Gemcitabine and cisplatin in the treatment of advanced non-small cell lung cancer: national cancer institute Cairo experience

The aim of the present study is to document the antitumor activity of the combination of gemcitabine and cisplatin for the treatment of advanced NSCLC, assess the nature and severity of the side effects and elicit the impact of the combination chemotherapy on progression free survival and overall survival. From August 1997 to August 2001 we conducted a phase II study of gemcitabine and cisplatin in 60 chemonaive patients [21 stage IIIB and 39 stage IV]. For the first 34 cases, gemcitabine was given at a dose of 1,000 mg/m[2] IV on days 1, 8 and 15 with cisplatin 100 mg/m[2] on day 15, every 28 days. In the following 26 patients, the regimen was modified to gemcitabine 1,250 mg/m[2] days 1 and 8 and cisplatin 80 mg/m[2] day 1, every 21 days. Patients included 53 males and 7 females [median age. 52 years [range, 28-69]]. Twenty-nine had adenocarcinoma, 18 large-cell carcinoma and 13 squamous-cell carcinoma. Thirty-one patients had a performance status [PS] of 2 and 22 presented with weight loss. All patients were evaluable for response. Three patients achieved a complete response [CR] and 22 had partial response [PR], giving an overall response of 41.7%, with a median duration of 10 months [range, 4-46 months]. The time to progression [TTP] was 8 months [range, 2-46 months], with a median overall survival of 9 months [range, 2-46 months]. The one-year survival rate was 30.3% for the entire study population, 44% for responders, and statistically improved in patients with a PS of 1 and those with no weight loss. A total of 255 cycles were administered [median, four cycles/patient]. Myelosuppresion was significant [but manageable] with grade 3/4 neutropenia in 32.6% of cases, anemia in 18.6% and thrombocytopenia in 20.4%, Nonhematologic toxicity was limited to grade 3/4 nausea and vomiting in 28.8% of cases and impaired liver enzymes in 13.6%. Inspite of the relatively poor prognostic characteristics in the study population, gemcitabine and cisplatin was an effective combination with tolerable, manageable toxicity in advanced NSCLC

Evaluation of serum total bile acids in the diagnosis of hepatocellular carcinoma

Fasting total serum bile acids [FSBA] concentrations were measured in 140 cases of chronic liver diseases including 50 patients with liver cirrhosis, 40 patients with chronic hepatitis and 50 patients with hepatocellular carcinoma [HCC]. FSBA concentrations were significantly higher in patients with HCC than those with chronic hepatitis and cirrhosis and both were significantly higher than the controls [p<0.0001]. FSBA concentrations were not correlated to the size of the tumor, the Child Pugh grades, the histopathologic grades and most of the liver function tests. Using the receiver operative characteristic [ROC] and the differential positive rate [DPR] analysis, 30 pmol/l was the optimal cut-off value that differentiates patients with HCC from those with cirrhosis. At this level, the sensitivity, the specificity and the diagnostic accuracy were 42%, 98% and 70% respectively. AFP was found to be significantly increased in patients with HCC than those with chronic hepatitis and cirrhosis. The best cut-off value of AFP was 100 ng/ml, at which the sensitivity, the speci-ficity and diagnostic accuracy were 52%, 96% and 74% respectively. The simultaneous determination of AFP and total bile acids raised the sensitivity of the test to 76%. The area under the ROC curve for AFP and total bile acids was 0.764 and 0.744 respectively, the difference is non-significant. In conclusion, both AFP and total bile acids are good markers for HCC and their simultaneous determination may improve the detection of HCC in cirrhotic patients negative for AFP