Efficacy of paclitaxel in the treatment of Kaposi sarcoma.

OBJECTIVE: Kaposi sarcoma is an angioproliferative disease. Kaposi sarcoma is clinicopathologically classified into four subgroups based on epidemiological data. For its systemic treatment, in addition to some chemotherapeutics, taxanes have also been used during the recent years for their anti-angiogenic properties. In this study, we aimed to compare paclitaxel and non-paclitaxel chemotherapeutic regimens in terms of efficacy and side effects. PATIENTS AND METHODS: In our center, demographical, clinical and histopathological characteristics of a total of 13 patients diagnosed with Kaposi sarcoma who received therapy were retrospectively recorded based on their medical files RESULTS: Among these subjects, 7 have been treated with paclitaxel and 6 with non-paclitaxel therapies. Eleven patients were male. Twelve patients were found to have classical type of Kaposi Sarcoma. The recurrence was observed in 2 patients treated with paclitaxel and in 1 patient treated with non-paclitaxel therapy. No statistically significant difference was found between the therapeutic modality, the stage of the disease and the percentage of the recurrence. Neuropathy developed in 3 patients treated with paclitaxel, whereas there was no neuropathy in the other group. Although the recurrence-free survival was worse in the patients treated with paclitaxel, there was no statistically significant difference. CONCLUSIONS: Cytotoxic chemotherapy is effective in treating patients with Kaposi Sarcoma, although it is palliative. Taxanes have demonstrated effectiveness against AIDS-associated Kaposi Sarcoma. The experience suggests that paclitaxel is an effective alternative in the treatment of classical form Kaposi's sarcoma. There was no difference in efficacy between paclitaxel and non-paclitaxel therapies whereas difference in occurrence of neuropathy which is one of the side effects, showed borderline statistical significance.

The evaluation of minimal residual disease in multiple myeloma by fluorescent molecular beacons in real time PCR of IgH gene rearrangements and correlation with flow cytometry.

PURPOSE: Multiple myeloma (MM) patients relapse after a period of time despite longer disease-free survival due to novel treatment options. In this study we aimed to assess the value of real-time polymerase chain reaction (RT-PCR) for detecting the immunoglobulin heavy chain (IgH) gene rearrangement using allele-specific molecular beacons as fluorescence probes to quantify minimal residual disease (MRD) and also to correlate post-treatment flow cytometric detection of plasma cells' (PCs) expression of CD19, CD38, CD45, CD56 and CD138 in MM. METHODS: After diagnosis of 17 MM patients, the CDR1, CDR2 and CDR3 regions of the IgH gene were analysed and sequenced to identify IgH's clonal nature. Unique sequences of the clonal IgH rearrangement were used to design specific molecular beacon probes for each MM patient. Examined were also the co-expression of CD19, CD38, CD45, CD56, and CD138 molecules in bone marrow aspirates of patients with MM by flow cytometry. RESULTS: Detection of MRD was positive in 13 (76%) of 17 patients by RT-PCR. The infiltration ratio was significantly correlated with CD138 expression (p=0.009). Significant correlation was also found between RT-PCR detection of MRD and CD138 expression (p=0.006). Nevertheless, no correlation was observed among other surface antigens (CD38, CD45, CD56). CONCLUSION: Our results indicated that RT-PCR with specific molecular beacons provide a feasible, accurate and reproducible method for the determination of MRD in MM. Flow cytometry detection of CD138 expression may be used as a disease marker in addition to RT-PCR.

PTEN, Akt, MAPK, p53 and p95 expression to predict trastuzumab resistance in HER2 positive breast cancer.

PURPOSE: Mutations that activate the PIK3CA oncogene and inhibit the tumor suppressor gene PTEN action are commonly found in breast tumors. Akt is a key activator of cell survival. p53 is frequently found mutated in human tumors, and mutant p53 protein actively contributes to tumorigenesis. In selected cases of breast cancer, trastuzumab (TZMB) is incorporated in the primary treatment in the adjuvant and metastatic settings. Many studies have reported that selected patients are resistant to TZMB due to the presence of p95 HER2 fragments. To address this, we analysed PTEN, Akt, MAPK, p53 and p95 expression in breast cancer patients treated with TZMB. METHODS: Out of 90 patients histologically diagnosed with breast cancer between 2004 and 2011, analysed were 25 patients with HER2 positive, and estrogen (ER) and progesterone receptors (PR) negative, metastatic or locally advanced disease. All 25 patients were treated with TZMB and resistance to TZMB was assessed. All patients were on anthracycline-and taxane-containing regimens. Tissue samples were obtained from paraffin blocks and evaluated immunohistochemically for PTEN, Akt, MAPK, p53, and p95 expression. RESULTS: TZMB resistance was detected in 5 (20%) patients. Akt expression was positive in 2 patients (8%) and MAPK, p95, and p53 expression was positive in 1 patient (4%); PTEN expression was negative in 3 patients (12%). No significant differences were found between TZMB resistance and PTEN, Akt, MAPK, p53, and p95 expression. Subgroup analysis was carried out in the neoadjuvant treatment group. Complete pathologic response was detected in 3 patients (21.4%). Statistically significant differences were not found between the complete response rate and PTEN, Akt, MAPK, and p95 expression. There was a statistically significant correlation between p53 expression and complete pathologic response (p=0.02). CONCLUSION: No statistically significant correlation between TZMB resistance and the expression of these biomarkers was noted. In patients with HER2-positive breast cancer that were treated with 4 dose-dense sequential cycles of doxorubicin and cyclophosphamide, followed by TZMB and paclitaxel combination therapy in the neodjuvant setting, p53 expression could predict complete response to chemotherapy.

Nurse-assisted education and exercise decrease the prevalence and morbidity of lymphedema following breast cancer surgery.

PURPOSE: To evaluate an educational and exercise program for the prevention and progression of post-mastectomy lymphedema of the arm and shoulder. METHODS: Fifty-five patients who had undergone mastectomy and axillary lymph node dissection between June 2009 and January 2010 were included in this study. The patients were informed by a trainer nurse about the precautions they should take to prevent the development of lymphedema. The patients were also trained for the appropriate exercises and were given written educational material prepared by the investigators. RESULTS: Among the participants, 96.4% underwent modified radical mastectomy (MRM) and 3.6% breast-conserving (BCS) surgery. The mean postoperative follow-up period was 9.87 ± 17.55 months. The degree of lymphedema was found lower, even within 6 months, in the patients that exercised as compared to the patients that did not (p<0.05). CONCLUSIONS: The results indicate that the risk of development and progression of mastectomy-related lymphedema was reduced with education and exercise provided by trained nurses at an early stage.