Lenvatinib - A multikinase inhibitor for radioiodine-refractory differentiated thyroid cancer.

Lenvatinib, an oral multikinase inhibitor, was approved by the US Food and Drug Administration in February 2015. In a pivotal phase III study of 392 patients with progressive radioiodine-refractory thyroid cancer, the overall response rate of patients receiving lenvatinib was 64.8%, with complete response in four patients. The median progression-free survival was 18.3 months in the lenvatinib arm versus 3.6 months in patients receiving placebo. Median overall survival was not reached in either arm. Lenvatinib is a promising new treatment for patients with radioiodine (iodine-131)-refractory differentiated thyroid cancer.

Secondary acute myeloid leukemia in survivors of Hodgkin lymphoma.

BACKGROUND: This large population-based study determined the epidemiology and outcomes of secondary acute myeloid leukemia (sAML) developing in Hodgkin lymphoma survivors. METHODS: We utilized the Surveillance Epidemiology and End Results (SEER) 9 database to identify 104 cases of sAML. RESULTS: Patients with sAML (median age: 47 years; 82% <60 years) were significantly younger than de novo AML cases (66 years; p < 0.01). sAML had worse overall survival (OS) than de novo AML (p < 0.01). OS was better in younger patients and in more recent years. CONCLUSION: Older patients with sAML have a dismal OS and should be enrolled in trials of novel therapies. Younger patients have improved OS and hence may benefit from curative intent intensive therapy and allogeneic transplant.

Idelalisib- a PI3Kδ targeting agent for B-cell malignancies.

Idelalisib, the first in-class phosphotidlyinositol 3-kinase delta (PI3Kδ) inhibitor, was approved by the US Food and Drug Administration in July 2014. It simultaneously received breakthrough therapy designation in combination with rituximab for the treatment of relapsed chronic lymphocytic leukemia (CLL) as well as accelerated approval as monotherapy for the treatment of relapsed follicular lymphoma and relapsed small lymphocytic lymphoma. In a pivotal phase III study of 220 patients with relapsed CLL, the overall response rate of patients who received rituximab plus idelalisib was 81%. The median progression-free survival (PFS) was 5 months with rituximab plus placebo group, but was not reached in the idelalisib arm. At 24 weeks, the PFS in patients receiving idelalisib was 93%. In a phase II trial of 125 patients with relapsed or refractory indolent non-Hodgkin lymphoma who received idelalisib 150 mg twice daily, the response rate was 57%. Complete response was seen in 6% of patients. The median duration of response was 12.5 months, and median PFS was 11 months. Idelalisib is a promising new therapy for relapsed indolent B-cell malignancies.

Disparities in chronic myeloid leukemia survival by age, gender, and ethnicity in pre- and post-imatinib eras in the US.

BACKGROUND: Since May 2001, imatinib mesylate has become the first-line therapy for chronic myeloid leukemia (CML) but the survival pattern by age, sex, and ethnicity is not clear. MATERIAL AND METHODS: We analyzed the Surveillance, Epidemiology, and End Results (SEER*Stat) database to compare survival rates in CML among Caucasians, African-Americans (AA), and other races, and also within each race to see survival differences from the pre-imatinib (1973-2000) to post-imatinib eras (2002-2008). We used Z-tests in SEER*Stat to compare relative survival rates categorized by race, gender, and age groups (all ages, < 50, 50+ years). RESULTS: The three-year relative survival rates among Caucasians, AA, and other races in the pre-imatinib era were 44.9 ± 0.6%, 46.8 ± 1.8%, and 48.0 ± 2.2%, respectively, and in the post-imatinib era 64.4 ± 0.8%, 67.3 ± 2.4%, and 69.6 ± 1.6%, respectively. The relative survival increased from the pre-to post-imatinib era for all ethnic groups. In the post-imatinib era, three-year relative survival rates among young AA women were significantly lower (Z-value = -2.54, p = 0.011) than young Caucasian women, 80.5 ± 4.5% (n = 105) vs. 90.3 ± 1.4% (n = 589). CONCLUSIONS: The relative survival rates of CML patients have improved in the post-imatinib era. However, the improvement in survival rates has been modest in this population-based data compared to those reported from randomized trials. Improvement in survival among older patients is lower than in younger patients. Young (<50 years) AA women with CML had lower relative survival rates compared to young Caucasian women in the post-imatinib era.

First case report of locally advanced malignant nodular hidradenoma of the scrotum.

BACKGROUND: Malignant nodular hidradenoma (MNH) is a malignant tumor of the eccrine glands, and most commonly involves the head, trunk, and extremities. To the best of our knowledge, MNH of the scrotum has not yet been described in the English literature. Despite the use of surgery, chemotherapy, radiotherapy, and hormonal therapy, optimal treatment of MNH is unclear. CASE REPORT: We describe the case of a 30-year-old African American man who was diagnosed with locally advanced MNH of the scrotum and treated with surgery. More than 2 years after surgery, the patient is without evidence of disease. CONCLUSIONS: This is the first case report of MNH of the scrotum. Surgery alone may be sufficient for the treatment of localized or locally advanced MNH.

Impact of Parental Cancer on Children.

BACKGROUND/AIM: The majority of cancers affect the elderly, but 22.4% of all cases occur in the ages of 21-55. This age range represents common childbearing and child-rearing years, which imply that many of these patients have minor children. Approximately 2.85 million children under 18 live with a parent affected by cancer. MATERIALS AND METHODS: The Pubmed and Google Scholar were searched to identify literature on impact of parental cancer on children and potential interventions to support parents and children. RESULTS: We reviewed impact of parental cancer on daily routine, role changes, emotional problems and social functioning of children. We also discuss interventions that may be useful for parents and children. CONCLUSION: It is essential that we learn more about the impact of parental cancer on children and ways to support the families using evidence-based interventions.

Unstaged Diffuse Large B-Cell Lymphoma in the United States: Predictors and Patient Outcomes.

BACKGROUND: Treatment and prognosis of diffuse large B-cell lymphoma (DLBCL) depends on the stage of lymphoma. We conducted this study to examine unstaged DLBCL in the United States. MATERIALS AND METHODS: We used Surveillance Epidemiology and End Result (SEER) 18 registries to select patients with DLBCL diagnosed during January 2000 to December 2012. Limited regional distant Summary stage 2000 was used to determine stage of the disease as localized, regional, distant or unstaged. We used logistic regression to investigate factors associated with unstaged DLBCL. Cox proportional hazards model was used to compare survival outcomes. RESULTS: Among 67,765 patients, disease in 3,194 (4.71%) was unstaged. Age (60+years), non-African American, not married marital status, metropolitan residence, median household income >$50,000, lymph node as the primary site and those with other primary malignancies before diagnosis of DLBCL were the factors associated with cases being unstaged. The 5-year relative survival rate for patients with unstaged DLBCL was inferior to that of those with localized and regional disease, and superior to that of those with distant disease (hazard ratios of 0.58, 0.66 and 1.24 for localized, regional and distant disease, respectively, when compared to unstaged cases). CONCLUSION: Several factors are associated with higher risk of unstaged DLBCL. Patients with unstaged DLBC had significantly inferior survival rates compared to patients with localized and regional stage.

Second Primary Malignancy in Bladder Carcinoma - A Population-based Study.

BACKGROUND: A second primary malignancy is a serious long-term complication in cancer survivors. The aim of this study was to evaluate the risk of second primary malignancies (SPM) in adult patients with bladder cancer. MATERIALS AND METHODS: We selected patients ≥18 years diagnosed with bladder cancer from National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) 13 database. We calculated the risk of second primary malignancies in the bladder cancer patients using the MP-SIR session of SEER*stat software. RESULTS: A total of 103,516 cases of bladder cancer was included in the study. Among them, 17,004 (16.4%) developed 19,318 second primary malignancies. The risk of development of SPM was significantly higher compared to the general population with O/E ratio of 1.42 (95% CI=1.4-1.44, AER=89.22 and p-value of <0.001). Prostate cancer, lung and bronchial cancer and urinary bladder cancer were the three commonest SPMs. CONCLUSION: There is significant increased risk of second primary malignancies in adult patients with bladder cancer to general population. Bladder cancer survivors may benefit from life-long follow-up for development of SPM.

Disparities in receipt of radiotherapy and survival by age, sex, and race among patients with non-metastatic squamous cell carcinoma of the anus.

BACKGROUND: Combination chemoradiotherapy is the standard of care for treatment of non-metastatic squamous cell carcinoma of the anus (SCCA). This population based study evaluated disparities in receipt of radiotherapy (RT) as well as comparative survival rates for SCCA patients in the United States. METHODS: The Surveillance, Epidemiology, and End Results (SEER) 18 database was used to identify patients with non-metastatic SCCA diagnosed between 1998 and 2008. Multivariate logistic regression was used to model the relationships between age, sex, and race and the receipt of RT, adjusting for marital status and stage of disease. Relative survival (RS) rates were compared by each factor, with added adjustment for RT status, using Cox proportional hazards model. RESULTS: A total of 3,885 patients with localized or regional SCCA as the only primary malignancy were included in the study, of which, 3,192 (82%) received RT. In our multivariate analysis, lower rates of RT were found for those 65+ years old [adjusted odds ratio (OR) 0.71; P<0.001], males (adjusted OR 0.65; P<0.001), and blacks (adjusted OR 0.78; P=0.049). Multivariate survival analysis showed worse survival among those 65+ years old (adjusted HR 1.65; P<0.001), males (adjusted HR 1.53; P<0.001), and blacks (adjusted HR 1.35; P=0.001). CONCLUSIONS: This population based study identified older patients, males, and blacks as less likely to receive RT. Worse survival was also found in these groups.

Second Primary Malignancies in Hepatocellular Cancer - A US Population-based Study.

BACKGROUND/AIM: A second primary malignancy is a serious long-term complication in cancer survivors. The aim of this study was to evaluate the risk of second primary malignancies in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: We selected adult patients (≥18 years) diagnosed with HCC from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) 13 database. We calculated the risk of second primary malignancies in these patients using multiple primary standardized incidence ratio (MP-SIR) session of SEER* stat software. Second primary malignancy was defined as a metachronous malignancy diagnosed 6 months or more after an index HCC. RESULTS: A total of 15,296 patients with a diagnosis of primary HCC were reported in the SEER 13 registry during January 1992 to December 2011. A total of 446 (2.83%) developed 466 second primary malignancies with an observed/expected ratio of 10.07 (95% confidence interval=0.97-1.17, p=0.16) and absolute risk of 7.17 per 10,000 population. Risk of stomach and of thyroid cancer were significantly increased among older patients. Risk of lung cancer and of hepatobiliary cancer were significantly higher compared to that of the general population after two years of latency. CONCLUSION: Risk of specific second primary malignancies in adult patients with HCC depends on age of the patient and latency.

Duodenal obstruction as the presenting manifestation of recurrent breast cancer.

In this report, we present a case of duodenal obstruction as the initial presenting manifestation of a patient with recurrent invasive lobular breast carcinoma.