Eribulin as first-line treatment in older patients with advanced breast cancer: A multicenter phase II trial [SAKK 25/14].

INTRODUCTION: Standard-dose eribulin mesylate (1.4 mg/m2 d1 + 8) achieves clinical benefit rates of 26%-52% in patients with metastatic breast cancer (mBC). <10% of patients in the registration trial were ≥ 70 years old; dose reductions were common in these older patients. MATERIALS AND METHODS: This single-arm phase II trial explored the efficacy of reduced starting dosing of first-line eribulin at 1 mg/m2 d1 + 8 q3 weeks in patients with mBC aged ≥70 years. The primary endpoint was a disease control rate (DCR) ≥55%. The secondary endpoints were objective response (OR), progression-free survival (PFS), overall survival (OS), and patient-reported neurotoxicity. RESULTS: Overall, 77 patients were accrued; their median age was 76 years and Eastern Cooperative Oncology Group performance status was 0-1 in 90%. The DCR was 40% (90% confidence interval [CI]: 31-50); therefore, the primary endpoint was not reached. The overall response rate was 22% (95%CI: 13-33), median PFS 5.4 months (95%CI: 4.5-7.7), and median OS 16.1 months (95%CI: 13.5-26.9). Dose modifications were necessary in 35% of patients. In nine patients, more than fifteen cycles were given; 48 patients (62%) experienced at least one grade 3 toxicity. Median patient-reported neurotoxicity scores remained stable for at least fifteen cycles. The main reason for treatment discontinuation was disease progression (57%). DISCUSSION: We report the first prospective data on first-line eribulin in older patients. The reduced starting dose of 1.1 mg/m2 was safe, with prolonged treatment and DC achieved in a considerable proportion of patients (but less than the 55% assumed), without cumulative neurotoxicity. The reduced dose was apparently within the range of the minimal effective dose, as shown by the efficacy lack in patients requiring further dose reductions. Thus, our results do not support the approach of a reduced starting dose for older patients.

[From Gleason score to Ann Arbor staging- a selective choice of important scores and staging systems in oncology]. / Gleason-Score bis Ann Arbor-Klassifizierung - eine Auswahl bedeutender Scores und Stadien in der Onkologie.

Hundreds scores and dozens staging systems exist in Oncology. They provide for example information on the spread and prognosis of a disease or are included in treatment decisions. Because of the existing diversity a description of all oncological codes would exceed the scope of this paper, the following articles focuses in the first part on some exemplary and lesser-known scores and in the second part on main staging systems in Oncology. Internet sites such as Wikipedia or Onkopedia provide answers to many other questions regarding ongologic scores and stages. As an example of a tumor graduation the Gleason score in prostate cancer is described. It provides not only information about the prognosis of the disease, but influences the primary treatment. In metastasic disease, the general condition of the patient is decisive on the question of whether a (further) systemic therapy should be applied. The general condition is classified with the Karnofsky index and in Oncology more frequently with the ECOG- or WHO-performance status. In solid tumors the response to treatment is assessed with RECIST criteria. The spread of solid malignancies is documented according to the TNM classification. This classification is regularly updated according to latest prognostic and therapeutic results. In contrast the Ann Arbor criterias - the staging system of lymphomas - have little changed since their initial description.

Nontyphoidal salmonellosis and mycotic aneurysm: a case report.

A 74-year-old male with atherosclerosis presented with severe nontyphoidal salmonellosis, and received outpatient therapeutic antimicrobial treatment. Nevertheless, within seven days he developed a mycotic aortic aneurysm, a serious but treatable complication. Its surgical management was successful. Rapid formation of mycotic aortic aneurysm represents a rare complication of a common disease, nontyphoidal salmonellosis. Atherosclerosis seems to be an important risk factor. Extensive work-up for mycotic aneurysm by CT-scan in patients older than 50 years, with nontyphoidal Salmonella -positive blood cultures, especially in the presence of risk factors for atherosclerosis, is prudent. However, blood and stool cultures of these patients can be negative in 15% and 35% of cases, respectively. And the results of the blood cultures may be delayed. So it is sensible to extend the previous recommendation to patients older than 50 years, with typical symptoms of nontyphoidal salmonellosis and imminent aneurysmatic rupture, independent of previous results of CT-scans, and blood or stool cultures.