The role of haemoglobin level in predicting the response to first-line chemotherapy in advanced colorectal cancer patients.

The purpose of the study was to evaluate the influence of baseline haemoglobin level in predicting response to 5-fluorouracil (5FU)-based first-line chemotherapy in advanced colorectal cancer patients. Data from 631 patients were collected from three different institutions. Globally, overall response rate was 35.8% (226 out of 631). Factors influencing response rate were 5FU dose intensity (high: 43.1%, low: 34.0%, P = 0.03); oxaliplatin (yes: 45.8%, no: 22.9%, P < 0.0001), performance status (PS 0: 46.1%, 1: 28.8%, 2: 26.7%, P < 0.0001), and haemoglobin levels (> or = 12 g dl(-1): 40.4%, < 12 g dl(-1): 29.2%, P = 0.004). In subgroup analysis significant differences in response rate between anaemic and nonanaemic patients were recorded in those patients treated with infusional chemotherapies (45.7 vs 25.5%, P < 0.0001), with high 5FU dose intensity (50.3 vs 32.7%, P = 0.005), with PS = 0 (49.8 vs 37.9%, P = 0.03), and with liver metastases (44.8 vs 33.8%, P = 0.002), whereas no difference was evident in those subjects treated with bolus schedules or according to gender. Anaemia was a strong predictor for activity of first-line 5FU-based chemotherapy especially in those groups that showed the best responses, for example high performance status, infusionally treated, higher 5FU dose and those with liver secondaries. Patients with higher haemoglobin levels recorded a greater response rate and a longer time to progression and survival than anaemic subjects. Prospective evaluation of role of correcting anaemia on response to therapy is justified by these results.

Phase II trial of primary radiation therapy and concurrent chemotherapy for patients with locally advanced pancreatic cancer.

OBJECTIVES: Primary chemoradiotherapy for locally advanced pancreatic cancer (LAPC) may improve local control, curative resection rate and long-term survival. We performed a phase II study to evaluate toxicity and activity of primary radiation therapy and concurrent chemotherapy with gemcitabine (GEM) twice weekly in patients (pts) with LAPC. METHODS: From 6/1999 to 6/2003, 23 LAPC pts received GEM 100 mg/m2 twice weekly in the first 15 pts and 50 mg/m2 in the last 8 pts, concurrently with radiotherapy (1.8 Gy/day for a total dose of 45 Gy). RESULTS: The treatment was completed in 19/23 pts. Toxicities: G3-4 hematological toxicity occurred in 35 and 4% respectively; G3 nausea and vomiting and gastrointestinal toxicity in 30%. Clinical benefit was found in 10/18 pts (55%). Overall response: partial response rate 4/18 (22%); stable disease 13/18 (72%); progressive disease 1/18 (6%). Six pts underwent pancreaticoduodenectomy with extended lymphadenectomy (5/6 pts pT3, 1/6 pts microscopic cancer foci, 1/6 N+, 5/6 negative retroperitoneal margin). MEDIAN SURVIVAL: 14 months for the entire group, 12 months for unresected pts, 20 months for resected pts. CONCLUSIONS: The treatment with GEM twice weekly at 50 mg/m2 associated with radiotherapy (45 Gy) is feasible and permits to obtain clinical benefit in a good percentage of pts. Objective response, median survival, and local and systemic control are similar to other studies and need further improvement.

Asbestos exposure, physical activity and colon cancer: a case-control study.

AIMS AND BACKGROUND: An association between colon cancer and the occupation of model or pattern maker in the car industry has been repeatedly suggested. The aim of our study was to investigate colon cancer and occupational exposures (in particular in the car industry) in an industrialized area of northern Italy. METHODS: We conducted a hospital-based case-referent study on colon cancer (n = 131; hospital controls, n = 463). All subjects were interviewed, and jobs in the car industry were investigated. Occupational exposure to asbestos and the level of physical activity were blindly assessed. All the jobs were classified according to energy expenditure (less than 8, 8-12 and more than 12 kJ/min). RESULTS: We found no association between colon cancer and any job in the car industry. No subject had worked as a model or pattern maker. Sedentary work was associated with colon cancer in men but not in women. An excess risk was demonstrated among males for job titles involving putative exposure to asbestos (4 cases and 3 controls; OR = 4.8, 95% c.i. 1.05-21.5), in particular pipe fitters and boilermakers (3 cases and 1 control; OR = 10.7; 1.07-103).

Diagnostic delay, clinical stage, and social class: a hospital based study.

STUDY OBJECTIVE: To measure delay in admission to a large hospital and to study the role of social class and other potential determinants of delay. DESIGN: Interview of a 10% sample of newly diagnosed patients admitted to medical or surgical wards, and all those admitted for external hernia or colon cancer between June 1989 and May 1990. SETTING: The largest hospital in an Italian region of five million inhabitants. SUBJECTS: The study population consisted of 330 patients with a range of different medical and surgical conditions, 83 patients with external hernias, and 97 patients with colon cancers. MEASUREMENTS AND MAIN RESULTS: After patient interview and discharge from hospital, the clinical record was consulted for information on the length of stay and the diagnosis, and in particular for the staging of hernia or colon cancer (according to the protocol of the Jefferson Medical College). Multiple logistic regression was used to estimate odds ratios and 95% confidence intervals. There was an association between advanced disease at hospital admission and the patient's educational level. In each of the three groups of patients, those with the highest educational level had a 30% or lower probability of being admitted to hospital with advanced disease compared with those with the lowest education level (after allowance for sex, age, area of residence, and marital status). CONCLUSION: Lower social class was associated with a more advanced clinical stage of hernia or colon cancer, and with a higher probability of urgent admission to the hospital for a newly diagnosed disease. Delay in seeking care, did not however, seem to explain the social class differentials for disease stage.