First Course Of Chemotherapy Research Articles

Anticancer drugs utilization for initiation phase of breast and cervical cancers chemotherapies in a Nigerian tertiary hospital

Background: Selection of anticancer drugs for initiation of chemotherapy is an important determinant of whether the patient would continue the chemotherapy, switch to another agent and discontinue after the first course of chemotherapy. Therefore, it is important that attention should be given to the initiating agents, their side effects and general safety of the patients. Objectives: This study assessed the utilization of anticancer drugs at the first course of breast and cervical cancers chemotherapies over a five-year period (2012 - 2016) in Oncology unit of Ahmadu Bello University Teaching Hospital (ABUTH), Shika, Kaduna State. Methods: This retrospective study audited 1000 randomly selected folders (100 folders each for breast and cervical cancer per year), resulting in 500 folders each for breast and cervical cancer patients. Results: Majority (31% vs 29%) were in the age bracket of 40 to 49 years for breast and cervical cancers respectively. About 79% and 97% of the anticancer and antiemetic drugs respectively were prescribed by their generic names. The most utilized anticancer drugs for initiation of chemotherapy of 500 patients with breast or cervical cancer within the study period for breast versus cervical cancer, respectively, were Cisplatin (1140 vs 624 DUs), 5-Fluorouracil (860 vs 292 DUs) and Paclitaxel (709 vs 319 DUs). The widely utilized antiemetic agents for prevention or management of Nausea and Vomiting at the initiation of chemotherapy of 500 patients with breast or cervical cancer during the study periods for breast versus cervical cancer, respectively, were Dexamethasone (1940 vs 1260 DUs), Metoclopramide (1220 vs 320 DUs), and Ondansetron (1080 vs 300 DUs). Conclusion: Cisplatin and Dexamethasone were most utilized anticancer and antiemetic drugs respectively for initiation of chemotherapy for both breast and cervical cancers in the studied hospital. Keywords: Drug utilization, Nigeria, Breast cancer, cervical cancer, chemotherapy

Serum urea nitrogen and creatinine changes and its clinical significance in children with retinoblastoma before and after chemotherapy

Objective To analyze the alterations in blood urea nitrogen (BUN) and serum creatinine (Scr) in children with retinoblastoma(Rb) before and after chemotherapy and the clinical significance of the chemotherapy effect, and to provide the evidence for the further improvement of the safety of treatment. Methods A total of 280 children with Rb were enrolled in the study, and each of them was treated with CEV (Carboplatin+ Etoposide+ Vincristine) methods.There subjects included 153 males and 127 females, with a mean treatment of 4.5 cycles (range 2 to 12 cycles) and a mean age of 21.5 months (range 1 to 84 months). Among them, 149 cases were diagnosed clinically, 131 cases were diagnosed pathologically.Eight cases were in the extraocular stage, 3 cases were in glaucoma and 269 cases in intraocular period(101 cases of single eyes and 168 cases of double eyes). BUN and Scr were detected before the first course of chemotherapy and after the last course of chemotherapy. Results BUN and Scr values were analyzed before and after chemotherapy.BUN was 3.05 mmol/L before chemotherapy and 3.46 mmol/L after chemotherapy in the group aged from 4 months to less than 12 months (73 cases), the values of BUN after chemotherapy was higher than that before chemotherapy, and only in this group the change was statistically different (t=-2.829, P=0.006), but all BUN values in this group were not beyond the highest reference value(1.70 mmol/L-7.10 mmol/L). Before initial chemotherapy, 149 patients(53.2%) had Scr below the reference range(male: 30-104 μmol/L, female: 30-84 μmol/L), and 20 cases(7.0%) had the BUN below the reference value.In 2 cases, BUN(7.25 mmol/L and 7.34 mmol/L, respectively)before the initial chemotherapy was slightly higher than the normal value, but the value was normal(5.01 mmol/L and 4.98 mmol/L, respectively)after the last chemotherapy.In one case, the BUN(5.62 mmol/L)was normal before the initial chemotherapy, but it was elevated(7.33 mmol/L) after the last chemotherapy.In another one case, the BUN was normal before and after chemotherapy, but the value after chemotherapy was 4.69 times higher than that before chemotherapy. Conclusions Renal function of Rb children before treatment is normal.Seven percent of these patients have BUN under the BUN reference range, and 53.2% of these patients have Scr under the Scr reference range.It suggested that the reference values of BUN and Scr need to be adjusted.BUN of infant Rb may increase significantly after chemotherapy, but it does not meet the current diagnostic criteria of mild nephrotoxicity.Still, the early renal damage needs to be noticed. Key words: Retinoblastoma; Blood urea nitrogen; Serum creatinine; Clinical significance; Chemotherapy

Alterations in multipotent mesenchymal stromal cells from the bone marrow of acute myeloid leukemia patients at diagnosis and during treatment

We analyzed multipotent mesenchymal stromal cells (MMSCs) from the bone marrow (BM) of 33 acute myeloid leukemia (AML) patients at diagnosis, after the first course of chemotherapy (day 37), and at days 100 and 180 after diagnosis. All patients were treated according to the AML 01.10 protocol. Cumulative production of MMSCs from AML patients at diagnosis was normal but increased during treatment. Most of the studied genes were upregulated at AML diagnosis, some (IL6, IL1B, LIF) remained upregulated during treatment, and others were downregulated (FGFR1, ICAM1) or normalized. A few genes were normal at diagnosis but decreased during treatment (FGF2, FGFR2, VEGF, SDF1, SOX9, TGFB1). The upregulation of proinflammatory genes both at diagnosis and during remission reflects ongoing inflammation. PDGFRB expression was upregulated in MMSCs from patients in relapse versus those in remission. The AML 01.10 protocol downregulates the expression of genes related to proliferation, differentiation and niche formation.

Study of clinical outcome and prognosis in pediatric core binding factor-acute myeloid leukemia

目的分析儿童核心结合因子相关性急性髓系白血病（CBF-AML）的疗效及预后因素。方法对2005年8月至2017年9月收治住院的初诊CBF-AML患儿共121例进行回顾性研究。采用Kaplan-Meier曲线评估患儿的累积复发率（CIR）、无事件生存（EFS）率和总生存（OS）率，Cox回归模型评估预后因素。结果121例患儿中，120例有化疗后骨髓缓解情况评估结果，1个疗程后完全缓解（CR）100例（83.3%），2个疗程后CR 119例（99.2%）。121例患儿中复发13例（10.7%），中位复发时间13.8（3.7~58.8）个月，死亡17例（14.0%）。全部患儿3年CIR、EFS、OS率分别为12.7%、77.5%、82.8%。对发病时年龄、性别、初诊时WBC、是否有髓外白血病、是否伴C-KIT突变、是否有附加染色体异常、第1个疗程是否达CR等进行Cox多因素回归分析，只有伴附加染色体异常是影响患儿OS的独立危险因素（HR=4.289，95%CI 1.070~17.183，P=0.040）。结论儿童CBF-AML是一组独特的预后亚型，化疗疗效较好，伴附加染色体异常是影响患儿OS的独立危险因素。

Microflora analysis in the postchemotherapy patients of oral cancer.

Background:To assess changes in oral microflora in dental plaque from cancer patients within 7 days of the first course of chemotherapy and the relationship of the changes with mucositis.Materials and Methods:Thirty cancer patients, divided into a test group undergoing chemotherapy and a control group not undergoing chemotherapy, were enrolled in this pilot study. Oral microflora was cultured from three samples of dental plaque at t0 (before chemotherapy), t1 (1 day after chemotherapy), and t2 (7 days after chemotherapy). Single and crossed descriptive analyses were used to establish prevalence, and the Chi-square test was used to establish the statistical significance of the differences observed in distributions (significance level: P < 0.05).Results:In most patients (55%), oral microflora consisted mainly of Gram-positive cocci, while the remaining 45% of the bacterial flora also had periodontal-pathogenic species. No Porphyromonas gingivalis appeared in the test group. Actinobacillus was the least frequently found bacterium among periodontal pathogens in the test group, while Fusobacterium nucleatum was the most frequently found. No significant differences were found in quantitative bacterial changes between t0, t1, and t2 in either the test or control groups, or between the two groups. According to World Health Organization scores, oral mucositis developed in 10 patients (66.6%) in the test group.Conclusions:The results of this pilot study indicate that there were no changes in microflora in dental plaque in cancer patients within 7 days of the first course of chemotherapy. No correlations between oral mucositis and specific microorganisms were assessed.

IMPACT OF POLYCHEMOTHERAPY ON THE ORAL SOFT TISSUES IN CHILDREN WITH MALIGNANT ABDOMINAL TUMORS

Introduction: According to modern standards of treatment of malignant neoplasms conducting polychemotherapy requires up to 90% of cancer patients. However, in addition to the expected cytotoxic effects, it is accompanied by disorders in dental health in the vast majority of patients. The aim: To study the effect of cytostatics on soft tissues of the oral cavity in children with malignant tumors of the abdominal cavity. Materials and methods: Material for writing this scientific work served as a synthesis of results for 25 people aged 7 to 15 years with malignant tumors of the abdominal cavity, in which a comprehensive oral examination was performed to determine the manifestations of dental toxicity cytostatics. Results: At the end of the first course of chemotherapy, all patients had dry redness of the lips, 20 - (80,0%) with eruptions, in 18 - (20,0%) erosion. The Green-Vermillion, PMA, and PBI indices grew by 1,8; 7 and 3,3 times respectively. In cytograms with buccal epithelium an increase in the number of cells of polymorphic sizes and forms with signs of gidropic dystrophy was found. The nuclear-cytoplasmic ratio decreased by 1,4 times compared with the primary examination. Conclusions: This situation creates the preconditions for the development of inflammatory process in the tissues of the oral cavity and requires the use in this category of patients of a substantiated pathogenetic correction of existing disorders.

Changes in Oral Microflora Related to Immunosuppressive Chemotherapy in Denture Wearing Cancer Patients

Objective: To investigate changes in oral microflora in oral cavity from denture wearing cancer patients within seven days of the first course of chemotherapy, and the association between these changes and the distressing oral problems of the patients. Material and methods: Prospective uncontrolled study design was carried out with sixty cancer patients were enrolled in this study. Oral microflora of the buccal mucosa was cultured from two saliva samples before chemotherapy and after receiving the first dose of chemotherapy. Convenience-based sampling method was used based on the patient availability on recruitment days. Informed consent was obtained from the patients for enrollment in the present study. Results: The results from this study have shown that in general, no statistically significant differences were found in the existence of bacteria between before and after chemotherapy, there is no association between the changes of bacterial types and chemotherapy. Types and number of oral bacteria were found to correlate to degree of oral health care or oral hygiene, saliva, and gender, and there is a direct relation between chemotherapy and decrease saliva amount and viscosity and the development of bad oral habits after chemotherapy in these patients. Conclusion: the results of this study indicate that there were no changes in the microflora in the oral cavity in denture wearing cancer patients within seven days of the first dose of chemotherapy. No correlations between oral mucositis and specific microorganisms were assessed.

Implementation of a Telechemotherapy Module in the Peruvian Jungle with Adequate Quality of Life: Breaking the Access Gaps to Health with Teleoncology

Background: Cancer is a leading cause of death worldwide as well as in Peru. The national cancer plan includes decentralization, but one of the greatest barriers is our complicated geography. San Martin is a department located in the Peruvian jungle where there are no public services for cancer care. Our aim was to implement a “distance telemedicine-enabled” outpatient chemotherapy module, monitored by oncologists. Methods: The implementation was conducted in 3 stages: 1) Planning and Organization: working teams were formed, a chemotherapy room was developed and people were trained. 2) Execution: patients from San Martin region, aged >18 years with pathological confirmation of cancer, requiring systemic chemotherapy, ECOG <3, and first course of chemotherapy received at INEN without adverse reaction were selected. 3) Evaluation: adverse events, cost-user evaluation and quality of life (QoL) were assessed. Results: By November 2015, a module with a chemotherapy room with 18 chairs, a pharmacy, a hospitalization room, 1 medical office, a training room, a nutrition area, and a nursing station was implemented. 3 physicians, 3 nurses and 1 pharmacist were trained. Through March 2018, 501 sessions of teleoncology were completed to deliver 232 cycles of chemotherapy for 56 patients aged 19 - 78 years with different solid tumors, with no serious adverse event, without negatively affecting their QoL, and with an average out-of-pocket expense saving of 500 PEN. Conclusions: Using information and communication technology, a telechemotherapy module was successfully implemented in the Peruvian jungle, without adversely affecting the QoL of patients. Neither patients nor family members needed to travel to Lima to receive chemotherapy. This first program can be replicated in other rural and remote regions through non-specialized personnel and facilities, providing chemotherapy services equivalent to a tertiary center through trained health care professionals, supported through telemedicine.

Inhibition of autophagy by chloroquine makes chemotherapy in nasopharyngeal carcinoma more efficient

ObjectivesA combination of platinum-based chemotherapy and radiotherapy is the standard treatment for nasopharyngeal carcinoma (NPC). However, the efficacy of chemotherapy has reached a plateau. Many autophagy studies suggest that autophagy can either promote or suppress to cancer progression. Thus, a role of autophagy in the acquisition of chemoradioresistance has recently been a notable event. Therefore, we examined the relationship between autophagy and chemotherapy in NPC. MethodsThe expression of Beclin 1 and microtubule-associated protein light chain 3 (LC3), a marker of autophagy, was determined by immunohistochemistry in the biopsy samples of patients with NPC before and after the first course of chemotherapy. Additionally, to investigate in the effect of autophagy suppression in chemotherapy, NPC cell line C666-1 cells were treated with cisplatin and/or chloroquine, an inhibitor of autophagy. ResultsThe expression of Beclin 1 increased after chemotherapy in all patients. In NPC cell line C666-1, compared to cisplatin alone, combination therapy (cisplatin and chloroquine) reduced cell viability, and promoted cell apoptosis. ConclusionsThese results suggest that autophagy, represented by Beclin 1, is upregulated after chemotherapy in both in vitro and in vivo NPC studies. Inhibition of autophagy could therefore be new strategy for NPC treatment.

Favorable Inductive Remission Rate of Decitabine Combined Chemotherapy on < 60-Years of Age MDS-like AML in the First Course

Background: Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) includes a history of myelodysplasia syndrome (MDS) and no MDS history (30% of AML, MDS-related cytogenetic abnormalities, and multilineage dysplasia) which was called MDS-like AML. We assume that traditional AML therapy combined with decitabine (DAC) may improve the effectiveness. We retrospectively analyzed 98 patients diagnosed as MDS-like AML and evaluated the curative effect and side effects of decitabine combined chemotherapy comparing to standard 3+7 induction protocol.Patients and methods:This study analyzed AML patients aged 14-60 (exclude M3) diagnosed between 2014 to 2017. All patients were supposed to be on at least one of the conditions below: ① anemia, leucopenia, or thrombocytopenia for over 6 months; ② macrocytic anemia (MCV>95.0fL); ③ observation of marrow dyshaematopoiesis; ④immature cells >20% but with low percentage; ⑤FISH detected 5q-, 7q-, +8 or 20q-; ⑥methylation related gene mutation. Ninety-eight eligible patients were included (51 in DAC group; 47 in non-DAC group). 1. DAC group: 22 patients were treated with DAC+CAG, which included decitabine of 20 mg/m2 intravenously d1-5 and G-CSF of 300μg/day (d0-9) for priming combined with cytarabine of 20 mg/m2 for d3-9, aclarubicin of 7 mg/m2 d3-6. 29 patients received DAC+IA/MA regimen (IA for 25 cases, MA for 4 cases), included decitabine of 20 mg/m2 intravenously d1-5 combined with a standard “3+7” induction chemotherapy using standard dose of cytarabine (100 mg q12h) intravenously for day1-7 with idarubicin or mitoxantrone of 8 mg/m2 d1-3. Non-DAC group: all 47 patients were treated with standard 3+7 induction chemotherapy using cytarabine combined with idarubicin or mitoxantrone (IA for 41 cases, MA for 6 cases, the dose and usage are the same as before).Results:In DAC group, the overall response rate after first course of induction therapy was 90.2%vs. 78.7% in non-DAC group, including 84.3% CR vs. 63.8% in non-DAC group (p=0.023). Curative effects in favorable prognosis group showed no pertinence to decitabine (85.7% vs. 92.3%, p=1.000). The decitabine combined therapy showed a favorable inductive remission rate of 81.6% in intermediate- or high-risk patients, while 54.5% in non-DAC group (p=0.020) (Table 1). Six patients were DNMT3A mutation positive in DAC group,. After the first course of chemotherapy, 4 reached CR (CR%=66.7). 16 patients were TET2 or ASXL1 mutation positive, with respective remission rate of 81.3% and 87.5% at the end of the first course. On hematologic toxicities, comparing with non-DAC group, the combined therapy did not extend the duration of agranulocytosis (p=0.0965) and platelet recovery time (p=0.1335). Relatively, DAC+CAG protocol had reduced the amount of infused suspension of red blood cells. Infection incidence showed no obvious difference between groups.Conclusions:Decitabine combined chemotherapy could improve the inductive remission rate on MDS-like AML patients under 60 years old in the first course. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Granulocyte colony stimulating factor priming chemotherapy is more effective than standard chemotherapy as salvage therapy in relapsed acute myeloid leukemia

Introduction and objectiveTo improve the complete remission (CR) rate of newly diagnosed acute myeloid leukemia (AML) patients and alleviate the severe side effects of double induction chemotherapy, we combined a standard regimen with granulocyte colony-stimulating factor (G-CSF) priming chemotherapy to compose a new double induction regimen for AML patients who failed to achieve CR after the first course. Patients and methodsNinety-seven patients with AML who did not achieve CR after the first course of standard chemotherapy were enrolled. Among them, 45 patients received G-CSF priming combined with low-dose chemotherapy during days 20–22 of the first course of chemotherapy, serving as priming group, 52 patients were administered standard chemotherapy again, serving as control group. ResultsBetween the two groups there were no differences in the French–American–British (FAB) classification, risk status, the first course of chemotherapy, blood cell count or blasts percentage of bone marrow before the second course. But the CR rate was significantly higher and the adverse effect was much lower in the priming group than the control group. Cox multivariate regression analysis showed that WBC level before the second course and the selection of the second chemotherapy regimen were two independent factors for long survival of patients. DiscussionThese results elucidate that standard chemotherapy followed by G-CSF priming new double induction chemotherapy is an effective method for AML patients to improve CR rate and reduce adverse effects.

PC02.03 BID Radiation - CON

PC02.03 BID Radiation - CON

914P - Intermediate prognosis in metastatic germ cell tumors (IPGCT): Outcome and prognostic stratification

Background: Germ cell tumor patients with intermediate prognosis (IPGCT) according to the IGCCCG classification represent a heterogeneous group exhibiting a variety of clinical features. We established a registry to identify prognostic markers to further characterize IPGCT. Methods: A retrospective observational study was performed. Eligibility criteria were intermediate prognosis according to IGCCCG criteria, male sex, age ≥16 years. Patients were diagnosed from 1979 to 2014. Clinical characteristics were evaluated with uni- and multivariate analyses to detect new prognosticators. AFP and HCG were available in 85% and LDH levels in 72% of the cases, respectively. Overall survival (OS) was the primary endpoint. Results: The database included n = 707 IPGCT with a median follow-up of 8.6 years (IQR: 14.4). First line cisplatin-based chemotherapy was administered to 701 patients (99%) and the 5-year OS rate was 87%. First diagnosis in the 1980s (n = 115), the 1990s (n = 158), and after 2000 (n = 434) were associated with 5-year OS rates of 81%, 85%, and 89%, respectively. Statistical analyses revealed AFP and LDH, but not HCG levels prior chemotherapy as prognosticators. A patient stratification according to AFP levels 2000 to 5000 IU/ml (n = 93) and >5000 (n = 74) IU/ml prior first course of chemotherapy, revealed a significant correlation between AFP levels and OS, associated with 5-year OS rates of 89%, 87%, 86% and 82%, respectively (p = 0.037). LDH levels prior chemotherapy also correlated with outcome, associated with five-year OS rates of 92% for 3 to 4 ULN (n = 37), and 78% for >4 ULN (n = 89), respectively (p = 0.011). In multivariate analysis cut-off values of AFP levels >6000 IU/ml (p = 0.036; HR 2.096) and LHD levels >2 ULN (p = 0.02; HR 2.121) or > 3 ULN (p = <0.001; HR 2.305) were independent prognosticators for OS. Conclusions: Prognostication according to LDH and AFP levels prior chemotherapy could offer a new approach to stratify IPGCT. The largest fraction of patients had AFP levels <2000 IU/ml and LDH <2 ULN associated with an outcome similar to the good prognosis category. These results need to be confirmed in the upcoming IGCCCG reclassification. (Less)

A male with multiple cardiac masses

SummaryThirty-seven-year-old male presented with cough, dyspnea, significant weight loss (20 kg) and subacute fever for the past 2 months. Physical examination revealed inspiratory and expiratory wheezing bilaterally. A normal S1, S2 and a 3/6 systolic ejection murmur at the left upper parasternal border with respiratory variation were found during cardiac auscultation. Kidney and bone marrow biopsy reported a high-grade B-cell lymphoma. Echocardiography and cardiac CT findings consisted of multiple intracardiac masses affecting the right ventricular (RV) outflow track, RV apex, medial portion of the right atrium and posterior left atrium, as well as mild impairment of the RV systolic function. The masses in the RV outflow track caused partial obstruction (pulmonary valve peak velocity 2.3 m/s) with a RV systolic pressure of 43 mmHg. The infiltrative mass in the interatrial septum extended into both the right and left atrial cavities. The right superior pulmonary vein was occluded. This patient was treated with aggressive chemotherapy and had a good clinical response that resulted in mass size reduction after the first course of chemotherapy. Multimodality imaging techniques such as echocardiography, cardiac CT and PET scan can provide complementary information to better evaluate, stage and manage these patients.

Effects of gene polymorphisms on the risk of severe hyponatremia during DCF chemotherapy for patients with esophageal squamous cell carcinoma.

Combination chemotherapy using docetaxel, cisplatin and 5-fluorouracil (DCF) is a promising treatment option for patients with advanced esophageal squamous cell carcinoma (ESCC), although its clinical application is limited by severe systemic toxicities. There are no validated markers for predicting the adverse effects caused by this regimen. This pharmacogenetic study enrolled 57 patients with chemotherapy-naive advanced ESCC between July 2012 and March 2016 (UMIN000008462). All patients received at least one course of DCF chemotherapy (docetaxel, 60 mg/m2 on day 1; cisplatin, 70 mg/m2 on day 1; 5-fluorouracil, 600 mg/m2 on days 1-5). The associations between four gene polymorphisms (ERCC1 rs11615, GSTP1 rs1695, TYMS rs151264360 and XPD rs13181) and the development of grade 3/4 adverse events during the first course of chemotherapy were prospectively investigated. The patients had a median age of 66 years (range, 45-77 years) and the majority were male (51 males vs. 6 females). The treatment settings were neoadjuvant (47 patients), adjuvant (1 patient) and salvage (9 patients), with dose intensities of 100% (51 patients) or 80% (6 patients). The severe adverse events were leukopenia (70.2%), neutropenia (86.0%), febrile neutropenia (36.8%), acute kidney injury (29.1%) and hyponatremia (43.9%). Two polymorphisms were independently associated with the development of severe hyponatremia among patients carrying the minor allele (vs. patients with major homozygote genotype): TYMS 3'-UTR rs151264360 (odds ratio, 3.64; 95% confidence interval, 1.11-11.9) and XPD Lys751Gln rs13181 (odds ratio, 10.1; 95% confidence interval, 1.10-93.3). Therefore, the presence of the TYMS and XPD polymorphisms may aid in identifying patients with a high risk of developing severe hyponatremia during DCF chemotherapy.

Clinical features and prognosis of acute myeloid leukemia patients with incomplete blood recovery at the time of achieving morphologic complete remission

Objective To analyze the clinical features and prognosis of acute myeloid leukemia (AML) patients with incomplete blood recovery [platelet count (Plt) < 100×109/L or absolute neutrophil count (ANC) < 1.0×109/L] at the first time of achieving morphologic complete remission(CR). Methods The clinical data of 302 AML patients (non-M3) who were treated at the First Affiliated Hospital of Zhengzhou University from January 2010 to September 2015 were retrospectively reviewed. They were divided into CR group (Plt≥100×109/L and ANC≥1.0×109/L) and CR with incomplete blood recovery group (Plt < 100×109/L or ANC < 1.0×109/L) according to the condition of blood count at the first time of achieving morphologic CR. The clinical features and prognostic differences between the two groups were compared, and univariate analysis and mutivariate analysis were performed to compare the recurrence and survival of AML with incomplete blood recovery. Results Two hundred and sixteen (71.5%) patients were in CR group and 86 (28.5%) were in CR with incomplete blood recovery group. There was no statistically difference between the two groups in terms of age, high white blood cell, peripheral blasts ratio, France-American-Britain (FAB) type, cytogenetic risk classification and FLT3-ITD/ NPM1 gene mutation (all P > 0.05). Bone marrow blasts before therapy and the proportion of bone marrow CR in the first course of chemotherapy in CR group were higher than those in CR with incomplete blood recovery group (both P 0.05). In addition, FLT3-ITD positive was an independent risk factor for OS rate(P < 0.001), and peripheral blood blasts ≥0.60 was an independent risk factor for DFS rate (P= 0.047). Conclusions AML patients with incomplete blood recovery at the first time of achieving morphologic CR have a poor prognosis. AML patients with high-risk karyotype, ≥2 courses of induction therapy, incomplete neutrophils recovery may have a worse prognosis, and they should be regarded as high-risk groups and given more aggressive treatment. Key words: Leukemia, myeloid, acute; Blood cell count; Prognosis

Acute pancreatitis linked to bevacizumab: A case report

Abstract Introduction The monoclonal anti-vascular endothelial growth factor antibody bevacizumab is increasingly being used in the treatment of malignant tumors. It is the first molecular-targeted agent used in the treatment of several ovarian cancers. The typical side effects of this drug are hypertension and proteinuria. Bevacizumab-related acute pancreatitis (AP) has not been described before, but AP associated with other chemotherapeutic agents has been reported. Research has shown that patients can develop AP when taking sorafenib, a multiple tyrosine kinase inhibitor that inhibits VEGF. Case presentation We explored the case of a 48-year-old woman who presented with undefined upper abdominal pain after receiving a cisplatin-gemcitabine-bevacizumab combination treatment as second-line therapy for metastatic ovarian cancer. Our patient was hospitalized because of AP after two cycles of this treatment. The patient started experiencing abdominal pain after the first course of chemotherapy. The severity and duration of this pain increased after the second cycle of chemotherapy. Her abdominal pain and elevated serum amylase disappeared when treated by chemotherapy without bevacizumab; this also improved her clinical pancreatitis. Conclusions AP without other etiological factors can occur in patients treated by chemotherapy. Furthermore, bevacizumab might induce the side effects of AP.

Long-term outcomes of alternating chemoradiotherapy in patients with advanced nasopharyngeal cancer: a single-centre experience over the last decade.

We assessed the long-term outcomes of alternating chemoradiotherapy (ACRT) using 5-fluorouracil and cisplatin (FP) in 25 patients with stage II or advanced nasopharyngeal cancer treated at our institution between April 1999 and April 2010. Median follow-up duration was 87 months (range 2-189). According to the 2009 TNM classification (UICC), six patients were in stage II, nine in stage III, and 10 in stage IV. Treatment completion, response and five-year survival rates were retrospectively assessed. ACRT was performed with a first course of chemotherapy administered followed by the initial round of radiotherapy (36 Gy). Then, a second course of chemotherapy with additional radiotherapy (20-30 Gy) was administered, followed by a final third course of chemotherapy. For chemotherapy, 5-fluorouracil (5-FU, 800 mg/m2/24 h) was intravenously administered for five days, and cisplatin (CDDP, 50 mg/m2/24 h) was administered on the last two days. Treatment completion rate was 96% (24 of 25 cases), and the response rate was 100% (CR: 24 cases and PR: 1 case). Additionally, the five-year overall survival rate was 89.3%. We have demonstrated that ACRT is an effective regimen to treat nasopharyngeal cancer, revealing higher treatment completion, response, and five-year overall survival rates compared with other combinatorial radiotherapy and chemotherapy treatment regimens.

Early assessment of response to chemotherapy in lung cancer using dynamic contrast-enhanced MRI: a proof-of-concept study

To evaluate the early treatment response to chemotherapy in patients with lung cancer using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). Twenty-two patients with lung cancer underwent DCE-MRI before chemotherapy and 1 week after the start of the first course of chemotherapy. Pharmacokinetic parameters (Ktrans, Kep, and Ve) derived from DCE MRI were generated using the post-processing platform. These parameters and corresponding changes were compared between responders and non-responders after treatment using Student's t or Mann-Whitney U-tests. Diagnostic efficiency of kinetic parameters in differentiating responders from non-responders after 1 week of chemotherapy was also investigated. Thirteen responders after 1 week of chemotherapy had a significant decrease in Ktrans and Ve compared with the pretreatment value (p<0.05), and had no significant changes in Kep (p>0.05). Nine non-responders had no significant changes in Ktrans, Kep, and Ve compared with the pretreatment value (p>0.05). Changes in Ktrans (ΔKtrans) were significantly larger in responders than that in non-responders (p<0.05). Changes in Ve and Kep (ΔVe andΔKep) were without statistical significance after treatment between responders and non-responders (p>0.05). The cut-off value of ΔKtrans in best predicting tumour's chemotherapeutic response was 0.032/min and the corresponding AUC (area under the curve), sensitivity, specificity, and accuracy were 0.821, 84.62%, 77.78%, and 81.82%, respectively. DCE MRI may be useful for evaluating the early response to chemotherapy in patients with lung cancer, but larger, more definitive studies are needed.

Free Radical Activity as Diagnostic and Prognostic Criteria in Solid Tumors and Their Therapy

Blood plasma of 39 cancer patients who had not previously undergone anti-tumor treatment, and 21 patients with recurrent epithelial tissues cancer before treatment and after the first course of chemotherapy were investigated. The treatment effectiveness of patients with relapse was evaluated throughout the year. The control group was the blood plasma of 14 healthy people. Free radical activity and oxidative modification of proteins were assessed in blood plasma. In malignant neoplasms of epithelial tissues, free radical activity and oxidative modification of plasma proteins are significantly higher. At the initial stages of carcinogenesis, the oxidative modification level of plasma proteins increases both due to aldehyde and ketone carbonyl derivatives. In the terminal stage of malignant tumors, an increase in the oxidative modification of proteins occurs due to aliphatic ketone dinitrophenyl hydrazones, which are the markers of protein aggregation characteristic of the late stages of oxidative stress. In case of an objective response to polychemotherapy, there is a significant decrease in free radical plasma activity after the first course of therapy and a significant increase in carbonyl derivatives recorded at a wavelength of 230 nm, which can serve as a marker of its effectiveness.