Single-dose dexamethasone for the prevention of pemetrexed associated cutaneous adverse reactions.

Pemetrexed (Alimta®) is a novel anti-folate antimetabolite agent that is used in combination with cisplatin for the treatment of patients with unresectable malignant pleural mesothelioma and as a single agent or in combination with cisplatin for patients with locally advanced or metastatic non-small-cell-lung-cancer. Cutaneous adverse reactions are common side effects of pemetrexed for which the manufacturer recommends 3-day premedication with dexamethasone 4 mg by mouth twice daily-(the day before, the day of, and the day after treatment). Patients' adherence to this premedication regimen is of concern. We report 14 cases of metastatic non-small-cell-lung-cancer patients who were premedicated with a single dose of dexamethasone 20 mg prior to pemetrexed or pemetrexed-based chemotherapy. None of these patients reported a grade 3 or above skin reactions over the course of their treatments. These findings suggest that a single dose of dexamethasone 20 mg may be an alternative premedication regimen in patients with metastatic non small cell lung cancer receiving pemetrexed or pemetrexed-based chemotherapy.

Safety and efficacy of FOLFOX followed by cetuximab for metastatic colorectal cancer with severe liver dysfunction.

Both 5-FU and oxaliplatin have been used as single agents in patients with colorectal cancer and severe liver dysfunction, but the combination of these drugs has not yet been investigated. A 67-year-old man diagnosed with colorectal cancer in 2008 presented in April 2011 to Appalachian Regional Healthcare Cancer Center with obstructive jaundice and weight loss. Imaging studies were compatible with a liver mass and dilatation of the intrahepatic bile ducts. A liver biopsy confirmed metastatic colorectal cancer. Because his total bilirubin level was 23.1 mg/dL, a percutaneous catheter was placed in May 2011. His total bilirubin level decreased to 5.9 mg/dL, but then increased to 9.4 mg/dL in June 2011. He was started on a FOLFOX regimen, with a 50% dose reduction of 5-FU bolus (200 mg/m(2)) and continuous infusion (1200 mg/m(2)) over 46 hours, and a 15% dose reduction of oxaliplatin (75 mg/m(2)) every 2 weeks. He tolerated this regimen very well, with normalization of his bilirubin level, a significant decrease in his tumor markers, and a partial response seen on PET/CT scan. His only significant toxicity was a grade 2 stomatitis. He received 21 cycles of FOLFOX, and was later switched to cetuximab treatment after disease progression. These findings suggest that FOLFOX might be effective in metastatic colon cancer with severe liver dysfunction, with minimal toxicity, and deserves further investigation.

Bendamustine treatment in a heavily pretreated Hodgkin lymphoma patient.

Hodgkin lymphoma is a curable disease in the vast majority of cases with a cure rate approaching 85 to 95% with initial therapy. However, some patients experience relapse and in patients with relapsed/refractory disease, prognosis remains poor and active agents are needed in this setting. Bendamustine is an alkylating agent with clinical activity against various lymphomas including follicular, mantle, diffuse large B cell lymphoma, and chronic lymphocytic leukemia; however, its activity in Hodgkin lymphoma is not yet well established. We report a case of a 55-year-old man with relapsed Hodgkin lymphoma that is heavily pretreated and was successfully treated with four cycles of single agent bendamustine (90 mg/m(2)) with complete response after two cycles and without any significant toxicity. These findings suggest that bendamustine is highly active in Hodgkin lymphoma.

Extranodal Natural Killer/T-Cell Lymphoma of the Nasal Type with Skin Metastases.

Extranodal natural killer/T-cell lymphoma (ENKL) of the nasal type is a rare, clinically aggressive disease. ENKL of the nasal type is often localized in the upper aerodigestive tract, including the nasal cavity, nasopharynx, paranasal sinuses, tonsils, hypopharynx and larynx, and usually presents as stage I/II. Extranasal involvement can occur, and a common site of extranasal involvement or metastatic disease includes the skin. Identifying skin metastases is important for the appropriate staging and treatment. We report a case of ENKL of the nasal type that presented with localized disease and subsequent skin lesions that were consistent with skin metastases.

Bilateral hilar lymphadenopathy in a young female: a case report.

Hilar or mediastinal lymphadenopathy is not included in the wide spectrum of radiologic findings associated with bronchiolitis obliterans-organizing pneumonia (BOOP). We present a patient who presented with extensive hilar and mediastinal lymphadenopathy. We suspected a diagnosis of sarcoidosis. The patient was diagnosed with idiopathic BOOP. This is the first case demonstrating that BOOP, now referred to as cryptogenic organizing pneumonia (COP), can present with bilateral hilar lymphadenopathy.