New horizons from novel therapies in malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is a relatively rare, but highly lethal cancer of the pleural mesothelial cells. Its pathoge-nesis is integrally linked to asbestos exposure. In spite of recent developments providing a more detailed understanding of the pathogenesis, the outcomes continue to be poor. To date, trimodality therapy involving surgery coupled with chemotherapy and/or radiotherapy remains the standard of therapy. The development of resistance of the tumor cells to radiation and several che-motherapeutic agents poses even greater challenges in the management of this cancer. Ionizing radiation damages cancer cell DNA and aids in therapeutic response, but it also activates cell survival signaling pathways that helps the tumor cells to overcome radiation-induced cytotoxicity. A careful evaluation of the biology involved in mesothelioma with an emphasis on the workings of pro-survival signaling pathways might offer some guidance for treatment options. This review focuses on the existing treatment options for MPM, novel treatment approaches based on recent studies combining the use of inhibitors which target different pro-survival pathways, and radiotherapy to optimize treatment.

The efficacy and safety of capecitabine plus bevacizumab combination as first-line treatment in elderly metastatic colorectal cancer patients

AIM

The optimal treatment in older persons with metastatic colorectal cancer (mCRC) is complicated by a lack of general agreement. The aim of this study was to evaluate the activity of bevacizumab plus capecitabine combination in elderly mCRC patients who were not suitable for chemotherapy with irinotecan and oxaliplatin-containing regimens.

MATERIALS AND METHODS

Seventy years and older patients with metastatic colorectal carcinoma were included in this retrospective study. Bevacizumab was administered at a dose of 7.5 mg/kg on day 1 as an intravenous (IV) infusion over 30-90 min every 21 days, and capecitabine was prescribed at 1000 mg/m(2) twice daily on days 1-14 of the same 21-day schedule.

RESULTS

Eighty-two consecutive patients (47 men, 35 women) were included in the study. The mean age was 75.5 (SD 3.9, range 70-87). Half of the patients were older than 75 years. There were 55 patients (67.1 %) with a good Eastern Cooperative Oncology Group (ECOG) performance status (PS: 0-1) and the remaining 27 patients (32.9 %) had a poor ECOG performance status (PS: 2). With a median follow-up period of 18.5 months, the median progression-free survival (PFS) was 10 months (95 % CI, 7.8-12.1) and the median OS was 25 months (95 % CI, 18.6-31.3). The main toxicities recorded were non-hematological. Thirty-one patients (37 %) experienced grade 3/4 adverse events, the most common being hand-foot syndrome (9.8 %). No fatal toxicity resulting from this regimen was recorded.

CONCLUSIONS

Considering the toxicity profile and survival outcomes, the combination regimen of capecitabine and bevacizumab is a potentially feasible treatment option in elderly mCRC patients.

Prognostic significance of ADAM17 expression in patients with gastric cancer who underwent curative gastrectomy

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Background: Tumor invasion and metastasis are complex processes, involving regulation at the molecular level of adhesive molecules, proteolitic enzymes, and cell growth and angiogenesis factors. A Disintegrin and Metalloproteinase (ADAM)17 has been indicated to be indispensable regulator of celular event from proliferation to migration.Although prognostic importance of ADAM17 expression has been investigated in several tumors, its clinical utility as a useful prognostic molecular marker remains unclearin gastric cancer.In the present study, we evaluated the expression of ADAM17 and its prognostic significance in gastric cancer patients after surgery. Methods: Prognostic significance of ADAM17 expression was analyzed by immunohistochemically in 158 patients with gastric cancer and the relationship between its expression and clinicopathological factors was also evaluated. Results: High expression of ADAM17 was detected in 81 patients(51%),while low expression was found in 77 cases (49%). There was significant correlation between gender, histology, lymph node metastasis, vascular invasion, the presence of recurrence and high ADAM17 expression. Recurrence in patients with high ADAM17 expression was significantly higher than that for patients with low ADAM17 expression(p=0.032). The median disease-free survival (DFS) time for patients with high ADAM17 expressed tumors were worse than those of patients with low ADAM17 expressed tumor (16.6 vs. 44.2 months, p=0.004).In addition, patients with low ADAM17 expression had a higher median overall survival (OS)interval than those of high ADAM17 expressed patients (49.6 vs. 26.9 months, p=0.019). Multivariate analysis indicated that the rate of ADAM17 expression was an independent prognostic factor for DFS, in addition to known important clinicopathological prognostic indicator for DFS. But its' prognostic importance could not be proved by multivariate analysis for OS. Conclusions: The potential value of ADAM17 expression as a useful molecular marker in gastric cancer progression should be evaluated comprehensively,it may predict recurrence and poor prognosis in patients with gastric cancer after curative resection.

The relationship between collapsin response mediator protein-1 (CRMP 1) expression and histopathogic parameters and survival in patient with gastric cancer

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Background: Biomarkers which indicate invasion and metastasis in patients with gastric cancer are important. Collapsin response mediator protein (CRMP) family proteins are cytosolic phosphoproteins involved in semaphorin 3A-mediated neuronal cell growth cone collapse and cancer invasion. CRMP1 over expression levels were found to have negative association with invasion and metastasis in lung cancer tissue samples. The aim of the study was to investigate relationship between CRMP1 expression and histopathological parameters and prognostic value of CRMP1 expression in patients with gastric cancer. Methods: We analyzed 52 patients who were diagnosed with gastric cancer. The CRMP1 expression was examined by performing immunohistochemical staining. High CRMP1 expression in gastric tumor samples was defined as being immunoreactive to CRMP1 antibody in more than 50% of the cancer cells. The correlation between CRMP1 expression and age, gender, tumor grade, lenfovascular-perineural invasion, t stage and nodal involvement was investigated. Results: Among the 52 patients (CRMP1 positive/CRMP1 negative= 24/28), median age was 56 years (27-84). Thirty-five patients were male and 17 patients were female. The median follow-up time was 14 (2-60) months. The median disease-free survival time (DFS) was 20 (SE: 4; 95% CI: 13-27) months. In addition, the median overall survival time (OS) was not reached. The significant relationship was found between CRMP1 high expression levels and high grade tumors (p:0.03), and nodal metastasis (p:0.019). In univariate analysis, only high CRMP1 expression was associated with poor disease-free survival (p:0.004). Also, male gender (p:0.023), high grade tumors (p:0.044), nodal involvement (p:0.028) and high CRMP-1 expression were associated shorter overall survival. In multivariate analysis, no independent prognostic factor was found in this group. Conclusions: We found that high expression of CRMP1 was associated with tumor aggressiveness of tumor and poor survival. Larger studies and further clinical trials are warranted to confirm these findings.

Netrin-1 concentrations in patients with advanced gastric cancer and its relation with treatment

CONTEXT

Netrin-1 is found to be elevated and usable as a diagnostic biomarker in many human cancers.

OBJECTIVES

We evaluated serum Netrin-1 concentrations in patients with advanced gastric cancer compared with those in a healthy group.

MATERIAL AND METHODS

Thirty patients with advanced gastric cancer and thirty healthy people were included in the study. Serum netrin-1 concentrations were measured by quantitative ELISA method in both groups.

RESULTS

The mean serum Netrin-1 concentrations were found to be significantly higher in patients with gastric cancer than in healthy controls. The mean serum Netrin-1 concentrations were found to be significantly higher in patients with gastric cancer before the beginning of chemotherapy when compared after the completion of third cycle.

DISCUSSION AND CONCLUSION

Our results indicated that netrin-1 concentrations elevated in advanced gastric cancer compared to a healthy control group and netrin-1 concentrations decreased with chemotherapy.