Efficacy of platinum combination chemotherapy after first-line gefitinib treatment in non-small cell lung cancer patients harboring sensitive EGFR mutations.

PURPOSE: Gefitinib is an effective first-line chemotherapy for advanced non-small cell lung cancer (NSCLC) patients harboring sensitive EGFR mutations. However, whether second-line platinum combination chemotherapy after first-line gefitinib treatment shows similar effects to first-line platinum combination chemotherapy in these patients remains unclear. Therefore, we here aimed to investigate the efficacy of platinum combination chemotherapy after first-line gefitinib treatment in NSCLC patients harboring sensitive EGFR mutations. METHODS/PATIENTS: We retrospectively evaluated the clinical effects of second-line platinum combination chemotherapy after first-line gefitinib treatment in NSCLC patients harboring sensitive EGFR mutations (exon 19 deletion or exon 21 L858R mutation) at five institutions. All patients were initially treated with gefitinib (250 mg/day) followed by platinum combination chemotherapy as second-line chemotherapy. RESULTS: Between January 2006 and December 2012, 42 patients [8 men, 34 women; median age, 63 years (range 39-75 years)] were enrolled. The overall response rate, disease control rate, and median progression-free survival (PFS) were 26.2, 61.9%, and 5.1 months, respectively, after the second-line treatment. The corresponding values for first-line gefitinib treatment were 69.0, 95.2%, and 11.1 months, respectively. Moreover, second-line platinum combination chemotherapy with pemetrexed or bevacizumab-containing regimens was independently associated with improved PFS. CONCLUSIONS: Second-line platinum combination chemotherapy after first-line gefitinib treatment in NSCLC patients harboring sensitive EGFR mutations was effective and showed equivalent outcomes to first-line platinum combination chemotherapy. After failure of first-line gefitinib therapy, second-line platinum combination chemotherapy with pemetrexed or bevacizumab might result in improved PFS.

Animal reservoirs for Trypanosoma cruzi infection in an endemic area in Paraguay.

Animal reservoirs for Trypanosoma cruzi infection were investigated in 5 communities in the Department of San Pedro, currently one of Paraguay's most highly endemic areas. A total of 112 domestic animals (37 cattle, 2 horses, 1 ass, 20 pigs, 44 dogs and 8 cats) and 4 wild animals (1 white-eared opossum, 2 yellow armadillos and 1 common long-nosed armadillo) were examined for blood. Although no trypomastigotes were found by 2 direct observation methods, the microhaematocrit and Giemsa stained thick and thin smears methods, several forms of trypanosoma flagellates morphologically identical to T. cruzi were detected in the liver infusion tryptose (LIT) medium from a single sample taken from a yellow armadillo, Euphractus sexicintus. When serum samples of all the animals were examined for antibody to T. cruzi by direct agglutination (DA) test, 3 cattle, 2 pigs, 16 dogs and 3 cats had positive titers (1:32 or greater), but no wild animals showed positive reactions. T. cruzi was not found by culture nor microscopic examination of samples from any of the seropositive animals. However, domestic animals such as cattle, pigs, dogs and cats which were found to be seropositive in this study, possibly act as an animal reservoir in this endemic area as well as armadillos in which T. cruzi was observed.