Biweekly cetuximab in combination with platinum and 5-fluorouracil in metastatic head and neck carcinoma

Background and Aim: The combination of cetuximab with platinum and 5-fluorouracil (5-FU) chemotherapy prolongs survival in patients with metastatic or recurrent squamous-cell carcinoma of the head and neck (SCCHN). Biweekly (once in 2 weeks) administration of cetuximab requires fewer hospital visits and decreases treatment costs; therefore, it is more convenient both for the patients and for the healthcare providers. Here, we assessed the efficacy, safety, and tolerability of an alternative biweekly regimen of cetuximab in combination with platinum and 5-FU chemotherapy as a first-line treatment for these patients. Methods and Materials: Medical records of patients with metastatic or recurrent non-nasopharyngeal SCCHN who were treated with a biweekly regimen of cetuximab (500 mg/m2 on day 1), cisplatin (40 mg/m2 on day 1) or carboplatin (target area under the curve 3.5 mg/ml × min on day 1), folinic acid (400 mg/m2 on day 1), and 5-FU (400 mg/m2 bolus on day 1 followed by continuous infusion of 2,400 mg/m2 5-FU over 46 h) were retrospectively reviewed. Survival estimates were calculated with the Kaplan–Meier method. Results: In total, 60 patients were included. The median age of the patients was 60.5. The objective response rate was 53.3% (95% confidence interval [CI] = 40.7–65.9). The median progression-free survival duration was 6.8 months (95% CI = 5.5–8.1) and the median overall survival duration was 13.3 months (95% CI = 8.4–18.2). The most common grade 3 or 4 adverse events were neutropenia (28.3%) and leucopenia (13.3%). Grade 3 or 4 rash was observed in 3.3% of the patients. Conclusion: Biweekly administration of cetuximab, cisplatin, and 5-FU is an effective regimen with a favorable toxicity profile for the first-line treatment of metastatic or recurrent SCCHN. These results warrant further evaluation of this regimen in prospective trials.

frequency and significance of radiologically detected indeterminate pulmonary nodules in patients with colorectal cancer

To investigate the frequency and significance of pulmonary nodules in patients with colorectal cancer [CRC]. Medical records of 1,344 patients with CRC who underwent thoracic computerized tomography scans between January 2003 and December 2009 were reviewed. Those with any distant metastatic disease or who were already known to have pulmonary malignancies were excluded. Number, size, shape and location of the nodules were evaluated. A multivariate analysis was performed to determine the predictive factors for evidence of metastases. Results: Of the 1,344 patients, 55 [4.09%] had nodules that met the criteria of an indeterminate pulmonary nodule. The mean follow-up time was 25 +/- 17.9 months and the mean time to develop pulmonary metastasis was 15.5 +/- 6.4 months. The nodules of 17 [30.9%] patients showed pro-gression at follow-up; 8 had metastasized. Multivariate analysis showed multiple indeterminate pulmonary nodules [p = 0.006] of parenchymal localization [p = 0.016] with an irregular border [p = 0.002], which is predictive of metastatic disease. Conclusion: Our study has shown that multiple indeterminate pulmonary nodules with an irregular border in a parenchymal location were more likely to represent metastatic disease. However, the frequency of the occurrence of indeterminate pulmonary metastases of CRC was low

p53 protein accumulation and presence of visceral metastasis are independent prognostic factors for survival in patients with metastatic inflammatory breast carcinoma

The aim of this study was to determine the markers of prognosis in metastatic inflammatory breast cancer [IBC]. The prognostic value of patients' clinical characteristics and expression of c-erbB-2, p53, Ki-67, ER and PgR were assessed in the 45 patients with IBC who had developed distant metastasis. Immunohisto-chemical methods were used to detect the expression of c-erbB-2, p53, Ki-67, ER and PgR in surgical resection specimens of the patients' primary tumor. The median overall survival [OS] measured from the diagnosis of metastatic disease was 23 months. In the univariate analysis, p53 protein accumulation and the presence of visceral metastasis were predictive of poor survival [p = 0.01 and 0.003, respectively]. In the multivariate analysis, accumulation of p53 protein and the presence of visceral metastasis correlated with OS [p = 0.02 and 0.008, respectively]. In metastatic IBC, accumulation of p53 protein and presence of visceral metastasis are independent prognostic factors for OS. Established prognostic factors in non-IBC patients such as patient age, histologic grade, hormone receptor status and c-erbB-2 status did not have independent significance in IBC in this Study

Comparison of inflammatory breast cancer and noninflammatory breast cancer in Western Turkey

The study was aimed at investigating the clinical and biological features and survival outcomes of patients who were treated for metastatic inflammatory and noninflammatory breast carcinoma. One hundred and sixty-seven metastatic breast cancer patients were enrolled into this study and divided into two groups: inflammatory [n = 46] and noninflammatory [n = 121]. The clinical and hormone receptor status, c-erbB-2, Ki-67, and p53 expression, based on the immunohistochemical staining patterns, were compared between the two groups. The inflammatory breast carcinoma group had a younger patient population, higher rate of adjuvant anthracycline therapy, number of lymph node metastases, rates of extranodal extension and c-erbB-2 overexpression than noninflammatory breast cancer patients [p < 0.05]. With regard to survival, there were slightly better outcomes in the noninflammatory breast carcinoma group [30 months] compared to the inflammatory breast carcinoma group [23 months], but the difference was not statistically significant [p = 0.08]. While survival results of p53-negative inflammatory and noninflammatory breast carcinoma patients were similar, p53-positive survival was significantly worse [p < 0.05] in inflammatory breast cancer carcinoma patients. Because of c-erbB-2 overexpression in inflammatory breast carcinoma patients, treatment options including trastuzumab could have given better survival outcomes. Survival of inflammatory breast carcinoma patients with a low p53 immunohistochemistry staining appeared similar to that for noninflammatory breast carcinoma. For this reason, new treatment options are needed especially in inflammatory breast carcinoma patients with high p53 positivity

Comparison of the clinical and pathological features between patients with recurrent metastatic breasr carcinoma and patients with initially metastatic breasr carcinoma

To compare initial metastatic breast carcinoma [MBC] with recurrent MBC and assess their biologic phenotypes and clinical behaviors. A comparison of clinical and biological characteristics and median overall survival times were assessed in the 251 patients with MBC at the Division of Medical Oncology, Ege University School of Medicine, and the Division of Radiation Oncology, Tepecik Government Hospital, Izmir, Turkey between 1995 and 2004. Hormone receptors, c-erbB-2, Ki-67, and p53 expressions were performed by immunohistochemistry. Out of 251 MBC patients, 206 patients had recurrent MBC, and 45 had initial MBC. Regarding survival, there was no difference between the recurrent MBC group and the initial MBC group. The initial MBC group had a higher proportion of T4 tumors [46% versus 27%], a lower proportion of T1-2 tumors [31% versus 55%; p=0.01], and a higher percentage of patients with high Ki-67 expression [64% versus 49%; p=0.05]. Multivariate analysis showed that T stage was an independent prognostic factor [p=0.02]. Patients with initial MBC tended to present with larger tumors. This relationship can be explained by delayed diagnosis. The potential for reducing death rates from breast cancer is contingent on educational improvement and increased screening rates

Single-agent irinotecan for recurrent/metastatic colorectal cancer: a retrospective analysis

To evaluate the efficacy, toxicity and factors affecting the survival rate of patients treated with irinotecan. Data from the medical records of 74 patients who had recurrent/metastatic colorectal cancer treated with single-agent irinotecan were analyzed. The mean age for all the patients was 56 years [range 19-77]. Forty-one [55%] and 33 [45%] patients had recurrent and/or metastatic colon cancer, respectively. All the patients were treated with irinotecan 350 mg/m[2] every 21 days. Grade 3-4 emesis, grade 3-4 diarrhea, grade 3-4 neutropenia and severe early cholinergic events developed in 7, 15, 7 and 1.3% of patients, respectively. One patient died due to acute renal failure. The overall response rate was 14% [complete response 5%, partial response 9%]; 61% had stable response while another 25% had progressive disease. Patients with multiple metastatic foci, patients