Efficacy Of Chemotherapy Regimens Research Articles

Oncological perspective on Kaposi sarcoma: A single-centre experience

Objective: Kaposi sarcoma (KS) presents as a multifocal angioproliferative disease with distinct four subtypes, including classical, AIDS-related(epidemic), endemic, and iatrogenic. The rarity of the disease and the clinically different characteristics of the subtypes have led to insufficient experience in treatment and follow-up. Based on this, we aim to investigate the clinicopathological features and treatment options of the KS patients treated and followed up in our clinic. Patients and Methods: The study included 66 patients diagnosed with KS by histopathological examination. KS subtypes, stages, distribution of lesions, chemotherapy regimens and efficacy of chemotherapy regimens were recorded. The efficacies of paclitaxel and pegylated liposomal doxorubicin (PLD) were compared. Kaplan-Meier and Cox regression analyses were used for statistical analyses. Results: Classical KS was the most common subtype (n=50), followed by AIDS-related (n=14) and iatrogenic (n=2) types. 32 patients received systemic treatment. In different lines, paclitaxel was administered to 32 patients and PLD to 12 patients. Disease control rate (DCR) was 78.1% for paclitaxel and 75% for PLD, while overall response rate (ORR) was 68.7% and 58.3%, respectively. Conclusion: Paclitaxel and PLD demonstrated efficacy in controlling aggressive KS. However, larger studies are warranted to further validate these findings and optimize chemotherapy strategies.

Advances of Treatment of Pulmonary Large Cell Neuroendocrine Carcinoma

Large cell neuroendocrine carcinoma (LCNEC) of lung is a rare neuroendocrine carcinoma subtype with difficulty in early diagnosis and poor prognosis which is treated with standard strategies of small cell lung cancer and non-small cell lung cancer. In recent years, the precise types of LCNEC and its response to therapy have been identified by next-generation sequencing. Some researches have also found the correlation between different subtypes of LCNEC and the efficacy of chemotherapy regimens. However, there is no consensual agreement of its therapy. Recently, immune checkpoint inhibitors (ICIs) has provided a new option for LCNEC patients based on some retrospective research data and case reports. In this review, we aimed to summarize the epidemiological characteristics, standard therapy, the advances of molecular subtypes and clinical applications of ICIs of LCNEC, so as to provide optimal systemic clinical decision-making for LCNEC patients. .

The Use of Rifapentine for Preventive Chemotherapy in Children from Risk Groups of Developing Tuberculosis

The objective: to compare efficacy of preventive treatment of children with latent tuberculosis infection using various regimens of anti-tuberculosis drugs and assess the risk of adverse events to these drugs.Subjects and Methods. 117 children of 2-17 years old with latent tuberculosis infection [a positive result of the test with tuberculous recombinant allergen (TRA)] were enrolled in the prospective study. They received preventive treatment with the regimen containing isoniazid and rifapentine. The comparison group included 84 children who received isoniazid and rifampicin.Results. In terms of safety and efficacy of chemotherapy regimens in the study, the best results were obtained when using the regimen containing isoniazid and rifapentine: the therapy was well tolerated, hepatotoxic reactions were registered in 1.7% of children. After a full course of preventive treatment in 24 months of follow-up, there was a statistically significant decrease in the proportion of hyperergic results of the skit test with TRA from 44 (41.9%) to 0 (0%) χ2 McNemar 43.00; p < 0.01; and conversion of the TRA test result from positive to negative was observed in 18.1% of children.

Management of Older Adults with Mantle Cell Lymphoma.

Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma that is largely a disease of older adults with a median age at diagnosis of 67years. MCL is considered incurable with current therapies and has historically been associated with a poor prognosis. A subset of patients will present with features of more indolent disease and can be safely observed for a period of time after diagnosis, but the majority will require treatment at some point in the disease course. Younger patients who are eligible to undergo intensive induction chemotherapy followed by consolidation with an autologous stem cell transplant can experience prolonged survival times with a median overall survival of 13years; however, there are limited data to support this treatment approach in older adults and these patients often have medical comorbidities that preclude such intensive therapy. Fortunately, an increased understanding of the disease biology has led to the development of novel therapies in recent years that are well-tolerated and have led to improved outcomes in this patient population. In this article, we will review the current treatment landscape for older adults with MCL, with a focus on the safety and efficacy of chemotherapy regimens and novel agents such as lenalidomide, bortezomib, and the Bruton's tyrosine kinase inhibitors that have been formally studied in this population.

Association Between RET Fusions and Efficacy of Pemetrexed-based Chemotherapy for Patients With Advanced NSCLC in China: A Multicenter Retrospective Study

BackgroundRearranged during transfection (RET) proto-oncogene gene fusions are rare in non–small-cell lung cancer (NSCLC). We compared the efficacy of pemetrexed-based chemotherapy with other chemotherapy regimens in patients with NSCLC with different RET fusion subtypes. Patients and MethodsA retrospective, multicenter study of patients with pathologically confirmed stage IIIB/IV lung adenocarcinomas was conducted. RET rearrangements were detected using next generation sequencing. We analyzed the clinical characteristics of patients with RET-rearranged NSCLC and the efficacy of chemotherapy regimens. We also evaluated the efficacy between groups of patients with and without KIF5B-RET–rearranged lung cancer. ResultsWe evaluated 62 patients with NSCLC and RET rearrangements, including 41 with KIF5B-RET, 15 with CCDC6-RET, and 6 with other rare fusion subtypes. Of these 62 patients, 50 had stage IIIB/IV. We also evaluated 40 patients with first-line chemotherapy information available. The median progression-free survival was significantly different between those receiving pemetrexed-based chemotherapy and those receiving other chemotherapy regimens (9.2 vs. 5.2 months; P = .007). The median progression-free survival for patients with KIF5B-RET fusion and non–KIF5B-RET fusion was not significantly different statistically (7.8 vs. 11.2 months; P = .847). For second-line chemotherapy, a statistically significant difference was found between the chemotherapy regimens (4.9 vs. 2.8 months; P = .049). Survival follow-up data were available for 38 patients with advanced NSCLC. The median overall survival was 26.4 months. The overall survival of the patients with RET-rearranged NSCLC who had received pemetrexed-based chemotherapy versus no pemetrexed-based chemotherapy was 35.2 versus 22.6 months (P = .052). No difference in survival was observed between the patients with KIF5B-RET and non–KIF5B-RET rearrangements. ConclusionsPemetrexed-based treatment should be considered first when selecting the chemotherapy regimen for patients with NSCLC and RET rearrangements.

New Treatment Options in Advanced Stage Follicular Lymphoma.

Follicular lymphoma is one of the most common non-Hodgkin's lymphomas with an expected survival of more than 20 years for the majority of patients. This impressive outcome has been achieved with the introduction of immunochemotherapy, as first line treatment with remissions lasting over 8 years, followed by other treatment options at first or subsequent relapse. However, certain groups of patients still have a poor prognosis. In recent years the efficacy of chemotherapy regimens has been augmented by new compounds selectively targeting the cell surface, intracellular pathways, and/or the microenvironment. Some of these are beginning to change the therapeutic landscape. This review summarizes prognostic factors in follicular lymphoma in order to identify patients with greatest medical need for these new treatment options and reviews recent data from prospective clinical studies testing new agents in first-line and relapsed follicular lymphoma. Finally, we assess the current role of immunochemotherapy and discuss the requirements for future clinical trials.

Standard chemotherapy with cetuximab for treatment of colorectal cancer.

To review and assess the evidence related to cetuximab treatment in metastatic colorectal cancer (mCRC) with regard to KRAS status. PubMed, EMBASE, Cochrane database and American Society of Clinical Oncology meeting abstracts were searched for randomized controlled trials (RCTs) reporting the effect of KRAS status on efficacy of chemotherapy regimen with or without cetuximab in mCRC. Baseline information such as sex and age was summarized from the included studies. Hazard ratios of progression-free survival (PFS) and overall survival (OS) as well as objective response based on KRAS status were extracted for analysis. A total of 8 RCTs with 6780 patients were included. The combined analysis showed that cetuximab failed to improve the OS and PFS in patients with mCRC. However, in subgroup analysis, the pooled data showed that addition of cetuximab to irinotecan containing chemotherapy regimen was sufficient to improve OS and PFS in wild-type KRAS mCRC patients, but not in patients with mutant-type KRAS. The addition of cetuximab increased the incidence of adverse events such as diarrhea, rash, skin toxicity/rash, and nausea and vomiting. There was no significant publication bias existing in the included studies. The clinical benefit of cetuximab was only confirmed in patients with wild-type KRAS. KRAS status could be considered a biomarker of efficacy of cetuximab.

PCN134 Effects of Clinical Pharmacist Interventions on Clinical Outcomes in Oncology Patients

To assess the effect of clinical pharmacist interventions on the clinical outcomes in oncology patients. A total of 100 patients received their chemotherapy cycles with clinical pharmacy interventions were enrolled in the present study during January 2007 to January 2008. Clinical pharmacy interventions include: Detecting medication errors by using a modified form of the American Society of Hospital Pharmacists (ASHP) worksheet. Correcting those errors and sending recommendations to the medical staff. The clinical pharmacy interventions reduced the number of medication errors from 1548 to 444 which was statistically significant (p=0.004). A total of 1104 clinical pharmacy interventions were documented in this present study. Forty-five percent of clinical pharmacy interventions have led to increase in the efficacy of chemotherapy regimen and 54.7% have led to decrease in the chemotherapy toxicity. Seventy six percent of the errors recorded in the present study occurred in the prescribing stage, about 20 % in the administration stage and 3.8% in the dispensing stage. The clinical pharmacy interventions among oncology patients can reduce the number of medication errors; improve the clinical outcomes through increasing chemotherapy efficacy and reducing the toxicity.

A target based approach identifies genomic predictors of breast cancer patient response to chemotherapy

BackgroundThe efficacy of chemotherapy regimens in breast cancer patients is variable and unpredictable. Whether individual patients either achieve long-term remission or suffer recurrence after therapy may be dictated by intrinsic properties of their breast tumors including genetic lesions and consequent aberrant transcriptional programs. Global gene expression profiling provides a powerful tool to identify such tumor-intrinsic transcriptional programs, whose analyses provide insight into the underlying biology of individual patient tumors. For example, multi-gene expression signatures have been identified that can predict the likelihood of disease reccurrence, and thus guide patient prognosis. Whereas such prognostic signatures are being introduced in the clinical setting, similar signatures that predict sensitivity or resistance to chemotherapy are not currently clinically available.MethodsWe used gene expression profiling to identify genes that were co-expressed with genes whose transcripts encode the protein targets of commonly used chemotherapeutic agents.ResultsHere, we present target based expression indices that predict breast tumor response to anthracycline and taxane based chemotherapy. Indeed, these signatures were independently predictive of chemotherapy response after adjusting for standard clinic-pathological variables such as age, grade, and estrogen receptor status in a cohort of 488 breast cancer patients treated with adriamycin and taxotere/taxol.ConclusionsImportantly, our findings suggest the practicality of developing target based indices that predict response to therapeutics, as well as highlight the possibility of using gene signatures to guide the use of chemotherapy during treatment of breast cancer patients.

Comparison of the Toxicities and Efficacies of the Combination Chemotherapy Regimens in Advanced Gastric Cancer Patients Who Achieved Complete Response after Chemotherapy

We retrospectively analyzed comparative toxicities and efficacies of chemotherapy regimens in advanced gastric cancer (AGC) patients who achieved complete response (CR) after chemotherapy. We reviewed the medical records of 1,203 patients, who were pathologically diagnosed as AGC in a single center between January 2001 and October 2007. On the basis of the Response Evaluation Criteria in Solid Tumors, CR was evaluated with abdominal computed tomography. Toxicities were evaluated using the National Cancer Institute's common toxicity criteria before each chemotherapy cycle. Among the 1,203 AGC patients enrolled in this study, 568 received chemotherapy and 635 received best supportive care. The major chemotherapy regimens were 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX), docetaxel, cisplatin and 5-fluorouracil (DCF) and 5-fluorouracil, leucovorin and irinotecan (FOLFIRI). Among the 568 patients, 51 (9.0%) achieved CR (49 [8.6%] with FOLFOX [n=12], DCF [n=26], or FOLFIRI [n=11] and 2 [0.3%] with etoposide, leucovorin and 5-fluorouracil). For patients administered FOLFOX, DCF, and FOLFIRI, the median time to disease progression was 4 months (range, 1.8-59.5), 15 months (range, 2.9-31.2) and 10 months (range, 2.0-39.5), and the median survival times were 48 months (range, 5.9-74.0), 37 months (range, 14.0-86.0), and 30 months (range, 6.0-50.0), respectively. Grades 3-4 mucositis occurred mostly in patients administered DCF (n=8, 30.8%). Grades 3-4 leucopenia were observed in 1 (8.3%), 11 (42.3%), and 4 (36.4%) patients administered FOLFOX, DCF and FOLFIRI, respectively. No statistically significant differences were observed in the 3 regimens. All 3 regimens (FOLFOX, DCF and FOLFIRI) were active and tolerable. Their efficacies and toxicities were not significantly different.

Variability in Determination of Body Weight Used for Dosing Busulphan and Cyclophosphamide in Adult Patients: Results of an International Survey

Fifty-two BMT institutions were sent a questionnaire asking for details of dosing for busulphan, cyclophosphamide (bu-cy), cyclosporin and methotrexate (CSA-MTX). The following data were requested: (a) the method used to determine the body weight for dosage calculations (b) the actual dose per weight and (c) the schedule of administration. Thirty-six (69%) institutions responded and 33 were evaluable. There was substantial variation in the method used to determine weight for bu-cy. No single method was used in more than 30% of units, although most units made some allowance for discrepancies between actual and ideal body weight. There was more uniformity in the method of weight determination for CSA-MTX, with the majority of units using actual body weight. Conversely, there was much more variation in the dose per weight formulae and schedules used for CSA-MTX than for bu-cy. These substantial differences highlight the importance of specifying these criteria when the toxicity and efficacy of chemotherapy regimens is reported and the need for further studies to determine the optimal weight formulae for dosage calculations.