Important serum markers in malignant lymphoma

e22225

Background: In this study, 78 patients with new diagnosed, 21 patients with relapsed malignant lymphoma who applied to Cukurova University Hospital between March 2006 - 2008, and 36 age and sex matched healthy control group were evaluated and have been followed up. Methods: The aim of this study was to investigate if; any acute phase reactants or lymphocyte markers in peripheral blood have any predictive role concerning the treatment response, or disease progression. Results: Peripheral blood CD20 (+) lymphocyte levels were slightly higher in new diagnosed patients (12.09±13.79), than the control group (11.25 ±4. 79) but, much lower in relapsed patients (7.30±9.51, P= 0.038). After the chemotherapy (CT), CD20 (+) cell percentage decreased significantly only in new diagnosed patients (p<0.001). Pretreatment CD20 (+) cell levels were higher in responding patients than no responders (15. 42 ± 13.30 versus, 6.72 ± 5.24 p= 0.052). Peripheral blood CD 4 (+) cell levels were below the healthy control group (p= 0.01) and remained low after the CT. Interestingly, CD8 (+) cell levels increased in responders, after the CT (p= 0.046) in both patient groups. CD 56(+) lymphocyte levels were higher only in new diagnosed patients than healthy group (p= 0.05). Its level increased further after the CT (p= 0.044). Serum TNF α levels were higher in patient groups than control (p<0.001). Its level decreased following CT (p= 0.002). CRP levels were higher in both patient groups and remained high following the CT (p<0.001), regardless of the response status. Ferritin levels were also higher in patients groups (p<0.001). Pre-treatment serum ferritin levels were lower in responders, than no responders (236.65 ± 242.17 ng/ml versus 718.77 ± 645.24 ng/ml, p= 0.02). Serum prealbumine levels were lower in lymphoma patients than the healthy controls (p< 0.001). Its level was increased after treatment, especially in patients with recurrent disease (21.15± 5.89 versus 26.60 ± 7.29 mg/dl, p= 0.019). Conclusions: In conclusion, it was decided that; during the different stages of lymphoma progression, several mutations may occur, in the different components of the host immune system. Some of the immune responses would continue in spite of complete clinical remission, as some others would predict the response.

No significant financial relationships to disclose.

Topoisomerase-II, c-erb B2, c-kit and bcl-2 expression in non-small cell lung cancer treated with docetaxel and gemcitabine based threapy

18212

Background: This study was conducted to determine the expression of the topoisomeras-II, c-erb B2, c-kit and bcl-2 in patients with non-small cell lung cancer (NSCLC). Material-methods: These factors expression were identified by immunohistochemical method in 62 NSCLC patients pathologically verified on before therapy. Results: 3 patients were in stage-II, 10 in stage-IIIA, 21 in stage-IIIB and 28 in stage-IV. 14 patients had refused therapy, 12 were undergone to surgery alone and 36 recieved multimodality therapy. 27 patients recieved docetaxel-cisplatin therapy and 7 had recieved gemcitabine-cisplatin therapy. Of those docetaxel treated patients 14 received radiation therapy and others undewent surgery in combination therapy. In 31 patients topoisomerase-II was +2 (50%), +1 in 3 patients, +3 in 27 patients and in 1 patient the expression was negative. c-erb B2 was negative in 1, +1 in 2, +2 in 14 and +3 in 45 patients. bcl-2 was negative in 9, +1 in 16, +2 in 22 and +3 in 15 patients. c-kit was negative in 9, +1 in 26, +2 in 15 and +3 in 12 patients. Statistical analysis was done by SPSS- 14 software program. The disease stage, received therapies and the expression of the these proteins was correlated, median survival time and possible prognostic factors were identified. There were statistically significant between stage and patient status (P=0.000), either with therapy or no therapy (p=0.003), bcl-2 (p=0.09) and c-kit (p=0.022), respectively. There were statisticaly significant between stage and bcl-2 (p=0.023), bcl-2 and c-kit (p=0.001), respectively. At the end of the follow-up time, 38 (61.3%) patients were alive. The median survival was 37.2 months. There were not any prognostic values for topoisomerase-II (p=0.7), c-erb B2 (p=0.6), bcl-2 p=0.15) and c-kit (p=0.118) expression. Conclussion: In conclussion, we suggested that the treatment modality of patients with NSCLC should be combination therapy. The patients received docetaxel based therapy had long median survival time. In addition there was no prognosticeffect of the expression of the topoisomeras-II, c- erb B2, c-kit and bcl-2 in patients with non-small cell lung cancer (NSCLC).

No significant financial relationships to disclose.

Combined expression of bcl-2, bcl-6, HIF, HGF, c-kit, neu/cerb2 and VEGF-C and their clinical significance in laryngeal squamous cell carcinoma

20079

Background: Proteins regulating the cell cycle and cell death are frequently abnormally expressed in cancer. Several of these, particularly Bcl-2, Bcl-6, neu/cerb2 have been widely suggested as possible prognostic markers in diverse human malignancies. Their role in predicting outcome in squamous cell carcinomas of the head and neck is unclear. In addition c-kit protein has been shown in tumorogenesis. Because HNSCC preferentially metastasizes to regional lymph nodes, we investigated the expression of bcl-2, bcl-6, HIF, HGF, c-kit, neu/cerb2 and VEGF-C and their clinical significance in laryngeal squamous cell carcinomas by semiquantitative immunohistochemistry. Methods: We studied 115 patients with stage I o III tumors, all were treated with surgery ± postoperative irradiation/chemotherapy by a single institute. We studied the patients retrospectively to test the association between expression of Bcl-2, bcl-6, HIF, HGF, c-kit, neu/cerb2 and VEGF-C, as assessed by immunohistochemistry in formalin-fixed paraffin-embedded tissue and evaluated by two pathologist. We scored the expression of the proteins from negativ to severe expression. In addition we evaluated the degree of tumor grade, necrosis and also inflamation, respectively. Results: Within 115 patients we found severe expression of bcl-2 in 2 (1%), bcl-6 in 16 (13%), HIF in 57 (49%), HGF in 38 (33%), c-kit in 4 (3%), neu/cerb2 in 17 (14%) and VEGF-C in 11 (9%) patients, respectively. We found significant correlation between bcl-2 and necrosis (p = 0.003), HGF and inflamation (p = 0.05), c-kit and necrosis (p = 0.04), c-kit and tumor grade (p = 0.03) respectively. We found that the significant relation between bcl-6 and HIF (p = 0.000), bcl-6 and HGF (p = 0.02), bcl-6 and c-kit (p = 0.005), bcl-6 and VEGF-C (p = 0.000), HGF and VEGF-C (p = 0.005) respectively. Also we found that the significant correlation between tumor grade and HGF (p = 0.05). Conclusion: These data indicate that assessing expression of bcl-2 or bcl-6, c-kit and HGF is unlikely to be prognostically useful for surgically treated laryngeal carcinoma.

No significant financial relationships to disclose.

Palmar–plantar erythrodysesthesia due to docetaxel–capecitabine therapy is treated with vitamin E without dose reduction

Palmar-plantar erythrodysesthesia (PPE) is a distinctive and relatively frequent toxic reaction related to some chemotherapeutic agents. Doxorubicin, cytarabine, docetaxel, fluorouracil, and capecitabine are the most frequently implicated agents. Recently, taxanes, especially docetaxel, have been widely used in combination with capecitabine in patients with metastatic breast cancer (MBC). A high percentage of PPE has been seen in patients undergoing this combination therapy. PPE seems to be dose dependent and both peak drug concentration and total cumulative dose determine its occurrence. Withdrawal or dose reduction of the implicated drug usually gives rise to amelioration of the symptoms. Supportive treatments such as topical wound care, elevation, and cold compresses may help to relieve the pain. Use of systemic corticosteroids, pyridoxine (vitamin B6), blood flow reduction, and, recently, topical 99% dimethyl-sulfoxide have been used with variable outcomes. Vitamin E treatment has not been published before, especially without dose reduction of docetaxel-capecitabine therapy. Here we present five MBC patients treated with docetaxel-capecitabine combination therapy in whom PPE was observed during the clinical follow-up period. In all patients grade 2-3 PPE was observed. Vitamin E therapy was started at 300 mg/day p.o. without dose reduction of therapy and after 1 week of treatment PPE began to disappear. We suggest that it could be of interest to consider vitamin E as a preventive drug when drugs with a strong association with PPE are going to be administered.

Cisplatin plus oral etoposide (EoP) combination is more effective than paclitaxel in patients with advanced breast cancer pretreated with anthracyclines: a randomised phase III trial of Turkish Oncology Group

Our objective was to determine whether oral etoposide and cisplatin combination (EoP) is superior to paclitaxel in the treatment of advanced breast cancer (ABC) patients pretreated with anthracyclines. From December 1997 to August 2003, 201 patients were randomised, 100 to EoP and 101 to paclitaxel arms. Four patients in each arm were ineligible. The doses of etoposide and cisplatin were 50 mg p.o. twice a day for 7 days and 70 mg m⁻² intravenously (i.v.) on day 1, respectively, and it was 175 mg m⁻² on day 1 for paclitaxel. Both treatments were repeated every 3 weeks. A median of four cycles of study treatment was given in both arms. The response rate obtained in the EoP arm was significantly higher (36.3 vs 22.2%; P=0.038). Median response duration was longer for the EoP arm (7 vs 4 months) (P=0.132). Also, time to progression was significantly in favour of the EoP arm (5.5 vs 3.9 months; P=0.003). Median overall survival was again significantly longer in the EoP arm (14 vs 9.5 months; P=0.039). Toxicity profile of both groups was similar. Two patients in each arm were lost due to febrile neutropenia. The observed activity and acceptable toxicity of EoP endorses the employment of this combination in the treatment of ABC following anthracyclines.

Anticipated administration of GM-CSF in the treatment of non small cell lung cancer

The purpose of this study was to verify the kinetic response of the human marrow myeloid progenitor cells to the short term use of GM-CSF and its impact on the therapeutic activity of this three-drug cisplatinum containing regimen in non small cell lung cancer (NSCLC). Sixty patients with stage III-B and IV NSCLC were randomised to receive GM-CSF for 3 days, five days prior to the onset of chemotherapy. The chemotherapy regimen consisted of Mitomycin-C: 6 mg/m2 on day one, Ifosfamide: 2000 mg/m2 days 1 to 3, Mesna: 2000 mg/m2 days 1 to 3, Cisplatinum: 30 mg/m2 days 1 to 3, and was repeated every 4 weeks. All the patients received 30-50 Gy of radiotherapy to the primary and/or metastatic sites. There were positive correlations between stage of the disease, chemosensitivity of the tumor, number of chemotherapy cycles and overall survival (p=0.000). Administration of GM-CSF was an independent prognostic parameter in locally advanced and metastatic disease (p=0.041). In the GM-CSF receiving arm more courses could be given (117 versus 99, p=0.0415), and less courses were postponed (6 versus 22). In this arm, the mean of granulocyte nadir was higher (p=0.033) and mean time to granulocyte recovery became shorter (p=0.001) as the number of chemotherapy cycles increased. It was concluded that, dose intensification with GM-CSF prophylaxis is benefical in increasing the treatment tolerability by decreasing the intensity of granulocytopenia as well as providing rapid recovery.

Supportive treatment in weight-losing cancer patients due to the additive adverse effects of radiation treatment and/or chemotherapy

The reversal of anorexia and weight loss especially in patients with advanced cancer suffering from radiation treatment (RT) -related complications and debilitated furtherly during RT would be a welcome relief. The purpose of this study is to evaluate the feasibility of supportive treatment with megestrol acetate (MA) in our weight-losing cancer patients increasingly experiencing anorexia, smell, taste, and weight loss due to the additive adverse effects of RT +/- chemotherapy and how MA changes the additive role of the severity of RT reactions on such patients. From June 1997 to October 1998, 100 eligible patients were enrolled on a randomized, placebo-controlled clinical trial. Of the 100 patients, 46 received MA during RT and 4 after the end of the RT, and 50 received placebo for 3 months. Subjective parameters were assessed by a brief questionnaire form based on scoring from 1 to 5, according to the degree of the loss or change for each parameter of malnutrition, appetite, taste and smell developed by us. At the end of the study a statistically significant weight gain was achieved in the patient group receiving MA compared to the placebo group (+3 to +5 kg versus -3.7 to -5.9 kg, p=0.000). Significant improvements were seen in performance status (p=0.000), appetite (p=0.000), malnutrition (p=0.000), loss of taste (p=0.000) and smell qualities (p=0.02) in the MA group compared to the placebo group. In the MA group there was no statistically significant difference related to the weight changes according to the grade of either the acute or late RT effects (p=0.65 and 0.07, respectively). Whereas, in the placebo group a statistically significant additive effect of the acute and late RT effects was detected on weight loss (p=0.008 and 0.007, respectively). We observed no side-effects of MA in a 3-month time follow-up. The use of MA 480 mg/day during RT was effective in reversing anorexia and weight loss in spite of the acute RT effects, and helped most patients to well tolerate specific tumor therapy. Further evaluation of its mechanisms of action on RT-related adverse effects, tumor response relationships, and effect on patient survival are researched.

Refractory breast cancer: a comparison of two different chemotherapy regimens

Sixty metastatic and recurrent breast cancer patients who had been given cyclophosphamide, methotrexate and fluorouracil (CMF) therapy previously and were treated at the Oncology Departments of Cukurova and Ege University Medical Schools between March 1992-94, were randomized into 2 groups for the chemotherapy program. The 30 patients in the 1st group were given etoposide: 200 mg x day x 5 days orally every 3 weeks. The 30 patients of the 2nd group were given fluorouracil: 500 mg x m2, doxorubicin: 5O mg/m2, cyclophosphamide: 500 mg/m2 intravenously every 3 weeks. The response rates were 21/30 in group 1 and 17/30 in group 2. The median duration of responses was 11 months (8-21) in the 1st and 9 months (4-18) in the 2nd group. Severe myelotoxicity was observed in 2 of the patients in the 1st group and in 5 of the patients in the 2nd group.

Relationship of Helicobacter pylori infection to several malignant and non-malignant gastrointestinal diseases

The importance of the Helicobacter pylori infection was investigated as a risk factor for several gastrointestinal diseases. In this study 203 patients with gastric cancer, 61 with peptic ulcus, 60 with gastritis and 100 asymptomatic control subjects were investigated. Serum samples were examined for IgC antibodies to H. pylori by enzyme linked immunoassay - tissue samples were stained for H. pylori by Wartin-Stary technique and by Giemsa for routine histopathology. H. pylori seropositivity was 58.1% in gastric cancer, 54% in peptic ulcus, 63.3% in gastritis and 27% in asymptomatic control group. There was a 10.1% discordance between the serum and tumor determinants in the seropositive group and 11.3% of discordance in the seronegative group. The frequency of H. pylori seropositivity was lowest in cardia tumors (22.7%) and highest in antral tumors (65.5%, p=0.00002). H. pylori seropositivity was 29% in diffuse type of histology, 35% in mixed type and 79% in the intestinal type (p=0.00000). In the gastric cancer patients the frequent use of salty food (p=0.00001, OR=6.4), excessive salt, pickled food (p=0.0000, OR=24.92) and proteins (p=0.003, OR=0.45) were more significant than asymptomatic volunteers. In gastric cancer patients the frequent use of salty and pickled food were relevantly associated with H. pylori infection (p=0.001). It was concluded that H. pylori infection could play a role in the pathogenesis of non-malignant gastrointestinal diseases which may be the precursor of carcinoma. However, other contributing factors to carcinogenesis must be investigated.

The use of recombinant human granulocyte colony-stimulating factor in combination with single or fractionated doses of ifosfamide and doxorubicin in patients with advanced soft tissue sarcoma

Sixty patients with stage III-B and IV soft tissue sarcomas were randomized to receive either ifosfamide 5 g/m2xdx1 and doxorubicin 60 mg/m2xdx1 given every 3 weeks (arm A) or ifosfamide 1.8 g/m2xdx5 and doxorubicin 60 mg/m2xdx1 given every 4 weeks (arm B). Recombinant human granulocyte colony-stimulating factor (r-met Hu G-CSF: 250 micrograms/m2xd) was applied with a prophylactic intent to patients in arm A only. The response rate was higher in arm A patients (56% versus 33%, p = 0.03). In stage III patients, the complete response rate was significantly higher (53% versus, 13.3%, p = 0.01) and the duration of response was significantly longer in arm A (20 +/- 8.2 months versus, 13.4 +/- 7 months, p = 0.05). Chemotherapy related myelotoxicity and mucositis were also less frequent in this arm as a result of prophylactic r-met Hu G-CSF administration (p = 0.04, p = 0.003). It was concluded that single dose ifosfamide and doxorubicin combinations deserve further investigation under the cover of hematopoietic growth factors, particularly in patients with stage III soft tissue sarcomas.

A randomised trial of two cisplatin-containing chemotherapy regimens in patients with stage III-B and IV non-small cell lung cancer

Seventy-four newly diagnosed patients with histologically proven Stage III-B and IV non-small cell lung cancer were randomized to receive either cisplatin: 20 mg/m2 x day x 5, ifosfamide: 1.8 g/m2 x day x 5, mesna: 1.2 g/m2 x day x 5, etoposide: 100 mg/m2 x day x 5 (ICE) or cisplatin: 20 g/m2 x day x 5 and etoposide: 100 mg/m2 x day x 5. Response rates were 59% in the ICE and 40% in the CE arm with a significant advantage in response duration and overall survival in the ICE receiving patients (P = 0.03, P = 0.0008). As we used granulocyte colony stimulating factor (G-CSF) very frequently, myelotoxicity remained substantial but acceptable.