Medical oncology
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Randomized Controlled Trial Multicenter Study
Transfusion risk in cancer patients with chemotherapy-induced anemia when initiating darbepoetin alfa therapy at a baseline hemoglobin level of <9 g/dL versus 9 to <10 g/dL versus ≥ 10 g/dL: an exploratory analysis of a phase 3 trial.
Darbepoetin alfa (DA) is an erythropoiesis-stimulating agent (ESA) approved for treating chemotherapy-induced anemia (CIA). Safety concerns have prompted changes to the ESA-product information, which now recommends initiating ESAs at hemoglobin (Hb) levels < 10 g/dL (US) or ≤ 10 g/dL (EU). The present exploratory analysis of a DA trial examined how baseline-Hb levels at ESA initiation affect transfusion rates, Hb response, and safety outcomes in CIA patients. ⋯ Overall, transfusion risk increased and Hb response decreased at lower baseline-Hb levels in this exploratory analysis. When following ESA-product information to initiate ESAs at Hb ≤ 10 g/dL, the greatest benefit may be achieved when initiating close to 10 g/dL. Prospective studies are needed to further examine this hypothesis.
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Gastrointestinal stromal tumors (GISTs) are the most common human sarcoma. Most of the data available on GISTs derive from retrospective studies of patients referred to oncology centers. The MolecGIST study sought to determine and correlate clinicopathological and molecular characteristics of GISTs. ⋯ KIT and PDGFRA mutations were detected in 348 (71%) and 74 (15%) patients, respectively, contrasting with 82.8 and 2.1% in patients with advanced GIST (MetaGIST) (P < 0.0001). Further comparison of localized GISTs in the MolecGIST cohort with advanced GISTs from previous clinical trials showed that the mutations of PDGFRA exon18 (D842V and others) as well as KIT exon11 substitutions (W557R and V559D) were more likely to be seen in patients with localized GISTs (odds ratio 7.9, 3.1, 2.7 and 2.5, respectively), while KIT exon 9 502_503dup and KIT exon 11 557_559del were more frequent in metastatic GISTs (odds ratio of 0.3 and 0.5, respectively). These data suggest that KIT and PDGFRA mutations and standardized mitotic count deserve to be investigated to evaluate the relapse risk of GISTs.
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The purpose of this study was to investigate the feasibility and efficacy of pirarubicin (THP)-cisplatin (DDP) chemotherapy for refractory and recurrent high-grade osteosarcoma. Between 2008 and 2010, 23 patients with refractory and recurrent high-grade osteosarcoma were included in this analysis. THP was given at a dose of 50 mg/m(2) i.v. d1 and DDP 100-120 mg/m(2) i.v. d2-3 every 3 weeks. ⋯ Major severe toxicities were grade 3 or 4 leucopenia occurred 12 times (17.7%) in total cycles; Mild toxicities included grade 1 or 2 nausea and vomiting (80.9%), leucopenia (61.8%), fatigue (50.0%), and alopecia (79.4%). THP-DDP regimen chemotherapy represents an active and well-tolerated treatment for Chinese refractory and recurrent high-grade osteosarcoma patients. Further assessment is necessary to confirm the safety and efficacy of this treatment.
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The purpose of this study was to explore the accuracy of (18)F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) in the assessment of mediastinal lymph node in coal workers who had non-small cell lung cancer. We retrospectively reviewed 42 retired coal workers who had lung cancer without distant metastasis, between May 2007 and May 2010. Regarding the mediastinal lymph nodes, when the standard uptake value was greater than 2.5, it was considered "malignancy positive." After histological examination of the mediastinal lymph nodes, anthracotic and metastatic ones were detected. ⋯ The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET/CT in detecting nodal metastases were 84% (16/19), 65% (15/23), 66% (16/24), 83% (15/18), and 74% (31/42) on a per-patient basis, respectively. Mediastinal node staging with FDG-PET/CT in coal workers is insufficient due to the high false-positive rates due to the presence of pneumoconiosis. In these patients, an invasive technique such as mediastinoscopy seems mandatory for confirmation of ipsilateral or contralateral mediastinal lymph node metastasis.
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The association of prolonged rituximab therapy and hepatitis B virus (HBV) reactivation in diffuse large B-cell lymphoma (DLBCL) and the role of lamivudine prophylaxis remain undefined. The prevalence and mortality of HBV reactivation in HBsAg-positive patients with DLBCL undergoing rituximab-based treatment, who received prophylactic treatment with or without lamivudine, were retrospectively analyzed. From January 2003 to December 2009, there were 50 patients enrolled in the study, among of which 30 received the prophylactic treatment of lamivudine and 20 without prophylactic treatment of lamivudine. ⋯ The effect of lamivudine prophylaxis on preventing HBV reactivation was found to be less in patients undergoing longer duration of rituximab treatment. A longer duration of rituximab treatment contributed to higher morbidity and mortality of HBV reactivation in HbsAg-positive patients with DLBCL. Further study is warranted for the optimal management of hepatitis caused by HBV reactivation.