Pathologic complete response in HER2-positive breast cancer patients receiving trastuzumab in neoadjuvant setting

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

Frequency and causes of anemia in Lymphoma patients

Objective: Purpose of this study was to find out frequency of anemia and its causes in newly diagnosed treatment naive lymphoma patients

Methods: We retrospectively studied all lymphoma patients [> 18 years age] diagnosed and treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, from January 2016 till January 2017. The data was collected from electronic Hospital Information System. Descriptive statistics were done by using summary measures for categorical variables as well as continuous variables

Results: Out of a total 408 patients, 272 were males and 136 females. Median age of patients was 33 years [18-76]. Hodgkin lymphoma [HL] and diffuse large B cell lymphoma [DLBCL] were the diagnosis in 201 and 134 patients respectively; rest of the patients had low grade lymphomas. Anemia was present in 184 [45%] patients. Anemia of chronic disease was the commonest cause of anemia and was present in 61 [33.1%] patients. Remaining patients had anemia secondary to marrow involvement 50[27.17%]; iron deficiency anemia, Vitamin B-12 deficiency anemia and hemolytic anemia were the causes in 7.6, 1.6%, % and 0.54% respectively

Conclusion: Anemia is a common feature in newly diagnosed lymphoma patients with anemia of chronic disease as the commonest cause. It is more frequent in patients with higher stages of lymphoma especially when bone marrow is involved by lymphoma. Since anemia is an important adverse prognostic factor for the outcome of lymphoma patients, work up for anemia prior to initiation of chemotherapy should be done in every lymphoma patient in order to help improve the management of these patients

Borderline tumors of the ovary: a clinicopathological study

Objective: To report experience with borderline ovarian tumors [BOTs] in a developing country like Pakistan with limited resources and weak database of health system

Methods: Patients with BOTs managed at Shaukat Khanum Cancer hospital, Lahore, Pakistan from 2004 to 2014 were included and reviewed retrospectively. Data was recorded on histopathological types, age, CA-125, stage of disease, treatment modalities and outcomes

Results: Eighty-six patients with BOT were included with a median age of 35 years. Forty-two [49%] patients had serous BOTs and 43 [50%] had mucinous BOTs, while one [1%] had mixed type. Using FIGO staging, 80 patients had stage I; two patients had IIA, IIB and stage III each. Median follow-up time was 31.5 months. All patients had primary surgery. Seventy [81%] patients underwent complete surgical resection of tumor. Forty-three [50%] patients had fertility preserving surgery. Seventy-three [85%] patients remained in remission. Recurrent disease was observed in 13 [15%] patients. Median time to recurrence was 22 months. On further analysis, age above forty years, late stage at diagnosis and incomplete surgery were significantly associated with invasive recurrence

Conclusion: Despite a low malignant potential, relapses may occur in patients above forty years of age, incomplete surgery and staging information and advanced stage at presentation. Fertility sparing surgery should be considered in young patients. Complete excision of tumor and prolonged follow-up are advised because recurrence and transformation to invasive carcinoma may occur

Clinical predictors of anticipatory emesis in patients treated with chemotherapy at a tertiary care cancer hospital

Objective: To determine the clinical predictors of anticipatory emesis in patients treated with chemotherapy at a tertiary care cancer hospital

Methods: This was a cross-sectional study conducted on 200 patients undergoing first line chemotherapy with minimum of two cycles at inpatient department and chemotherapy bay of Shaukat Khanum Memorial Cancer Hospital and Research Centre Pakistan. Anticipatory nausea and vomiting develops before administration of chemotherapy. Clinical signs and symptoms in patients with or without anticipatory emesis were compared using chi square test statistics

Results: The mean age of the study participants was 36.68 years [SD +/- 12.23]. The mean numbers of chemotherapy cycles administered were 3.23 [SD +/- 1.2]. Chemotherapy related nausea and vomiting was experienced by 188 [94%] patients and anticipatory nausea vomiting was reported in 90 [45%] of patients. Greater proportions of patients with anticipatory emesis were females. Fourteen [15.5%] p-value=0.031 patients with anticipatory emesis had history of anxiety and depression. Fifty nine [65.5%] p-value =< 0.0001 patients with anticipatory emesis had severe nausea after last chemotherapy cycle. Forty six [51.11%] p=<0.0001 patients had motion sickness

Conclusion: Female gender, history of motion sickness, anxiety and depression, severe nausea and vomiting experienced in pervious cycle of chemotherapy were clinical predictors of anticipatory nausea and vomiting

Impact of rituximab and IPI on survival in diffuse large B cell lymphoma patients treated at a tertiary level cancer centre in Pakistan: a single-centre experience

To determine the impact of Rituximab and international prognostic index score on survival in diffuse large B-cell lymphoma patients. The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from January to May 2013 and comprised record of patients with diffuse large B-cell lymphoma who were treated from 2007 to 2010. Baseline international prognostic index score, stage at presentation were noted and the records were divided into two groups A and B on the basis of the type of chemotherapy. SPSS 19 was used for statistical analysis. Of the 93 patients in the study whose records were reviewed, 54[58%] were men. Overall median age was 43 years [range: 18-76]. Stages at presentation were stage-I 14 [15.1%], stage-II 41 [44.1%], stage-III 20 [21.5%] and stage-IV 18 [19.4%]. International prognostic index risk categorisation was low risk 59[63.4%], low intermediate risk 23[24.7%], high intermediate risk 10[10.8%] and high risk 1[1.1%]. There were 31[33%] patients in Group A and 62[67%] in Group B. Median follow-up was 3.9 years [range: 1.2-6.1]. Overall survival at 4 years was 66.4%; for Group A 65.3% and for Group B 66.7% [p<0.4]. On the basis of risk categories, overall survival was statistically significant [p<0.001] between the groups. International prognostic index risk categorisation had statistically significant impact on survival. However, there was no evidence of a significant survival benefit between types of chemotherapy. Further controlled trials are needed in this regard

Pelvic-peritoneal tuberculosis mimicking ovarian cancer

Pelvic-peritoneal tuberculosis is a common extrapulmonary site in young females mimicking an advanced ovarian malignancy. We present 2 cases with the classical triad of advanced-stage ovarian carcinoma-ascites, abdominopelvic masses and elevated serum CA-125 levels. Laparoscopic examination revealed peritoneal nodules which on biopsy showed granulomatous inflammation and no malignant cells. Patients were started on anti-tuberculous therapy and on follow-up their symptoms as well as CA-125 levels normalized. Medical awareness of peritoneal tuberculosis is lacking and many young women with this disease undergo unnecessary extended surgery. Diagnostic laparoscopy combined with peritoneal biopsy seems to be a sufficient and safe method to provide a definitive diagnosis for this curable infection. If left untreated, the disease may disseminate and result in significant organ dysfunctions particularly infertility

Intrapericardial chemotherapy for the management of neoplastic cardiac tamponade

A young patient with disseminated osteogenic sarcoma presented with cardiac tamponade. She was successfully managed with pericardiocentesis and intrapericardial instillation of cisplatin. There was no reaccumulation of pericardial fluid or recurrence of tamponade until the patient's death 12 months later. Intrapericardial chemotherapy may be effective in the management of cardiac tamponade secondary to malignancy

changing trends of adult Hodgkin's disease in Saudi Arabia

Hodgkin's disease is one of the most common malignant lymphomas affecting the younger population. This disease has diversified pathologies and clinical stages that necessitate a well optimized clinical management. Regular updating of epidemiological behavior of Hodgkin's disease is obvious from various parts of the world; however, studies from the Kingdom of Saudi Arabia [KSA] in this field are scanty and more than a decade old. The aim of this study was to investigate the current trends in presentation and distribution of Hodgkin's disease with special reference to gender, age, histopathological subtypes, and clinical stages of this disease in Saudi patients. A total of 142 Hodgkin's disease patients attending 2 referral hospitals [King Khalid University Hospital and Security Forces Hospital] in Riyadh, KSA, were included in this study. The records from the questionnaires were analyzed retrospectively for determining the trends of Hodgkin's disease in Saudi adults, over a period of 15 years [1985-2000]. There were 86 males and 56 females, with a male to female ratio of 1.53:1. The mean age of the patients was 28.63 years, while most of the patients were <40 years [80.3%]. Nodular sclerosis was the most frequent pathology. Presence of B symptoms had a significant correlation with histology type as well as clinical stage of Hodgkin's disease. Time course analysis showed the increasing trend of Hodgkin's disease frequency, especially in younger adults. The rate of nodular sclerosis continued to increase during the entire course of study whereas the frequency of other histology types showed a decreasing trend during 1992-2000. To the author's knowledge, this is the largest case series of adult Hodgkin's disease from KSA. The results of this study revealed a different pattern of Hodgkin's disease as compared to earlier studies reported from this region. These findings provide valuable insights in the understanding of current epidemiological features of Hodgkin's disease in KSA