A Low Body Fat Mass Ratio Predicts Poor Prognosis in Patients with Advanced Non-Small Cell Lung Cancer

PURPOSE

The aim of this study was to investigate the effect of the body fat mass ratio on survival and prognosis in advanced non-small-cell lung cancer patients.

METHODS

The study includes 200 patients who were diagnosed with advanced non-small-cell lung cancer between 2014 and 2018 and whose body fat mass percentage and body mass index (BMI) were determined using the Tanita Body Composition Analyzer during admission.

RESULTS

All patients had advanced incurable non-small-cell lung cancer (30% had locally advanced disease, 70% were stage IV). In the univariate and multivariate analyses, age, gender, histopathological type, smoking history, comorbidities, weight loss in the last six months and body mass index had no statistically significant effect on survival (p > 0.05). However, the performance status (p = 0.008), metastatic status (p = 0.003) and body fat mass ratio (p = 0.01) were found to have a significant effect on overall survival (OS): the median OS was 16.4 mo, in patients with the BFM ratio ≤ 22% and 29.2 mo, in those with > 22% (p = 0.01).

CONCLUSION

In this study, it was found that the body fat mass ratio was an important prognostic factor in patients with advanced non-small-cell lung cancer.

Photodynamic Therapy of Sarcoma M-1 in Rats with Photosensitizer Photoran E6

We studied the effectiveness of photodynamic therapy with the photosensitizer Photoran E6 on the model of rat sarcoma M-1 positive for mutant p53 gene. Experiments showed that Photoran E6 exhibits high antitumor activity in photodynamic therapy of solid tumor of the connective tissue. Photodynamic therapy carried out during the optimal period after injections of Photoran E6 with the determined parameters of laser exposure allows achieving the maximum inhibitory effect on sarcoma M-1: 100% cured animals. Immunohistochemical study revealed no live tumor cells with expression of the mutant p53 protein in areas of photodynamic exposure.

Efficacy and tolerability of current treatments for hormone-refractory prostate cancer patients with visceral metastases

Aim: To assess the efficacy and tolerability of the first-line treatment options for hormone-refractory prostate cancer patients with visceral metastases. Materials & methods: The records of 191 patients diagnosed with hormone-refractory prostate cancer with visceral metastases were analyzed retrospectively. Results: Docetaxel was administered to 61.2% (n = 117), abiraterone to 14.2% (n = 27) and enzalutamide to 9.4% (n = 18) as the first-line treatment. The median survival of the patients receiving docetaxel, abiraterone and enzalutamide as the first-line treatment during the hormone-refractory period was 15 (95% Cl: 12.9-17) months, 6 (95% Cl: 1.8-10.1) months and 11 (95% Cl: 0.9-23.1) months (p = 0.038), respectively. Conclusion: The present study established a statistically significant difference in favor of docetaxel in terms of overall survival and progression-free survival.

Rare Tumours of the Testis: Twelve Years of Experience

Rare tumours of the testis includes a wide variety of tumours. We aim to present clinical and histological characteristics of our patients with rare tumours of the testis. The medical records of 33 patients who were treated and followed-up for testicular rare tumours in our center between 2007 and 2020 were retrospectively reviewed. Of all the 243 testicular tumours, 222 cases (91.4%) were germ cell tumours and 21 cases (8.6%) were non-germ cell tumours. Thirty-three rare tumours of the testis including rare germ cell tumours and non-germ cell tumours were detected. The mean age of the patients at diagnosis was 34 years (range 18-68 years). The histological types of rare testicular tumours were as follows: teratoma 4.5% (n=11), sex-cord stromal tumours 4.5% (n=11), paratesticular tumours 3.2% (n=8), and the others [lymphoma 0.4% (n=1), mesothelioma 0.4% (n=1) and choriocarcinoma 0.4% (n=1)]. The median duration of follow-up was 32 months (range 1 to 256 months). None of the patients with non-metastatic disease stage developed recurrence after having received appropriate therapy. Metastatic disease was documented in 9 cases at the time of diagnosis (five patients with teratomas, two patients with Leydig cell tumour, one patient with choriocarcinoma and rhabdomyosarcoma). The most common subtypes of testicular rare tumours in our center was teratoma and sex-cord stromal tumours. Because of testicular rare tumours have different biological features and different clinical outcomes, the management of each tumour requires a different approach.

GLASS: Global Lorlatinib for ALK(+) and ROS1(+) retrospective Study: real world data of 123 NSCLC patients

Lorlatinib is a third-generation tyrosine-kinases inhibitor (TKI) targeting ALK/ROS1 fusions. The FDA has approved lorlatinib for TKI-pretreated ALK(+) NSCLC, while its approval for ROS1(+) is still pending. Here we present the largest real-world data of NSCLC patients harboring ALK/ROS1 rearrangements treated with lorlatinib.

METHODS

123 patients were enrolled retrospectively (data cut-off 1/1/2019). Lorlatinib was administered through an early access program for patients with no other available therapy. Outcome and response were defined by each investigator upon RECIST 1.1 criteria.

RESULTS

106 ALK(+) and 17 ROS1(+) patients recruited from 8 different countries. The ALK(+) cohort included 50 % males, 73 % never-smokers and 68 % with brain metastases. Extracranial (EC) and intracranial (IC) response rates (RR) were 60 % and 62 %, with disease control rates (DCR) of 91 % and 88 % respectively. Mean duration of therapy (DoT) was 23.9 ± 1.6 months and median overall survival (mOS) was 89.1 ± 19.6 months. ROS1 cohort enrolled 53 % males, 65 % never-smokers and 65 % had brain metastases. EC and IC RR were 62 % and 67 % with DCR of 92 % and 78 % respectively. Median DoT was 18.1 ± 2.5 months and mOS of 90.3 ± 24.4 months. OS and DoT in both cohorts were not significantly correlated with line of therapy nor other parameters. The most common adverse events of any grade were peripheral edema (48 %), hyperlipidemia (47 %), weight gain (25 %) and fatigue (30 %). CNS adverse events such as cognitive effect of grade 1-2 were reported in 18 % of patients.

CONCLUSION

Lorlatinib shows outstanding EC/IC efficacy in ALK/ROS1(+) NSCLC. The observed mOS of 89 ± 19 months in ALK(+) NSCLC supports previous reports, while mOS from of 90 ± 24 months is unprecedented for ROS1(+) NSCLC.

Abstract P6-18-37: The efficacy and safety analysis of the treatments of everolimus and exemestane combination in 101 metastatic breast cancer patients: Real-life experience from Turkey

Background: Endocrine treatment and chemotherapy are a treatment options for patients with hormone receptor (HR) positive and HER2-negative metastatic breast cancer (MBC). However, response to first-line hormone treatment could not obtained in all patients, and even patients who havea response will eventually relapse. After disease progression, second-line hormonal treatmentoptions are used sequentially. Everolimus with exemestane has demonstrated promising activity in patients with HR-positive HER2-negative endocrine-resistant MBC with respect to the results of the BOLERO-2 study. In the present study, we aimed to evaluate the efficacy and safety of this combination in the real-life clinical setting for the unselected population in Turkey. Material and Methods: One hundred and one patients with HR-positive HER-2 negative MBC progressing after prior endocrine treatment who were treated with everolimus with exemestane were retrospectively analyzed. The tolerability and efficacy of this combination were evaluated in the unselected Turkish patients. Results: Among 101 patients, 45% of patients had visceral and %50 patients had only bone metastasis. Everolimus with exemestane treatment was administered as a second-line in 21.3% of patients, third-line in 40.4% and forth-line and later in 38.2%. The objective response rate was 24.7% (CR+PR) and stable disease was obtained in 37.7% of patients. At the median follow-up time of 13.5 months, the median progression-free survival (PFS) time and 1-year PFS were 13.8 months and 57.2%, while the median overall survival (OS) interval and 1-year OS were 40 months and 85%. The median treatment duration was 8.3 and 6.5 months for exemestane and everolimus, respectively. The most frequent reason for discontinuation of treatment were disease progression (39%). Moreover, the most common advers events (AE) causing permanent discontinuation were stomatitis (3%) and pneumonitis (3%). A total of 81 % of patients experienced at least one AE of any grade, 25% of patients at least one grade 3 or 4 AE. Due to AEs, everolimus dosage was reduced to 5 mg in 16 (15.8%) of patients. Conclusions: Our findings confirmed that the combination of everolimus with exemestane was the safe and effective treatment options for patients with HR-positive HER-2 negative MBC after second or later lines treatments.

Citation Format: Bilici A, Menekse S, Akin S, Degirmenci M, Olmez OF, Avci N, Sakalar T, Tural D, Kaplan MA, Tanriverdi O, Bilgetekin I, Uslu R. The efficacy and safety analysis of the treatments of everolimus and exemestane combination in 101 metastatic breast cancer patients: Real-life experience from Turkey [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-37.

Pertuzumab, trastuzumab and taxane-based treatment for visceral organ metastatic, trastuzumab-naïve breast cancer: real-life practice outcomes

PURPOSE

In this study, we aimed to describe the real-life practice outcomes of pertuzumab-trastuzumab-taxane (PTT) combination in visceral organ metastatic, trastuzumab-naive breast cancer (BC) patients.

METHODS

This study was conducted by Turkish Oncology Group and included 317 patients' data from 36 centers.

RESULTS

Median age was 51 (22-82). Median PFS was 28.5 months, while median OS was 40.3 months. Patients with brain metastases (n: 13, 4.1%) had worse PFS (16.8 m vs. 28.5 m; p = 0.002) and OS (26.7 m vs. 40.3 m; p = 0.009). Patients older than 65 years of age (n: 42, 13.2%) had significantly lower OS results (19.8 m vs. 40.3 m; p = 0.01). Two hundred sixty-eight patients (86.7%) received docetaxel while 37 patients (11.7%) received paclitaxel. PFS and OS were similar between taxane groups. In eight patients (2.5%), 5-40% ejection fraction decrement from baseline was detected without any clinical sign of heart failure.

CONCLUSIONS

Our RLP trial included only visceral metastatic, trastuzumab-naïve BC patients including cases with brain involvement who received PTT combination in the first-line treatment. Regardless of negative prognostic characteristics, our results are in parallel with pivotal trial. Further strategies for brain metastasis should be developed to improve outcomes despite encouraging results with PTT treatment. Taxane selection can be personalized and endocrine maintenance may further improve outcomes after taxanes were discontinued. To our knowledge, this is the largest scale real-life clinical practice study of pertuzumab-trastuzumab-taxane therapy to date.

Abstract P6-14-04: Is fat mass more effective than body mass index (BMI) to predict toxicity in early breast cancer patients treated with doxorubicin and cyclophosphamide?

Patients and Methods:We performed a retrospective cohort study of 207 operated breast cancer women treated with doxorubicin (60 mg/m2) and cyclophosphamide (600 mg/m2) for adjuvant setting between 2007 and 2016. Patients' demographic features, toxicities, fat mass, body mass index (BMI) and body surface area (BSA) were evaluated in their charts. Patients were evaluated according to fat mass (high ≥35% vs. low <35%), BMI (obese ≥30 kg/m2 vs. nonobese <30 kg/m2), and BSA (≥1.73 vs. <1.73) levels.

Results:Median age was 46 (23-82) and 61.8% of the patients (n=128) were premenopausal. Median fat mass, BSA, and BMI level was 37 (10-55), 1.75 (1.3-2.27) and 29.4 (16-54.7), respectively. Grade ≥3 toxicity was observed in 68 patients (%32.9). Although, in univariate analyses [table 1] there are no differences in terms of grade ≥3 toxicity according to BMI (in obese and nonobese patients, 34.8% vs. 31.4%, respectively, p=0.589), and BSA (in patients with m2 ≥1.73 vs. m2 <1.73, 35.8% vs. 29.6%, respectively, p=0.344), statistically significant difference was observed according to fat mass (fat mass high and low, 39.1% vs. 25.0%, respectively, p=0.031). In multivariate analyses [table 2], fat mass [<35 vs. >35, OR (odds ratio): 2.341 %95CI:0.39-5.27, p=0.040] was affect grade ≥3 toxicity, while BMI [<30 vs. >30; OR:0.876 %95 CI=0.392-1.959, p=0.748], BSA [<1,73 vs. >1.73 m2, OR:0.956, %95CI:0.450-2.034, p=0.908], age [<50 vs. >50, OR:2.171, %95CI:0.338-13.956, P= 0.414], menopausal status [premenopausal vs. postmenopausal, OR:4.374, %95CI:0.661-28.964, p=0,126], stage [1,2 vs 3, OR:0.535, %95CI:0.279-1.024, p=0.059] and histologic subtype [ductal vs. others; OR:2.010 %95 CI=0.368-2.010, p:0.729] was not.

Grade ≥3 toxicity according to BMI, BSA, and fat massMethodGrade ≥3 toxicityP valueBMI (obese vs nonobese)34.8% vs. 31.4%0.589BSA (≥1.73 vs. m2 <1.73)35.8% vs. 29.6%0.344Fat mass (≥35% vs. <35%)39.1% vs. 25.0%0.031BMI: Body mass index, BSA: body surface area

Multivariate analayses for grade ≥ 3 tocicityParametersOdds Ratio%95 Confidence IntervalP valueFat mass (≥35% vs. 35%)2.3410.39-5.270.040BMI (≥30 vs. < 30)0.8760.392-1.9590.748BSA (<1,73 vs. >1.73)0.9560.450-2.0340.908Age (≥50 vs. <50)2.1710.338-13.9560.414Menopausal status4.3740.661-28.9640,126Stage0.5350.279-1.0240.059Histhologic type2.0100.368-2.0100.729BMI: Body mass index, BSA: Body surface area

Discussion:BSA-based dosing has been widely adopted in oncology as a means of safely administering cytotoxic drugs. In our study demonstrated that fat mass is most valuable than BSA and BMI for evaluation to grade ≥3 toxicity for breast cancer patients treated with AC in the adjuvant setting.

Citation Format: Kaplan MA, Kavak H, Urakci Z, Nas N, Oruç Z, Yerlikaya H, Akdeniz N, Isikdogan A. Is fat mass more effective than body mass index (BMI) to predict toxicity in early breast cancer patients treated with doxorubicin and cyclophosphamide? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-14-04.

Modifying Effect of Autotransfusion of Mesenchymal Stromal Cells on the Production of Reactive Oxygen Species and Cytokines by Mononuclear Cells in Patients with Chronic Heart Failure

We studied in vivo modifying effect of autotransfusion of human bone marrow mesenchymal stromal cells on ROS generation and production of cytokines (TNFα,TNFβ, IL-1α, IL-10, IFNγ, and GM-CSF) and PGE₂ by mononuclear cells of patients (N=21) with chronic heart failure. These parameters were evaluated prior to (control) and after (immediately and on day 14) intravenous administration of stromal cells in doses of 100-200×10⁶. Immediately after autotransfusion, significant increase of in vitro zymosan-induced chemiluminescence of blood mononuclear cells from 10 patients was observed. At later terms after autotransfusion (day 14), inhibition of chemiluminescent activity of blood mononuclear cells was revealed in 50% patients. We discuss possible mechanisms of involvement of transplanted autologous bone marrow mesenchymal stromal cells in reprogramming of blood mononuclear phagocytes from the pro- to anti-inflammatory phenotype under conditions of their in vivo interaction manifesting in transition from activation to inhibition of ROS-producing activity of macrophages and significant suppression of in vitro LPS-induced production of TNFα and GM-CSF by blood mononuclears against the background of significantly elevated TNFβ, IL-10, and IL-1α concentrations.

The predictive role of Paraoxonase 1 (PON1) activity on survival in patients with metastatic and nonmetastatic gastric cancer

BACKGROUND

Oxidative stress is known to be implicated in the pathogenesis of malignancies including gastric cancer (GC). Paraoxonase 1(PON1) is a member of antioxidant defense system which acts by hydrolysing peroxidases. Our aim is to assess the levels PON1 activity in different stages and localizations of GC and analyze the predictive role of PON1 activity on overall survival in GC.

MATERIALS AND METHODS

One hundred and twenty six patients with GC were enrolled to the study. Patients were divided into two groups; group I (nonmetastatic GC, n=65) and group II (metastatic GC, n=61). Paraoxonase 1 activity, albumine and lactate dehidrogenase levels and whole blood count were analyzed. Union Internationale Contre le Cancer system was used for staging procedure.

RESULTS

Patients at advanced N or M stage have significantly lower levels of PON1 (34.26 U/L and 29.88 U/L, p=0.04 and p=0.03; respectively). Gender, Lauren's classification, grade, localization and T stage of tumor have nonsignificant impact on PON1 activity. PON1 activity was a significant prognostic factor in GC as well as metastasis, localization of tumor and low hemoglobine or albumine level.

CONCLUSIONS

Lower levels of paraoxonase 1 activity in patients with metastatic gastric cancer may reflect the presence of enhanced oxidative stress in advanced stages of the disease. PON1 activity is a significant and independent predictor of overall survival. Identifying novel prognostic markers can help to establish appropriate therapeutic strategies, to determine preventive measures and to improve survival rates.

Abstract P3-01-21: Is lymph node ratio (LNR) having additional contribution for predict prognosis on pathologic lymph node staging in node-positive breast cancer patients?

PURPOSE:

The aim of the study was to determine whether LNR have additional contribution on pathologic lymph node staging.

METHODS:

To examine the prognostic value of LNR examined the original histopathological reports of 2049 node-positive breast cancer patients treated in the references centers of the Turkey. The LNR was defined as the number of positive lymph nodes (LNs) over the total number of LNs removed. The LNR cutoffs were defined as low-risk, 0.01-0.20; intermediate-risk, 0.21- 0.65; and high-risk, LNR >0.65.

RESULTS:

The median follow-up was 11.8 years. Median Disease free survival (DFS) was 191.8, 110.6 and 78.2 months in patients with pN1, pN2 and pN3 tumor, respectively (p<0.001). Median DFS was 191.9, 106.4 and 78.1 months in patients with LNR low, intermediate and high risk tumor, respectively (p<0.001). Median DFS was not reached and 200.1 months in patients with pN2 and LNR low risk patients, pN1 and LNR high risk patients, respectively (p=0.254).

CONCLUSIONS:

LNR is an important prognostic parameter for DFS and might provide potentially more information than pN-stage in patients with pN1/LNR high risk and pN2/LNR low risk.

Citation Format: Kaplan MA, Odabasi H, Ozdemir N, Harputluoglu H, Aliustaoglu M, Berk V, Gunaydin Y, Uncu D, Elkiran T, Aydin D, Isikdogan A. Is lymph node ratio (LNR) having additional contribution for predict prognosis on pathologic lymph node staging in node-positive breast cancer patients?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-21.

[Efficacy of photodynamic therapy for basal cell carcinoma using photosensitizers of different classes]

The paper presented results of photodynamic therapy for 139 patients with basal cell carcinoma. We conducted a study of the efficacy and safety of four methods of photodynamic therapy. There were used the following photosensitizers: photohem, photosens, photolon and photodithazine. Photodynamic therapy using photosensitizers of chlorine series (photolon and photoditazin) provides a better long-term results improving disease-free 3-year survival rate to 90.4% and 92.3%, respectively compared to 54.7% and 71.1% in groups, in which treatment was restricted by photohem and photosens.

Efficacy and safety of raltitrexed combinations with uracil- tegafur or mitomycin C as salvage treatment in advanced colorectal cancer patients: a multicenter study of Anatolian Society of Medical Oncology (ASMO)

BACKGROUND

There is no standard treatment for patients with colorectal cancer (CRC) progressing after irinotecan and oxaliplatin treatment. Here we aimed to retrospectively evaluate the efficacy and tolerability of raltitrexed in combination with oral 5-fluoropyrimidine (uracil tegafur-UFT) or mitomycin C as salvage therapy in mCRC patients.

MATERIALS AND METHODS

A total of 62 patients who had received raltitrexed combined with UFT or mitomycin C were identified between December 2008 and June 2013. They were given raltitrexed 2.6 mg/m2 (max 5 mg) i.v. on day 1 in combination with either oral UFT 500 mg/day on days 1-14 every 3 weeks (group A) or mitomycin C 6 mg/m2 i.v. on day every 3 weeks (group B).

RESULTS

Forty-two patients (67.7%) were in group A and 20 (32.2%) in group B. In 15 patients (24%) grade 3/4 toxicity was observed, resulting in dose reduction, and in 13 patients (20.9%) dose delay was necessary. The median progression free survival (PFS) was 3 months (95%CI 2.65-3.34) and median overall survival (OS) was 6 months (95%CI 2.09-9.90) in the whole group. Median PFS was 3 months (95%CI 2.60-3.39) in group A vs 3 months (95%CI 1.64-4.35) in group B (p=0.90). Median OS was 6 months (95%CI 2.47-9.53) in group A vs 12 months (95%CI 2.83-21.1) in group B (p=0.46).

CONCLUSIONS

The combination of raltitrexed with UFT or mitomycin C seem to be a salvage therapy option due to safety profile and moderate clinical activity in heavily-pretreated mCRC patients.

Photodynamic therapy of experimental sarcoma M-1 with boronated chlorine as a photosensitizer

Using rat model of experimental sarcoma M-1 we studied the efficacy of photodynamic therapy with boronated chlorine as a photosensitizer in doses of 1.25, 2.5, 5.0, and 10.0 mg/ kg body weight. Laser irradiation was performed at energy densities of 150, 300 J/cm(2) and power density of 0.25 and 0.42 W/cm(2). Treatment efficacy was evaluated by the percentage of animals with complete tumor regression, percentage of tumor recurrence and, in cases of its growth, by tumor growth coefficient. The efficacy of photodynamic therapy depended on the dose of boronated chlorine and parameters of the laser irradiation. Optimal conditions were the dose of 2.5 mg/kg at laser energy density of 300 J/cm(2) and power density of 0.42 W/cm(2) and a dose of 5.0 mg/kg at 150 J/cm(2) and 0.25 W/cm(2).

The correlation between serum VEGF levels and known prognostic risk factors in colorectal carcinoma

BACKGROUND/AIMS

In the present study, we analyzed serum vascular endothelial growth factor (VEGF) levels and its correlation with the other clinicopathological characteristics of patients with colorectal carcinoma (CRC).

METHODOLOGY

Seventy-one patients (F/M, 29/42; Mean age +/- SD, 53.3 +/- 13.1 years) were included. The results of serum VEGF were analysed with respect to stage, gender, age, CEA, metastases and topographical tumour localization.

RESULTS

Patients with stage 3-4 disease had significantly higher values of VEGF (253.41 pg/mL +/- 302.24) than patients with stage 1-2 (49.99 pg/L +/- 100.30) (P < 0.003). Patients with the primary tumour localized in the colon had no significantly higher levels of serum VEGF than patients with the primary tumour localized in the rectum (225.97 +/- 324.88 pg/mL vs. 153.76 +/- 205.66 pg/ mL, respectively, P = 0.269). The VEGF expression significantly correlated with serum CEA level (P < 0.01) and clinical stages of colorectal cancer (P < 0.01). The VEGF expression was not correlated with patients' age (P = 0.955) and gender (P = 0.740).

CONCLUSIONS

The VEGF expression significantly correlated with advanced stage, and metastases but not age, gender, and tumour localization. VEGF may play an important role in the invasion and metastasis of CRC. Therefore, VEGF could be applied as prognostic markers in CRC.

Is diabetes mellitus a negative prognostic factor for the treatment of advanced non-small-cell lung cancer?

BACKGROUND

It has been demonstrated that there are a lot of different prognostic factors which are worthy of consideration whereas diabetes mellitus (DM) has not been clearly or consistently identified as a prognostic value in advanced non-small cell lung cancer (NSCLC). The aim of this study was to investigate the prognostic significance of the characteristics of patients in advanced NSCLC. Specifically, we investigated the impact of DM for progression-free survival (PFS) and overall survival (OS) in patients receiving first-line platinum-based doublets chemotherapy.

METHODS

We retrospectively reviewed 442 patients with advanced NSCLC. DM and other potential prognostic variables were chosen for analysis in this study. Univariate and multivariate analyses were conducted to identify prognostic factors associated with survival.

RESULT

The results of univariate analysis for OS were identified as having prognostic significance: performance status (p<0.001), stage (p<0.001), DM (p<0.001), liver metastasis (p=0.02) and brain metastasis (p<0.001). Stage, diabetes mellitus, and liver metastasis were identified as having prognostic significance for PFS. Multivariate analysis showed that poor performance status, presence of DM and advanced stage were considered independent negative prognostic factors for OS (p 0.001, p<0.001 and p<0.001 respectively). Furthermore, DM and stage were considered independent negative prognostic factors for PFS (p 0.005 and p 0.001 respectively).

CONCLUSION

In conclusion, DM at the time of diagnosis was associated with the negative prognostic importance for PFS and OS in the advanced stage patients who were receiving first-line platinum-based doublets chemotherapy. In addition poor performance status and advanced stage were identified as negative prognostic factors.

[Influence of systemic photodynamic therapy on circulating tumor cells in peripheral blood of cancer patients]

The aim of this investigation is to study the number of circulating tumor cells (CTCs) in the blood of cancer patients after systemic photodynamic therapy (PDT) at different times and to assess apoptosis of these cells. The study group consisted of 19 patients with malignant tumors of epithelial origin at various stages (II-IV). CTC identification was performed with flow cytometry by immunophenotype Ep-CAM (CD326)+ CD45-. CTC apoptosis was identified by criteria of plasma membrane integrity and phosphatidylserine translocation on the outer surface of the membrane. Negative correlation between the CTC frequency and apoptotic death rate of these cells was found in patients before the treatment (R = -0.51, p = 0.03). CTC frequency gradually reduced during the first three days after PDT, and then it was maintained at the same level until the end of the follow-up (7 days). At the individual level, the effect of PDT depended on the frequency of CTCs before the treatment: the decrease in these cell frequency occurred significantly more often in the patients with an initially high frequency of CTCs than in other patients (p = 0.05). With the decrease in the CTC frequency, apoptotic death increased within 6 hours after the treatment and remained at the same level until the end of the follow-up period. The results demonstrate the efficacy of systemic PDT for elimination of tumor cells circulating in the peripheral blood of cancer patients with different localization of primary tumor and stage of disease.

Prognostic analysis of patients with operable gastric cancer and tolerability to adjuvant radio-chemo-therapy

The aim of this study is to evaluate the tolerability and toxicity of adjuvant chemoradiotherapy (CRT) and to analyze the prognosis in patients with operable gastric cancer. The retrospective analysis included 723 patients with operable gastric cancer; stage IB-IV (M0), received adjuvant CRT from 8 Medical Centers in Turkey between 2003 and 2010. The patients' age, sex, tumor localization, Lauren classification, grade and stage of the disease, type of dissection, the toxicity and tolerability status and survival rate were analyzed. All patients were divided into two groups as tolerable group to adjuvant CRT and intolerable group to adjuvant CRT .Among the patient, 73.9% had stage III-IVM0 disease; 61.0% had the intestinal type of gastric cancer, 51.1% had the distal type, and 61.4% had undergone D2 dissections. The number of patients who completed the entire course of the adjuvant CRT was 545 (75.4%).The median follow-up period was 20.8 months (range: 1.5-107 months). Overall Survival (OS) rates were 80% and 52%, while the relapse free survival (RFS) rates were 75% and 48% at 1 and 3 years, respectively.In the univariate analysis of the groups based on the the age defined as <65 or ≥ 65 (p=0.16 / p=0.003), Lauren classification (p=0.004 / p<0.001), localization of tumor (p=0.02 / p=0.04), tumor grade (p=0.06 / p=0.003), disease stage (p<0.001 / p<0.001), type of dissection (p=0.445 / p=0.043), presence or absence of toxicity (p=0.062 / p=0.077) and tolerability of the therapy (p=0.002 / p=0.001). In the cox regression analysis, tumor stage (Hazard Ratio (HR): 0.332; 95% confidence interval (CI): 0.195-0.566; p<0.001), and tolerability (HR: 0.516; 95% CI: 0.305-0.872; p=0.014), were found to be related with the OS. Tumor stage (HR: 0.318; 95% CI: 0.190-0.533; p=<0.001) and tolerability (HR: 0.604; 95% CI: 0.367-0.995; p=0.048) were observed to be statistically significant in terms of the RFS.We have observed that whether a patient can or cannot tolerate adjuvant CRT due to its toxicity is an independent prognostic factor besides the known prognostic factors like tumor stage and Lauren classification. We are of the opinion that the treatment of patients who cannot tolerate adjuvant CRT should be replaced with less toxic adjuvant therapies.

Bevacizumab plus irinotecan in recurrent or progressive malign glioma: a multicenter study of the Anatolian Society of Medical Oncology (ASMO)

PURPOSES

The overall prognosis for recurrent malignant glioma (MG) is extremely poor, and treatment options are limited. We evaluated our multicenter retrospective experience for patients with recurrent MG administering bevacizumab and irinotecan in combination therapy.

METHODS

A total of 115 patients with grade IV glial tumor (n = 93) and grade III glial tumor (n = 22) were retrospectively evaluated at 14 centers in Turkey. Primary objectives of the study were to evaluate the efficacy and toxicity of the bevacizumab and irinotecan as salvage treatment based on response to therapy, progression-free survival (PFS), 6 months of PFS, overall survival (OS), and 6 months of OS (OS6).

RESULTS

Bevacizumab and irinotecan were performed as second line (79.1 %) and third line treatment (20.9 %). Median chemotherapy cycle was 6 (range 1-37), and median follow-up was 6 months (range 1-36 months). Objective response rate was 39.1 %. Six-month PFS and OS6 were 46.3 % and 67.5 %, respectively. Median PFS was 6 months (95 % CI 2.5-9.5) and 6 months (95 % CI 4.9-7.1) in the grade III and IV groups, respectively (p = 0.773). Median OS was 9 months (95 % CI 7.1-10.9) and 8 months (95 % CI 6.6-9.4) in the grade III and IV groups, respectively (p = 0.450). Serious toxicities were observed in 7.8 % of patients. Treatment-related toxic death was observed in 3 patients. There was no treatment related to central nervous system hemorrhage or other serious hemorrhages.

CONCLUSIONS

Present study results were consistent with previous studies. In addition, we detected similar outcomes in grade III and IV glial tumors.

Is diabetes mellitus a prognostic factor for survival in patients with small cell lung cancer?

BACKGROUND

Previous studies have pointed to many different prognostic factors for small cell lung cancer (SCLC) but diabetes mellitus (DM) has not been clearly or consistently identified as of prognostic value. The aim of this study was to investigate the prognostic significance of the characteristics of patients and clinical laboratory tests in SCLC. Specifically, we investigated that the impact of DM for survival in the patients receiving first-line etoposide plus cisplatin (EP) chemotherapy.

METHODS

We retrospectively reviewed 161 patients with SCLC with a focus on DM and other potential prognostic variables were chosen for univariate and multivariate analyses with respect to survival.

RESULT

Among the sixteen variables of univariate analysis, five were identified to have prognostic significance: performance status (PS) (p <0.001), stage (p=0.001), DM (p=0.005), serum albumin (p <0.001) and hemoglobin levels (p=0.03). Multivariate analysis showed PS, stage and serum albumin level to be independent prognostic factors for survival (p=0.02, p=0.02 and p=0.009 respectively), but DM was not an independnet factor.

CONCLUSION

In conclusion, PS, stage and serum albumin level were identified as important prognostic factors, while DM at the time of diagnosis of SCLC did not have prognostic importance for survival.

Effects of treatment regimens on survival in patients with malignant pleural mesothelioma

BACKGROUND AND OBJECTIVE

In this study, we aimed to investigate the factors affecting the survival of patients with malignant pleural mesothelioma (MPM) according to their treatment regimens, including best supportive care (BSC), chemotherapy, surgical group and multimodality (MM) therapy.

PATIENTS

A retrospective analysis was performed on clinical data and treatment outcomes of 400 patients registered in our hospital with MPM between January 1989 and April 2010.

RESULTS

Mean age (p < 0.001), presence of asbestos exposure (p = 0.0014), presence of smoking history (p < 0.001), Karnofsky performance status (p < 0.001), histological subtype (p = 0.034) and stage (p < 0.001) variables were found to be significantly different among the four treatment regimens. Mean survival time of all patients was 12.32 months. Mean survival time 10.5 months for the BSC group, 15.7 for the surgical group, 16.02 for the chemotherapy group, and 26.55 for the MM group. There were significant differences in mean survival time among the four treatment regimens. In addition, a significant difference was found in survival time between the two chemotherapy groups (p = 0.032). Mean survival time for cisplatin + gemcitabine was found to be 14.49 months and for cisplatin + pemetrexed, 18.34 months.

CONCLUSIONS

The MM group had better survival rates than the other groups. The new chemotherapy combination, cisplatin + pemetrexed, can be helpful in improving survival time.      

Complementary and alternative medicine usage in cancer patients in southeast of Turkey

The aim of this study was to investigate the frequency of complementary and alternative medicine (CAM) methods and clinical characteristics in cancer patients in southeast of Turkey. A total of 324 patients (173 female) were enrolled to this study. Questionnaire was applied to all patients individually for approximately 15 minutes by a doctor. At least one CAM method was used by 62% (n=201) of the patients. 82.5% (n=166) of patients treated with CAM were using at least one herbal species. Likewise, 40.9% (68/166) of these patients were using herbal mixtures and 39.8% (66/166) of them were using single herbal as nettle (Urtica dioica) or its seed, 19.3 % (32/166) of them were using other herbals. CAM methods were preferred more frequently by the patients with metastatic stage (p=0.005), receiving palliative treatment (p<0.001), chemotherapy (p=0.020), in between 40-60 ages patient groups (p=0.002), and when duration of disease was lengthened (p=0.002). CAM use among cancer patients is quite common. Presence of metastatic cancer at diagnosis, receiving chemotherapy and palliative treatment and long disease duration were found as main associated factors for CAM usage.

Multiple primary malignant neoplasms: multi-center results from Turkey

PURPOSE

Multiple primary malignant neoplasms (MPMNs) are defined as a diagnosis of two or more indepen-dent primary malignancies of different histologies/origins in an individual. The frequency of MPMN is being increasing. In this study we aimed to determine the frequency and clinical features of second primary cancers (SPCs).

METHODS

From January 1990 to December 2010, patients with MPMNs were screened in 5 centers. Data were obtained retrospectively from hospital charts.

RESULTS

Three hundred seventy-seven patients with MPMNs were evaluated. The median age at initial cancer diagnosis was 61 years (range 18-88). The median age at second cancer was 64 years (range 20-89). The median time between two cancer diagnoses was 15 months (range 0-504). Male to female ratio was 1.44 (M/F 223/154). The most frequent initial cancer types were head and neck (54 patients, 14.3%), breast (54 patients, 14.3%), and colorectal (43 patients, 11.4%). The most frequent second cancer types were lung (76 patients, 20.2%), colorectal (39 patients, 10.3%) and breast (33 patients, 8.8%). The most common cancer pairs in females were breast-gynecologic cancers (15 patients, 9.7%), colorectal-breast cancers (9 patients, 5.8%) and breast-colorectal cancers (7 patients, 4.5%). The most common cancer pairs in males were head and neck-lung cancers (29 patients, 13%), bladder-lung cancers (9 patients, 4%), and bladder-prostate cancers (7 patients, 3%). The median follow up was 36 months (range 17horbar;595).

CONCLUSION

Physicians should be aware of SPCs probabilities. Newly developed suspicious lesions should be evaluated rigorously. Histopathologic evaluations of suspicious lesions for second tumors should be used extensively if needed. In our series, the most common pairs were breast-gynecologic cancers in females and head and neck-lung cancers in males.

Prognostic value of fluorine-18 fluorodeoxyglucose positron emission tomography in patients with advanced non-small cell lung cancer: single center experience

PURPOSE

The purpose of this retrospective single-center study was to evaluate the prognostic implication on overall survival (OS) of the F-18 FDG PET scan in locally advanced or metastatic non small cell lung cancer (NSCLC) patients.

METHODS

We retrospectively reviewed 120 locally advanced or metastatic NSCLC patients (December 2004-November 2011) treated/followed at the Dicle University, School of Medicine, Department of Medical Oncology. SUVmax and other potential prognostic variables (n=18) were chosen for analysis. Univariate and multivariate analyses were conducted to identify prognostic factors for OS.

RESULTS

Among 18 variables of univariate analysis, 6 were identified to bear prognostic significance: sex (p=0.01), performance status (PS) (p =0.03), stage (p=0.04), bone metastases (p=0.002), serum albumin (p=0.01) and blood glucose level (p=0.03). Multivariate analysis showed that PS, bone metastases and serum albumin level were independent prognostic factors for OS (p=0.01, p=0.004, p=0.003, respectively).

CONCLUSION

PS, serum albumin levels and bone metastases were independent prognostic factors, while FDG uptake of the primary lesion was not associated with prognosis of OS in locally advanced or metastatic NSCLC patients.

Weekly topotecan for recurrent small cell lung cancer - a retrospective Anatolian Medical Oncology Group study

AIM

To evaluate efficacy and tolerability of topotecan treatment for recurrent small cell lung carcinoma.

PATIENTS AND METHODS

A total of 62 patients were evaluated retrospectively. Statistical analysis was performed using GraphPad Instat (version 3.05).

RESULTS

Fifty five patients (89%) were male and 7 (11%) were female. Median age was 56.7 ± 9.3 (34-75). Forty eight of patients (80%) were extensive stage (ES) at the time of diagnosis. Fifty of the patients (80.6 Medical Oncology Clinic) were given median 5.36 cycles of cisplatin-etoposide (2-8 cycles). Time to recurrence was 15.6 ± 6.13 weeks in patients with limited stage (LS) and 6.3 ± 3.82 weeks in extensive stage (ES) (p<0.0001). Overall survival was 14.0 ± 6.08 months in ES and 17.9 ± 6.88 months in LS. The difference between two groups was statistically meaningful (p=0.0447). The overall survival of the patients was 14.8 ± 6.43 months (4.5-40 months). In terms of survival, there was no difference between males and females (p=0.1171). In 17 (27%) patients who were refractory to topotecan or in whom progression occurred other chemotherapies were used.

CONCLUSION

Small cell lung cancer is chemosensitive, but recurrences occur in short time. Other chemotherapy regimens are used in progression. Topotecan is one of them. Patients who were young and in whom recurrences occur late had given better response to topotecan. Because of the retrospective nature of the study, we couldn't reach the records exactly and consequently, rate and duration of response couldn't be calculated. In recurrent SCLC topotecan is one of the treatment choices. But both hematological and non hematological side effects should be taken into consideration.

Prognostic factors for second-line treatment of advanced non-small-cell lung cancer: retrospective analysis at a single institution

BACKGROUND

Platinum-based chemotherapy for advanced non-small cell lung cancer (NSCLC) is still considered the first choice, presenting a modest survival advantage. However, the patients eventually experience disease progression and require second-line therapy. While there are reliable predictors to identify patients receiving first-line chemotherapy, very little knowledge is available about the prognostic factors in patients who receive second-line treatments. The present study was therefore performed.

METHODS

We retrospectively reviewed 107 patients receiving second-line treatments from August 2002 to March 2012 in the Dicle University, School of Medicine, Department of Medical Oncology. Fourteen potential prognostic variables were chosen for analysis in this study. Univariate and multivariate analyses were conducted to identify prognostic factors associated with survival.

RESULT

The results of univariate analysis for overall survival (OS) were identified to have prognostic significance: performance status (PS), stage, response to first-line chemotherapy, response to second- line chemotherapy and number of metastasis. PS, diabetes mellitus (DM), response to first-line chemotherapy and response to second-line chemotherapy were identified to have prognostic significance for progression-free survival (PFS). Multivariate analysis showed that PS, response to first-line chemotherapy and response to second- line chemotherapy were considered independent prognostic factors for OS. Furthermore, PS and response to second-line chemotherapy were considered independent prognostic factors for PFS.

CONCLUSION

In conclusion, PS, response to first and second-line chemotherapy were identified as important prognostic factors for OS in advanced NSCLC patients who were undergoing second-line palliative treatment. Furthermore, PS and response to second-line chemotherapy were considered independent prognostic factors for PFS. It may be concluded that these findings may facilitate pretreatment prediction of survival and can be used for selecting patients for the correct choice of treatment.

Docetaxel and Cisplatin Plus Fluorouracil compared with Modified Docetaxel, Cisplatin, and 5-Fluorouracil as first-line therapy for advanced gastric cancer: a retrospective analysis of single institution

Gastric cancer is the second most common among cancer-related deaths in the world. Systemic chemotherapy for patients with gastric cancer has limited impact on overall survival. We performed a retrospective analysis of the efficacy and side effects of Docetaxel and Cisplatin Plus Fluorouracil (DCF) versus Modified-Dose Docetaxel, Cisplatin, and 5-Fluorouracil (mDCF) in the metastatic gastric cancer with first-line chemotherapy treated patients. Retrospectively were reviewed 107 locally advanced or metastatic gastric cancer patients who were treated DCF or mDCF as first-line treatment from June 2007 to August 2011 in Dicle University Hospital, Department of Medical Oncology.The DCF protocol included 75 mg/m2 docetaxel and cisplatin on day 1 and 750 mg/m2/day 5-FU infusion for 5 days, repeated every 3 weeks. The mDCF protocol included 60 mg/m² docetaxel and cisplatin on day 1 and 600 mg/m² 5-Fluorouracil continuous infusion per day on days 1-5, every 3 weeks.Patients were treated using DCF arm 85 (M: 56, F: 29), the mDCF arm 22 (M: 13, F: 9) After treatment toxicities were: Grade III-IV neutropenia (48.2% vs 13.6% p=0.003), anemia (21.2% vs 4.5% p=0.06), nausea (44.7% vs 13.6% p=0.008) and vomiting (31.8% vs 4.5%, p=0.01) was higher in the DCF arm. Other toxicities profile was similar in both groups (p>0.05). The rate of response was similar in both arm. Among patients with the DCF and mDCF arm rate complete response (10.3% vs 6.7%, p>0.05), partial response (35.3% vs 40.0%, p>0.05), stable disease (32.4% vs 33.3%, p>0.05), progressive disease (22.1% vs 20.0%, p>0.05) and overall response (45.6% vs 46.7%, p>0.05) did not have a statistically difference (p>0.05). Progression-free survival (PFS) and overall survival (OS) were more favorable in the DCF arm than mDCF arm, but the difference was not significant statistically (9.9 vs 8.6, 7.4 vs 6.5 p>0.05)In conclusion, the response rate, median PFS and median OS are similar in both arms, while the mDCF regimen are more favorable than the DCF for toxicity profile regimen in advanced gastric cancer patients who were undergoing first-line palliative treatment. Therefore, a prospective and larger clinical trials are needed.

Gemcitabine and cisplatin combination chemotherapy in triple negative metastatic breast cancer previously treated with a taxane/anthracycline chemotherapy; multicenter experience

This study was aimed to establish clinical efficacy and tolerability of gemcitabine and cisplatin combination in patients with metastatic triple negative breast cancer progressing after anthracycline and taxane based chemotherapies.Thirty-three patients who were given cisplatin and gemcitabine for triple negative and metastatic breast cancer were evaluated retrospectively. A total of 141 cycles were administered with a median 4 cycles per patient. Median follow-up time was 14 months (range, 2-36 months). Objective response rate was 27.3%. Total clinical benefit of the combination was 48.4%. The estimated median progression free survival and median overall survival were 5 months and 14 months, respectively. The most common Grade 3 and 4 toxicity were neutropenia and thrombocytopenia observed in 10 (27.7%) and 9 (24.9%) patients, respectively. The combination of the gemcitabine and cisplatin after taxane/anthracycline is well tolerated and seems to be effective with acceptable toxicity profile.

Prognostic factors in elderly patients with advanced non-small cell lung cancer treated with first-line cisplatin-based chemotherapy: a retrospective analysis of single institution

PURPOSE

Non-small cell lung cancer (NSCLC) makes up 80-85% of all lung cancers cases. Lung cancer in older individuals is frequently undertreated. Patients eligible for cisplatin- based chemotherapy should be selected carefully. The aim of this retrospective single-center study was to evaluate prognostic factors for overall survival (OS) in elderly (≥65 years) patients with advanced NSCLC who received first-line cisplatin-based chemotherapy.

METHODS

We retrospectively reviewed 110 elderly patients with locally advanced or metastatic NSCLC who had been administered cisplatin-based first-line chemotherapy between December 2004 and November 2011. Seventeen potential prognostic variables were chosen for analysis. Univariate and multivariate analyses were conducted to identify prognostic factors associated with OS.

RESULTS

Among the 17 variables of univariate analysis, 4 were identified to have prognostic significance for OS: comorbidities (p<0.001), Eastern Cooperative Oncology Group (ECOG) performance status (PS) (p=0.02), first-line chemotherapy cycles (p<0.001) and serum albumin level (p=0.04). Multivariate analysis showed that only ECOG PS (p=0.01) was independent prognostic factor for OS.

CONCLUSION

PS was important prognostic factor in elderly patients with advanced NSCLC. The findings of this study may facilitate pretreatment prediction of OS and therefore can be used for selecting the most appropriate treatment for elderly patients.

Contribution of low-molecular weight heparin addition to concomitant chemoradiotherapy in the treatment of glioblastoma multiforme

PURPOSE

Glioblastoma multiforme (GBM) is the most common brain tumor in adults and has a very aggressive course. Median survival is as short as 2 years with standard treatment (chemoradiotherapy followed by adjuvant temozolomide). The purpose of this study was to determine the contribution of low molecular weight heparin (LMWH) addition to concomitant chemoradiotherapy in the treatment of GBM.

METHODS

All patients with newly diagnosed GBM between March 2004-May 2009 were evaluated. After surgical intervention (total, subtotal resection or only biopsy) all of them were treated with concomitant chemoradiotherapy (2 Gy daily, 5 days a week, 30 fractions, total tumor dose 60 Gy; and 75 mg/m² temozolomide, 7 days a week), followed by adjuvant temozolomide (6 cycles, 150-200 mg/m², 5 days every 28 days), with or without LMWH (4000 IU/day, 7 days a week, concomitant with radiotherapy) because of risk of thrombosis. The primary endpoint was the determination of progression-free survival (PFS) and overall survival (OS); secondary endpoints were 1- and 2-year OS survival.

RESULTS

30 patients (13 patients in the group non receiving LMWH (LMWH-) and 17 patients in the group receiving LMWH (LMWH+)) were included in the study. Median age was 54 years (range 24-75). Median PFS was 57 and 38 weeks in LMWH+ and LMWH- groups, respectively (p=0.068). Median OS was 69 and 44 weeks (p=0.095), 1-year OS survival 84.6 and 41.2% (p=0.016), and 2-year OS survival 38.5 and 5.9% in LMWH+ and LMWH-, respectively (p=0.061). No significant difference was noted between the two groups for grade 3-4 toxicity (p>0.05).

CONCLUSION

Better PFS, OS and 2-year OS survival were obtained in present study with the addition of LMWH to concomitant chemoradiation for GBM but without statistical significance. One-year OS survival was statistically significant favoring the LMWH group. The addition of LMWH did not increase temozolomide toxicity.

Prognostic factors in patients with advanced pancreatic cancer treated with gemcitabine alone or gemcitabine plus cisplatin: retrospective analysis of a multicenter study

PURPOSE

The majority of patients with pancreatic cancer present with advanced disease. Systemic chemotherapy for patients with pancreatic cancer has limited impact on overall survival (OS). Patients eligible for chemotherapy should be selected carefully. The aim of this study was to analyse prognostic factors for OS in advanced pancreatic cancer patients treated with first-line palliative chemotherapy with gemcitabine alone or gemcitabine plus cisplatin.

METHODS

We retrospectively reviewed 343 locally advanced or metastatic pancreatic cancer patients who were treated with gemcitabine or gemcitabine plus cisplatin as first-line chemotherapy between December 2000 and June 2011. Fifteen potential prognostic variables were chosen for analysis. Univariate and multivariate analyses were conducted to identify prognostic factors associated with OS. Univariate and multivariate statistical methods were used to determine prognostic factors.

RESULTS

Among the 15 variables of univariate analysis, 6 were identified to have prognostic significance: stage (p<0.001), cholestasis (p=0.02), weight loss, prior pancreatectomy, serum CEA level (p<0.001) and serum CA19-9 level (p>0.001). In addition, age, chemotherapy and liver metastasis were of borderline significance (p=0.06). Multivariate analysis (Cox proportional hazard model) included the 6 significant prognostic factors of univariate analysis and showed that stage was independent prognostic factor for OS, as were weight loss, and serum CEA level.

CONCLUSION

Stage, weight loss, and serum CEA level were identified as important prognostic factors for OS in advanced pancreatic cancer patients. These findings may also facilitate pretreatment prediction of OS and can be used for selecting patients for treatment.

P4-17-08: Is Cranial Magnetic Resonance Imaging (MRI) Necessary for Staging of Asymptomatic HER2−Positive Breast Cancer Patients?

Background

Breast cancer one of the most common tumors of the adults. Approximately 20% to 25% of all breast cancers are HER2−positive. It can be assumed that up to 30% of HER2−positive metastatic breast cancer (MBC) patients may experience brain metastasis during the course of their disease. The aim of this study to investigate that whether cranial MR is necessary for staging in asymptomatic HER2−positive breast cancer patients.

Material and metods: HER2−positive breast cancer patients without symptoms of brain metastasis included in the study. Cranial MRI was added to the staging procedures. Subgroup analysis was performed to determine risk factors for developing brain metastasis.

Results: Seventy five patients included in the study. Of whom, 71 were women (94.7%). Median age was 42.5 (22-76). Ten of the 75 patients (13.3%) had brain metastasis. The distribution rate of brain metastasis according to breast cancer stage at diagnosis was: 0% for stage I, 9.1% for stage 2, 4.3% for stage 3 and 28.6% for stage 4 (p=0.027). There was no association between presence of brain metastasis and the site of metastasis, estrogen and progesterone receptor positivity, grade, histological subgroup, menopausal status and gender.

Discussion: Brain metastasis is an important problem for breast cancer patients. Treatment strategies may vary in the presence of brain metastasis. In our study we found brain metastasis nearly one quarter of patients with metastatic HER2−positive breast cancer. Cranial MRI imaging can be performed routinely in patient with metastatic HER2−positive breast cancer patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-17-08.

The access rate to diagnosis and treatment modalities in breast cancer patients in Turkey; multicenter observational study

PURPOSE

To determine the time elapsed between the first notification of the disease and the access to the diagnosis and treatment modalities and the associated factors in female patients with breast cancer in Turkey.

METHODS

Data was acquired from a questionnaire involving 535 patients who applied to 14 various oncology clinics in Turkey between 1st and 28th of February 2010. Analyses were performed by the participating clinics and were divided into 3 groups: centers located in metropolitan areas formed group 1 (n=161), those located in Marmara and central Anatolia region formed group 2 (n=189), and centers located in Karadeniz and East-Southeast Anatolia region formed group 3 (n=185). The groups of these centers were formed according to the socioeconomic development of the provinces.

RESULTS

The median patient age was 48 years, 56.1% of patients were less than 50 years of age. Eighty-five percent of the patients detected a mass in their breast by self examination and 27% of the patients older than 50 years never had breast imaging until the definite diagnosis was established. The median time elapsed between disease noticed by the patient and application to a health care center was 10 days, between application and biopsy 19 days, between biopsy and surgery 10 days, and between surgery and systemic therapy 31 days. The median time elapsed between patients applying for surgery in groups 1 and 2 centers was 11 and 21 days, respectively (p=0.01). The median time elapsed between biopsy and surgery in groups 1,2 and 3 centers was 14,1.5, and 12 days, respectively (p<0.05).

CONCLUSION

A high level of awareness regarding breast cancer in our country is related with the time that is defined as 10 days between disease recognition and medical application. The time elapsed between the application and biopsy, surgery and systemic therapy was longer compared with the corresponding figures in developed countries.

[The development of method of intravenous laser irradiation of blood with green laser in patients with hyperlipidemia]

The impact of intravenous laser irradiation of blood with green laser in patients with hyperlipidemia was investigated. The blood of patients was chosen as sample for analysis. The patients were divided in two groups: patients with atherosclerosis of various localization and patients with atherosclerosis associated with diabetes mellitus. The effectiveness of laser impact was evaluated according the blood biochemical indicators. The levels of crude cholesterol, triglycerides, low and very low density lipoproteins, apoproteins A and B, highly sensitive C-reactive protein, atherogenity indicator, glucose content, uric acid content were determined befor and after 1, 3 and 6 months after impact. The study results indicate the occurrence of hypolipedemic and hypoglycemic effects.

Mitomycin-C in combination with fluoropyrimidines in the treatment of metastatic colorectal cancer after oxaliplatin and irinotecan failure

PURPOSE

To retrospectively evaluate the efficacy and tolerability of mitomycin-C (MMC) in combination with fluoropyrimidines as salvage 3rd -or 4th-line therapy in metastatic colorectal cancer (MCRC) patients.

METHODS

All patients in this study had previously failed oxaliplatin and irinotecan-based chemotherapy. Patients were treated with MMC (6 mg/m(2) intravenously/i.v.) on day 1 in combination with either oral UFT (500 mg/m(2)) and oral leucovorin (LV) (30 mg) on days 1-14 every 3 weeks (group A) or infusional 5-fluorouracil (5-FU) by deGramont regimen with i.v. LV (200 mg/m(2)) on days 1 and 2, every 2 weeks (group B).

RESULTS

Thirty-nine MCRC patients were analyzed. Twenty-two of them were in group A and 17 in group B. Thirty-three were evaluable for clinical efficacy. The clinical benefit in the intent-to-treat (ITT) population was 30.8%. Median progression free survival (PFS) was 6 months (95% confidence interval/ CI 4-8) and median overall survival (OS) 9 months (95% CI 6.5-11.5). Median PFS was 3 months (95% CI 2.4-3.6) in group A and 7 months (95% CI 5.1-8.9) in group B (p=0.009). Median OS was 7 months (95% CI 4.3-9.7) in group A and 12 months (95% CI 5.4-18.6) in group B (p=0.422). The combination of MMC and fluoropyrimidines was generally well tolerated. The most common severe toxicities were nausea and vomiting, neutropenia, hepatotoxicity and diarrhea.

CONCLUSION

MMC in combination with fluoropyrimidines is safe and active in heavily-pretreated MCRC patients. This combination remains a viable option in these patients. However, better therapies are urgently needed.

[Study of photodynamic treatment for P-388 lympho-leukemia in mice]

Data are presented on the results of photodynamic treatment (PDT) of mice DBA2 with transplantable lympho-leukemia P-388. Different regimens of photosensitizer Dimegin and emission were used. Both intravenous PDT and in combination with local PDT should be recommended.

A case of successful application of the photodynamic therapy for a patientwith kaposis sarcoma of the penis

The article describes a case of successful application of the photodynamic therapy for treatment of the classic type of Kaposis sarcoma in the area of the glans of a 60-year-old patient.

Evaluation of antitumor efficiency of experimental interstitial photodynamic therapy on the model of M1 sarcoma

Antitumor efficiency of interstitial photodynamic therapy was evaluated in experiments on outbred albino rats with implanted M-1 sarcoma. Interstitial photodynamic therapy was carried out using one diffusor at different output power and duration of exposure. The percentage of complete regression of the tumors increased with increasing exposure parameters.

[Intravenous photodynamic therapy: first experimental and clinical data]

We carried out the first investigation to establish rat tumor M-1 by laser irradiation of the large blood vessel zone in the inguinal triangle in conjunction with photosensitinogen growth inhibition. Relatively small-size metastases to the lymph nodes and liver (stage III-IV) were identified after the blood was exposed to laser radiation in combination with intravenous injection of photosensitinogen under clinical conditions.

Evaluation of antitumor efficiency of electrochemical lysis on the model of M-1 sarcoma

Antitumor efficiency of electrochemical lysis was evaluated on the model of M-1 sarcoma. At stage 1 of the study, the results of therapy with electrodes in different position were compared, at stage 2 various combination of electrochemical lysis parameters (current strength and duration of exposure) were evaluated. The increase in parameters was associated with the increase in the percentage of cases with complete regression of tumors, which was confirmed by morphological data.

[Influence of Laminaria japonica and fucus on hemostasis and sarcoma M-1 growth in Wistar rats]

The study was concerned with the effects of brown seaweeds on hemostasis and sarcoma M-1 growth in rats. Laminaria japonica and focus were shown to exert anticoagulant action to inhibit carcinogenesis. They may be used for adjuvant therapy of tumors.

[Experimental study of photodynamic treatment with Laminaria japonica and Fucus sp for sarcoma M-1]

In the course of photodynamic treatment with supernatants of Laminaria japonica and Fucus sp the former was found to significantly inhibit the growth of experimental tumor M-1.

[Biological effects of Lamipharen photodynamic therapy]

Biological effects of Lamipharen treatment of sarcoma M-1 was studied in newborn rats and photodynamic therapy in combination with radiation was evaluated.

Role of laser energy density for photodynamic therapy of radiation injuries of the skin

The role of different laser energy densities used in photodynamic therapy in the reparation of radiation ulcers caused by X-ray exposure in a dose of 80 Gy was studied. Tissue reparation manifested differently at different laser energy densities. After photodynamic therapy at energy density of 0.1 J/cm2 the rate of healing was notably higher during early periods. After exposure at 5 and 40 J/cm2 acceleration of ulcer healing was observed 14 and more days after the treatment, indicating the emergence of another mechanism of photodynamic therapy effect. Laser energy density of 5 J/cm2 was the most effective for maximally complete healing of radiation ulcers.

Relationship between antitumor efficiency of photodynamic therapy with photoditasine and photoenergy density

We studied the effect of photodynamic therapy with photoditasine at different protocols of photoenergy exposure on morphofunctional parameters of M-1 sarcoma. It was found that proliferative activity of tumor cells (evaluated by immunostaining for PCNA) nonlinearly decreases after exposure to 150, 300, and 600 J/cm2. The main form of cell death during the early period after photodynamic therapy was direct photocoagulation necrosis caused by destruction of sensitized cell structures and ischemic necrosis developing as a result of alteration of vascular network in the tumors. Photoenergy density was not essential for the intensity of induced apoptosis.

[Use of photosense treatment to enhance photodynamic effect on solid sarcoma-1 in Wistar rats]

Interaction between such components of photodynamic therapy as tumor, intact tissues, lighting and photosensitizers has been investigated. The efficacy of Photosense treatment was demonstrated in the experiments using transplantable tumors in Wistar rats. The photodynamic procedure both inhibited tumor process and stimulated immune system.