Cancer treatment communications最新文献

Purpose

Recurrence rates following nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) remain high. As such, adjuvant therapy directed at high risk sites may improve long term outcomes. We describe patterns and predictors of UTUC recurrence according to patient, disease and treatment-related factors.

Methods and materials

We reviewed the records of 113 patients treated with NU for UTUC at our institution between 2006 and 2013. Time to locoregional (LR), intravesical (IV), distant recurrence and death were described using the Kaplan–Meier method and compared using the log rank statistic. Cox Proportional Hazards analyses were performed to evaluate the adjusted hazard for LR/IV and LR recurrence.

Results

Advanced T stage (T3/4) was present in 41 (36%) patients, 10 (9%) were node-positive and 21 (19%) showed evidence of lymphovascular space invasion (LVSI). Median overall survival and time to any recurrence was 54.6 and 20.7 months, respectively. Disease recurrence was observed in 48 (42%) patients. The location of failure was intravesical in 27 (24%), locoregional in 22 (19%) and distant in 20 (18%). Three-year LR/IV and distant failure rates were 38.7% and 22.2%, respectively. Three-year LR failure was 4.6% in pTa-2 vs. 25.8% in T3–T4 disease. Multivariate analysis identified history of prior bladder disease as a significant predictor of LR/IV recurrence.

Conclusions

In this study we demonstrate LR/IV recurrence as the predominant pattern of failure in UTUC patients treated with nephroureterectomy. This systematic description of recurrence patterns and associated factors will guide further investigation of adjuvant therapy to minimize the treatment failures defined herein.

Micro-abstract

We retrospectively analyzed 162 patients with non-squamous non-small cell lung cancer (NSCLC) who underwent first-line chemotherapy with bevacizumab (BEV); 127 patients without driver oncogenes, 17 patients with EGFR major mutations, 12 patients with ALK rearrangements, 4 patients with EGFR minor mutations and 2 patients with rare types of histology.

Background

BEV has been approved for treatment of non-squamous NSCLC and is authenticated as one of the key drugs in the treatment of advanced non-squamous NSCLC.

Patients and methods

We retrospectively analyzed patients with stage IIIB/IV non-squamous NSCLC who underwent chemotherapy with BEV in first-line setting.

Results

In 162 patients who underwent chemotherapy combined with BEV as first-line treatment, the median overall survival (OS) and progression-free survival (PFS) were 23.5 months and 6.8 months, respectively. The PFS did not differ significantly by the presence of driver oncogenes. In patients without driver oncogenes, more patients who received carboplatin plus pemetrexed with BEV could complete at least 4 cycles of induction therapy and more of these patients proceeded to maintenance therapy than those who received carboplatin plus paclitaxel with BEV, which resulted in better outcome associated with carboplatin plus pemetrexed with BEV. Continuation of BEV beyond first progression did not show any survival benefit. In EGFR mutation-positive patients, the order of BEV-containing regimen and TKI did not influence on OS. None of 18 patients with brain metastases detected at diagnosis developed intracranial hemorrhage.

Conclusions

PFS of first-line chemotherapy using BEV was not influenced by the existence of driver oncogenes. In patients without driver mutations in real clinical practice, as the first-line partner regimen with BEV, carboplatin plus pemetrexed may be more feasible as compared to carboplatin plus paclitaxel. BEV use beyond first progression did not deliver significant survival benefit. BEV was safe for brain metastases.

Background

Trastuzumab emtansine (T-DM1), a novel drug-antibody conjugate, has shown promising activity in HER2-positive breast cancer and is the recommended agent of choice for second line therapy for advanced HER 2-positive breast cancer. Elevations in transaminase levels have been reported in up to 40% of patients treated with T-DM1 on phase I-III clinical studies. More serious hepatotoxicity can also result from this drug-antibody conjugate, but has been infrequently described in the literature.

Case Presentation

Here we report a 73 year old female with previously untreated metastatic HER 2-positive breast cancer who developed nodular regenerative hyperplasia and noncirrhotic portal hypertension while on treatment with single agent T-DM1. Liver biopsy demonstrated nodular regenerative hyperplasia, bile duct injury, and portal fibrosis.

Conclusion

A high index of suspicion for liver injury and NRH must be maintained for patients who develop liver test abnormalities and/or signs of portal hypertension during treatment with T-DM1. Abdominal imaging, liver biopsy, and prompt discontinuation of T-DM1 is recommended for patients with signs or symptoms of liver injury.

Introduction

Granulocytic sarcoma is an event associated with acute or chronic myeloid leukemia in which, the extramedullary site consists of myeloid blasts and/or immature myeloid cells. Primary granulocytic sarcoma becomes a diagnostic challenge especially in the absence of cited hematological disorder or when lymphnode becomes an extramedullary with remote co-incidence.

Presentation of case

This is a case of granulocytic sarcoma in a 15-year-old girl, who presented with a mass in the right side of neck, along with progressive dysphagia and aphasia. Histomorphologic diagnosis of the tissue was supported by immunohistochemical study with Avidin-biotin-peroxidase complex technique that was performed on formalin fixed tissue from the patient.

Discussion

The clinicopathologic diagnosis remains an elusive decision with a malignant lymphoma, because of the isolated cervical mass presentation. Moreover, the patient was hemodynamically stable without the presence of any leukemic blast cell in the peripheral blood.

Conclusion

Immunohistochemical study of the tissue from the neck mass helped to reach a correct diagnosis. The diagnosis was further reconfirmed on bone marrow trephine biopsy. A final trial with myeloid panel markers was the last alternatives to all differential diagnosis to round cell tumor. Tumor cells were immunoreactive to CD68, CD34, CD117 and myeloperoxidase, suggesting myeloid sarcoma.

Current management of Hodgkin lymphoma (HL) allows high cure rates to be achieved with initial therapy in both early-stage and advanced-stage disease. However, adverse events and the emergence of late effects are important issues for patients who respond well to frontline treatment. A further challenge in HL is the treatment of patients who are either refractory to, or relapse following, initial therapy. High-dose chemotherapy with autologous stem cell transplantation (HDCT/ASCT) is a potentially curative second-line treatment option for many patients with relapsed/refractory (R/R) HL. However, not all patients are candidates for HDCT/ASCT, and the frequency and duration of responses vary. For patients who fail HDCT/ASCT, current treatment options include further salvage chemotherapy, allogeneic transplantation or novel targeted therapies. Similar issues surround the management of R/R systemic anaplastic large cell lymphoma (sALCL), which is a rare and aggressive tumour. CD30 is strongly expressed in both HL and sALCL tumour cells and is a promising therapeutic target, as demonstrated by the activity of the novel antibody–drug conjugate brentuximab vedotin. New approaches to individualising and optimising patient management, including improved application of imaging, better prognostication through use of biomarkers and the potential use of new treatment combinations and agents targeting signalling pathways in malignant cells, may help to improve outcomes. The case studies included herein were presented at a symposium during the European Hematology Association (EHA) meeting in 2014. This publication aims to share clinical experiences and solutions to the management of HL and sALCL patients in very challenging disease settings.

Background

Invasive lobular carcinoma (ILC) comprises 5–16% of all breast cancers, with its incidence gradually increasing. ILC has a disproportionately higher incidence of spread to the gastrointestinal (GI) system.

Methods

This study is a retrospective chart review of all cases of ILC with gastrointestinal metastases seen at a university affiliated tertiary cancer institute between 2005 and 2010, examining demographic, epidemiological, medical, and treatment factors that may have an association with the risk of GI metastases.

Results

343 consecutive cases of lobular breast cancer were reviewed, and 21(6%) were found to have GI metastases. The mean age at initial diagnosis of primary tumor was 63 years. Stages at presentation of the breast primary were: Stages 1/2%=73% and stages 3/4=27%. Receptor status of the primary breast cancer was as follows: HER2+=5%, PR+=76%, ER+=90%. The mean age at time of diagnosis of metastatic disease was 67 years. The main presenting symptoms of GI metastatic disease were: incidental finding/asymptomatic (20%), nausea (20%), and abdominal pain (15%). The major sites of extrahepatic gastrointestinal spread were the stomach (52%), peritoneum (38%), and omentum (19%). Average five-year survival from initial diagnosis of ILC was 46%. Five-year survival from diagnosis of gastrointestinal metastasis was 29%.

Conclusions

Approximately 1 in 20 patients diagnosed with ILC will have spread to the GI tract, presenting 4 years after their initial primary diagnosis. Future research is needed in developing treatment regimens for these patients, as the 5-year survival is only approximately 1 in 4.

Introduction

Primary malignant melanoma of the urethra is an extremely rare disease associated with a poor prognosis due to early metastasis and often delayed diagnosis. There is limited literature on this entity, especially with regard to radiologic imaging.

Presentation of case

The case presented is a 67-year-old African American woman with primary urethral melanoma who underwent bladder-sparing surgery based upon pelvic magnetic resonance imaging (MRI) findings.

Discussion

MRI can be used for diagnosis of primary urethral melanoma and evaluation of tumor extent for surgical planning purposes.

Conclusion

Pelvic exenteration is often required for primary urethral melanoma treatment, though bladder conservation surgery may be a viable option in patients without evidence of bladder invasion on MRI.

Solitary neurofibromas are a benign tumor composed of a mixture of Schwann, perineurial-like, and fibroblastic cells. Neurofibroma of the breast is rare. In this article, we reported a case of a giant solitary neurofibroma of the breast in a 48-year-old Chinese female. To our knowledge, this is the first case of breast giant solitary neurofibroma originating from the upper margin of the breast near the neck.