ABSTRACT
Objective: To compare the pathological complete response in human epidermal growth factor receptor type 2 [HER-2] positive breast cancer patients getting neoadjuvant chemotherapy with or without trastuzumab
Study Design: Retrospective randomised double-arm observational study
Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from 2008 to 2016
Methodology: HER2-positive, lymph node positive, breast cancer patients receiving neoadjuvant chemotherapy [NACT] were retrospectively observed. Patients getting neoadjuvant trastuzumab, fulfilling the inclusion criteria were studied. The comparison group included randomly selected equal number of HER2-positive breast cancer patients having similar tumor characteristics, getting NACT only. Pathological complete response [pCR] was defined as no residual invasive or in situ residual tumor in breast tissue, or in the lymph nodes. One hundred and fifty-six patients were studied. Eighty-nine patients with HER2-positive disease received trastuzumab preoperatively. Sixty-four [n=64] patients received the complete standard dose of neoadjuvant trastuzumab along with chemotherapy. Almost equal number of patients [n=67] with HER2- positive disease were selected by random assortment for the reference group who did not receive trastuzumab before surgery
Results: The pathological complete response of study group was [n=32] 50%, which was 26.1% higher than the reference group [n=16] 23.9%; and this difference was statistically significant with a p-value of 0.002 [<0.05]. The overall pCR was 36.6% [n=48]
Conclusion: Addition of trastuzumab to neoadjuvant chemotherapy doubled the pCR in HER2-positive breast cancer. Targeted therapy should be offered to all eligible patients with HER2-overexpressing breast cancer
ABSTRACT
Objective: Chronic lymphocytic leukemia [CLL] is a heterogeneous disease in terms of survival with and without treatment. Many chemo and immunotherapeutic agents are available to treat this indolent disease. Aim of this study was to determine the outcomes of patients with chronic lymphocytic leukemia treated with different available chemotherapeutic regimens
Methods:All patients with diagnosis of CLL from 2008 to 2013 were included. Data were collected from hospital information system. Objective response rate [ORR] in terms of complete or partial response [CR, PR], stable or progressive disease [SD, PD], overall survival [OS], and progression free survival [PFS] were calculated
Results:Fifty seven patients were included; 42 [74%] male and 15 [26%] were female. Patients with Binet stage A 10 [18%]; B 20 [35%] and C were 27[47%]. Median age was 50.9 years. Forty six [80%] were treated and 11[20%] remained on watch and wait. Treatment indications were B symptoms 14 [30%], symptomatic nodal disease 18[39%], thrombocytopenia 4[9%], anemia 7[15%] and doubling of lymphocyte count 3 [7%]. Chemotherapy regimens used were FC in 38 [83%], FCR 5[11%], chlorambucil 2[4%] and CVP in 1[2%] patient. Twenty two [56%] patients had CR, 13[33%] PR, 3[7.6 %] SD, and 1[2.5%] had PD. ORR was 89%. Median PFS was 23.1 months and median 3 years OS was 55%
Conclusion:Majority of patients was in a relatively younger age group and presented with advanced stage disease requiring treatment. Small number of patients received rituximab due to cost. PFS and OS are comparable with published literature
ABSTRACT
Objective: To determine the outcome of patients with early-stage [stage I-II] favorable risk classical Hodgkin lymphoma treated with chemotherapy alone or combined modality treatment [CMT] utilizing chemotherapy and involved field radiotherapy
Methods: This retrospective study was done at Department of Medical oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan from January 2004 to December 2013
Results: There were 101 patients, with male predominance [71.3%]. Mean age was 34 years. Sixty three [62.4%] patients received CMT and 38 [37.6%] patients had chemotherapy alone. Ninety eight percent patients had ABVD chemotherapy. Dose of radiotherapy ranged from 20 to 36 gray. Difference between baseline characteristics and major toxicities among the two groups was insignificant. Patients treated with CMT had better overall survival compared to chemotherapy alone: 100% versus 91% at five years and 96% versus 81% at 10 years, respectively [p=0.03]. Progression free survival was also better with CMT against chemotherapy alone at five years [98% versus 81%] and 10 years [82% versus 71%] [p=0.01]
Conclusion: Favorable risk classical Hodgkin lymphoma patients had better overall survival and progression free survival when treated with CMT against chemotherapy alone
ABSTRACT
Objective: To determine a frequency distribution of the type and clinical profile of cancer cases registered at the Shaukat Khanum Memorial Cancer Hospital and Research Centre [SKMCH and RC]. Study Design: A retrospective, observational study. Place and Duration of Study: The SKMCH and RC, Lahore, from December 1994 to December 2012. Methodology: The time period taken into consideration for the three most common diagnoses was December 1994 - December 2012. Summaries were obtained for gender, age-group, and cancer type on: [i] all age-groups, both genders combined; [ii] adults [> 18 years]; [iii] adult males [> 18 years]; [iv] adult females [> 18 years]; and [v] children [= 18 years]. For a subset of cases registered between January 2004 to December 31, 2012 [9 years], summaries on cancers, age, addiction, family history, disease stage, and grade were obtained for the above groups. Statistical Package for Social Sciences, version 19, was used to analyze the data. Results: The most common malignancies, for the 18-year time period, among adults, were those of breast [11, 848/ 49, 765, 23.81%], lip and oral cavity [3, 291/49, 765, 6.61%], and liver and intrahepatic bile ducts [2, 836/49, 765, 5.70%]. Conclusion: Hospital-based results obtained from various oncology hospital and departments, can be considered as an effective way forward in getting a preview of cancer burden in the region. Key Words: Hospital-based. Cancer registration. Malignancies
ABSTRACT
Objective: To describe the demographic and clinical features of females presenting with breast malignancies at the Shaukat Khanum Memorial Cancer Hospital and Research Center [SKMCH and RC], Lahore, Pakistan
Study Design: An observational study
Place and Duration of Study: SKMCH and RC, Lahore, from January 2008 to December 2012
Methodology: Demographic and clinical features of female breast cancer patients, registered at SKMCH and RC, were studied. Mean values, counts, and percentages were obtained
Results: Four-thousand, three-hundred and sixty-six female breast malignancies were recorded. Nearly 80.4% of the patients belonged to Punjab. Mean age at presentation was 48.6 +/- 12.2 years, at menarche was 13.2 +/- 1.2 years, and at first childbirth was 23.7 +/- 4.8 years. Mean Body Mass Index [BMI] was 29.0 +/- 5.7 kg/m[2]. In 60.1%, history of breast feeding was positive. In 55.7%, there was no history of use of any Oral Contraceptive Pills [OCP]/Hormone Replacement Therapy [HRT]. Nearly 42.7% were postmenopausal, 85.2% had infiltrating ductal carcinoma, 49.6% had grade 3 tumor, 60.7% had stage II disease, and 37.3% were Estrogen Receptor [ER]/Progesterone Receptor [PR]+, Human Epidermal Growth Factor Receptor 2 [HER2]-. Family history of breast cancer was positive in 16.9% of the cases
Conclusion: The mean presenting age is lower than what has been recorded in the West. It may be worthwhile collating results from different institutions in order to study the epidemiology of the disease more extensively and develop cancer control and early detection programs