Background: Homeopathy has the potential to reduce symptoms related to cancer treatment. The present study examined the feasibility of a homeopathic consultation and treatment program, provided as ...part of an integrative oncology service. Methods: The electronic medical files of patients undergoing a homeopathic consultation in an integrative oncology service clinic were examined retrospectively. Adherence to the homeopathic treatment regimen and perceived response to the treatment were evaluated. Results: The files of 124 patient (34 males, 90 females) were examined, of which two-thirds reported acquiring and self-administering the homeopathic remedy as prescribed, and nearly three-quarters reporting a beneficial effect. Adherence to the homeopathic treatment regimen was greatest among patients attending a second visit, as opposed to having only telephone/e-mail follow-up (P < .005). An association was found between a perceived beneficial effect of treatment with attending a follow-up visit (P = .04), female gender (P = .02), younger age (P = .048), diagnosis of breast cancer (P = .014), and current radiation treatment (vs chemotherapy; P = .003). Patients reporting chemotherapy-induced peripheral neuropathy were also more likely to report a beneficial effect (P = .004), as were female patients reporting hot flashes (P = .005) and those referred by an oncologist (P = .046). No adverse effects were attributed to the homeopathic treatment. Conclusions: Homeopathy can be successfully incorporated within a supportive care integrative oncology service. In addition to demographic and cancer-related characteristics, as well as symptoms, patients attending a second visit (vs only telephone/e-mail follow-up) were more likely to adhere to and perceive a beneficial effect from the homeopathic regimen.
Studies suggested the existence of a 'trial effect', in which for a given treatment, participation in a clinical trial is associated with a better outcome. Sunitinib is a standard treatment for ...metastatic renal cell carcinoma (mRCC). We aimed to study the effect of clinical trial participation on the outcome of mRCC patients treated with sunitinib, which at present, is poorly defined.
The records of mRCC patients treated with sunitinib between 2004-2013 in 7 centers across 2 countries were reviewed. We compared the response rate (RR), progression free survival (PFS), and overall survival (OS), between clinical trial participants (n=49) and a matched cohort of non-participants (n=49) who received standard therapy. Each clinical trial participant was individually matched with a non-participant by clinicopathologic factors. PFS and OS were determined by Cox regression.
The groups were matched by age (median 64), gender (male 67%), Heng risk (favorable 25%, intermediate 59%, poor 16%), prior nephrectomy (92%), RCC histology (clear cell 86%), pre-treatment NLR (>3 in 55%, n=27), sunitinib induced hypertension (45%), and sunitinib dose reduction/treatment interruption (41%). In clinical trial participants versus non-participants, RR was partial response/stable disease 80% (n=39) versus 74% (n=36), and progressive disease 20% (n=10) versus 26% (n=13) (p=0.63, OR 1.2). The median PFS was 10 versus 11 months (HR=0.96, p=0.84), and the median OS 23 versus 24 months (HR=0.97, p=0.89).
In mRCC patients treated with sunitinib, the outcome of clinical trial participants was similar to that of non-participants who received standard therapy.
Castration-resistant prostate cancer (CRPC) is a devastating and incurable disease. Combined therapy using conventional anticancer drugs and a proprietary medical nutriment, fermented wheat germ ...extract (FWGE), also known as Avemar, has been suggested as a treatment for progressing prostate cancer (PCa) patients, who have become resistant to first line hormonal therapy (gonadotropin releasing hormone, GnRH). The primary aim of this study was to test if this combined therapy would slow down disease progression in CRPC patients. We tested the nontoxic, readily available, inexpensive FWGE, together with the conventional treatment, GnRH analogue, in 36 CRPC patients. Although this is a pilot study, with the drawback of a statistically small sample size, some anticancer clinical activity of FWGE could be seen in the CRPC patients, as measured by prostate specific antigen doubling time (PSADT). We found that the intake of GnRH with FWGE for at least 4 months, improved the overall health as well as the quality of life (QOL) in 4 patients (11%) and was instrumental in extending the PSADT in about 17 (out of 26) patients (65.4%), six of whom were significant. Since no mentionable adverse events were noticed, this treatment may permit the postponement of chemotherapy for these patients.
Ki-67 is a marker of cellular proliferation that is commonly used for the assessment of rhabdomyosarcoma. The aim of this study was to investigate the associations between Ki-67 expression and ...primary tumor diameter with CT evidence of lymph node and solid organ metastatic spread in rhabdomyosarcoma.
An institutional review board approval was granted for this study.
A retrospective search for rhabdomyosarcoma patients was conducted. Pathology reports were examined for Ki-67 expression. Chest-abdomen CT was assessed for radiological evidence of lymph node and metastatic spread. The maximal primary tumor diameter (termed tumor size) was also measured in different modalities CT, MRI, PET-CT and US. Ki-67 levels and primary tumor maximal diameters were compared to CT evidence of lymph node and organ metastatic spread.
Twenty-four patients with rhabdomyosarcoma were included. CT evidence of lymph node spread was associated with Ki-67 levels (AUC = 0.896, p = 0.006) and to a lesser extent with tumor size (AUC = 0.790, p = 0.030). However, organ metastatic spread was associated only with tumor size (AUC = 0.854, p = 0.006) and not with Ki-67 levels (AUC = 0.604, p = 0.469). A combination of tumor size ≥50 mm and Ki-67 levels ≥60% was significantly associated with CT evidence of lymph node spread (p = 0.004).
In conclusion, this study demonstrates radiological-pathological correlation in RMS. Lymph node spread detected by radiological images is associated with Ki-67 values. Lymph node and metastatic spread are associated with primary tumor size.
•Ki-67 is a marker of cellular proliferation commonly used for rhabdomyosarcoma assessment.•Rhabdomyosarcoma demonstrates radiological-pathological correlation.•Rhabdomyosarcoma lymphatic spread detected by radiological images is associated with Ki-67 values.•Rhabdomyosarcoma lymphatic and metastatic spread demonstrated on radiological images are associated with primary tumor size.
Learning Objectives
Describe the association between risk factors for renal cell carcinoma and the outcome of sunitinib treatment for metastatic disease.
Explain the impact of active smoking on the ...outcome of sunitinib‐treated metastatic renal cell carcinoma.
Discuss obesity, hypertension, and diabetes in relation to the outcome of sunitinib‐treated metastatic renal cell carcinoma.
Background.
Obesity, smoking, hypertension, and diabetes are risk factors for renal cell carcinoma development. Their presence has been associated with a worse outcome in various cancers. We sought to determine their association with outcome of sunitinib treatment in metastatic renal cell carcinoma (mRCC).
Methods.
An international multicenter retrospective study of sunitinib‐treated mRCC patients was performed. Multivariate analyses were performed to determine the association between outcome and the pretreatment status of smoking, body mass index, hypertension, diabetes, and other known prognostic factors.
Results.
Between 2004 and 2013, 278 mRCC patients were treated with sunitinib: 59 were active smokers, 67 were obese, 73 were diabetic, and 165 had pretreatment hypertension. Median progression‐free survival (PFS) was 9 months, and overall survival (OS) was 22 months. Factors associated with PFS were smoking status (past and active smokers: hazard ratio HR: 1.17, p = .39; never smokers: HR: 2.94, p < .0001), non‐clear cell histology (HR: 1.62, p = .011), pretreatment neutrophil‐to‐lymphocyte ratio >3 (HR: 3.51, p < .0001), use of angiotensin system inhibitors (HR: 0.63, p = .01), sunitinib dose reduction or treatment interruption (HR: 0.72, p = .045), and Heng risk (good and intermediate risk: HR: 1.07, p = .77; poor risk: HR: 1.87, p = .046). Factors associated with OS were smoking status (past and active smokers: HR: 1.25, p = .29; never smokers: HR: 2.7, p < .0001), pretreatment neutrophil‐to‐lymphocyte ratio >3 (HR: 2.95, p < .0001), and sunitinib‐induced hypertension (HR: 0.57, p = .002).
Conclusion.
Active smoking may negatively affect the PFS and OS of sunitinib‐treated mRCC. Clinicians should consider advising patients to quit smoking at initiation of sunitinib treatment for mRCC.
摘要
背景。肥胖、吸烟、高血压以及糖尿病是肾细胞癌发展的风险因素。它们在各种癌症中都可导致疾病转归变差。本研究旨在明确以上状况在受舒尼替尼治疗的转移性肾细胞癌（mRCC）中与疾病转归的相关性。
方法。在本次国际性、多中心、回顾性研究中，入组受舒尼替尼治疗的mRCC患者。通过多变量分析来明确吸烟、体重指数、高血压、糖尿病以及其他已知预后因素与疾病转归的关联。
结果。2004∼2013年间，在接受舒尼替尼治疗的278例mRCC患者中：59例为主动吸烟者，67例肥胖，73例患有糖尿病，165例为预处理高血压。中位无疾病进展生存期（PFS）为9个月，总生存期（OS）为22个月。PFS相关因素包括吸烟状态（既往吸烟与现行主动吸烟者：风险比HR：1.17，p = 0.39；从不吸烟者：HR：2.94，p ˂ 0.0001），非透明细胞组织学类型（HR：1.62，p = 0.011），预处理中性粒细胞与淋巴细胞比例> 3（HR：3.51，p ˂ 0.0001），使用血管紧张素抑制剂（HR：0.63；p = 0.01），舒尼替尼供药量减少或治疗中断（HR：0.72；p = 0.045）以及Heng风险（低中风险：HR：1.07；p = 0.77；高风险：HR：1.87，p = 0.046）。OS相关因素包括吸烟状态（既往吸烟与现行主动吸烟者：HR：1.25；p = 0.29；从不吸烟者：HR：2.7，p ˂ 0.0001），预处理中性粒细胞与淋巴细胞比例> 3（HR：2.95；p ˂ 0.0001）以及舒尼替尼诱导的高血压（HR：0.57；p = 0.002）。
结论。现行主动吸烟可能对接受舒尼替尼治疗的mRCC患者的PFS与OS产生不良影响。临床医生在开始对mRCC患者进行舒尼替尼治疗时，应建议其戒烟。The Oncologist 2014;19:1‐10
An international multicenter retrospective study of sunitinib‐treated metastatic renal cell carcinoma patients was performed to determine the association between outcome and the pretreatment status of smoking, body mass index, hypertension, diabetes, and other known prognostic factors. The results showed that active smoking may negatively affect the progression‐free and overall survival of these patients.
Metaplastic carcinoma of the breast is a general definition referring to a heterogeneous group of neoplasms characterized by a mixture of adenocarcinoma with areas of spindled, squamous or ...mesenchymal differentiation. Metaplastic breast carcinoma comprising of both epithelial and melanocytic elements is rare, with just nine cases reported in medical literature so far. “metaplastic breast carcinoma with melanocytic differentiation” does not exist as a separate entity on the WHO classification.
Patient reported is a woman diagnosed with having invasive ductal carcinoma in 1997, with new skin lesions appearing in 2009 and 2019. These lesions were biopsied and reviewed for histopathology. On microscopic examination, we observed skin involved by a malignant tumor, showing clusters of atypical cells with solid architecture and focal duct differentiation. Immunohistochemistry revealed tumor cells were positive for breast and melanocytic markers. Given the patient’s clinical history, the possibility of metaplastic breast carcinoma with focal melanocytic differentiation was suggested.
In our case report, we were able to show dermal breast lesions from the same patient during a 10-year span, showing change and evolution of the lesion to its current form. Recurrent biopsies of similar malignant lesions showing evolution have been described scarcely in the medical literature. From immune-histochemical stains performed on blocks obtained from 2009, we were able to show the development of melanocytic markers over time in similar samples resected ten years apart.
Translating preclinical studies to effective treatment protocols and identifying specific therapeutic responses in individuals with cancer is challenging. This may arise due to the complex genetic ...makeup of tumor cells and the impact of their multifaceted tumor microenvironment on drug response. To find new clinically relevant drug combinations for colorectal cancer (CRC), we prioritized the top five synergistic combinations from a large in vitro screen for ex vivo testing on 29 freshly resected human CRC tumors and found that only the combination of mitogen-activated protein kinase kinase (MEK) and proto-oncogene tyrosine-protein kinase Src (Src) inhibition was effective when tested ex vivo. Pretreatment phosphorylated Src (pSrc) was identified as a predictive biomarker for MEK and Src inhibition only in the absence of KRAS
mutations. Overall, we demonstrate the potential of using ex vivo platforms to identify drug combinations and discover MEK and Src dual inhibition as an effective drug combination in a predefined subset of individuals with CRC.
Abstract Computerized Tomography (CT) images are High Dynamic Range (HDR) images of the X-ray attenuation coefficients of the body's tissues. The inability to see abnormalities in tissues with marked ...differences in their X-ray attenuation coefficients, in a single CT window, poses a significant clinical problem in radiology. In order to provide proper contrast, which reveals all the required clinical details within each specifically imaged tissue, a single CT slice must be viewed by a radiologist four times: the first viewing focuses on the lung window; the second viewing focuses on the soft tissues window; the third viewing focuses on the liver window; and the fourth viewing focuses on the bone window. In order to enhance the ability to perform a complete diagnosis, while decreasing diagnostic time, we developed the BACCT (Biologically-based Algorithm for Companding CT images) method. Our algorithm compresses and expands (compands) the HDR CT image into a single, low dynamic range image. Before performing the companding procedure, unique processing is required which involves operations that enhance and stretch the image. The performance of our algorithm has been demonstrated on a large repertoire of CT body images. All the clinically required CT information is exposed in each CT slice in a single image. The algorithm compands the CT images in a fully automatic way. Collaborating radiologists have already tested the results of our algorithmic method, and reported that the images seem to provide all the necessary information. However, clinical tests for statistical reliability are still required.
Recently, we have seen the development of diagnostic tools based on the rationale that the measurement of electrical impedance of specific dermal zones might reflect the occurrence of pathological ...states in corresponding internal organs. Studies published lately have shown the diagnostic potential of this technique. We set out to evaluate the accuracy of this tool in diagnosing cancer. Our study group was composed of cancer patients visiting the Oncology clinic for a routine follow-up. All patients underwent conventional medical history and physical examination by a physician. We evaluated a device manufactured by Medex Screen Ltd. The device analysis was carried out by a physician who was blinded to the previous diagnosis. A third researcher compared the "conventional" diagnosis with the Medex device output using standard statistical analysis. Overall, 125 cancer patients were included in the study. When comparing Medex Screen diagnostic technique with the conventional methods of diagnosis for the various disorders we found a sensitivity of 76.2%, 78.7%, and 92.9% and a specificity of 95.0%, 90.7%, and 90.4% for lung, breast, and prostate cancer, respectively. Existence of metastatic disease or specific treatment did not affect the diagnostic properties of the described device. Although the exact mechanism is not entirely clear, measurement of electrical impedance of dermal-visceral zones has the potential to serve as a diagnostic and perhaps a screening tool for neoplastic pathologies. Further research should be conducted to create more evidence to support or dispute the use of this technique as a reliable diagnostic tool.
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