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Background: Atypical fibroxanthoma is a rare cutaneous tumour of mesenchymal origin, often presenting as a rapidly growing, painless mass in sun-exposed areas. Although historically considered benign, it has an intermediate malignant potential with a risk of recurrence and, in rare cases, metastasis. Treatment primarily involves surgical excision, although recurrence rates can occur. Adjuvant superficial high-dose-rate (HDR) brachytherapy (plesiotherapy) is able to reduce recurrence risk, particularly after local tumour relapses and/or when complete excision with wide margins is unfeasible. It provides excellent local control, cosmetic outcomes and minimal toxicity, making it a promising option in selected cases. This report highlights the utility of customised-mold HDR plesiotherapy for a locally recurrent atypical fibroxanthoma.

Background: The D-TORCH trial demonstrated superiority of 1% topical diclofenac over placebo in preventing capecitabine-induced hand-foot syndrome (HFS). We conducted an exploratory analysis of this study to assess the relationship between HFS and serum levels of the inflammatory marker, cyclooxygenase-2 (COX-2).

Methods: Serum COX-2 levels were measured in patients in the D-TORCH study's experimental and placebo arms at baseline and 12 weeks of capecitabine-based therapy or at the development of HFS (whichever occurred earlier) and in 20 age-matched healthy controls using a human COX-2 ELISA kit (E-EL-H5574).

Results: 233 (88.5%) patients of the D-TORCH cohort (n = 263) underwent serial COX-2 analysis. The population was female predominant (n = 165, 70.8) with a median age of 47 years (range: 19-73), including breast (n = 130, 55.8%) and gastrointestinal cancers (n = 103, 44.2%). 31 (13.3%) patients developed any-grade HFS, with 25 (10.7%) having grade 2 or worse HFS. Mean serum COX-2 levels at baseline and 12 weeks did not show a statistically significant difference (mean + standard deviation, 3.41 + 2.15 ng/ml versus 3.35 + 2.40 ng/ml, p = 0.69); however, baseline levels in patients were significantly higher than healthy controls (p < 0.001). No statistically significant difference was found between serial COX-2 levels by gender, use of topical diclofenac, type of malignancy or severity of HFS.

Conclusion: Serum COX-2 levels did not show a significant change with capecitabine-based therapy, regardless of the use of topical diclofenac possibly reflecting the predominant stromal production of the enzyme. This finding highlights the need to assess HFS-affected tissues for local COX-2 immuno-expression along with further blood-based biomarkers.

The plethora of targetable variants among non-small cell lung cancers is on the rise, making it one of the most important cancer types in the context of precision oncology. Recently, the MET exon14 skipping mutation has emerged as a novel therapeutic target. This mutation results from somatic alterations at the splice junction of exon 14 of the MET gene, leading to constitutive activation of downstream signaling pathways. The approval of targeted therapy for this variation makes it a compelling need to use appropriate testing systems for detection. Utilising a robust next-generation sequencing platform, we have identified this mutation in 5.3% of cases in our cohort. In the absence of information on MET exon 14 skipping from India, this case series will throw some light on this variation in our subcontinent and highlights the fact that the real-world effectiveness of MET inhibitors like Tepotinib and Capmantinib might be lower than expected.

Purpose: This study aimed to identify key aspects of health-related quality of life in women with locally advanced breast cancer (LABC) and analyse their links to factors and treatment modalities.

Method: A cross-sectional study was conducted from August to October 2023 in Ulin Regional Public Hospital, Banjarmasin, Indonesia, involving LABC women whose quality of life (QoL) was assessed using Quality-of-Life Questionnaire Breast Cancer 23. Data were analysed using ANOVA, independent t-tests for parametric data, Kruskal-Wallis and Mann-Whitney tests for non-parametric data and significant variables (p < 0.05) included in a final regression model for identifying predictors.

Results: Of 100 participants (mean age 50 years), most had low education levels (41%), were unemployed (74%) and had stage IIIB cancer. Body image score was the highest, while systemic therapy side effect was the lowest. Better sexual enjoyment was reported in post-menopausal women (p = 0.043), those with higher education (p = 0.036) and married individuals (p = 0.021). Higher economic status was associated with better sexual enjoyment (p = 0.008) and fewer breast symptoms (p = 0.011); however, economic status was negatively associated with employment status (p = 0.043). Worsening arm symptoms were associated with prolonged illness (p = 0.022). Surgical intervention was associated with higher body image (p = 0.010) and lower systemic side effects (p = 0.023). Traditional medicine was associated with lower arm symptoms (p = 0.026). Economic/occupational status explained 10.5% of sexual functioning scores.

Conclusion: Poor QoL in LABC patients overall was associated with low sociodemographic conditions, late presentation and chemotherapy-related side effects.

Background: The treatment of choice as the first line for patients with metastatic breast cancer (MBC) who are hormone receptor-positive (HR+)/HER2-negative (HER2-) is the combination of endocrine therapy (ET) with cyclin-dependent kinase 4/6 inhibitors (CDK4/6i). Identifying prognostic or predictive factors of response could have important clinical implications. This study analysed the prognostic value of Ki-67 and progesterone receptor (PR) expression on progression-free survival (PFS) in this population.

Methods: A retrospective cohort study was conducted in patients with HR+/HER2- MBC, who had received first-line treatment with CDK4/6i combined with ET. For the PFS analysis, the log-rank test was used and for the multivariate analysis, a Cox regression analysis was performed.

Results: A total of 155 patients were analysed. Patients with PR values <20% showed a trend in univariate analysis towards shorter PFS, with a median of 20.7 months compared to those with a value ≥20%, with a median PFS of 33.0 months (p = 0.090). The Ki-67 value showed no statistically significant association with PFS. The prognostic role of PR was confirmed in the multivariate analysis with an HR of 0.59 (95% CI 0.36-0.98, p = 0.041) in patients with PR >20%.

Conclusion: Patients with PR values <20% tended to have shorter PFS, unlike the Ki-67 value, which did not demonstrate an impact on PFS. This suggests a prognostic value of PR expression levels in this scenario.

Clear cell renal cell carcinoma (ccRCC) is a malignancy with a diverse clinical presentation, often characterised by its resistance to conventional therapies. We present the case of a 53-year-old Indian male diagnosed with ccRCC, pT3aN0M1exhibiting lymphovascular invasion and non-contiguous tumour deposits in the left adrenal gland. Following an initial course of Pazopanib and subsequent Everolimus, the disease progressed. Notably, just 3 months after receiving fractionated stereotactic radiosurgery (FSR) for a cerebellar metastasis, spontaneous regression was observed at a distant skeletal site. This case highlights the significance of considering FSR as a therapeutic option for selected patients with ccRCC, as well as the potential role of an abscopal effect to impact the course of this aggressive malignancy.

Renal cell carcinoma (RCC) is one of the common genitourinary malignancies that has an increasing incidence. RCC presents a diagnostic challenge due to its wide range of clinical manifestations, often leading to delays in diagnosis and complicating management strategies. These tumours have clear cells in 70% of cases and have a high preponderance of haematogenous metastases to distant organs such as lungs, bones and liver. Skin metastases of RCC in the absence of an obvious renal tumour are rare. We report a young woman with clear cell renal carcinoma with skin metastasis who presented with left loin pain and acute kidney injury, prompting a series of comprehensive investigations, including imaging studies and laboratory tests. Despite these efforts, a primary tumour remained elusive. However, a breakthrough occurred when histopathological examination of a skin nodule biopsy, alongside cytological analysis of nephrostomy fluid, ultimately identified the underlying cause as malignant RCC. Despite commencing palliative Sunitinib therapy based on intermediate risk criteria, the patient died from lung metastases after 6 months of systemic medication. Here is a more succinct version. This case report emphasises the need to investigate renal primaries in unknown-origin metastases and the importance of a thorough diagnostic approach for RCC.

Background: Epidermal growth factor receptor (EGFR)-mutated advanced adenocarcinoma of the lung is among the most prevalent mutation types. The treatment paradigm for this condition is rapidly evolving. This study focuses on the clinical outcomes in resource-limited settings. The findings aim to guide treatment strategies for such populations.

Methods: A retrospective analysis was conducted on 51 patients aged over 18 years with EGFR-positive nonsquamous lung carcinoma treated at Aga Khan University Hospital between January 2017 and December 2021. Data were collected using nonprobability consecutive sampling and reviewed retrospectively from patient records. Statistical analyses were performed using Statistical Package for Social Science version 20.0. Continuous data were analysed using an independent sample T-test, while categorical data were assessed using the Cox regression test. Kaplan-Meier survival curves were generated to evaluate overall survival (OS) and progression-free survival (PFS), and the log-rank test was used to compare median PFS. A p-value of <0.05 was considered statistically significant for all analyses.

Results: The median age of the cohort was 60 years, with a gender distribution of 56% females and 44% males. A total of 98% of the patients presented with de novo stage IV lung adenocarcinoma. All patients had EGFR-mutated adenocarcinoma, and the majority (80.4%) were nonsmokers. Mutational analysis revealed the following: Exon 19 deletion in 56.9% of patients, Exon 20 insertion in 9.8%, Exon 21 mutations in 19.6%, compound mutations in 7.8%, other mutations in 2.0% and the de novo T790M mutation in 3.9%. Among the cohort, 82% received at least one line of EGFR tyrosine kinase inhibitors (TKIs). The median PFS with TKIs was 15 months, and the median OS with first-line TKIs was 38 months.

Conclusion: This study demonstrates that EGFR-targeted therapy, when used in a first-line setting, significantly improves OS and PFS in this population. Further research is warranted to optimise treatment strategies, particularly in resource-limited settings.

Hepatocellular carcinoma (HCC) is primarily a malignant liver tumour. In rare cases, HCC may be asymptomatic and incidentally identified in radiological exams. Although extrahepatic metastasis to organs such as the lungs or bones is not very uncommon, isolated extrahepatic lesions with hepatoid characteristics, in the absence of a primary tumour in the liver or gastrointestinal tract, are incredibly uncommon. Herein, we present an intriguing case of an isolated skull lesion with hepatoid features with no identifiable primary hepatic or gastrointestinal lesion. This case highlights the need for further research into these rare presentations to deepen our understanding of HCC pathogenesis and ectopic tissue transformation.

Background: BFM-95 protocol is among the common regimens used to treat adolescent and young adult (AYA) acute lymphoblastic leukaemia. Five-year survival in AYA patients with acute lymphoblastic leukaemia is inferior when compared to children.

Objective: To study treatment outcomes in adolescent and young adult patients with acute lymphoblastic leukaemia on BFM 95 protocol.

Material and methods: We retrospectively analysed the available data of 75 patients diagnosed with acute lymphoblastic leukaemia in the AYA age group who received treatment as per BFM-95 protocol from 2016 to 2020 in the clinical hematology department in a tertiary health care centre.

Results: Among 75 patients, 56 were male and 19 were female. High-risk patients were 15 (20%), 3 due to poor prednisolone response and 12 due to high-risk cytogenetics. Most of the patients were CNS-1 and three patients were of CNS-3. Eight (10.6%) patients did not complete induction treatment. The median duration of induction phase A was 40 days (range 35-45 days). The most common complication during induction phase A treatment was febrile neutropenia which was seen in 21 patients (28%), followed by transaminitis in 12 patients (21.1%). The median duration of follow-up was 2 years (range 8 months-5 years). Five (6%) patients' bone marrow were not in remission after induction-A. Relapse occurred in 23 patients (30.6%), with the highest incidence observed during the maintenance phase of treatment. Thirty-three (44%) patients completed maintenance and were still on follow-up. Twenty-three (30.7%) patients relapsed while six patients were lost to follow-up during maintenance. At a median follow-up of 2 years, disease-free survival was (44%).

Conclusion: This study on AYA patients with acute lymphoblastic leukaemia/lymphoma using a pediatric protocol in a resource-limited setting observed suboptimal survival rates, which may be attributed to the retrospective design, significant data gaps and a small patient cohort with limited follow-up.