Second- and third-line chemotherapy in patients with metastatic pancreatic adenocarcinoma: feasibility and potential benefits in a retrospective series of 117 patients

BACKGROUND

Chemotherapy is effective in metastatic pancreatic adenocarcinoma (PAC), but the benefits of second- and third-line chemotherapy remain unclear.

METHODS

We studied all patients followed consecutively for metastatic PAC, and registered at our institution between 1997 and 2006. We retrospectively analyzed the following data in terms of chemotherapy: tumor response; time to tumor progression (TTP) for each line; and overall survival (OS). Efficacy of second-line regimens was assessed using the growth modulation index (GMI).

RESULTS

Out of 117 patients, 99 (85%) received at least one line of chemotherapy, 53 (45%) received two lines and 24 (21%) had three or more lines. Median OS was 6.7 months for all 117 patients, 1.8 months for 18 patients who never received chemotherapy, 4.6 months for 46 patients who received one-line chemotherapy and 11.5 months for 53 patients who received at least two lines. Median OS from the beginning of the second-line was 4.7 months. The GMI demonstrated beneficial effects of second-line treatment on disease progression, with a GMI greater than 1.33 in 57% (30/53) of patients.

CONCLUSION

More than half the patients with metastatic PAC progression while receiving one-line chemotherapy achieved better disease control on receiving two lines of treatment.

Chemotherapy as initial treatment of locally advanced unresectable pancreatic cancer: a valid option?

INTRODUCTION

Radio-chemotherapy is the standard treatment for locally advanced unresectable pancreatic cancer (LAPC). Chemotherapy has been shown to be effective in the treatment of metastatic disease and we therefore evaluated its use as a first-line treatment for LAPC.

PATIENTS AND METHODS

We carried out a retrospective analysis of all consecutive patients treated for LAPC (N=33) between July 1997 and April 2005, analysing the results of first-line chemotherapy (CT group) and radio-chemotherapy (RCT group) in this setting.

RESULTS

The first-line treatment was RCT in six patients (18.3%) and CT in 26 patients (78.8%). Secondary treatment was administered to nine patients of CT group with well-controlled disease: "closure" radio-chemotherapy for seven patients (26.9%) and secondary resection for three (12%). After a median follow-up of 27 months, 23 patients died (69.7%). Overall survival was 13.8 months [95% CI: 10.1-19.4] for the whole population, 9.5 months [95% CI: 4.6-] for the RCT and 18.0 months [95% CI: 12.4-25.5] for the CT. Overall survival for the CT patients undergoing secondary surgery or "consolidation" radio-chemotherapy was 28.8 months [95% CI: 13.8-].

CONCLUSION

First-line chemotherapy is a valid option for LAPC treatment, making it possible to identify the patients who may benefit from secondary resection or radio-chemotherapy.

[Yersinia enterocolitica: a cause of acute intestinal intussusception]

OBJECTIVES

Yersinia enterocolitica infection is a rare cause of intestinal intussusception, especially in adults. We report here a case in a 29-year-old man and review the literature on diagnosis and therapy.

CASE REPORT

A 29-year-old man presented with a 2-week history of diarrhea and weight loss. Ultrasonography revealed acute intestinal intussusception localized at the site of enlarged mesenteric nodes. At laparostomy, intestinal resection was not required. Histology examination of the mesenteric nodes showed follicular hyperplasia. Serology was positive for Yersinia enterocolitica. Outcome was favorable after treatment with tetracycline for 15 days.

DISCUSSION

Yersinia enterocolitica are Gram negative bacilli that grow at low temperature. Food contamination is the most frequent source of infection in man, usually in children. Clinical manifestations include gastroenteritis or pseudoappendicular syndrome. Intestinal intussusception is rare. Operative reduction by taxis is generally sufficient. Histology examination of the lymph nodes excludes lymphoma. The diagnosis is confirmed by serology. A 10 to 15-day antibiotic regimen is needed.

[Increase of alpha-fetoprotein in pancreatic endocrine tumors with hepatic metastases. Apropos of 2 cases]

We report two cases of metastatic non-functioning pancreatic endocrine tumour with very elevated plasma levels of alpha-fetoprotein. In these two cases, serial plasma levels of alpha-fetoprotein, initially normal, correlated well with hepatic tumour progression and were associated with fatal outcome. These results suggest that elevated plasma concentration of alpha-fetoprotein may be caused by metastatic pancreatic endocrine tumour and than alpha-fetoprotein serial measurement may be useful in prognostic evaluation.

[Effect of a buzepide metiodide-haloperidol combination in treating functional intestinal disorders. Randomized double-blind controlled versus placebo study]

The efficacy and safety of a combination of buzepide metiodide and haloperidol was assessed in a placebo-controlled double-blind trial during 2 months in 224 patients (154 women, 79 men) with the irritable bowel syndrome. The 2 groups were comparable at inclusion. The efficacy was assessed at days 15, 30 and 60. Inclusion and assessment criteria were clinical, abdominal pain being considered as the main assessment criterion. The combination proved statistically better than placebo on the frequency of symptoms at all visits and on the intensity of the most frequent symptoms (abdominal pain and distension) at the final visit. A previously defined global assessment score was found significantly better in favor of the treated group at day 15 and day 30. At the final visit, the score of a visual scale assessing the patient's global impression was also found significantly better on the combination, There was no serious side-effect. In conclusion, this study demonstrates the efficacy and safety of a combination of buzepide metiodide and haloperidol in patients with the irritable bowel syndrome.

Rioprostil vs. ranitidine in duodenal ulcer healing: a double-blind multicentre trial

A total of 156 patients with endoscopically proven duodenal ulcers are randomized in a double-blind, multicentre trial comparing rioprostil, 300 micrograms b.d., with ranitidine, 150 mg b.d. With rioprostil, the cumulative healing rate by endoscopy is 73% at 4 weeks, and 87% at 6 weeks. With ranitidine it is 79% and 92%, respectively. There is no difference in the occurrence of pain after the two types of treatment, and the side effects are comparable in the two groups. These results show that rioprostil is probably as effective and safe as ranitidine in the treatment of duodenal ulcer.

Surgical treatment of a tuberculous thoracoabdominal aneurysm

We report a case of tuberculous thoracoabdominal aneurysm successfully treated by surgery. Computerized tomography was diagnostic for location and etiology. The therapeutic plan included antituberculosis drug therapy started before surgery, direct PTFE prosthetic replacement and omentoplasty. A survey of other reports dealing with tuberculous abdominal or thoracic aorta involvement shows that their frequency, as that of tuberculosis in general, is diminishing.

Transcatheter embolization of multiple pulmonary artery aneurysms in Behçet's syndrome. Report of a case

Transcatheter embolization of a pulmonary artery aneurysm in Behçet's disease has rarely been attempted. A report is presented of a case with four pulmonary aneurysms and massive hemoptysis. Transcatheter embolization was successfully performed in three of these aneurysms, with clinical improvement during a follow-up period of 11 months. Technical problems, hazards, and indications for embolization in these patients are discussed.

[Parathyroid adenoma disclosed by a massive subcapsular hemorrhage]

In the case reported here a parathyroid gland adenoma was revealed by the sudden occurrence of a large subcapsular haematoma compressing cervical structures and causing recurrent nerve paralysis; spontaneously regressive hypercalcaemia was present. The place of these haemorrhages among other manifestations of a hitherto silent parathyroid gland adenoma is discussed, together with the diagnostic value of thyroid gland scintigraphy and cervical ultrasonography. In view of their potentially somber prognosis, emergency surgery is mandatory in such cases.

[Decrease of the 3rd fraction of serum complement. Study in a hospital population of 13000 patients]

Patients with serum concentrations of C3 lower than 0.40 g/l among 13 000 patients in a general hospital seen over an 18 months period were studied. 95 cases were eligible for study. Diffuse and severe liver disease accounts for 50% of cases. Immunologic diseases represent little more than 10% of cases. The other common causes are severe infections and nutritional deficiencies. Besides the immunological diseases, low C3 serum concentration represents a poor prognosis factor since 55% of patients died during hospitalization.

[Relation between monoclonal gammopathy and hepatobiliary disease]

Eleven cases of monoclonal gammopathy associated with chronic hepato-biliary diseases are reported. The gammopathy was benign and the majority of hepato-biliary diseases consisted of cirrhosis complicated or not by hepatocellular carcinoma. The small number of cases reported and the absence of distinctive clinical, biochemical and evolutive features of the gammopathy and hepato-biliary disease suggest that the association was fortuitous.

[Aortic stenosis associated with vascular malformations of the digestive tract. 2 cases (author's transl)]

Two patients with aortic stenosis had recurrent digestive haemorrhages. Fiberoscopy showed the presence of angiodysplasia of the stomach in one patient and of the colon in the other. This association had been reported in subjects older than 60. It does not seem to be fortuitous. The authors discuss the theoretical and practical implications, including the need for full radiological and endoscopic exploration of patients with recurrent digestive haemorrhages, particularly when associated with aortic stenosis.