Concurrent chemoimmunotherapy: is it still the best option for the treatment of metastatic melanoma in patients with good performance status?

PURPOSE: To determine the efficacy, toxicity and survival of metastatic melanoma patients with Eastern Cooperative Oncology group good performance status (ECOG PS 0-1) receiving concurrent chemotherapy and immunotherapy. METHODS: From March 2003 to August 2008, 25 patients with metastatic melanoma were enrolled in the study. No patient had previously received chemotherapy or immunotherapy. Patients with ECOG PS 0-1 were treated with cisplatin+vinblastine+DTIC (CVD) and interferon-A2a (IFN-a). RESULTS: Response rate was 11/25 (44%): complete response (CR) 2, partial response (PR) 9, stable disease (SD) 11, progressive disease (PD) 3. Adverse effects were mild. The most common toxicities were nausea, vomiting and fever. Grade 3 and 4 toxicity was more common in hematologic parameters. No treatment-related deaths occurred. The median overall survival (OS) was 14 months and time to progression 8.0 months. CONCLUSION: Concomitant chemoimmunotherapy appeared to be a beneficial option for metastatic melanoma patients with good PS. Therapeutic approaches with less toxicity and regimens that could improve OS are still highly desired in the treatment of advanced malignant melanoma.

Chemotherapy in carcinomas of unknown primary site.

PURPOSE: Carcinomas of unknown primary site (CUPS) are highly malignant diseases with a usually ominous prognosis. We report on the efficacy of chemotherapy in the treatment and survival of patients with CUPS. PATIENTS AND METHODS: The study involved 63 patients with metastatic CUPS. Following routine light microscopy, the histological findings were classified into 3 groups: squamous cell carcinoma - 8 patients; adenocarcinoma - 33 patients; and undifferentiated carcinoma - 22 patients. Combination chemotherapy with doxorubicin 50 mg/m(2) (day 1), cisplatin 60 mg/m(2) (day 1), and etoposide 120 mg/m(2)/day (days 1-3) every 3 weeks was administered to 32 patients (20 females and 12 males), aged 29-70 years (median 54 years) who met the inclusion criteria. All patients with stable disease (SD), partial response (PR) or complete response (CR) received 6 cycles of chemotherapy. RESULTS: CR was achieved in 3 (9.4%), PR in 12 (37.5%), and SD in 10 (31.2%) patients. Seven (21.9%) patients had progressive disease (PD). The overall response rate (RR) was 46.9% (15/32) and the median response duration of CR+PR was 11 months (range 4-43(+) months). The overall survival (OS) of patients treated with chemotherapy (n=32; 50.8%) was better compared with the OS of those not receiving chemotherapy (n=31; 49.2%/; p <0.01). Also the 2-year survival of patients with chemotherapy (40%) and without chemotherapy (0%) implies potential curability in a specific subset of these patients. CONCLUSION: The usage of the aforementioned doses and chemotherapy scheme appears to improve the outcome of patients with carcinoma of unknown primary site.

[Echocardiographic evaluation of left ventricular size and function in children with arterial hypertension on hemodialysis]. / Ehokardiografska procena velicine i sistolne funkcije leve komore kod dece s arterijskom hipertensijom na hemodijalizi.

In order to evaluate the effects of hypertension on left ventricular (LV) anatomy and function, we investigated children on long-term hemodialysis using two-dimensional and M-mode echocardiography. The following echocardiographic estimations were made: indexed left atrial diameter (LAi) LV and diastolic diameter (LVDDi), inter ventricular septum (IVSi) and I.V posterior wall (PWi), with calculations of the LV mass index (massi), ejection fraction (EF), fractional shortening (FS), the velocity of circumferential fiber shortening (VCF) and wall stress (WS). LAi, LVEDDi, IVSi, PWi and massi were significantly higher in hypertensive patients than in normotensive and healthy children. EF and FS were significantly lower in both groups of dialyzed patients. The best correlation with mean arterial pressure had massi (r = 0.624), IVSi (r = 0.576) and PWi (r = 0.575). Those results suggest an important correlation between hypertension and concentric LV hypertrophy in long-term dialyzed patients.