Clinical characteristics, diagnosis, treatment, and prognosis in lung cancer patients under the age of 45

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Background: Lung cancer remains uncommon among young adults but it causes great loss of life expectancy in this age group. The definition of young age varies in the published studies from 40 to 50 years of age. Methods: Our aim was to assess whether patients diagnosed at young ages have unique clinicopathological and prognostic characteristics. We retrospectively reviewed records of patients aged 45 or younger who were treated for primary lung cancer at a large tertiary center between June 2003 and June 2011. Results: 2,651 patients with lung cancer were screened of whom 73 (2.8%) were aged ≤45. The male-to-female ratio was 1.6:1 and the median age at diagnosis was 42. 89% of patients were smokers. Performance status (PS) was 0, 1 and 2 in 61%, 29% and 10% of patients, respectively. The most common histological types were adenocarcinoma (47%), small-cell lung cancer (SCLC) (18%) and squamous cell carcinoma (18%). The median time elapsing between beginning of symptoms and diagnosis was 3 months. Chronic hepatitis B or C was mentioned in the medical history of 5/13 (38%) SCLC patients, whereas it was present in 4/60 NSCLC patients under 45 (p=0.008) and in 16/518 SCLC patients over the age of 45 (p<0.0001). Patients were diagnosed with stages I, II, III and IV in 2 (3%), 11 (18%), 13 (22%) and 34 (57%) of NSCLC cases, respectively, whereas 7 of 13 (54%) SCLC patients were diagnosed with limited disease. The median overall survival was 21 months and multivariate analysis indicated that PS and time until diagnosis were independent prognostic factors. Conclusions: Although more than half of young patients are at stage IV when diagnosed, prognosis does not seem as dismal as previously considered. Larger studies need to be conducted in order to elucidate the possible role of chronic hepatitis in the pathogenesis of SCLC in young patients.

Prolonged survival after splenectomy in Wiskott-Aldrich syndrome: a case report

Wiskott-Aldrich syndrome is a rare X-linked immunodeficiency disorder that is characterized by a variable clinical phenotype. Matched donor bone marrow transplantation is currently the only curative therapeutic option. We present the case of a 24-year-old male who was diagnosed at the age of seven with Wiskott-Aldrich syndrome. He did not respond to intravenous gammaglobulin and he experienced recurrent pulmonary infections despite prophylactic antibiotics. The patient had no matched donor. At the age of nine, he was submitted to splenectomy and his platelet count was normalized. Fifteen years later, the patient remains asymptomatic with a normal platelet count. He is still receiving prophylactic antibiotics and no bleeding episodes or septic complications have been reported. This case demonstrates that splenectomy can represent a safe therapeutic option in selected WAS patients, provided that there is a tight follow-up program, patient education and adherence to guidelines regarding post-splenectomy prophylaxis.

Updates on treatment of gemcitabine-refractory pancreatic adenocarcinoma. Highlights from the "2011 ASCO Annual Meeting". Chicago, IL, USA; June 3-7, 2011

Gemcitabine monotherapy and gemcitabine-based regimens are the current standard of care for locally advanced or metastatic pancreatic adenocarcinoma. However, there is still great controversy over the role of salvage chemotherapy after failure of gemcitabine. This review is an update on the 2011 American Society of Clinical Oncology (ASCO) Annual Meeting regarding the most important developments in the treatment of refractory pancreatic cancer, as they were reported in Abstracts #e14542 and #e14588.

Treatment for refractory pancreatic cancer. Highlights from the "2011 ASCO Gastrointestinal Cancers Symposium". San Francisco, CA, USA. January 20-22, 2011

While gemcitabine-based regimens are currently accepted as the standard first-line treatment of patients with locally advanced or metastatic pancreatic adenocarcinoma, there is no consensus regarding treatment in the second-line setting. This review is an update from the 2011 American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium regarding recent developments in the treatment of refractory pancreatic cancer, as these were presented in Abstracts #237 and #272 of the meeting.

Gastric cancer in the elderly: an overview

AIMS

Gastric cancer in the elderly represents a distinct entity with specific clinicopathological characteristics and the majority of affected patients belong to this age group. Subtotal or total gastrectomy with radical lymph node dissection, adjuvant chemoradiotherapy or perioperative chemotherapy represent the only potentially curative treatment options and seem to be performed with acceptable morbidity and mortality rates in selected elderly patients. Published research is very limited due to the strict selection and under-representation of elderly patients in clinical trials. A review of current recommendations and practice was performed.

METHODS

A comprehensive literature review was performed searching Medline for articles published since 1974, using "gastric cancer", "elderly" and "treatment" as keywords.

OBSERVATIONS

The data suggest that elderly patients that fulfill the inclusion criteria of clinical trials experience the same advantages and toxicities from chemotherapy as younger patients. Fit elderly patients with operable gastric cancer should be candidates for the standard surgical resection provided that preoperative comorbidities are taken into account. Perioperative chemotherapy or postoperative chemoradiotherapy should be added in case of locally advanced disease. Palliative systemic chemotherapy seems to prolong survival in recurrent and metastatic disease.

CONCLUSIONS

Chronological age alone is not sufficient reason to withhold curative or palliative treatment from an elderly gastric cancer patient. Performance status does not suffice in order to estimate the general condition of elderly patients and cofactors regarding their functional, social and mental status have to be considered.

Role and cost effectiveness of PET/CT in management of patients with cancer

PET/CT is a relatively new imaging technology, whose undoubted advantages are valuable in clinical oncology as well as in all fields of diagnosis, staging, and treatment. The hardware combination of anatomy and function has been the true evolution in imaging. PET using 18F-fluorodeoxyglucose (FDG) is increasingly used for the staging of solid malignancies, including colon, lung, etc., but anatomic information is limited. Integrated PET/CT enables optimal anatomic delineation of PET findings and identification of FDG-negative lesions on computed tomography (CT) images and might improve preoperative staging. However, controversy still exists in relation to the application of PET/CT in clinical practice, mainly because of its high cost. It is evident that apart from additional costs, potential savings also are associated with PET/CT as a result of avoiding additional imaging examinations or invasive procedures and by helping clinicians make the optimum treatment decisions. The authors review the literature on the role of PET/CT in management of various tumors and discuss the medicoeconomic usefulness.

Carboplatin plus pemetrexed as first-line treatment of patients with malignant pleural mesothelioma: a phase II study

INTRODUCTION

Malignant pleural mesothelioma (MPM) is a rapidly progressive tumor that is increasing in frequency worldwide. Treatment options are limited, and response to chemotherapy is poor. The aim of this phase II study was to evaluate the activity of the carboplatin/pemetrexed combination as first-line chemotherapy in patients with unresectable MPM.

PATIENTS AND METHODS

Chemotherapy-naive patients with histologically confirmed MPM and an Eastern Cooperative Oncology Group performance status of 0-2 were enrolled. Treatment consisted of pemetrexed 500 mg/m2 and carboplatin area under the concentration-time curve of 5 mg/mL/min, both administered on day 1 of a 21-day cycle. The treatment continued until 6 cycles were completed or until unacceptable toxicity or disease progression were observed.

RESULTS

A total of 62 patients were enrolled. Of these patients, 18 (29%) had a confirmed partial response, whereas the disease remained stable in 34 patients (54.9%) and progressed in 10 patients (16.1%). The median overall survival (OS) was estimated at 14 months (95% CI, 11.8-16.2 months), and the median time to progression was 7 months (95% CI, 5.8-8.2 months). The difference in median OS between the epithelial histologic subtype (16 months) and the sarcomatoid subtype (11 months) was statistically significant.

CONCLUSION

This study confirmed the activity of the carboplatin/ pemetrexed combination in the first-line treatment of patients with MPM. It is a viable option, especially in cases in which side effects are generally anticipated.

Thrombotic microangiopathy associated with gemcitabine: rare but real

Gemcitabine-associated thrombotic thrombocytopenic purpura is a rare complication of gemcitabine treatment with an incidence ranging from 0.015 to 1.4%. Clinically, this disease manifests as haemolytic anaemia, thrombocytopenia and renal insufficiency; hypertension and neurological and pulmonary symptoms are also known complications. The risk of thrombotic thrombocytopenic purpura increases as the cumulative dose of gemcitabine approaches 20,000 mg/m(2). The pathophysiology of this disease entity is unknown although several theories, involving both immune and non-immune mechanisms, have been proposed. The most effective treatment is discontinuation of gemcitabine, the provision of antihypertensive medications as needed, and consideration of plasmapheresis or use of immunoadsorption column in severe cases.

Cell adhesion molecules: role and clinical significance in cancer

There is a growing body of evidence suggesting that alterations in the adhesion properties of neoplastic cells endow them with an invasive and migratory phenotype. Indeed, changes in the expression or function of cell adhesion molecules have been implicated in all steps of tumor progression, including detachment of tumor cells from the primary site, intravasation into the blood stream, extravasation into distant target organs, and formation of the secondary lesions. This review presents recent data regarding the role of cell adhesion molecules in tumor development and progress with concern to their clinical exploitation as potential biomarkers in neoplastic diseases.

The role of angiogenesis in solid tumours: an overview

Angiogenesis is the physiological process of the formation of new blood vessels from pre-existing ones. Multiple molecules regulate angiogenesis, such as the vascular endothelial growth factor, angiopoietins, the fibroblast growth factor, the platelet-derived growth factor and the transforming growth factor-beta. Angiogenesis plays an important role in the growth, progression and metastasis of a tumour. Inhibiting the angiogenic process or targeting existing tumour vessels can be used for treatment of tumours as an alternative or in parallel with conventional chemotherapy. Many anti-angiogenic factors are under investigation and some are already being used in clinical practice with various results.

Docetaxel plus gemcitabine as first-line treatment in malignant pleural mesothelioma: a single institution phase II study

BACKGROUND

The cisplatin-pemetrexed and cisplatin-gemcitabine combinations are considered the standard treatment for malignant pleural mesothelioma. The purpose of this study was to examine the efficacy of gemcitabine plus docetaxel in the first-line setting, as this combination has not been investigated in mesothelioma before.

PATIENTS AND METHODS

Twenty-five consecutive patients with malignant pleural mesothelioma were enrolled. They received 80 mg/m(2) of docetaxel and 1,000 mg/m(2) of gemcitabine on days 1 and 14 of a 28-day cycle. The treatment was scheduled for a maximum of 6 cycles or until disease progression or unacceptable toxicity.

RESULTS

A total of 7 out of our 25 patients (28%) responded to treatment. In 14 patients (56%), the disease remained stable, while in 4 (16%) it progressed. The median time to progression was 7 months (range: 5.4-8.6 months) and the median overall survival was 15 months (range: 12.4-17.5 months).

CONCLUSION

The administration of gemcitabine and doctaxel appears to be promising first-line therapy for patients with mesothelioma, as it is well tolerated and appears to improve survival.

Overexpression of hnRNPA2/B1 in bronchoscopic specimens: a potential early detection marker in lung cancer

BACKGROUND

Overexpression of heterogeneous nuclear ribonucleoprotein (hnRNP) A2/B1 has recently been suggested to be a promising marker for early detection of lung cancer. The aim of this study was to determine the utility of its detection in bronchoscopic specimens.

PATIENTS AND METHODS

Brushing and biopsy specimens were obtained from 61 patients suspected of having lung cancer, as well as from 30 healthy subjects (controls), who underwent bronchoscopy. hnRNPA2/B1 expression levels were evaluated by immunoblotting.

RESULTS

Specificity of hnRNP A2/B1 overexpression was 75.9% in brushing and 78.3% in biopsy. Sensitivity in non-small cell lung cancer was 84.8% in brushing and 80.8% in biopsies, while in small cell lung cancer it was 66.7 % and 75%, respectively. Overexpression of hnRNPA2/B1 was also detected in bronchoscopic specimens of nine patients initially undiagnosed. The follow-up of these patients 2 years later showed that seven of them had developed lung cancer.

CONCLUSION

Overexpression of hnRNPA2/B1 was significantly higher in patients suffering from lung cancer and may be useful in the early detection of lung cancer.