Three weekly irinotecan and bolus 5-fluorouracil combination in the first line treatment of advanced gastric cancer - a single institution experience

Background: The goal of this study is to determine the efficacy and toxicity of a non-platinum based chemotherapy combination using irinotecan associated to bolus 5-FU as first line treatment in advanced gastric cancer. Materiel and methods: Retrospective analysis of a population of patients treated for metastatic and locally advanced gastric cancer with irinotecan and 5-FU as upfront chemotherapy. Results: Thirteen patients were enrolled. The median age was 56 years. Seven patients were males and six were of females. Ten patients had a metastatic disease and three patients had a locally advanced disease. Patients received a total number of 43 cycles of chemotherapy. Overall response rate was 38,4%, median time to progression (TTP) was 3 months, and median overall survival was 4 months. Three patients (23,1%) presented grade 3 /4 neutropenia complicated with an infectious episode with fever in two cases, three patients (23,1%) required blood transfusion for a grade 4 anemia, and one patient (7,6%) was hospitalized for a severe episode of diarrhea. Conclusion: Three weekly irinotecan and bolus 5-FU is an interesting combination as first line treatment of advanced gastric cancer; designed clinical trials are needed to confirm the activity of this combination

The Cost of Nephroblastoma Treatment in South Africa: A Very Cost-Effective Investment with Guidelines for the Rest of Africa

Background. Nephroblastoma is one of the most common childhood malignancies in Africa; but with a survival rate significantly lower than in developed countries. In African countries with a small gross domestic product (GDP) per capita; the cost of treating nephroblastoma may be prohibitive. Objectives. To determine the direct costs of treatment of nephroblastoma in South Africa (SA) and to propose a more cost-effective approach to investigations and treatment for the disease in Africa. Methods. Data from 2000 - 2010 from two SA paediatric oncology units were retrospectively analysed. The costs included investigations; chemotherapy and radiotherapy; comparing early-v. advanced-stage disease. In both units; the nephroblastoma International Society of Paediatric Oncology (SIOP) protocol was used. Results. Stage I disease was the most common; followed by stage IV. The total cost of diagnosis; staging and treatment of stage I disease was ZAR9 304.97 (EUR882.80 or USD1 093.40); compared with a five-times higher cost for stage IV (ZAR48 293.62 (EUR4 581.9 or USD5 674.9)). Treating one patient averted more than 32 disability adjusted life years. The investigation and treatment of early- and advanced-stage disease is very cost-effective when compared with the local GDP per capita. Conclusion. The cost of investigation and treatment of nephroblastoma remains a challenge everywhere; but especially in Africa. However; it is a very cost-effective disease to treat and children in Africa should not be denied treatment

Clinical prognostic factors in patients with advanced stage prostate cancer

Objectives: To determine the prognostic factors that could predict patient outcome in patients with advanced stage prostate cancer. Patients and Methods: In this study we retrospectively evaluated the medical record data of 222 patients with advanced stage prostate cancer treated by hormonal therapy (either castration or total androgen blockade (TAB)). All pre- and post- treatment data records were evaluated with respect to patient age; prostate and tumor size; tumor grade; stage; PSA; alkaline and acid phosphatase and the number of bone lesions. The response to the hormonal treatment was evaluated either early (12 months after treatment) or late (over all follow-up visits until the last visit or death). Descriptive statistics; student T test; multivariate and Kaplan Meier's curve were used for data analysis. Results: Within 12 months of treatment 70of the cases showed an improvement with a significant decrease of their pre-treatment values after hormonal therapy. Patient age; tumor stage; the number of bone lesions; serum alkaline and acid phosphatase levels in the pre-treatment data were significantly independent predictors of the overall survival outcome (p= 0.0015; 0.002; 0.001; 0.0002 and 0.028; respectively); while the pre-treatment PSA serum level; tumor grade and the type of hormonal treatment used (either castration or TAB) were no predictors of patient outcome (p= 0.18; 0.82 and 0.47; respectively). Importantly; the PSA serum level and the number of bone lesions in the first 12 months of patient follow-up were significant predictors of the overall disease survival status (p=0.001 and 0.028; respectively). The mean follow-up period of alive cases was 39.42 months ranging from 6 - 171 months. Of the 222 cases 110 (51.6) had overall disease progression during a mean of 59.4 months; while mortality was reported in 118 cases (53.2) in the course of a mean of 59.9 months. Conclusion: The pre-treatment patient age; tumor stage; serum alkaline and acid phosphatase; as well as the post-treatment PSA level and the number of bone lesions were significant independent predictors of the overall patient outcome in patients with advanced stage prostate cancer. However; a survival analysis in relation to the treatment type did not reveal a statistically significant difference between the outcomes of castration and TAB

Sequential intravesical immunochemotherapy for stages Ta and T1 transitional cell carcinoma of the bladder : an update

Objectives: To present an update of our experience with sequential immuno-chemotherapy using bacillus Calmette-Guerin (BCG) and epirubicin in superficial bladder tumors. In addition; the question of whether to start with BCG or epirubicin is answered. Methods: Between January 1993 and December 2001; 156 patients with histologically proven Ta and T1 bladder transitional cell carcinoma were included in a prospective randomized study. Following transurethral resection of the bladder tumor (TURBT); patients were randomly assigned to 1 of 2 groups. Patients in group 1 received weekly doses of 150 mg BCG alternating with 50 mg epirubicin for 6 weeks. Maintenance was carried out by a monthly dose of BCG alternating with epirubicin; to complete 1 year of treatment. Patients in group 2 received the same protocol; but with a reversed order with epirubicin being used initially. Results: 149 patients; 114 men and 35 women with a mean age of 55 years; were evaluable. 7 patients were excluded due to severe side effects. Mean and median follow-up was 42.8 and 43 months; respectively. In the whole series recurrence rate was 18.1; recurrence rate per year was 0.06; mean interval to first recurrence was 29 months and progression rate was 12. Side effects developed in 40 patients (25.6) and were mostly in the form of mild cystitis (26 patients). The 2 groups of therapy were comparable regarding recurrence rate; recurrence rate per year; progression rate and side effects. Conclusions: The sequential therapy is effective in recurrence prophylaxis of superficial bladder tumors. The side effects were less frequent than in our historical controls treated with BCG alone. It does not matter to start with epirubicin or BCG in this regimen