Cancer treatment communications最新文献

Malignant pleural mesothelioma (MPM) is a rare pleural disease with a poor prognosis. Currently treatment options are limited and the outcome is generally quite poor.

We report the case of a 76-year-old man diagnosed with locally advanced MPM who had partial spontaneous response for 2 years and remained asymptomatic for more than 3 years. The patient was taking specific herbal and vegetable diet during the course of response.

In our review of literature, a number of prognostic factors predict for better survival and response. However our patients did not have any of these factors. There have been reports of immune-induced responses in the literature. Our patient did indeed use some herbal products that might interfere with the immune system and explain his tumour regression and long period of disease stability. Further analyses and studies are needed in this setting to explore and identify specific immune pathways and targets to develop more effective treatment for MPM.

Lung cancer is the main cause of cancer-related death worldwide and conventional treatment strategies must be improved. In addition to mutations in several well-known cancer-associated genes, recent advances in sequencing technology have led to the discovery of numerous novel gene mutations and translocations. Some of these genomic aberrations occur at similar frequencies in all lung cancer subtypes, whereas others appear to be specific for adenocarcinoma or squamous cell lung cancer. High frequency mutations or recurrent translocations support involvement of the affected genes in the pathogenesis of lung cancer. The presence of activating aberrations is indicative for putative driver genes that might be essential for tumor cell growth and survival. These driver genes are potential targets for developing new treatments for lung cancer patients. Indeed, multiple tyrosine kinase inhibitors (TKIs) are currently used to treat lung cancer patients based on the presence of activating mutations, and novel drugs are under investigation. Patients benefit for about one year from current targeted treatments, but progression of disease inevitably occurs and resistance of the tumor to the TKI used can be observed in re-biopsied tumor samples. The aim of this review is to provide an overview of mutated genes in non-small cell lung cancer, an overview of targeted treatment strategies that are currently applied, and the known resistance mechanisms.

Introduction/Background

βIII-tubulin expression correlates with poor outcome in various malignancies.

Materials and methods

βIII-tubulin expression was analyzed by immunohistochemistry on a tissue microarray containing 1800 colorectal cancers. Results were compared to clinic-pathological and molecular parameters.

Results

βIII-tubulin expression was detectable in 79.2% of 1619 interpretable colorectal cancers. Whole tumor slide analysis showed that βIII-tubulin is homogenously expressed in CRC. High βIII-tubulin expression was associated with left-sided tumor localization (p=0.0303) and nuclear β-catenin expression (p=0.003). High βIII-tubulin expression was not linked to the gender of the patient (p=0.5842).

When all tumors were analyzed the prognostic role of βIII-tubulin expression was not independent of pT stage, pN stage, tumor grade or tumor localization (p=0.0517).

Conclusion

βIII-tubulin expression is not an independent prognostic parameter in colorectal cancer. The significant association with left-sided tumor localization and a key genomic alteration of colorectal cancer such as β-catenin suggest interaction with important pathways involved in colorectal cancer.

An important part of personalized medicine in colorectal cancer (CRC) relies on using the most effective treatment based on molecular biomarkers, which define groups of patients according to specific tumor alterations. Therefore, anti-tumoral drugs are administered selectively to a subgroup of patients whose genetic alterations in the tumors indicate that they have an increased probability of recurrence without treatment or to those patients who will most likely respond to the treatment.

Currently, pharmaceutical companies use targeted drugs with biomarkers during the early stages of drug development. Then, the companion diagnostics that are developed based on response-specific biomarkers allow for the administration of the right drug to the right patient. Because CRC has become one of the most common neoplasias, personalized medicine has changed the oncologists' and pathologists' daily routines. In fact, KRAS mutations represented a revolution in targeted therapies and had clinical relevance for patients, clinicians and pharmaceutical companies. However, the new biomarkers, including microsatellite instability (MSI) and both NRAS and BRAF mutations, are well established molecular markers that determine CRC subgroups and should be considered separately when debating treatment options. However, despite the scientific evidence, these biomarkers have not yet been incorporated into practice. More clinical facts and cost-effectiveness analysis may be needed for their uniform implementation.

We experienced a rare case of uterine metastasis of non-small cell lung cancer in an 82-year-old Japanese woman revealed by detecting the same epidermal growth factor receptor (EGFR) gene mutation in both lung and endometrial biopsy specimens. The patient noticed abnormal genital bleeding at the first presentation. Further examination revealed huge masses in both lung and uterus. Biopsies from the lung and endometrium were performed. Although the pathological findings of both specimens showed similar adenocarcinomatous features including intracytoplasmic luminas, immunohistochemical analyses could not clarify whether these two tumors are lung metastasis of endometrial adenocarcinoma, uterine metastasis of lung adenocarcinoma or double primary adenocarcinomas of the lung and endometrium. Mutational analyses of EGFR gene using genomic DNA revealed that both lung and endometrial tumors had the same substitution mutation (L858R) at exon 21 which is often observed in lung adenocarcinomas. Since EGFR mutations are rarely detected in primary endometrial cancers and especially L858R mutation has not been reported in them, detection of the same L858R EGFR gene mutation in both lung and endometrial tumors strongly suggested that uterine tumor is the metastasis of lung adenocarcinoma. Mutational analyses might be useful to determine whether the tumor is primary or metastatic when the particular mutational types are observed in particular tumor types and/or particular organs.

Microabstract

Study investigated if there was a survival difference between sinN2 and mulN2 disease in operated NSCLC patients. 73 patients had sinN2 and 38 patients had mulN2 disease. The median survival and the 5-year survival rate of sinN2 and mulN2 were 26 months and 20.5% against 20 months and 0%, respectively, and there was a statistically significant difference between two groups (0.032).

Background

The most important parameter determining the treatment and survival in non-small cell lung cancer is the stage of the disease and the associated lymph node involvement. The present study investigated if there was a survival difference between single-station N2 (sinN2-Group 1) and multi-station N2 (mulN2-Group 2) disease in operated non-small cell lung cancer (NSCLC) patients.

Materials and methods

The patients, who were diagnosed with NSCLC and underwent anatomic resection and mediastinal lymph node dissection and found to have ipsilateral lymph node metastasis between January 2005 and December 2011 in our clinic, were investigated retrospectively.

Results

801 patients had anatomic resection. Among these patients, a total of 111 patients (13.8%) were found pathological N2 (+). 73 (66.6%) patients had sinN2 and 38 (33.4%) patients had mulN2 disease. Out of these patients, 94 (85.4%) were male and 17 (14.6%) were female, and the mean age was 58.9±10.2 (35–82) years. The median survival and the 5-year survival rate of sinN2 and mulN2 were 26 months and 20.5% against 20 months and 0%, respectively, and there was a statistically significant difference between two groups (0.032).

Conclusions

TNM system used in the current lung cancer staging assesses only the localizations of the metastatic lymph node stations. However, it seems that the localization of the lymph node stations alone is not completely enough for an estimated survival. The present study has found poorer survival in the multi-station N2 patients than the single-station N2 patients, which is also statistically significant.

Adenoid cystic carcinoma (ACC) of the breast is a rare breast tumor, comprising less than 1% of breast adenocarcinomas. Histopathologically, it is estrogen receptor (ER), progesterone receptor (PR), and HER2-negative (i.e., triple negative) but has a more indolent course than typical triple negative breast cancers. Most of what is known regarding ACC of the breast's treatment and prognosis is from case reports and case series. This case series reports a single institution's experience with ACC. Between 2003 and 2014, seven patients were found to have ACC of the breast. Most (6 of 7 cases) presented as a mammogram abnormality on routine screening. One patient was lost to follow up after initial diagnosis. All six patients underwent lumpectomy, sentinel lymph node biopsy (SLNB), and adjuvant radiation. None received systemic endocrine therapy or chemotherapy. All of the patients are without disease recurrence at median follow up of 6.2 years (range 0.4–10). Given the generally excellent prognosis of ACC of the breast and low tumor metastatic potential, it is reasonable to withhold adjuvant chemotherapy in the treatment of ACC and instead manage this malignancy with local therapy.

Introduction

Tumor genotyping using single gene assays (SGAs) is standard practice in advanced non-small-cell lung cancer (NSCLC). We evaluated how the introduction of next generation sequencing (NGS) into day-to-day clinical practice altered therapeutic decision-making.

Methods

Clinicopathologic data, tumor genotype, and clinical decisions were retrospectively compiled over 6 months following introduction of NGS assay use at our institution in 82 patient-tumor samples (7 by primary NGS, 22 by sequential SGAs followed by NGS, and 53 by SGAs).

Results

SGAs identified abnormalities in 34 samples, and all patients with advanced EGFR-mutated or ALK-rearranged tumors received approved tyrosine kinase inhibitors (TKIs) or were consented for clinical trials. NGS was more commonly requested for EGFR, ALK, and KRAS-negative tumors (p<0.0001). NGS was successful in 24/29 (82.7%) tumors. Of 17 adenocarcinomas (ACs), 11 (7 from patients with ≤15 pack-years of smoking) had abnormalities in a known driver oncogene. This led to a change in decision-making in 8 patients, trial consideration in 6, and off-label TKI use in 2. Of 7 squamous cell (SC) carcinomas, 1 had a driver aberration (FGFR1); 6 had other genomic events (all with TP53 mutations). In no cases were clinical decisions altered (p=0.0538 when compared to ACs).

Conclusions

Targeted NGS can identify a significant number of therapeutically-relevant driver events in lung ACs; particularly in never or light smokers. For SC lung cancers, NGS is less likely to alter current practice. Further research into the cost effectiveness and optimal use of NGS and improved provider training in genomic oncology are warranted.

Objective

In this study, we aimed to investigate the prognostic significance of preoperative anemia in bladder cancer patients who have undergone radical cystectomy.

Materials and methods

Data of 148 patients were collected, who underwent radical cystectomy with or without neoadjuvant chemotherapy for bladder cancer. Preoperative hemoglobin levels of these patients were measured and then classified as normal or anemia. Hemoglobin threshold value of the patients in the study was taken as the average of all patients. The results were assessed by using the univariate and multivariate analyses.

Results

The mean preoperative hemoglobin value was 12.2 g/dl (6.9–16). With reference to the specified threshold hemoglobin value (12.2 g/dl), 70 patients were anemic. Cancer-specific survival was found significantly lower in patients with low preoperative hemoglobin value, as determined by univariate analysis. After an average follow-up period of 21.1 months, anemia was found to be associated with decreased cancer-specific survival. Low preoperative hemoglobin value is an independent risk factor for shorter cancer-specific survival.

Conclusion

Preoperative anemia is an independent risk factor for cancer-specific survival. This is associated with aggressive tumor structure of patients with bladder cancer who underwent radical cystectomy. Hemoglobin value is an important marker that can be used to determine the prognosis in these patients.