Docetaxel and irinotecan as first-line chemotherapy in patients with advanced non-small-cell lung cancer: a pilot study

The aim of this study is to evaluate the activity and toxicity of the combination docetaxel and irinotecan as first-line therapy for advanced non-small-cell lung cancer [NSCLC]. Twenty-two chemotherapy-naive patients with stage IIIB with pleural effusion or stage IV NSCLC received irinotecan 50 mg/m[2] on days 1, 8, and 15, and docetaxel 50 mg/m[2] on day 2, every 28 days until disease progression. Median follow-up was 10 months [range: 2-28 months]. The overall response rate was 36.4% [8/22 patients; 95% confidence interval: 16.8-56.0], with no complete responses. Median time to disease progression was 5 months [range: 1-24 months] and median overall survival was 10 months [range: 2-28]. Grade 3-4 diarrhea was observed in 2 patients [9.1%]. Grade 3-4 neutropenia occurred in 2 patients [9.1%]: 1 episode of febrile neutropenia in one patient, and 1 death due to neutropenic sepsis in another patient. One patient received transfusion for grade 4 anemia. Irinotecan showed a moderate response rate and overall survival of clinical interest. Diarrhea was the main toxicity. This regimen may be suitable for patients unable to tolerate cisplatin-based therapy, for elderly and/or for patients with poor performance status, and should be investigated in a larger trial

Secondary adenocarcinoma of the urinary bladder from a primary gastric cancer

Primary bladder tumor is a frequent urological malignancy, whereas the incidence of secondary bladder tumor from a distant organ is quite rare. Secondary bladder neoplasms represent no more than 3% of all malignant bladder tumors in surgical specimens, of which distant metastases from stomach account for about 4%. The signs of bladder neoplasm in a patient with malignancy elsewhere should alarm the clinician for a possible metastatic origin. We present a patient with primary adenocarcinoma of the stomach, who underwent total gastrectomy and received adjuvant chemotherapy, and was diagnosed with metastasis to the urinary bladder 15 months later. We review the epidemiology of secondary adenocarcinoma of the bladder, mechanisms of metastasis, associated common primaries with focus on gastric malignancies, radiological findings, and role of immu-nohistochemical staining