Efficacy and safety of TC dose-dense chemotherapy as first-line treatment of epithelial ovarian cancer: a single-institution retrospective cohort study.

BACKGROUND: The optimal first-line therapy of advanced ovarian cancer still remains questionable: standard paclitaxel-carboplatin (TC), dose-dense TC, intraperitoneal chemotherapy or TC plus bevacizumab. In this study, we present the real-life results of dose-dense treatment of the single-institution on Caucasian population. METHODS: A retrospective cohort study was used on consecutive samples of 74 patients treated with the conventional 3-weekly TC protocol (2008-11) and on 70 treated with TC dose-dense protocol (2012-16). The primary endpoint of this study was overall survival (OS). Secondary endpoints were progression free-survival (PFS) and toxicity. We made adjustments for age, pathohistological type, tumor grade, stage and postoperative residual disease by Cox regression. RESULTS: After adjustment for pre-planned clinical and sociodemographic factors, patients treated with dose-dense protocol showed a significantly lower hazard for dying from any cause, than patients treated with conventional protocol (HR = 0.50; 95% CI 0.26-0.98; P = 0.042). Median OS, at 60 months follow-up had not been reached in the dose-dense group, while in the standard treatment group was 48 months (95% CI 33-62). Unadjusted PFS was significantly longer in the dose-dense group (HR = 0.58; 95% CI 0.38-0.88; P = 0.011), but not after the adjustment (P = 0.096). Generally, the level of toxicity was similar in both groups of patients. The need for blood transfusions and usage of filgrastim was significantly higher in the TC dd group. The incidence of neutropenia and thrombocytopenia Grade 3 or 4 were not significantly different in both regimens. CONCLUSIONS: Our retrospective study has shown the superior efficacy and comparable toxicity of dose-dense chemotherapy regimen over the conventional regimen in treatment of ovarian cancer on Caucasian population at a single-institution.

Prognostic significance of MAPK, Topo IIα and E-cadherin immunoexpression in ovarian serous carcinomas.

Ovarian cancer accounts for only 3% of all cancers in women but is the most lethal gynaecologic malignancy. Low-grade and high-grade ovarian serous carcinomas (OSCs) represent two different diseases with different prognosis, approaches to detection and treatment. We assessed correlation between, MAPK, topoIIα, E-cadherin immunoexpression and clinicopathological features with overall survival (OS) in OSCs. The study included 81 patients undergoing surgery between January 1995 and December 2005.Formalin fixed paraffin embedded tumour sections were reviewed and examined immunohistochemically using antibodies against MAPK, topoIIα and E-cadherin. The clinicopathological features included: age at surgery, stage according to the criteria of the International Federation of Gynecology and Obstetrics (FIGO), tumour grade, residual disease and vascular invasion. Only ten patients (12.3%) were diagnosed in early FIGO stage of disease. According to morphological criteria, 13.6% of tumor samples were low-grade OSCs and 86.4% were high-grade OSCs. On uninominal analysis, residual disease (p<0.001), E-cadherin (p<0.001), vascular invasion (p=0.002), high-grade morphology (p=0.025) and FIGO stage III-IV (p=0.010) were related to significantly shorter OS. We found no significant association between, MAPK and topoIIα expression and OS. Multinominal analysis revealed that only residual disease (p<0.001) and negative E-cadherin immunoexpression were useful independent predictors of unfavourable clinical outcome and shorter OS.

Optimisation of breast cancer patients' follow-up - potential way to improve cancer care in transitional countries.

The aim of this analysis was to evaluate adherence of Croatian oncologists to follow-up criteria as suggested by the current national and international guidelines for women with breast cancer receiving adjuvant endocrine therapy. The use of clinical and diagnostic methods was documented in this prospective, non-interventional, multicenter study. A total of 438 post-menopausal patients receiving adjuvant endocrine treatment with non-steroidal aromatase inhibitors were included. Average annual frequency for each clinical and diagnostic method was calculated. Median adjuvant endocrine treatment duration before study recruitment was 10.5 months (interquartile 4.7-26.6). Patients were followed up for an average 23.5 ± 4.9 months. Average number of oncological visits was 5.3. Mammograms were performed at mean annual frequency of 0.7, chest radiographs at 0.5, abdominal ultrasounds at 0.9, breast ultrasounds at 1.2, complete blood counts and chemistry panels at 1.7, carcinoembryonic antigen at 0.8, cancer antigen 15-3 at 1.6, gynaecological examination at 0.3, and densitometry at mean annual frequency of 0.3. In conclusion, among post-menopausal women with breast cancer receiving adjuvant endocrine therapy in this study, more unnecessary and unproven follow-up procedures were done compared to the guidelines' recommendations.