Patient-tailored FOLFIRINOX as first line treatment of patients with advanced pancreatic adenocarcinoma

FOLFIRINOX is one of the most effective reference regimens in the 1st line treatment of locally advanced (LA) and metastatic pancreatic cancer (mPC), despite its high toxicity. We evaluated our real-life experience with "patient-tailored intent to treat FOLFIRINOX" in patients with LA or mPC compared to other reports along with the pivotal phase III trial.We analyzed data from all consecutive patients with pancreatic ductal adenocarcinoma treated with dose-modified FOLFIRINOX in 2016 at Paul Brousse University Hospital. Irinotecan was administered whenever initial serum bilirubin was <1.5 × upper limit of normal. Oxaliplatin was stopped for severe sensory neuropathy. Initial dose reductions were made according to patient profile (eg, age, comorbidities) and later due to toxicity. The treatment was continued until surgery or disease progression. Endpoints were time to progression (TTP), overall survival (OS), objective response rate (ORR), and secondary complete resection (R0R1).Thirty-seven patients with unresectable LA or mPC received patient-tailored FOLFIRINOX as 1st line chemotherapy. There were 22 male (59%) and 15 female patients (41%) aged 44 to 81 years with LA (18 patients, 49%) and mPC (19 patients, 51%). They had World Health Organization-performance status of 0 (59%) or 1 (41%). A total of 384 cycles were administered. Median dose intensities (mg/m/w) were 28.9 for oxaliplatin, 56.8 for irinotecan, and 886.2 for 5-fluorouracil. Thirty-four patients were assessed for response; ORR and disease control rates were 47% and 85%, respectively. R0R1 rate was 30%. Median TTP and OS were 9.6 and 14.6 months. LA disease was associated with significantly longer TTP and OS (P < .001).FOLFIRINOX with patient-tailored dose adaptations seems to offer better results in patients with advanced PC. This approach in the neoadjuvant setting results in a macroscopic R0R1 in 61% of patients with initially unresectable disease. It deserves prospective evaluation to further improve outcomes in the management of advanced PC.

Patient-tailored FOLFIRINOX in the first-line treatment of patients (pts) with advanced pancreatic cancer (PC)

499

Background: FOLFIRINOX is an effective reference regimen in the 1st line treatment of advanced PC, despite its high level of toxicity. We report recent data from pts treated with this regimen at Paul Brousse university hospital. Methods: From January to December 2016, 37 pts with advanced PC received patient-tailored FOLFIRINOX as 1st line intent to treat chemotherapy. The first 1 to 3 courses were administered without irinotecan if initial serum bilirubin was ≥ 1.5 x upper limit of normal. Oxaliplatin was stopped for severe sensory neuropathy. Initial dose reductions were made according to pt profile (e.g., age, comorbidity) and later due to toxicity. The treatment was continued until surgery or disease progression. Endpoints were time to progression (TTP), overall survival (OS), objective response rate (ORR) and secondary complete resection (R0R1). Results: There were 22 male (59%) and 15 female pts (41%) aged 44 to 81 years (median: 64). They had locally-advanced (18 pts, 49%) and metastatic PC (19 pts, 51%). PC was head, body, tail located in 24 (65%), 8 (22%) and 5 pts (14%) respectively. Biliary stent was placed in 22 pts (59%). Pts had a performance status (PS) of 0 (60%) or 1 (40%). Median treatment duration was 20 weeks for oxaliplatin, 22 weeks for irinotecan, 23 weeks for 5FU. At the cut-off on April 27th 2017, protocol was ongoing for 11 pts (30%). Median number of cycles was 9 (2-20). Median dose intensity was 29 mg/m2/w for oxaliplatin, 57 mg/m2/w for irinotecan and 886 mg/m2/w for 5FU. We observed 4 CR (11%), 12 PR (32%), 12 SD (32%) and 5 PD (14%). Four pts were not evaluable. ORR was 43%, disease control rate 75%, 11 pts (30%) underwent R0R1 resection. After a median follow-up of 8 months (1 - 16), median TTP and OS were not reached. TTP was associated with body location (HR = 3.5 [95% CL, 1.1-11.0], p = 0.033) and disease stage (HR = 10.5 [2.2-49.5], p = 0.003), a trend was observed with biliary stent placement (HR = 0.4 [0.1-1.1], p = 0.067). Conclusions: Modified FOLFIRINOX with patient-tailored dose adaptations seems to offer better results in pts with advanced PC compared with classic FOLFIRINOX. This strategy deserves prospective evaluation to further improve clinical outcomes in the management of advanced PC.

Larynx preservation: what is the best non-surgical strategy?

The concept of larynx preservation in locally advanced laryngeal or hypopharyngeal squamous cell carcinoma has evolved during the last three decades, especially with the advancement of nonsurgical strategies. These nonsurgical strategies include: (1) radiotherapy alone; (2) concomitant chemoradiotherapy (CCRT); and (3) induction chemotherapy followed by radiotherapy or CCRT and concurrent anti-epidermal growth factor receptor (EGFR). To date, the best approach for larynx preservation has yet to be defined. In this article, we review and discuss important recent randomized phase II/III trials investigating larynx preservation in order to facilitate the selection of an appropriate strategy in the clinical setting. However, the decision of larynx preservation should always be a multidisciplinary approach.

Primary anorectal melanoma: A case report with extended follow-up

Background:

Anorectal melanoma is a rare and aggressive disease. The mainstay of treatment is usually surgical with curative or palliative intent, since radio- and chemotherapy do not really improve the outcome. The poor prognosis is attributable to delay in diagnosis and its inherent biologic aggressiveness.

Case Report:

We present a case of anorectal melanoma in a 68-year-old man who underwent solely abdominoperineal amputation and was doing well 30 months after surgery, without any evidence of recurrent disease.

Conclusions:

Treatment of anorectal melanoma should be by the least morbid means possible. Surgical procedure that can achieve a complete local excision and respect the functional aspects and quality of life of the patient remains the best therapeutic approach. No systemic regimen for metastatic anorectal melanoma is considered standard of care.

Systemic therapy in the management of metastatic or advanced salivary gland cancers

Salivary gland cancers are very rare tumors. They are characterized by a histologic heterogeneity and a poor outcome. According to this rarity, few prospective data are available to date. No standard recommendations could be held for the use of systemic therapy in these tumors. Several case reports and small studies have investigated the contribution of different agents of chemotherapy. With the extension of molecular biology approach in oncology several signaling pathways have been discovered in different cancers including salivary gland cancers; thus a number of targeted therapies have been investigated. This paper reviewed exhaustively the studies investigating the role of systemic therapies (chemotherapy, targeted therapy, hormone therapy) in salivary gland cancers.

Cardiac Hydatid Cyst Rupture as Cause of Death

Echinococcosis is a frequent parasitic human infection in sheep-farming areas. It is caused by the larval or the cyst stage of a tapeworm, mainly Echinococcus granulosis. Humans can be infected by ingesting tapeworm eggs, from which cysts will be developed mostly in the liver and the lung. Cardiac involvement of echinococcosis is rare and its clinical evolution is silent till the complication stage. A young adult died suddenly. The autopsy showed a ruptured hydatid cyst hollowed on the right side of the interventricular septum, protruding in the ventricle. The left pulmonary artery contained white-colored fragments of a membrane, similar to the one found in the right ventricle, associated to small vesicles. All these elements were obstructing this vessel, extending to small pulmonary arterial branches. Dissection of the other organs did not show other locations. Microscopic examinations ascertained the diagnosis of echinococcosis. Death was imputed to a right ventricular hydatid cyst rupture with pulmonary artery embolism.