Efficacy and safety of trifluridine/tipiracil in third-line and beyond for the treatment of patients with metastatic colorectal cancer in routine clinical practice: patterns of use and prognostic nomogram.

INTRODUCTION: Trifluridine/tipiracil combination has shown a benefit over placebo in the treatment of patients with chemorefractory metastatic colorectal cancer (mCRC). We evaluated the efficacy and safety of this combination in the real-life setting at eight Galician centers in Spain. PATIENTS AND METHODS: This is a retrospective study of a cohort of patients with mCRC in treatment with trifluridine/tipiracil within usual clinical practice who have been previously treated or are not considered candidates for treatment with available therapies. RESULTS: A total of 160 mCRC patients were included. Our data showed that 11.9% of patients achieved disease control. Median progression-free survival was 2.75 months; at 5.66 months follow-up, median overall survival was 7.94 months. Asthenia and neutropenia (48.1% both) were the most frequent adverse events. Overall survival was lower in patients with ECOG 2, multiple metastatic sites, platelets count 350,000/µl, alkaline phosphatase > 500 IU/l, and carcinoembryonic antigen > 10 ng/ml. CONCLUSION: The results of this study confirm the efficacy and safety of trifluridine/tipiracil in chemorefractory mCRC patients. However, patients in clinical practice differ from patients in clinical trials. Due to this, prognostic factors have special importance to offer the best therapeutic approach.

Adjuvant treatment with infusional 5-fluorouracil in high risk adenocarcinoma of the stomach or gastroesophageal junction

Purpose. In high risk gastric and gastroesophageal adenocarcinoma, adjuvant radiochemotherapy with 5-fluorouracil bolus became a standard adjuvant treatment, showing significant improvement in overall survival after surgery, although with substantial toxicity. We explored the efficacy and toxicity of a modified 5-fluorouracil continuous infusion scheme. Methods. We conducted an observational retrospective study in our centre. Gastric/gastroesophageal junction adenocarcinoma patients were treated with a schedule consisting in four infusions of bolus 5-fluorouracil 400 mg/m2 iv with leucovorin 200 mg/m2 iv and 1200 mg/m2 in 46-hour infusion of 5-fluorouracil (D’Gramont scheme), followed by concomitant radiochemotherapy (45 Gy in 25 fractions of 1.8 Gy) with 5-fluorouracil continuously infusion 225 mg/m2/day and four additional infusions of chemotherapy one month after complete radiochemotherapy. Results. Between January 2007 and December 2013, 55 patients received a mean of 3.16 bi-weekly adjuvant infusions followed by 4.6 weeks of continuous treatment concurrent with radiotherapy and 3.72 bi-weekly infusions after radiotherapy treatment. During adjuvant treatment, grade III toxicity was mostly haematologic, while gastrointestinal and cutaneous toxicity was predominant during concurrent treatment. There were no grade IV- or treatment-related deaths during this study. Disease-free survival (DFS) was 79.2 months (56.3–102.1 months), and the 3-year survival rates were 52.7 %. Conclusions. This 5-fluorouracil infusional scheme has an excellent tolerability profile and favourable efficacy results (AU)

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Adjuvant treatment with infusional 5-fluorouracil in high risk adenocarcinoma of the stomach or gastroesophageal junction.

PURPOSE: In high risk gastric and gastroesophageal adenocarcinoma, adjuvant radiochemotherapy with 5-fluorouracil bolus became a standard adjuvant treatment, showing significant improvement in overall survival after surgery, although with substantial toxicity. We explored the efficacy and toxicity of a modified 5-fluorouracil continuous infusion scheme. METHODS: We conducted an observational retrospective study in our centre. Gastric/gastroesophageal junction adenocarcinoma patients were treated with a schedule consisting in four infusions of bolus 5-fluorouracil 400 mg/m(2) iv with leucovorin 200 mg/m(2) iv and 1200 mg/m(2) in 46-hour infusion of 5-fluorouracil (D'Gramont scheme), followed by concomitant radiochemotherapy (45 Gy in 25 fractions of 1.8 Gy) with 5-fluorouracil continuously infusion 225 mg/m(2)/day and four additional infusions of chemotherapy one month after complete radiochemotherapy. RESULTS: Between January 2007 and December 2013, 55 patients received a mean of 3.16 bi-weekly adjuvant infusions followed by 4.6 weeks of continuous treatment concurrent with radiotherapy and 3.72 bi-weekly infusions after radiotherapy treatment. During adjuvant treatment, grade III toxicity was mostly haematologic, while gastrointestinal and cutaneous toxicity was predominant during concurrent treatment. There were no grade IV- or treatment-related deaths during this study. Disease-free survival (DFS) was 79.2 months (56.3-102.1 months), and the 3-year survival rates were 52.7 %. CONCLUSIONS: This 5-fluorouracil infusional scheme has an excellent tolerability profile and favourable efficacy results.

[Pneumonia from Nocardia nova in lung cancer]. / Neumonía por Nocardia nova en cáncer de pulmón.

The clinical and radiographic manifestations of pulmonary nocardiosis are nonspecific. The diagnosis depends of the clinical suspicion for alerting the microbiology laboratory to use special culture and identification methods to initiate the appropriate therapy early. A nocardia pneumonia in a locally advanced non small cell lung cancer patients is present. Even after initiate the treatment the patient died. It is important to suspect the diagnosis of uncommon infection to begin the therapy.

Diagnóstico y tratamiento de cáncer de origen desconocido / Diagnosis and treatment of cancer of unknown primary site

El cáncer de origen desconocido es un diagnóstico frecuente en la práctica médica y representa un grupo heterogéneo de neoplasias. A pesar de que los datos de la literatura indican que excepcionalmente se identifica el tumor primario, estos pacientes son evaluados exhaustivamente. El tratamiento está orientado principalmente por el diagnóstico anatomopatológico de la lesión, siendo fundamental las técnicas anatomopatológicas especiales para la correcta identificación de aquellas neoplasias quimiocurables y aquellas que se benefician de un tratamiento específico. Los pacientes que por sus características no pertenezcan a estos grupos deberían ser incluidos dentro de ensayo clínico (AU)

Neumonía por Nocardia nova en cáncer de pulmón / Pneumonia by nocardia nova in lung cancer

Las manifestaciones clínicas y radiográficas de nocardiosis pulmonar son inespecíficas. El diagnóstico depende de un alto grado de sospecha, altertando al laboratorio de microbiología para obtener un aislamiento y cultivo precoz e iniciar el tratamiento antibiótico específico. Presentamos un caso de neumonía por Nocardia nova en un paciente diagnosticado de carcinoma epidermoide de pulmón localmente avanzado, iniciándose el tratamiento antibiótico específico (AU)

[Diagnosis and treatment of cancer of unknown origin]. / Diagnóstico y tratamiento de cáncer de origen desconocido.

The carcinoma of unknown primary is a frequent clinical problem and represents a very heterogeneous group of neoplasms. Despite data in the literature indicating minimal success in determining the location of primary carcinomas, these patients continue to be evaluated exhaustively. Clinical treatment is guide by the pathological evaluation of the lesion and is very important the special pathologic techniques characterizing a potentially curable malignancy or patients for whom there is are a specific treatment. The majority of the patients are not included in these groups and they should be received treatment in clinical trials.