Bevacizumab in HER2neu negative locally recurrent and metastatic breast cancer: The BHerN review

INTRODUCTION: A promising strategy for HER2-negative metastatic breast cancer (mBC) is to target the veascular endothelial growth factor receptor using bevecizumab. Several randomized controlled trials (RCTs) have consistently demonstrated improvement in progression-free survival (PFS).METHODS: This meta-analysis was undertaken to determine the added benefit of bevacizumab (BV) to chemotherapy in HER2-negative locally recurrent and mBC. RCTs that compared the efficacy and safety of BV+chemotherapy to placebo+chemotherapy in the first- or second-line setting were selected. The primary outcome was PFS. The secondary outcome measures were overall survival (OS) and objective response rate (ORR). Analysis of safety was done by pooling grades 3-5 toxicities. Four RCTs were included in the meta-analysis: E2100, AVADO, RIBBON-1, and RIBBON-2.RESULTS: The use of BV+chemotherapy showed statistically significant improvement in PFS (HR 0.73 [0.65, 0.82] 95% Cl, pCONCLUSION: BV prolongs PFS and increases ORR in patients with HER2-negative locally-recurrent and mBC. OS was comparable in both arms. Toxicities significantly increased with the addition of BV to chemotherapy, but fatal reactions were rare in all four trials. The addition of BV to conventional first- or second-line chemotherapy is justified in TN mBC since there is still no standard treatment fot this. 

Primary mediastinal liposarcoma of the superior, middle and anterior mediastinum

Primary liposarcomas constitute less than 1% of all mediastinal tumors. The posterior mediastinum is the location in 95% of cases. Literature search did not show a case that encompassed three mediastinal compartments.A 32-year old man was diagnosed with high grade primary mediastinal liposarcoma (80% myxoid plus 20% round cell), after presenting with superior vena cava syndrome. CT-scan revealed lobulated masses on the superior, anterior, and the right middle mediastinum measuring 7.8 x 9.0 x 7.5 cm and compressing the superior vena cava. He underwent surgical debulking and palliative 3 cycles doxorubicin-based chemotherapy, but later succumbed to pneumonia.

Correlation between demographic, socio-economic, and cancer-specific factors with quality of life scores among newly-diagnosed cancer patients of the Medical Oncology Clinics of the Philippine General Hospital Cancer Institute

INTRODUCTION: Over the last two decades, psychosocial research has explored the experience of cancer patients. This study evaluated if demographic, socio-economic and cancer-specific factors impact and correlate with quality of life (QoL) scores at the time of first consult of newly-diagnosed cancer patients seen at medical oncology clinics of the University of the Philippines¬Philippine General Hospital (UP-PGH) Cancer Institute from 2012-2013.METHODS: Review of charts and interview with a pre-approved and validated questionnaire were done after informed consent. Age, gender, marital status, number of close friends, household income band, employment status, cancer site and stage were recorded. Outcomes were cancer-specific QoL EORTC QLQ-C30 questionnaire and generic QoL EQ5D questionnaire. Scores were correlated with demographic, socio-economic, and cancer¬specific factors.RESULTS: 535 patients were included, 257 male and 278 female. Mean age was 52 years (SD 13.5 years; range20-92 years). Majority (28.7%) belonged to income bracket P4,293-P8,583/month. Majority were married (74.31%) and unemployed (58.4%). Top 5 cancers were colorectal (28.09%), breast (20.70%), head and neck (16.63%), lung (9.97%), lymphoma (7.94%). According to EORTC QLQ-C30, physical functioning (p=0.0037) and cognitive functioning (p=0.003) were significantly correlated with younger patients while role functioning (p=0.04) and emotional functioning (p=0.03) showed negative correlation with older patients. Fatigue was less in female patients (p=0.0005) while being the household head (p=0.0005) was significantly correlated with increased fatigue. According to EQ5D, single patients (p=0.016) had better mobility than the rest of patients. Having 5  family members significantly reported less pain (p=0.038). Breast cancer patients had best QOL while bladder cancer patients had the worst QOL. As cancer stage increased, QOL decreased.CONCLUSION: This is a first baseline study on self-reported QOL among newly-diagnosed Filipino cancer patients, an important relevant reference in the field of psychosocial issues among low-resourced cancer patients in the Philippines.

Hemolytic anemia presenting as hemoglobinuria from intentional paradichlorobenzene mothball ingestion

A 24-year-old Filipino male was diagnosed with hemolytic anemia when he presented with abrupt onset of anemia, hemoglobinuria, and increased bilirubins, after intentionally ingesting mothballs containing paradichlorobenzene. He was transfused with six units of packed red blood cells (PRBC) and was discharged improved. Paradichlorobenzene, a known oxidant, causes denaturation and precipitation of hemoglobin. These precipitates form Heins bodies within the erythrocytes that are removed by the reticuloendothelial system, fragmenting cells to produce hemoytic anemia from paradicholorobenzene ingestion as confirmed by the UP-National Poison Management and Control Center.

A case of chronic diarrhea secondary to Capillaria philippinesis in Occidental Mindoro: Possibly a newly-described endemic area?

A 41-year-old man from Occidental Mindoro was diagnosed with intestinal capillariasis at the Philippine General Hospital after a year of diarrhea and multiple hospital admissions. The patient was noted to be harboring Capillaria philippinensis, Strongyloides stercoralis, Entamoeba histolytica, Mycobacterium tuberculosis, and Candida albicans in his stool. He was treated with albendazole, metronidazole, diloxanide, fluconazole, and antiiKoch's. This case was reported to the Department of Health to pursue this site as a potential area for epidemiologic investigation.