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Abstract: Introduction: Bevacizumab combined with IFL (irinotecan, bolus 5-fluorouracil, and leucovorin) has been shown to improve outcomes for patients with metastatic colorectal cancer (mCRC). However, infusional 5-fluorouracil-based combinations are now considered optimal in this setting. We analyzed the efficacy and toxicity of FOLFIRI (irinotecan, infusional 5-fluorouracil, and leucovorin)–bevacizumab in an unselected cohort of consecutive patients with mCRC. Materials and Methods: Patients with unresectable mCRC received bevacizumab 5 mg/kg and irinotecan 180 mg/m² on day 1, leucovorin 200 mg/m² on days 1 and 2, 5-fluorouracil 400 mg/m² bolus, and 600 mg/m² continuous infusion on days 1 and 2, every 14 days. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and safety were assessed. Results: Overall, 127 patients were included (69% male, median age 64 years); 15 patients had diabetes, 40 had hypertension, and 23 were undergoing anticoagulant/antiplatelet therapy. Median PFS was 11.0 months (95% CI 10.0–12.0); median OS was 26.0 months (95% CI 21.9–30.1). The ORR was 55.1% (95% CI 46.3–63.6%), with 12 complete responses, 58 partial responses, and 44 patients with stable disease. Salvage surgery was performed in 31 patients (24%), including 23 with liver metastases and one with lung metastases. Grade 3/4 toxicities included neutropenia (17%), vomiting (6%), and diarrhea (17%); grade 3/4 bevacizumab-related toxicities included hypertension (2%), hemorrhage (2%), and venous (7%) and arterial thromboembolic events (5%). Conclusion: FOLFIRI–bevacizumab was active and tolerable in this cohort of unselected patients with mCRC, resulting in a high surgical rescue rate and prolonged survival. Keywords: Bevacizumab, colorectal cancer, FOLFIRI, anticoagulant therapy, surgical rescue.Download Full Article |
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Abstract: Background: This observational study evaluated the efficacy and safety of treatment with bevacizumab plus chemotherapy until disease progression (PD) in Spanish patients with metastatic colorectal cancer (mCRC). Methods: This multicentre, retrospective, observational analysis included patients receiving bevacizumab plus fluoropyrimidine-based chemotherapy as first-line treatment for mCRC who then developed PD. All patients received treatment in hospital oncology departments and none received bevacizumab as part of a clinical trial. Patients discontinuing treatment with bevacizumab for reasons other than PD were excluded. The primary endpoint was PFS; secondary endpoints were overall response rate (ORR) and safety. Results: Overall, 165 patients were evaluable for analysis: median age 63.0 years; male/female 62%/38%; ECOG performance status 0/1/2 55%/43%/2%. Median duration of bevacizumab treatment was 8.7 months. ORR was 48.5% (6 complete and 74 partial responses) and disease control rate was 74%. Median progression-free survival (PFS) was 8.4 months (95% CI 7.2–9.6). Patients receiving oxaliplatin- or irinotecan-based regimens had median PFS of 9.2 and 7.7 months, respectively; those receiving treatment not containing either oxaliplatin or irinotecan had a median PFS of 6.1 months. KRAS status did not have a statistically significant effect on PFS (9.5 vs. 7.8 months for KRAS wild-type vs. mutant tumours, respectively; p=0.647) or ORR (44.8% vs. 52.6%, respectively; p=0.391). The most common grade 3/4 adverse events were: diarrhoea (7%), paraesthesia (7%), neutropenia (3%), cutaneous toxicity (2%), and thrombocytopenia (2%). Conclusions: Treatment with bevacizumab plus standard chemotherapy is an effective and well-tolerated option for patients with mCRC who continue treatment until PD. Keywords: Bevacizumab, mCRC, observational, clinical practice, disease progression.Download Full Article |
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Abstract: Radiation therapy is a critical part of multi-modality management of head and neck cancers. Brachytherapy or internal radiation is an ideal method of treatment delivery to achieve the ultimate goal of radiation treatment, that is maximum dose to tumour and minimum dose to normal tissues. Brachytherapy enables the radiation oncologist to provide a perfect mixture of radiation physics, radiobiology and clinical acumen to counter head and neck cancers. Appropriate usage based on the clearly defined indications and simple methods can maximize the advantages of brachytherapy thus resulting in excellent outcomes. However, the steady decline in utilization of brachytherapy over the years coupled with the technological advances of highly conformal radiotherapy, have dented its broader application for head and neck cancers. Can the new age radiation oncologist afford to neglect this therapeutic skill set? Keywords: Head & Neck Cancer, Brachytherapy, Radiotherapy.Download Full Article |
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Abstract: Cancer represents the main cause of death in the economically developed countries and the second cause of death in developing ones. Head and neck squamous cell carcinomas are the sixth most common malignancies worldwide with oral cavity and pharynx cancers being the most common. Saliva qualifies as one of the most suitable diagnostic fluids due to the non-invasivity nature, simple handling procedures, easy collection and storage and good cooperation with patient groups such as children or persons with disabilities. The aim of the present study is to assess the presence in saliva of several cancer biomarkers such as: tumor cells proliferation - Ki-67 Antigen and Squamous Cell Carcinoma Antigen (SCCA), inflammation - Interleukin-6 (IL-6), extracellular matrix collagen degradation - Matrix Metallo-proteinase-9 (MMP-9) and Tissue Inhibitor of Metalloproteinases 2 (TIMP-2), oxidative stress - total antioxidant capacity and uric acid. Both uric acid and total antioxidant capacity showed decreased levelsin the saliva of oral cancer patients. IL-6, Ki-67, SCCA and MMP-9 showed increased levels in the saliva of oral patients compared to the control group. Salivary TIMP-2 levels were also decreased in the patients group. We can conclude that salivary diagnosis has the potential of becoming a powerful tool in detecting and monitoring oral cancer patients. Keywords: MMP-9, TIMP-2, IL-6, Ki-67, SCCA, saliva, oral cancer.Download Full Article |
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Abstract: Brain metastasis represents the most common intracranial tumor. The metastatic process involves the migration of a cancer cell from the bulk tumor into the surrounding tissue, extravasation from the blood vessels into the tissues, and formation of a secondary tumor. Patients affected by brain metastases are in need of a multidisciplinary approach that generally includes surgical treatment and radiation therapy. Conventional chemotherapies have generally produced disappointing results, possibly due to their limited ability to penetrate the blood-brain barrier. With new data regarding the biology of brain metastases, novel targeted therapies can be considered interesting and promising therapeutic options. Targeted therapies showed improved survival in patients with metastatic disease. The advent of new technologies such as graphene nanoparticles has led to the discovery of novel pathways that allow a better delivery of the therapeutic compounds to the brain. Keywords: Angiogenesis, brain metastases, graphene, microRNA, nanoparticles, targete therapy.Download Full Article |