RESUMO
Background: Cancer anorexia-cachexia syndrome (CAS) is a significant comorbidity among all patients with cancer, increasing the mortality rate. Almost all patients with head and neck cancer experience this syndrome. CAS causes increased energy expenditure by increasing systemic inflammation and decreasing energy consumption due to anorexia. It leads to skeleton muscle breakdown and reduces the quality of life. Nutritional interventions and primary cancer treatment are the mainstays to manage this situation. However, a vicious cycle causes CAS to persist, especially in head and neck cancer, where tumour location and its treatment interfere with nutritional interventions. Curcumin shows anti-inflammatory effects, including modulated CAS in animal and in vitro studies. Objective: The study aimed to determine the effect of curcumin to treat cancer anorexia-cachexia syndrome among current patients with locally advanced or advanced head and neck cancer. Methods: This constitutes a randomised, double-blind, placebo-controlled phase IIa study. Twenty patients with CAS in locally advanced or advanced head and neck cancer adequately nourished via a feeding tube were enrolled and randomised in a 1 : 1 ratio to receive oral curcumin (at a dose of 4000 mg daily) (n = 10) or placebo (n = 10) for 8 weeks. The primary endpoint was body composition (muscle mass, body fat mass, and basal metabolic rate). The secondary endpoints were handgrip muscle strength, body mass index, absolute lymphocyte count, and safety and toxicity. Result: There was a statistically significant benefit from curcumin on improving muscle mass compared with placebo (2.16% [95% confidence interval; CI, -0.75 to 5.07] vs. -3.82% [95% CI, -8.2 to 0.57]; P=0.019). The other parameters of body composition were not significant but tended to favour curcumin benefit. The body fat mass (-0.51 [95% CI, -21.89 to 20.86] vs. -8.97% [95% CI, -19.43 to 1.49]; P=0.432) and percentage of mean change in the basal metabolic rate were noted (BMR) (0.54% [95% CI, -1.6 to 2.67] vs. -1.61% [95% CI, -4.05 to 0.84]; P=0.153). Notably, patients treated with curcumin exhibited less reduction in handgrip muscle strength and absolute lymphocyte count but was not significant. Similarly, most adverse events were grade 1 in both groups. Conclusion: The curcumin add-on resulted in a significant increase in muscle mass than standard nutritional support. Furthermore, it may improve and delay a decrease in the other body composition parameters, handgrip strength, and absolute lymphocyte count. Curcumin was safe and well tolerated. This constitutes an unmet need for clinical trials. This trial is registered with NCT04208334.
RESUMO
Human epidermal growth factor receptor 2 (HER-2) is the prognostic and predictive biomarker for breast cancer found in a quarter of all breast cancer cases. Precise testing of HER-2 will impact treatment response.Based on the updated American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) HER-2 testing guidelines, we report 141 cases of positive concordance rate between HER-2 IHC stain and dual-probe ISH for HER-2 testing classified in equivocal (2+) and positive (3+) IHC groups in Nakhon Pathom Hospital, Thailand. Our study showed statistical significance in the relationship between positive (3+) IHC and dual-probe ISH for HER-2 testing with a correlation rate of 91.76% (r s = 0.38031, p < 0.0001) and 37.50% in equivocal (2+) IHC groups.This is the first report of a positive concordance rate between equivocal and positive HER-2 IHC and dual-probe ISH for HER-2 based on the ASCO/CAP 2018 guidelines in Thailand. Our study confirmed a statistically significant relationship in the positive IHC (3+) group. In addition, we suggested reflexing ISH testing only in equivocal IHC (2+) cases to decrease the waiting time and economical approach.
RESUMO
Hepatoid adenocarcinoma (HAC) is a rare tumour that produces an alpha-fetoprotein (AFP) mimicking hepatocellular carcinoma (HCC). Adrenal HAC is exceedingly rare. Here we report extremely high AFP-producing adrenal HAC, the first case in Thailand. A 47-year-old man presented with left flank pain and weight loss for 2 months. A palpably huge left flank mass was observed on physical examination. CT revealed a 7 cm enhanced mass involving the left adrenal gland and multiple contrast-enhanced hypodense masses in both liver lobes. The largest was a 3.7 cm at liver segment-VII without cirrhotic background, with an AFP level of 321 495 ng/mL. Both adrenal and liver biopsies were performed. This patient received a diagnosis of advanced adrenal HAC. Unfortunately, the tumour progressed, causing massive upper gastrointestinal bleeding and death. Adrenal HAC is challenging to diagnose, which multifocal HCC, pheochromocytoma and adrenocortical carcinoma should be excluded. Surgical resection is preferred among resectable patients. However, no systemic therapy has been standardised.
