Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor originating from endothelial cells. Clinical aspect of the disease covers a wide spectrum from a low-grade tumor to a fatal cancer. ...Most common sites of EHE are reported as lung, liver and bone. Hepatic EHE (HEHE) is a clinical form with an incidence of less than 1 person in a million. Due to rarity of the disease, there is no standard therapy established. Surgery and liver transplantation still seem to be the best approach if possible. However, most of the patients present with unresectable or metastatic disease. Many conventional chemotherapeutic agents and antiangiogenic drugs have been reported previously in the literature with inconsistent outcomes. Here we report 4 cases of HEHE, who benefit distinctly from anti-VEGF treatments in different settings. While combination of paclitaxel and bevacizumab resulted in partial response in 3 patients, one of them also achieved long-term disease stabilization with bevacizumab maintenance with no adverse event. Two of the patients had clear benefit from pazopanib during the course of disease. One patient was treated with thalidomide for 18 months with stable disease, and is still being followed without any treatment. Although targeting VEGF-VEGFR pathway seems to be the best approach in HEHE, randomized studies are urgently needed to support these findings.
Introduction: Anaplastic thyroid carcinoma (ATC) is a highly aggressive, undifferentiated rare tumor. Median overall survival is usually between 8 and10 months, with a 1-year survival rate of 20%. ...Conventional anthracycline based chemotherapy regimens demonstrate low response rates with short duration. Novel therapeutic agents including BRAF and MEK inhibitors based on the molecular landscape of ATC have been investigated. Case presentation: We herein report the rechallenge of a 52-year-old ATC patient with BRAF V600E mutation with dabrafenib plus trametinib. She presented with recurrent and progressive disease despite surgery, radiation therapy, 3 different chemotherapy regimens, and combination of dabrafenib-trametinib in different settings. She was rechallenged with dabrafenib-trametinib, and had a good response. Conclusion: To our knowledge, this is the first ATC case who responded to dabrafenib-trametinib rechallenge, reported in the literature. We want to emphasize that combination of dabrafenib and trametinib might be a good choice for resistant locoregional and metastatic ATC patients with BRAF V600E mutation, particularly in whom rapid clinical response is urgently needed. Moreover, rechallenge with this combination should be kept in mind in selected cases.
Mucinous colorectal adenocarcinoma (MCAC) is a distinct subtype of colorectal carcinoma (CRC). The prognostic and predictive significance of mucinous histology remains controversial. It was aimed to ...investigate the prognostic and/or predictive role of mucinous histology in left-sided metastatic CRC (mCRC) with wild-type RAS. This is a retrospective multicenter study of mCRC treated with first line anti-EGFR combined 5-fluorouracil based chemotherapy (CT). Patients were stratified according to presence (>50% extracellular mucin) or absence of mucinous histology. Survival analyses were performed firstly regardless of treatment options and then performed as separating according to CT regimens. Additional analyses were performed for MCAC patients considering backbone CT regimens. A total of 125 patients were included, consisting of 40 (32.0%) patients with MCAC and 85 (68.0%) patients with non-MCAC. Median follow-up time was 19.7 months. Median progression-free survival (PFS) was 10.7 months in all patients, and PFS was lower in MCAC than non-MCAC (9.9 vs. 12.0 months, respectively, P=0.005). Median overall survival (OS) was 25.7 months in all patients. OS was lower in MCAC than non-MCAC (22.8 vs. 29.7 months, respectively, P=0.005). When considering backbone CT regimens, in multivariate analyses, mucinous histology was an independent prognostic factor for OS in both for mFOLFOX6 (HR: 1.92, P=0.04) and FOLFIRI (HR: 2.04, P=0.04) groups and was associated with poor PFS in only mFOLFOX6 (HR: 3.86, P<0.001) group. When outcomes were analyzed for the MCAC group, median OS of MCAC patients receiving mFOLFOX6 and FOLFIRI was 22.47 and 14.22 months, respectively (P=0.41). Median PFS of MCAC patients receiving mFOLFOX6 and FOLFIRI was 10.15 and 8.11 months, respectively (P=0.73). The study revealed poor prognosis of mucinous histology, both in whole study population and in backbone CT groups. Moreover, lower PFS of MCAC patients was revealed in only mFOLFOX6 group and this finding may be a valuable issue for the future research. However, considering all analyses, the present results did not indicate a special benefit of any backbone CT regimen for MCAC patients. Key words: metastatic colorectal cancer, mucinous histology, prognosis, backbone chemotherapy
Purpose:
Lung adenocarcinoma is histologically diverse but has distinct histologic growth patterns. There is no consensus on the clinical benefit of this histologic model. We aimed to evaluate the ...differences in the distribution of the preoperative primary tumor positron emission tomography (PET)/computed tomography (CT) standardized uptake values (SUVs) and survival in the lung adenocarcinoma subtypes.
Methods:
We retrospectively evaluated the data of 107 patients with resected lung adenocarcinoma who had preoperative PET/CT between 2005 and 2017 in a single center. Patients had lepidic, acinar, papillary, micropapillary, and solid histologic subtypes. We compared fluorodeoxyglucose SUVs and survival data of histologic subtypes.
Results:
The median age of the patients was 62 years (40–75), 76.4% were male, the median SUVmax was 9.4 (1–36.7), and the median follow-up time was 29 months (3–135 months). The median overall survival (OS) was 71 months and the median progression-free survival (PFS) was 33 months. SUVmax was significantly different in histologic subtypes: values for papillary, micropapillary, solid, acinar, and lepidic subtypes were 9.7, 8, 12, 9.1, and 3.9, respectively (p = 0.000). Solid predominant adenocarcinoma had significantly higher SUVmax than the other subtypes (p = 0.001). Lepidic predominant adenocarcinoma had significantly lower SUVmax than the other subtypes (p = 0.000). There was no significant difference in OS between histologic subtypes (p = 0.66), but PFS was significantly different between the groups (p = 0.017), and the solid subtype had a shorter PFS than the other histologic subtypes.
Conclusion:
Lung adenocarcinoma consists of a diverse group of diseases. Different SUVmax values are seen in different histologic subtypes of nonmetastatic lung adenocarcinoma. Solid predominant types have high SUVmax values while lepidic predominant types have lower SUVmax values. The solid subtype had a shorter PFS than the other histologic subtypes.
Objective: The aim of this study was to investigate the differences between ampullary carcinomas and pancreatic head carcinomas and to contribute significantly to this issue, which has not been ...sufficiently addressed in the literature. Methods: The study was a retrospective descriptive study. The data of 125 patients with resected periampullary adenocarcinoma were retrospectively reviewed between July 2011 and July 2020. The patients were divided into two groups, ampullary and nonampullary carcinomas, and were compared in terms of clinical, demographic, and pathological aspects. Results: A total of 109 patients were included in the study with nonampullary carcinoma predominance (59.6% had nonampullary and 40.4% had ampullary). The most common admission complaint was jaundice. The median follow-up was 24 months (range: 1.4-80.4 months). Both median overall survival (OS) and median disease-free survival (DFS) were statistically significant longer in ampullary carcinomas compared with nonampullary carcinomas (OS: 74.5 months vs 16.9 months, 95% CI: 12.6-21.2, p<0.001; DFS: 21.6 months vs 8 months, 95% CI: 10.7-32.6, p<0.001). Conclusion: Ampulla carcinomas are rare tumors with a better prognosis and longer survival than pancreatic head carcinomas. If it is evaluated in a different category from pancreatic tumors, it may be possible to receive less aggressive treatment and avoid unnecessary toxicity for selected patients. Further studies are needed. Keywords: Adenocarcinoma; ampulla; jaundice; survival. Amac: Bu calismada, ampulla karsinomlari ile pankreas basi karsinomlari arasindaki farklari arastirdik. Literaturde henuz yeterince ele alinmamis olan bu konuya katkida bulunabilecegimize inaniyoruz. Gerec ve Yontem: Temmuz 2011 ile Temmuz 2020 arasinda rezeke edilmis periampuller adenokarsinomlu 125 hastanin verileri geriye donuk olarak incelendi. Hastalar ampuller ve ampuller olmayan karsinomlar olarak iki gruba ayrildi ve klinik, demografik ve patolojik acidan karsilastirildi. Bulgular: Ampulla disi kanserlerin cogunlukta oldugu 109 hasta calismaya dahil edildi (%59.6'si ampulla disi ve %40.4'u ampulla). En sik basvuru sikayeti sarilikti. Ortanca takip suresi 24 aydi (aralik: 1.4 ay-80.4 ay). Ortanca genel sagkalim (GS) 30.6 aydi (%95 guven araligi (GA): 24-37.1). Ortanca hastaliksiz sagkalim (HS) 11.6 aydi (%95 GA: 8.9-14.4). Hem GS hem de HS ampulla tumorlerinde ampulla disi tumorlere kiyasla istatistiksel olarak anlamli sekilde uzundu (p=<0.001). Sonuc: Ampulla karsinomlari, pankreas basi karsinomlarina gore daha iyi prognozlu ve daha uzun sagkalima sahip nadir tumorlerdir. Pankreas tumorlerinden farkli bir kategoride degerlendirilirse secilmis hastalarda daha az agresif tedavi almak ve gereksiz toksisiteden kacinmak mumkun olabilir. Bu konuda daha ileri calismalara ihtiyac vardir. Anahtar Sozcukler: Adenokanser; ampulla; sagkalim; sarilik.
Afatinib improves survival in metastatic non–small-cell lung cancer driven by activating epidermal growth factor receptor mutations. QT interval prolongation is a possible side effect of targeted ...anticancer drugs, but this has not been reported before with afatinib. We report a case of metastatic pulmonary adenocarcinoma with epidermal growth factor receptor exon 19 deletion who was treated with first-line afatinib. The patient was started on afatinib with a total dose of 40 mg/day and experienced grade 3 (>500 ms) QT interval prolongation in the seventh week. Dose was interrupted and then reduced to 30 mg/day after the event repeated. QT prolongation occurred only once with the reduced dose and radiologic oligoprogression was detected. Local therapy was performed and afatinib was continued as 30 mg/day. To the best of our knowledge, this case marks the first QT interval prolongation associated with afatinib. It is prudent to perform a baseline cardiologic evaluation and electrocardiogram monitoring in non-small cell lung cancer patients treated with this drug.
The aim of the study is to assess the prognostic value of pretreatment lymphocyte, neutrophil, platelet counts, mean platelet volume (MPV), platelet to lymphocyte ratio (PLR) and neutrophil to ...lymphocyte ratio (NLR) in patients with pancreatic cancer.
A total of 65 eligible patients were included in the study and retrospectively reviewed. Pre-treatment hematological parameters (platelet, lymphocyte, neutrophil counts, and mean platelet volume) and tumor marker (CA 19-9) levels were recorded. NLR was calculated by dividing the neutrophil count value by the number of lymphocytes. PLR was also calculated in a similar manner by dividing the platelet count value by the number of lymphocytes.
One-year survival was 22.3% and the median survival time was 7 months (95% CI, 5.7-8.2) in the study group. Patients with a NLR value of < 5 had a significantly higher median survival duration compared to those with a NLR value of > or = 5 (p = 0.015). All other hematological variables were not significantly different.
In patients with pancreatic cancer, pretreatment NLR may be use as a prognostic factor in pancreatic cancer patients. Further studies with larger patient cohorts are warranted to to better clarify the prognostic value of pre-treatment peripheral blood counts in patients with cancer.
Colorectal cancer is one of the leading causes of mortality both globally and in our country. In Turkey, we conducted a multicenter investigation into the effectiveness of second-line treatments and ...real-life data for patients with RAS wild-type metastatic colorectal cancer (NCT04757311).
In this retrospective analysis, records from 28 centers were collected, and histopathological, molecular, and clinical characteristics were documented. Patients were categorized into groups based on their second-line biological treatments: anti-EGFR (Group A and Group B, panitumumab and cetuximab) and anti-VEGF (Group C, bevacizumab and aflibercept). They were then compared within these groups.
A total of 588 patients with documented RAS wild-type status were evaluated. The median OS was 15.7, 14.3 and 14.7 months in Group A, Group B and Group C, respectively (
= 0.764). The median PFS of the patients in second-line setting that received panitumumab, cetuximab and bevacizumab/aflibercept were 7.8, 6.6 and 7.4 months, respectively (
= 0.848).
According to the results of our real-life data study, there is no significant difference in efficiency between the combination of biological agent and chemotherapy used in the second-line treatments.
Primary brain tumors are relatively rare malignancy, with high-grade gliomas (glioblastoma multiforme and anaplastic gliomas) are the most common types. We aimed to evaluate the prognostic value of ...Prognostic Nutritional Index (PNI), which is calculated by lymphocyte count and albumin, in recurrent glioblastoma patients treated with systemic treatment.
Data of 64 patients with recurrent glioblastoma who received systemic treatment and followed in our clinic between 2012 and 2018 was retrospectively collected and analyzed. PNI was calculated as: (10×serum albumin (g/dL))+(0.005×total lymphocyte count). Patients were categorized according to the median PNI value. We investigated the prognostic role of PNI groups, and survival outcomes.
Median value of PNI was 45.7, and median follow-up duration was 9 months (1-68 months). Median overall survival (OS) was 7.9 months (95%CI: 5.5-10.4). Median OS was significantly longer in patients with PNI>45.7 compared to patients with PNI≤45.7 (13.9 months (95%CI: 10.5-17.4), and 4.6 months (95%CI: 2.5-6.8), p<0.001, respectively). In multivariate analysis, PNI was found to be an independent prognostic factor for OS HR:0.41 (95%CI:0.22-0.74), p=0.03).
In our study, the PNI was found to be an independent prognostic biomarker in patients with recurrent glioblastoma, but further prospective trials are necessary to validate its prognostic role.
