Cardiotoxicity is an important side effect of trastuzumab therapy and cardiac surveillance is recommended.
The aim of our study was to prospectively assess baseline patients' characteristics, level ...of N-terminal pro-brain natriuretic peptide (NT-proBNP) and echocardiographic parameters as possible predictors of trastuzumab-related cardiac dysfunction.
In a prospective cohort study, clinical, echocardiographic and neurohumoral assessment was performed at baseline, after 4, 8 and 12 months in breast cancer patients undergoing post-anthracycline (3-4 cycles) adjuvant therapy with trastuzumab. Trastuzumab-related cardiac dysfunction was defined as a decline of ≥ 10% in left ventricular ejection fraction (LVEF).
92 patients (mean age, 53.6 ± 9.0 years) were included. Patients who developed trastuzumab-related LVEF decline ≥ 10% (20.6%) during treatment had significantly higher baseline LVEF (70.7 ± 4.4%) than those without (64.8 ± 5.5%) (p = 0.0035). All other measured baseline parameters (age, body mass index, arterial hypertension, level of NT-proBNP and other echocardiographic parameters) were not identified as significant.
Our findings suggest that baseline patient' characteristics, level of NT-proBNP and echocardiographic parameters, as long as they are within normal range, are not a reliable tool to predict early trastuzumab-related cardiac dysfunction in patients undergoing post-low dose anthracycline adjuvant trastuzumab therapy. A LVEF decline in patients with high-normal baseline level although statistically significant is not clinically relevant.
The aim of our study was to describe the survival of Slovenian cancer patients diagnosed in the last twenty years. An insight is given into the improvement made in different cancer types, population ...groups and prognostic factors.
The principal data source was the population-based Slovenian Cancer Registry. The survival analysis included patients diagnosed with cancer in twenty years period from 1997 to 2016, which has been divided into four consecutive five-year periods. In addition, the analysis was stratified by cancer type, gender, age and stage. The survival was estimated using net survival calculated by the Pohar-Perme method and the complete approach has been applied.
The survival of Slovenian cancer patients has been increasing over time. During the 20 years observed, five-year net survival increased by 11 percentage points. Significantly higher growth was observed in men. Age and stage at diagnosis are still crucial for the survival of cancer patients. Five-year net survival is lowest in those over 75 years of age at diagnosis but has also improved by seven percentage points over the past 20 years. The five-year net survival of patients in the localized stage increased by ten percentage points over the 20 years under observation. Survival of patients in the distant stage has not been improving. In both sexes, survival for melanoma, colorectal and lung cancers have increased significantly over the last 20 years. Progress has also been made in the two most common gender specific cancers: breast cancer in women and prostate cancer in men. Still, the significant progress in prostate cancer is probably mostly due to lead-time bias as during the study period, Slovenia used indiscriminate PSA testing, which probably artificially prolonged survival.
The survival of Slovenian cancer patients has been increasing over time, which gives us a basis and an incentive for future improvements. To monitor the effectiveness of managing the cancer epidemic, the cancer burden needs to be monitored also in the future, using quality data and scientifically justified methodological approaches. In this process a well organised population-based cancer registries should play a key role.
Introduction: In the spring of 2020, the covid-19 pandemic broke out with a major impact on global society, particular on the healthcare system. Epidemiological conditions and consequent measures ...have affected the treatment of patients enrolled in specialized palliative care. Methods: The study collected data about the number and type of treatments for cancer patients included in acute palliative care at the Institute of Oncology Ljubljana (OI) and provided observations on the covid-19 outbreak compared to pre-epidemic data. Results: In 2020, we recorded 25% more referrals than in 2019. The average length of stay decreased from 6,2 days to 5,1 days. The average number of family meetings in the period before covid-19 was 148 but last year 214. The calendar year and dismissals or deaths are statistically significantly related. In 2020, statistically significantly more people died at OAPO than expected (p <0.05, with a value = 2.76), statistically significantly fewer people than would be expected were transferred to hospice (p <0, 05, with value = -2.01) and elsewhere (p <0.05, with value = -2.56). In 2020, 22% of outpatient examinations were performed, which is 22% more than the average of previous years. The pandemic has had and continues to have implications for the conduct of specialized palliative care treatments. Conclusion: Care for cancer patients and palliative care was limited during covid-19. It has led us to important challenges in providing palliative care. The crisis model of palliative care organization was more or less focused on caring for the dying. Unfortunately, we cannot talk about providing comprehensive integrated palliative care in the treatment of cancer patients during this period. There has been a greater recognition of palliative care globally
OBJECTIVESOsteosarcoma is the most common primary bone malignancy that occurs mostly in adolescents. Treatment protocols usually include multiagent preoperative and postoperative chemotherapy based ...on methotrexate, cisplatin, doxorubicin and ifosfamide. Despite a favourable prognosis, there are considerable interindividual differences in treatment outcome. Genetic variability of enzymes involved in the metabolism and transport of methotrexate could contribute towards observed differences in response to chemotherapy. Our aim was to evaluate how polymorphisms in the folate pathway and transporter genes influence treatment outcome in osteosarcoma patients.
PATIENTS AND METHODSIn total, 44 osteosarcoma patients treated with methotrexate were genotyped for eleven polymorphisms in four folate pathway and five folate transporter genes. Cox regression was used in survival analysis. Logistic regression was used to assess the influence of polymorphisms on treatment efficacy and toxicity and nonparametric tests were used to determine the influence on serum methotrexate levels.
RESULTSPolymorphic SLCO1B1 rs4149056 and rs11045879 alleles were associated with significantly higher serum methotrexate area under the curve (P=0.001 and 0.011, respectively). Carriers of at least one polymorphic SLCO1B1 rs4149056 and rs11045879 allele tended to have longer event-free survival compared with patients with two wild-type alleles P=0.040, hazard ratio (HR)=0.26, 95% confidence interval (CI)=0.07–0.94; and P=0.034, HR=0.20, 95% CI=0.05–0.89, respectively. Compared with the most common haplotype, carriers of both polymorphic alleles had significantly longer event-free survival (P=0.009, HR=0.27, 95% CI=0.10–0.72).
CONCLUSIONWe have shown that SLCO1B1 polymorphisms influence methotrexate disposition and survival in methotrexate-treated osteosarcoma patients and therefore might serve as pharmacogenetic markers of treatment outcome.
Background. Human epidermal growth factor receptor 2 (HER2) positive breast cancer is an entity with aggressive behaviour. One year of adjuvant trastuzumab significantly improves the disease free ...survival in the range of 40-50% and reduces the risk of dying from HER2 positive breast cancer by one third. Adjuvant treatment with trastuzumab became available in Slovenia in 2005 and the aim of this study is to explore, if the exceptional results reported in adjuvant clinical trials are achieved also in daily clinical practice.
Patients and methods. An analysis of tumour and patient characteristics, type of treatment and outcome (relapse free and overall survival) of 313 patients (median age 52 years) treated at the Institute of Oncology Ljubljana in years 2005-2009 was performed.
Results. Median follow-up was 4.4 years. Sixty-one patients relapsed and 24 died. Three and four years relapse free survival was 84.2% and 80.8% and the overall survival was 94.4% and 92.5%, respectively. Independent prognostic factors for relapse were tumour grade (HR 2.10; 95% CI 1.07-4.14; p = 0.031) and nodal stage (HR 1.35; 1.16-1.56; p < 0.0001) and for the overall survival nodal stage only (HR 1.36; 1.05-1.78; p = 0.021).
Conclusions. The outcome in patients with adjuvant trastuzumab in daily clinical practice, treated by medical oncologists, is comparable to results obtained in international adjuvant studies.
Cytotoxic activity of most chemotherapeutic agents is based on their ability to induce DNA damage. Interstrand crosslinks are among the most detrimental forms of DNA damage as both DNA strands are ...affected. As translesion polymerases participate in their repair, they may be important for response to chemotherapeutic agents that induce such lesions, including commonly used cisplatin. Altered expression of translesion polymerase genes REV1 and REV3L may modify sensitivity to cisplatin. As osteosarcoma patients are commonly treated with cisplatin-based chemotherapy, our aim was to investigate if REV1 and REV3L polymorphisms influence survival of osteosarcoma patients treated with cisplatin-based chemotherapy. We determined the genotypes of common functional tag REV1 and REV3L polymorphisms in 66 osteosarcoma patients. Cox regression was used for survival analysis. Carriers of at least one polymorphic REV1 rs3087403 allele had significantly shorter EFS and overall survival (OS) (p = 0.004; HR = 3.79; 95%CI = 1.53-9.35 and p < 0.001; HR = 4.44; 95%CI = 1.92-10.27, respectively). Combination of REV1 rs3087403 and REV3L rs462779 polymorphisms was also significantly associated with shorter OS (ptrend<0.001) and shorter EFS (ptrend = 0.003). The results of this first study on polymorphisms in translesion polymerase genes in osteosarcoma suggest they could help predict outcome of cisplatin-based chemotherapy in osteosarcoma patients.
The aim of the study was to investigate how the expression of tumor markers p21, p27, p53, cyclin D1, EGFR, Ki-67, and CD31 influenced the outcome of advanced inoperable oropharyngeal carcinoma ...patients, treated with concomitant radiochemotherapy.
The pretreatment biopsy specimens of 74 consecutive patients with inoperable stage IV oropharyngeal squamous cell carcinoma treated with concomitant radiochemotherapy were in retrospective study processed by immunochemistry for p21, p27, p53, cyclin D1, EGFR, Ki-67, and CD31. Disease-free survival (DFS) was assessed according to the expression of tumor markers.
Patients with a high expression of p21 (≥10%), p27 (>50%), Ki-67 (>50%), CD31 (>130 vessels/mm2) and low expression of p53 (<10%), cyclin D1 (<10%) and EGFR (<10%) (favorable levels - FL) had better DFS than patients with a low expression of p21 (<10%), p27 (≤50%), Ki-67 (≤50%), CD31 (<130 vessels/mm2) and high expression of p53 (≥10%), cyclin D1 (≥10%) and EGFR (≥10%) (unfavorable levels - UL). However, statistical significance in survival between FL and UL was achieved only for p27 and cyclin D1. DFS significantly decreased with an increasing number of markers with an unfavorable level per tumor (1–4 vs. 5–7) (78% vs. 32%, respectively; p = 0.004). The number of markers per tumor with UL of expression retained prognostic significance also in multivariate analysis.
Statistical significance in survival between FL and UL emerged only for p27 and cyclin D1. The number of markers per tumor with UL of expression was an independent prognostic factor for an adverse outcome.
National Cancer Control Plan Branko Zakotnik; Sonja Tomšič
Onkologija,
05/2021, Letnik:
25, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Comprehensive systemic approaches are needed to address cancer, which is a major public health issue. In 2010, Slovenia adopted the first National Cancer Control Plan. A new document, for the period ...2022–2026, will include issues set forward in the Europe's Beating Cancer Plan, which was adopted in 2021. The National Cancer Control Plan has three strategic goals: (1) to slow the increase in the incidence of cancer, (2) to improve survival, and (3) to improve the quality of life of cancer patients through comprehensive rehabilitation and palliative care and here we present achievements and indicate our future challenges. Prevention programmes for chronic non-communicable diseases and the introduction of national screening programs for cervical and colorectal cancer had significant impact on the incidence of preventable cancers. Of concern, however, is the rising trend of lung cancer in women. The survival of all cancer patients improved, more cancers were detected at an earlier stage and modern treatments are widely available. Our challenge in the future is to establish monitoring of quality of care by establishing clinical registries for the five most common cancers. To improve the quality of life of patients, a pilot project for breast cancer patients has been launched in the field of integrated rehabilitation in two regions. Its results will serve as a model for implementation in the whole country and also for other types of cancer. In the field of palliative care, we are facing many challenges that we are only slowly overcoming. Comprehensive rehabilitation and palliative care are certainly areas to which we need to pay more attention.
Metastatic salivary duct carcinomas (SDC) are rare tumors and evidence-based guidelines for their treatment have not yet been established. Reports of such cases like ours could be beneficial in the ...decision-making in the similar clinical circumstances. Here we present the 64-year-old Caucasian man with bone pain and pancytopenia two years after local treatment of SDC, in whom a bone marrow biopsy revealed poorly differentiated carcinoma of salivary origin with nuclear androgen receptor (AR) and human epidermal growth factor receptor 2 (HER2/neu) positivity. Clinical response was achieved with cis-platin based cytotoxic therapy and maintenance hormonal treatment. At progression after 12 months, he was treated with anti-HER2 therapy combined with taxanes. The response lasted for 14 months. Then palliative therapy with capecitabine was introduced. With a relatively sustained quality of life, the response lasted for 15 months.
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