and memory T-cell subset fractions increased after treatment. Clinical trial information: NCT02036502.
Imatinib mesylate as first-line therapy in patients with chronic myeloid leukemia philadelphia + (CML-PH+) in accelerated phase (AP), comparison with chronic phase. a long-term retrospective study.
Authors: Rafael Hurtado-Monroy, Berenice Vicente, Diego Sarre-Alvarez, Pablo Vargas-Viveros, Montserrat Rojas, Carlos Best, Judith Cruz-Velazquez, Myrna Candelaria
Journal: Journal of Clinical Oncology (2016)

e18541 Background: Accelerated phase (AP), is a progression state of CML. Treatment options varies in some countries; however, Imatinib Mesylate (IM) is only the first line available treatment in our institution but the long-term outcome information is scarce in comparison with Chronic Phase (CP) CML. Methods: In a period of ten years, we analyzed the outcome of 75 consecutives patients with CML: CP 40 (53.3%) and AP 35 (46.7%) under the WHO criteria. CP received IM 400 mg and AP 600 mg per day orally. The median age of presentation in CP was 44 years (range 18-70) and 36 years (range 20-70) in AP respectively. The cytogenetic studies were performed using in situ hybridization with fluorescence (FISH) with a minimum of 200 nuclei analyzed. Results: Median time to reach complete hematologic response was 1 month (range 1-4) in CP and 3 month (1-13) in AP. The median time to complete cytogenetic response (CCgR) was 8 months (1-57) in CP, and 12 months (4-72) in 15 patients in AP, but in 20 without response. (Table 1) The length of this response in CP was 73 months (8-149) and in AP 30 months (6-100) in 18 patients. At a median follow-up of 120 months, the median overall survival in CML-AP was 70 months (n-19) and in CP 150 months (p ≤ 0.001), Kaplan-Meier Log Rank Mantle Cox. The median progression-free survival and event free survival in CP was 73 (8-149) months and 30 (5-108) in 19 patients in AP. Conclusions: Patients with AP obtain much less cytogenetic response compared with CP. The benefit of IM in AP was in 18 of 37 patients with median survival of 70 months (the other 19 had a fatal evolution) in comparison with 150 months in CP, with a statistical difference. Our data suggest the need of a change in the treatment of AP in future treatment at least in our institution. Chronic phase Accelerated phase (n = 40) (n = 35) CHR (months) 1 CHR (months) 3 CCgR (months) 8 CCgR (months) 12 MR (n) 33 MR (n) 5 Median free-survival (Months) 73 Median free-survival (Months) 30 p ≤ 0.001 Overall survival (Months) 150 Overall survival (Months) 70 p ≤ 0.001
Prognostic and predictive value of immunoscore signature in gastric cancer.
Authors: Xiaolong Qi, Yuming Jiang, Qi Zhang, Yanfeng Hu, Tuanjie Li, Jiang Yu, Liying Zhao, Gengtai Ye, Haijun Deng, Tingyu Mou, Hao Liu, Shirong Cai, Zhiwei Zhou, Guihua Chen, Guoxin Li
Journal: Journal of Clinical Oncology (2017)

e15594 Background: TNM staging system is not adequate to define the prognosis of patients with gastric cancer (GC). This system is also unable to predict whether the GC patients are likely to benefit from adjuvant chemotherapy. We postulated that ImmunoScore of GC (IS GC ) could markedly improve the prediction of postsurgical survival and adjuvant chemotherapeutic benefits. Methods: 125 GC patients were enrolled as a training cohort to detect the expression of 27 immune features using immunohistochemistry and then constructed a five-feature-based IS GC using the LASSO Cox regression model. Internal validation cohort (126 specimens) and two external validation cohorts (628 specimens) were utilized to validate the prognostic and predictive value of IS GC . Results: We established the IS GC classifier based on the five features: CD3 invasive margin (IM) , CD3 center of tumor (CT) , CD8 IM , CD45RO CT , and CD66b IM . The IS GC classifier could distinguish GC patients with high-IS GC from those with low-IS GC with significant differences in 5-year disease-free survival (45.0% v.s. 4.4%, p &lt; 0.001) and 5-year overall survival (48.8% v.s. 6.7%, p &lt; 0.001). According to the multivariate analysis, the IS GC classifier was proved to be an independent prognostic factor. A combination of IS GC and TNM had better prognostic value than TNM stage alone. In a further analysis, stage II and III GC patients with high-IS GC exhibited a favorable response to adjuvant chemotherapy. To provide a quantitative method to predict stage II and III GC patients’ probability of 3- and 5-year overall survival, we constructed two nomograms that integrated the IS GC and clinicopathological risk factors. Calibration plots showed that the nomograms performed well compared with an ideal model. The predictive accuracy and clinical usefulness of the nomograms were also demonstrated. Conclusions: The IS GC classifier could effectively predict recurrence and survival of GC, and complemented the prognostic value to TNM system. Moreover, the classifier might be a useful predictive tool to identify candidates with stage II and III GC who would benefit from adjuvant chemotherapy. Therefore, the IS GC might facilitate the counseling and personalize the postoperative management of GC patients.
Performance status (PS) in advanced germ cell tumors (aGCT): Clinical and prognostic value of an underreported important variable.
Authors: Vitor Fiorin de Vasconcellos, Diogo Assed Bastos, Allan Andresson Lima Pereira, Bruno Rodriguez Pereira, Jamile Almeida Silva, David Queiroz Borges Muniz, Giuliano Guglielmetti, William Carlos Nahas, Carlos Dzik
Journal: Journal of Clinical Oncology (2018)

e16537 Background: Although PS is a strong marker of adverse outcomes in most metastatic solid tumors, data of PS status are lacking in GCT, especially using validated scales such as Eastern Cooperative Oncology Group (ECOG-PS). Methods: From 2000 to 2015, 300 consecutive pts with aGCT treated at Instituto do Cancer do Estado de São Paulo were retrospectively analyzed. Kaplan-Meier curves were used for estimate progression-free survival (PFS) and overall survival (OS) and multivariate Cox regression to identified prognostic factors. Results: Median age was 28 years old. According to the International Germ Cell Cancer Collaborative Group (IGCCCG), 57% were classified as good-, 18.3% intermediate-, and 24.7% poor-risk disease. At baseline, 54 pts (18%) had ECOG-PS ≥ 2. At a median 46 months of follow-up, 93 PFS events and 45 deaths had occurred. All early deaths (n = 7) occurred in poor-PS pts, including 3 pts with grade 5 toxicity. 46 of poor-PS pts (85%) received the planned number of chemo cycles. Clinical features and treatment outcomes are detailed in the Table. In multivariable analysis, ECOG-PS ≥ 2 was a significant independent prognostic factor with a HR 2.63 (95% CI 1.58-4.38; p < 0.001) and 6.43 (95% CI 3.06-13.49; p < 0.001) for PFS and OS, respectively. IGCCCG groups confirmed it prognostic value and age ≥ 50 was underpowered. Conclusions: In our cohort, ECOG-PS ≥ 2 had a significant negative impact on survival. Further collaborative validation should be evaluated in order to potentially incorporate PS in prognostic classifications and to define treatment singularity in this subgroup. IGCCCG Good (N = 171) Intermediate (N = 55) Poor (N = 74) Primary tumor Testis 164 (95.9%) 49 (89.1%) 62 (83.8%) Retroperitoneal 3 (1.7%) 2 (3.6%) 2 (2.7%) Mediastinal 4 (2.3%) 4 (7.3%) 10 (13.5%) Histology Seminoma 86 (51.3%) 9 (16.4%) 0 NSGCT 85 (59.7%) 46 (83.6%) 74 (100%) ECOG-PS 0-1 164 (95.9%) 42 (76.4%) 40 (54.1%) ≥ 2 7 (4.1%) 13 (23.6%) 34 (45.9%) Chemo regimen No chemo 17 (10%) 0 0 BEP 133 (77.8%) 49 (89.1%) 65 (87.8%) EP 19 (11%) 3 (5.5%) 1 (1.4%) Other 2 (1.2%) 3 (5.5%) 8 (10.8%) Early deaths < 100 days from dx 0 2 (3.6%) 5 (6.7%) Survival 5 yr PFS 83% 70.9% 35.1% 5 yr OS 95% 83.6% 62.2% Salvage chemo 23 (13.4%) 8 (14.5%) 33 (44.6%)
Abstract 17663: Circulating Mir-221-3p is a Novel Predictive Biomarker in Patients With Acute Myocardial Infarction
Authors: Ender Coskunpinar, Huseyin A Cakmak, Ali Kemal Kalkan, Necip Ozan Tiryakioglu, Mehmet Erturk, Zeki Ongen
Journal: Circulation (2016)

Introduction: MicroRNAs (miRNAs) regulate gene expression at the post-transcriptional level. Recent studies have reported circulating miRNAs as novel biomarkers in heart failure, diabetes mellitus,...
Tongue cancer patients can be distinguished from healthy controls by specific N-glycopeptides found in serum.
Authors: Suvi Renkonen, Mayank Saraswat, Amy Dickinson, Antti Makitie, Tiia-Lotta Tohmola, Shruti Saraswat, Sakari Joenväärä, Linda Lindström
Journal: Journal of Clinical Oncology (2018)

e18047 Tongue cancer patients can be distinguished from healthy controls by specific N-glycopeptides found in serum. Background: There are no blood biomarkers to detect early-stage oral cavity squamous cell carcinoma (OSCC) prior to clinical signs. Most OSCC patients are diagnosed and managed at advanced stages with subsequent significant morbidity and poor survival. We aimed to use mass spectrometry (MS) technology to find specific N-glycopeptides to potentially serve as serum biomarkers for preclinical OSCC screening. Methods: Serum samples from 14 patients, treated for OSCC at the Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital (Finland) were collected. Tumors were either stage I or stage IV. Twelve matched healthy individuals served as controls. Quantitative label-free N-glycoproteomics was performed, with MS/MS analysis of the statistically significant N-glycopeptides showing altered expression between the groups. Combined with a database search using Web-based software (GlycopeptideID), this provided detailed N-glycopeptide information, including glycosylation site, glycan composition and proposed structures. Results: Forty-three tryptic N-glycopeptides were identified, having 17 unique N-glycosylation sites, representing 14 glycoproteins. OSCC patients, even with stage I tumors, could be differentiated from healthy controls based on the expression levels of these glycoforms. N-glycopeptides of IgG1, IgG4, Haptoglobin and Transferrin had significantly different abundances between cases and controls. Specifically, core-fucosylated glycoforms of IgG1 had high fold changes and statistical significance. Conclusions: Based on these serum N-glycopetide level differences between tongue cancer patients and healthy controls, we are the first to suggest specific N-glycopeptides to serve as potential serum biomarkers to detect preclinical OSCC in risk patients.
Co-existing alterations in cell-cycle pathway genes and impact on benefit from trastuzumab in advanced esophagogastric cancers (EGC): Analysis of 527 <i>Her2</i>-amplified cases.
Authors: Joseph Chao, Samuel Jacob Klempner, Steven Brad Maron, Mark Bailey, Seung Tae Kim, Jie He, Doron Lipson, Siraj Mahamed Ali, Vincent A. Miller, Jeffrey S. Ross, Russell Madison, Jeeyun Lee, Daniel V.T. Catenacci, Alexa Betzig Schrock
Journal: Journal of Clinical Oncology (2018)

4063 Background: The addition of targeted therapies, including trastuzumab, has resulted in limited benefit in EGC. The response rate for trastuzumab in combination with chemotherapy is under 50% in Her2 amplified EGC, reflecting a molecularly heterogeneous disease. The genomic context of Her2 amplification may impact trastuzumab responsiveness. Methods: We analyzed clinical samples from EGC patients using hybrid-capture based comprehensive genomic profiling (CGP). Pre-specified literature review was used to determine genomic alterations (GA) associated with de-novo trastuzumab resistance. Clinicopathologic features and outcomes data were abstracted, and descriptive statistics used to examine relationships between GA and outcomes. Results: From 2,245 GEJ adenocarcinomas and 1,883 gastric adenocarcinomas (GC) we identified 395 Her2-amplified GEJ (18%) and 132 Her2-amplified (Her2amp) GC (7.0%) cases. Median Her2 copy number was 19 in GEJ and 16 in GC samples. PIK3CA GA and METamp were observed in ~9% and ~5% of both Her2amp and non- Her2amp EGC cases; however, co-amplification of cell-cycle mediators CDK6 and CCCNE1 were enriched in Her2amp cases (Table). MYC amp and deleterious SMAD4 GA were enriched in cases with Her2amp. In cases with > 100 estimated Her2 copies, PIK3CA GA were significantly less frequent than cases with 6-99 copies (2.3% vs. 9.8%, P = 0.04). All Her2amp cases were microsatellite stable. A clinically annotated Her2amp cohort will be presented. Conclusions: GA predicted to decrease trastuzumab sensitivity exist in a significant portion of Her2amp EGC, although not all are enriched relative to non-Her2amp cases. Baseline tumoral heterogeneity and genomic context are anticipated to modify outcome and prospective stratification will be important to optimize therapies. Her2 Amp Non-Her2amp All cases (n = 527) GEJ (n = 395) GC (n = 132) All cases (n = 3,601) P value (All cases) PIK3CA GA 8.5% 9.1% 6.8% 9.5% 0.52 CDK6 amp 11% 9.6% 14% 6.8% 0.002 CCNE1 amp 19% 20% 17% 7.1% < 0.001 CCND1 amp 5.3% 5.8% 3.8% 7.7% 0.07 MET amp 3.8% 3.3% 5.3% 4.7% 0.39 MYC amp 16% 15% 17% 9.8% < 0.001 CDKN2A GA* 22% 25% 14% 19% 0.21 SMAD4 GA* 9.7% 10% 8.3% 5.5% < 0.001
Large retrospective study of lenalidome-dexamethasone (Rd) in patients older than 80 with multiple myeloma (MM): Is less more?
Authors: Magalie Pascale Tardy, Borhane Slama, Jerome Doyen, Anne-Marie Stoppa, Jean Gutnecht, Daniel Re, Valentine Richez, Regis Kaphan, Maria Kogay, Marie-Christine Etienne-Grimaldi, Annick Boscagli, Frederic Peyrade
Journal: Journal of Clinical Oncology (2018)

e20035 Background: Rd is a treatment option for patients (pts) ineligible for transplant. Lenalidomide (R) pharmacokinetics (PK) has been evaluated in pts under 65 and very few data are available about PK, dosage safety and efficacy for pts older than 80. This retrospective study aimed to describe safety and efficacy of R in pts > 80 years. Methods: We did a retrospective study in 7 centers in France. Inclusion criteria were: pts > 80 with a MM treated with Rd. The primary outcome was Progression-Free Survival (PFS). Secondary outcome were PFS according to the dose of Rd, Overall Survival (OS), grade 3 and 4 toxicities. Results: 144 consecutive pts received Rd at a median age of 83.5 [80 ; 93.5]. Charlson score was 4 [2 ; 12]. A majority of pts (n = 103, 78%) had stage III MM (Salmon and Durie) at diagnosis and 13% (n = 16) had a clearance of creatinine < 40mL/min or/and creatinine > 173µmol/L. Median number of lines of treatment was 1 [0 ; 4]. Initial dose of R was 15mg [5 ; 25] ; 56 pts had a daily dose < 15mg and 80 ≥ 15mg. Median number of cycles of Rd was 8 [1 ; 64]. With a median follow-up of 23.2 months [1 ; 93] the 1 and 2-years PFS and OS were 72.1%/62.8% and 87.1%/78.5% respectively. At the end of follow-up 29 pts died (20%), 27 from myeloma, 0 from treatment toxicities. Complete response rate (CR), Strict CR, very good partial response, PR, stable disease and immediate progression were respectively of 8.8%, 2.2%, 20.4%, 51.8%, 9.5% and 7.3%. Rd was discontinued for progression in 63.9% of pts. 14.6% and 2.8% of pts had grade 3 or 4 toxicities respectively. 24 pts had another line of treatment after Rd. In univariate analysis, R dosage did not correlate with OS (p = 0.3), PFS (p = 0.8) or response. In multivariate analysis, the unique significant predictive factor associated with a worse OS was Hb < 10g/dL (p = 0.01). Conclusions: Rd is feasible in very old pts at a dosage of 15mg per day. Our results compare favorably with previous large prospective phase 3 study. In patients over 80, PK analysis seems to be mandatory to determine the adapted dosage.