Cancer-related hypercalcemia is a common finding typically seen in patients with advanced cancer and occurs in about 20 to 30 percent of cases. The most common cause of hypercalcemia in hospitalized ...patients is hypercalcemia due to malignancy.This clinical problem is seen in patients with both solid tumors and patients with hematologic malignancies. Hypercalcemia is associated with a poor prognosis in oncology patients. This pathologic condition can occur due to many different mechanisms but is usually caused by abnormal calcium use resulting from bone resorption, intestinal absorption, or renal excretion. Hypercalcemia may present with a wide range of symptoms ranging from gastrointestinal system symptoms to neurologic symptoms. Timely diagnosis and initiation of treatment by the physician significantly reduce the risk of complications. Treatment aims to decrease serum calcium by increasing calciuresis, decreasing bone resorption, and decreasing intestinal calcium absorption. The mainstays of treatment are IV hydration, bisphosphonates and calcitonin, denosumab, and in some patients, prednisone, and cinacalcet. Patients with underlying advanced kidney disease and refractory severe hypercalcemia should be evaluated for hemodialysis. Every physician dealing with oncology patients should know the fastest and most effective management of hypercalcemia. We aimed to contribute in this sense.
Purpose
We aimed to identify the prognostic and predictive values of post-treatment prognostic nutritional index (PNI) and PNI dynamics in nasopharyngeal cancer patients (NPC) in this study.
Methods
...One hundred seven non-metastatic NPC patients were included. PNI was calculated by using the following formula: 10 × serum albumin value (gr/dL) + 0.005 × total lymphocyte count (per mm3). ROC analysis was used for determining prognostic PNI values and univariate and multivariate statistical analyses for prognostic characterization of PNI.
Results
The statistically significant cut-off values for pre- and post-treatment PNI were 50.65 and 44.75, respectively. Of the pre-treatment PNI analysis, PNI ≤ 50.65 group had shorter loco-regional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS). Furthermore, for post-treatment PNI analysis, PNI ≤ 44.75 group had shorter LRRFS and OS. In univariate analysis, only pre-treatment PNI was associated with LRRFS and DMFS, while pre- and post-treatment PNI were both associated with OS. In multivariate analysis, both PNI were independent prognostic markers for OS. In the combined analysis, pre- and post-treatment PNI, differences between the groups were statistically significant, and the PNI dynamics was an independent prognostic indicator for OS.
Conclusion
PNI is a useful, independent prognostic marker for non-metastatic NPC patients. It is used for either pre- or post-treatment patients. Furthermore, changes in pre-treatment PNI value after curative treatment is a significant indicator for OS.
The present report describes the late recovery of an emerging complete atrioventricular (AV block) in a patient with immune check point inhibitor–related myocarditis following a period of ...immunosuppresive therapy. Therefore, decision-making for permanent pacemaker implantation should be implemented after a substantial period of time owing to the potential recovery of bradyarrhythmic complications in similar cases.
Albumin-bilirubin (ALBI) grade is an objective measure of liver function for patients with hepatocellular carcinoma (HCC). The tyrosine kinase inhibitor cabozantinib is approved for patients with ...advanced HCC who have received prior sorafenib based on the phase 3 CELESTIAL trial (NCT01908426). Cabozantinib improved overall survival (OS) and progression-free survival (PFS) versus placebo in patients with previously treated HCC.
Patients were randomised 2:1 to receive cabozantinib 60 mg or placebo orally every day. Clinical outcomes in patients with ALBI grade 1 or 2 at baseline were evaluated in CELESTIAL. ALBI scores were retrospectively calculated based on baseline serum albumin and total bilirubin, with an ALBI grade of 1 defined as ≤ -2.60 score and a grade of 2 as a score of > -2.60 to ≤ -1.39.
Cabozantinib improved OS and PFS versus placebo in both ALBI grade 1 (hazard ratio HR 95% CI: 0.63 0.46-0.86 and 0.42 0.32-0.56) and ALBI grade 2 (HR 95% CI: 0.84 0.66-1.06 and 0.46 0.37-0.58) subgroups. Adverse events were consistent with those in the overall population. Rates of grade 3/4 adverse events associated with hepatic decompensation were generally low and were more common among patients in the ALBI grade 2 subgroup.
These results provide initial support of cabozantinib in patients with advanced HCC irrespective of ALBI grade 1 or 2.
ClinicalTrials.gov number, NCT01908426.
Background
Trifluridine and tipiracil (FTD/TPI) demonstrated survival benefit vs placebo and manageable safety in previously treated patients with metastatic gastric/gastroesophageal junction cancer ...(mGC/GEJC) in the randomized, placebo-controlled, phase 3 TAGS study. This subgroup analysis of TAGS examined efficacy/safety outcomes by age.
Methods
In TAGS, patients with mGC/GEJC and ≥ 2 prior therapies were randomized (2:1) to receive FTD/TPI 35 mg/m
2
or placebo, plus best supportive care. A preplanned subgroup analysis was performed to evaluate efficacy and safety outcomes in patients aged < 65, ≥ 65, and ≥ 75 years.
Results
Among 507 randomized patients (
n
= 337 FTD/TPI;
n
= 170 placebo), 55%, 45%, and 14% were aged < 65, ≥ 65, and ≥ 75 years, respectively. Overall survival hazard ratios for FTD/TPI vs placebo were 0.67 (95% CI 0.51–0.89), 0.73 (95% CI 0.52–1.02), and 0.67 (95% CI 0.33–1.37) in patients aged < 65, ≥ 65, and ≥ 75 years, respectively. Regardless of age, patients receiving FTD/TPI experienced improved progression-free survival and stayed longer on treatment than those receiving placebo. Among FTD/TPI-treated patients, frequencies of any-cause grade ≥ 3 adverse events (AEs) were similar across age subgroups (80% each), although grade ≥ 3 neutropenia was more frequent in older patients 40% (≥ 65 and ≥ 75 years); 29% (< 65 years); AE-related discontinuation rates did not increase with age 14% (< 65 years), 12% (≥ 65 years), and 12% (≥ 75 years).
Conclusions
The results of this subgroup analysis show the efficacy and tolerability of FTD/TPI treatment regardless of age in patients with mGC/GEJC who had received 2 or more prior treatments.
The aim of our study was to evaluate the incidence of KRAS/NRAS and BRAF mutations, analyze molecular patterns, and investigate associations with clinical parameters of these mutations in CRC ...KRAS/NRAS and BRAF mutations analyzed by next-generation sequencing. The detection rates of these mutations and patients’ demographics were recorded and the relationship between them was evaluated using the chi-square test. KRAS mutation was detected in 332 of 694 patients, while the mutation rates in KRAS exons 2/3 and 4 were 39.6%/3.2% and 5%, respectively. The most common mutation pattern was KRAS G12D. Five atypical variants were detected: V14I in KRAS exon 2, A18D, Q22K and T50I in exon 3, and T148P in exon 4. NRAS mutation was detected in 29 (4.5%) patients. One atypical variant L80W was detected in NRAS exon 3. BRAF mutation was seen in 37 (5.3%) patients, with BRAFV600E (83.8%) being the most common mutation pattern. NRAS mutation was significantly more frequent in patients > 64 years of age, BRAF mutation in women, and NRAS/BRAF mutations in right colon tumors. Grouping BRAF mutations into BRAFV600E and BRAFnon-V600E and their analysis according to specific tumor localizations showed that all four BRAFnon-V600E mutations originated in the rectum. In our study, KRAS exon 2 and other RAS mutation rates were higher than in the literature, while the BRAF v.600E mutation rate was similar. NRAS and BRAF mutations were significantly more frequent in the right colon. BRAF mutation was more common in women and in the right colon.
Background
The aim of this study is to investigate of the relationship between GSTM1 gene variations and serum trace elements, plasma malondialdehyde levels in patient with colorectal cancer.
...Mateials and Methods.
Genotype distributions of GSTM1 gene variations were determined using real-time polymerase chain reaction method. Serum trace element levels were determined using atomic absorption spectrophotometer method and plasma MDA levels were measurement by spectrophotometric method.
Results
Serum Cu levels, plasma MDA levels and Cu/Zn ratio were determined significantly higher in the group of CRC patient carrying the GA heterozygous genotype of the GSTM1 (rs 112,778,559) gene variation compared to healthy controls (p < 0.05). Serum Cu, Zn levels, plasma MDA levels and Cu/Zn ratio were determined significantly higher in patients carrying GG homozygous genotype of the GSTM1 (rs 112778559) gene variation compared to healthy controls carrying same genotype (p < 0.05). Serum Cu, Zn levels, plasma MDA levels and Cu/Zn ratio were determined significantly higher in the group of CRC patient carrying the GG homozygous genotype of the GSTM1 (rs 12068997) gene variation compared to healthy controls (p < 0.05). On the other hand, serum Se levels were detected significantly lower in CRC patients carrying GA heterozygous and GG homozygous genotypes for GSTM1 (rs 112,778,559) and (rs 12,068,997) gene variations compared to healthy controls (p < 0.05).
Conclusion
In our study, the evaluation of serum Cu, Zn and Se trace element levels and plasma MDA levels according to GSTM1 gene variations genotype distributions were enabled to obtain important biomarkers in terms of CRC development and progression.
Background and Design: Melanoma is a serious type of cancer. Patients previously diagnosed with melanoma are at an increased risk of
a second melanoma. Therefore, it is important to know and apply ...preventive measures. This study aimed to examine melanoma patients’
behaviors of sun protection and skin self-examination (SSE), knowledge on risk factors, and communication with their physicians about the
disease.
Materials and Methods: A questionnaire-based cross-sectional study was conducted in 65 melanoma patients to assess knowledge of
melanoma and sun protection and determine SSE attitudes and patient-physician communication.
Results: Sun exposure was a well-known melanoma risk factor (67.7%), but the knowledge level on other risk factors, especially regarding
skin, hair, and eye color phenotypes, was low (between, 21.5% and 36.9%). Sunscreen use practice was insufficient (33.8%) and mostly
inadequate. The most commonly reported reason for not using sunscreen was not having a habit of sunscreen use (83.7%). Compliance with
other sun protection behaviors was variable. Half (50.8%) of the melanoma patients reported that they perform SSE. The most commonly
reported reasons for not performing SSE was not knowing its necessity (71.8%). More than one-third (35%) of patients stated that they did not
receive information about melanoma from their physicians. Almost all patients who received information from their physicians were informed
verbally, and only 4% received written information.
Conclusion: Our study highlights the need for a comprehensive education for patients about all aspects of melanoma and strategies to
improve patient-physician communication. Barriers to preventive behaviors in melanoma patients may be determined in more detail in larger
future studies and the content of education may be planned accordingly
Objectives
Contrast nephropathy risk has been increasing in cancer patients. Nephrotoxic side effects of anti-vascular endothelial growth factor/receptor (anti-VEGF/R) drugs used in oncologic ...treatment are also prominent. The purpose of this study was to identify the possible association among anti-VEGF/R drugs use and development of the contrast-induced nephropathy (CIN) in patients with cancers.
Methods
A total of 92 patients were included in this prospective cross-sectional study. Patients whose glomerular filtration rate (GFR) of < 50 ml/min, hemoglobin of < 10 g/dl, and eastern cooperative oncology group (ECOG) score of ≥ 2 and had received nephrotoxic drugs were not included in the study. Blood samples were collected baseline at pre computed tomography (CT) and day 2, day 3 and day 7 later CT imaging. CIN was defined as either an increased serum creatinine value of 0.5 mg/dl or increased 25% to baseline. CIN frequency between groups receivingand not receiving anti-VEGF/R was compared using the chi-squared test. CIN frequency between bevacizumab and other anti-VEGF/R was also analyzed.
Results
There were 39 patients in the anti-VEGF/R (+) group and 53 patients in the anti-VEGF/R (−) group. Eleven patients (28%) in the anti-VEGF/R (+) group and 3 patients (5.6%) in the anti-VEGF/R (−) group had CIN (
p
= 0.006). In the anti-VEGF/R (+) group, 23 patients received bevacizumab (combined with FOLFOX/FOLFIRI), while 16 patients received other anti-VEGF/R (sunitinib, axitinib, regorafenib, aflibercept) effective treatments. CIN ratio in patients who received bevacizumab or other anti-VEGFR therapy was similar (
p
= 0 = 50). Of the patients, one patient had acute kidney injury leading to death.
Conclusion
CIN was significantly more frequent in cancer patients who receiving anti-VEGF/R drugs than those not receiving anti-VEGF/R drugs.
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. We aimed to evaluate the clinicopathological features of the patients in Thrace and ...improve our management.
In this retrospective study, 68 patients with a diagnosis of GIST referred to Trakya University Medical School Hospital between 1997 and 2015 were evaluated.
The most common symptom was abdominal pain (38.2%) and the location was small-intestine (42.6%). Large masses had higher metastasis and relapse rate. The mean tumor size with relapse was 11.8 ± 3.8 cm meanwhile it was 6.5 ± 3.0 cm in non-relapsed patients (p = 0.01). The mean size of the tumor was 13.5 ± 4.4 in the metastatic group although this data was 8.8 ± 4.7 cm in the non-metastatic group (p = 0.01). With necrotic tumors, mitotic rate and size were higher. The mean mitosis count was 21.0 ± 3.6 in necrotic tumors and 7.2 ± 9.9 in non-necrotic tumors (p = 0.005). The mean size was 10.8 ± 5.0 cm in necrotic tumors and 5.6 ± 3.0 cm in non-necrotic tumors (p = 0.009). According to AFIP criteria, most of the patients were in the high-risk group (57.4%). Overall survival (OS) was longer in non-smokers and non-drinkers. Median OS was 80.16 months in non-smoker group (95% CI, 27.83–132.49) and 24.64 months (95% CI, 15.49–33.78) in the smoker group (p = 0.001). The median OS was 80.09 months in the non-drinker group (95% CI, 13.99–146.20) and 24.64 months (95% CI, 13.18–36.10) in drinker group (p = 0.05). Median OS in stomach GIST was 41.39 months, in small-intestine were 80.09 months and in the colon were 35.68 months (p = 0.032). Patients underwent surgery had longer overall-survival. Median OS was 80.09 months in patients undergone surgery and 16.98 months in patients had not been operated (p = 0.001). Overall survival was longer in GIST with mitotic rate <5/50HPF than with >5/50HPF. Median OS was 80.16 months in patients who had less than 5 mitosis and 39.22 months in higher mitotic rate (95% CI, 31.58–46.87) (p = 0.034). Overall survival was shorter in GIST with Ki-67 > 5% than with 5%>. Median OS was 80.16 months (95% CI, 28.80–49.65) in <5% and 39.22 months (95% CI, 28.80–49.65) in 5%≤ Ki-67 (p = 0.004).
The most important factors about the survival and prognosis of GIST are location, size, mitotic rate, Ki-67, necrosis and surgery status. Using tobacco/alcohol may be related to survival. This study should be further investigated with extensive data.
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