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.

The prevalence and significance of autoantibodies in patients with non-Hodgkin's lymphoma: are they correlated with clinicopathological features?

PURPOSE

It is well known that an association exists between the pathogenesis of lymphomas and autoimmune diseases. Autoantibodies are detected at higher frequency in lymphoproliferative diseases, but neither the precise role of the immune system nor the cause of this is comprehensively understood. In this study we evaluated the presence and significance of some autoantibodies for patients with non- Hodgkin's lymphoma (NHL).

METHODS

150 patients with NHL who had either newly diagnosed disease, or active disease being under chemotherapy or were disease-free during follow-up, were analyzed. The frequency of autoantibodies and the relationship between autoantibodies and several clinicopathological factors were evaluated.

RESULTS

The majority of the patients (50%) had diffuse large B-cell lymphoma (DLBCL). Thirty-two patients (21.4%) were newly diagnosed, 81 (54%) had active disease and were receiving chemotherapy and 37 (24.6%) were disease-free and followed-up. Fifty-one patients (34%) had stage IV disease. Antinuclear antibodies (ANA) were found in 7 (4.7%) patients, perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) in 10 (6.7%), anti dsDNA in 1 (0.7%), anti ssDNA in 16 (10.7%), anti Jo-1 in 3 (2%), anti-scleroderma antibody (anti Scl-70) in 4 (2.7%), and rheumatoid factor (RF) in 85 (56.7%) patients. No c7horbar;ANCA positivity was found. The mean levels of anti Jo-1 (p=0.028), anti ssDNA (p=0.014), c-ANCA (p=0.015), ANA (p=0.026) and RF (p=0.046) were significantly higher in cases with DLBCL compared to patients with non-DLBCL. In addition, in patients with newly diagnosed NHL the mean levels of anti Scl- 70 (p=0.023), anti Jo-1 (p7equals;0.017), and RF (p=0.046) were significantly higher than the other patient groups. No significant correlation was detected between the presence of autoantibodies and other clinicopathological factors.

CONCLUSION

Our results show that the frequency of autoantibodies is high in NHL patients, especially in DLBCL and newly diagnosed cases. Autoantibodies may be helpful for the diagnosis of autoimmune diseases, but regular and long follow-up is needed in NHL patients with high levels of autoantibodies.

Is there any correlation among adiponectin levels in serum, tumor tissue and normal tissue of the same patients wih breast cancer?

PURPOSE

Adiponectin is secreted from adipose tissue and is characterized by hyperinsulinemia which is related with obesity. Although serum adiponectin levels in patients with breast cancer have been studied previously, adiponectin levels in the serum, tumor and normal tissue of the same patients have not been simultaneously investigated. The aim of this study was thus to evaluate the relationship among serum, tumor and normal tissue adiponectin levels in patients with breast cancer.

METHODS

Fifty-three patients with breast cancer who were operated at the Dr. Lutfi Kirdar Kartal Education and Research Hospital, Department of Surgery, between February 2008 and June 2008, were analyzed. Their serum adiponectin levels, tumor tissue and normal breast tissue adiponectin levels were compared. The correlation between postoperative histopathological parameters, insulin resistance parameters and adiponectin levels was also examined.

RESULTS

The mean adiponectin levels in tumor tissue, normal breast tissue and serum were 56 ± 9.6 ng/ml, 56 ± 10 ng/ml and 43.5 ± 3.1 ng/ml, respectively. The serum adiponectin levels were inversely correlated with tumor tissue adiponectin levels (p=0.001, r=-0.43). When tumor tissue adiponectin levels were increased, serum adiponectin levels were decreased. O n the other hand, there was a positive correlation between normal breast tissue adiponectin levels and tumor tissue adiponectin levels (p=0.0001, r= 0.850). The tumor tissue adiponectin level was inversely correlated with tumor stage (p=0.037 , r= -0.29). Moreover, in early-stage and low grade tumors, both tumor tissue and normal tissue adiponectin levels were high compared with those of advanced stage or high grade tumors (p=0.027, r= -0.32 and p=0.004, r= -0.408, respectively). In the subgroup analyses, no significant relationship was found between insulin resistance parameters and adiponectin levels (p>0.05).

CONCLUSION

Our results indicate that serum adiponectin levels were inversely correlated with tumor tissue adiponectin levels, but no relationship between normal breast tissue and tumor tissue adiponectin levels was demonstrated. Adiponectin levels in breast tumor tissue increase while serum adiponectin levels decrease. Adiponectin might play an important role in the prevention of tumor progression by decreasing tissue neovascularization.

A retrospective analysis of women's chances to become pregnant after completion of chemotherapy: a single center experience

PURPOSE

With the improvement in anticancer therapies, the survival of women with malignancies has increased and infertility may affect the quality of life of premenopausal women, who experience temporary or permanent amenorrhea due to chemotherapy. The aim of this study was to review the rate of pregnancies among women with malignancy previously treated with chemotherapy.

METHODS

We retrospectively recorded 317 women younger than 40 years of age who were treated with chemotherapy (and a number of them with additional radiotherapy/RT) due to several malignancies between 2007-2010. The patients who got pregnant after stopping chemotherapy and during followup were analyzed.

RESULTS

Among women with breast cancer (n=116), malignant lymphoma (n=85), ovarian cancer (n=26) and colon cancer (n=90), 20 got pregnant after a median 22.9 months (range 10.7-96.5) from the end of chemotherapy. Childbearing was uneventful and newborns were healthy.

CONCLUSION

Women who had previously received chemotherapy for malignancy can get pregnant and deliver healthy newborns.

Is there a cut-off value for standardized uptake values in positron emission tomography for predicting response to treatment and survival in patients with advanced non-small cell lung cancer? Single center experience

PURPOSE

Positron emission tomography (PET) is an important imaging technique for the diagnosis and staging of patients with non-small cell lung cancer (NSCLC). In this study, we evaluated the standardized uptake values (SUV) of PET in NSCLC patients to determine whether there was a cut-off value for predicting response to treatment and survival.

METHODS

We retrospectively analyzed 149 patients with locally advanced NSCLC. All the patients were staged by PET-computerized tomography (CT) after diagnosis. 18fluoro-2-deoxyribose (FDG) was used as the PET tracer. Univariate and multivariate analyses were performed to detect whether any prognostic factors were related to response to treatment.

RESULTS

The median patient age was 60 years and the median follow-up time 10.3 months. One-year progression-free survival (PFS) and overall survival (OS) rates were 31% and 58.7%, respectively. The median OS was 15.4 months. Stage, sex and response to treatment were important factors for OS and PFS. We defined a cut-off value for SUVmax (the highest standardized uptake value for all cross sectional areas) as 10.8 by using ROC analysis. Multivariate analysis identified response to treatment as the most significant (p<0.05) prognostic factor for OS. Logistic regression analysis showed that SUVmax and weight loss were important for response to treatment.

CONCLUSION

Multivariate analysis indicated that whilst response to treatment was an important factor for predicting survival, the SUVmax was also significant for determining response to therapy and a cut-off value for SUVmax was defined as 10.8.