Serum apelin levels and body composition changes in breast cancer patients treated with an aromatase inhibitor.

PURPOSE: The adipose tissue plays a role in carcinogenesis with the adipokines it generates. Apelin is an anti-obesigenic adipokine, and assumes roles in both vascularization and tumor cell proliferation. The present study aimed to investigate changes in apelin levels, in postmenopausal breast cancer (BC) patients receiving aromatase inhibitors (AIs). METHODS: Forty early-stage postmenopausal BC patients treated with AIs with no history of chemotherapy administration were included in the study. At the beginning, we measured serum apelin levels in postmenopausal BC patients who were receiving AIs and healthy women of similar age and normal body mass index (BMI) (control group). We evaluated changes in the body composition, serum lipid profile and serum apelin levels at the beginning and the 12th month through anthropometric measurements and bioelectric impedance analysis. RESULTS: Forty subjects with postmenopausal BC had a median age of 57 years (range 44-82)). BC patients exhibited significantly higher apelin levels and body mass index (BMI) scores compared to the control group (p=0.0001, p=0.0001, respectively). The 12th month's measurements indicated reduced apelin levels in 24 patients (60%) and increased apelin levels in 16 patients (40%) compared to the initial figures. With respect to the parameters, the patients with reduced apelin levels had significantly different waist-to-hip ratio (WHR) and fat mass scores compared to those with higher apelin levels (p=0.008, p=0.047, respectively). CONCLUSION: This study showed that postmenopausal BC patients had high levels of apelin and high BMI scores. This finding suggests that apelin promoted carcinogenesis particularly in obese individuals. The massive and metabolic changes observed in the fat tissues of the postmenopausal BC patients receiving AIs will especially affect the BC-associated outcome.

Uracil/tegafur as a possible salvage therapy in chemo-refractory colorectal cancer patients: a single institutional retrospective study.

AIM OF THE STUDY: Our aim was to determine the activity and toxicity of uracil/tegafur and leucovorin combination in metastatic colorectal cancer (mCRC) patients who have progressed with all currently active agents. MATERIAL AND METHODS: This study was a retrospective analysis of 50 mCRC patients who had previously failed to respond to all available chemotherapeutics and who received subsequent treatment with uracil/tegafur 250 mg/m(2) d1-5 in combination with leucovorin 90 mg/day, d1-5 followed by two days' rest. RESULTS: The median age of the patients was 60 years. Most of them (60%) were male. Bevacizumab was used in 65% and cetuximab in 55% of the patients. Thirty-nine patients (78%) were treated with uracil/tegafur in the fourth line setting. The median treatment duration was 4.2 months (range, 2-24 months). The objective response rate and the disease control rate were 4% and 34%, respectively. Median progression-free survival was 4.1 months (95% CI, 3.6-4.6 months) and overall survival was 6.6 months (95% CI, 4.5-8.6 months). Grade 3 or 4 toxicity was seen in 20% (n = 10) of the patients while 60% (n = 6) of them required dose reductions. CONCLUSIONS: This retrospective data show that uracil/tegafur may be considered in heavily pretreated mCRC patients because of its activity, lower toxicity, and feasibility.

Correlation of survivin and MMP9 expressions with prognosis and clinicopathological parameters in surface epithelial ovarian carcinomas.

OBJECTIVE: Pathological stage is the most important prognostic factor in ovarian carcinomas, and many studies have been carried out to predict prognosis. In our study, we searched the expression of survivin, which prevents apoptosis and matrix metalloproteinase-9 (MMP-9), which promotes the metastasis of the tumour by splitting up the basal membrane in primary epithelial ovarian carcinomas. We aimed to observe their effects on prognosis by comparing clinicopathological parameters. MATERIAL AND METHOD: 60 cases diagnosed with epithelial ovarian carcinoma between 2003 and 2008 and treated and followed up at the oncology clinic were included in the study. 42 patients were serous, 11 endometrioid, 5 mixed type, 1 was clear cell and 1 was undifferentiated adenocarcinoma. Survivin and MMP-9 expression was evaluated in each tumour and assosication with clinicopathological parameters (age, tumour diameter, localisation, histological type of tumour, grade, stage, recurrence and metastasis) were searched and also overall survival and disease free of survival were evaluated. RESULTS: Survivin was statistically insignificant within the clinicopathological parameters. The correlation between the tumour grade and the staining density of MMP-9 in epithelial cells (p=0.028) and the correlation between disease free of survival and MMP-9 expression in stromal cells (p=0.0326) was significant. When the stage was compered with clinocopathologic parameters; recurrence (p=0.005) and death rates (p < 0.001) were significantly increased but overall survival (p=0.0269) was significantly decreased in advanced-stage patients. CONCLUSION: In the present study, the stage was found to be an important prognostic parameter in surface epithelial ovarian carcinomas and an association was found between MMP-9 stromal staining and survival.

An Analysis of the Use of Complementary and Alternative Therapies in Patients with Breast Cancer.

BACKGROUND: The aim of the present study was to investigate the use of complementary and alternative medicine (CAM) and the factors that influence their use in patients with breast cancer. PATIENTS AND METHODS: This descriptive and cross-sectional study was carried out with 135 breast cancer patients on chemotherapy. RESULTS: 30.4% of patients admitted using one or more CAM methods. The most common method was herbal therapy (97.6%). There were statistically significant differences among CAM users and non-users in terms of time elapsed since initial diagnosis, current stage of the disease, and current type of therapy. As the time since the initial diagnosis increased, so did the percentage of CAM users. Those patients with advanced stage cancer or relapsed disease who were receiving palliative therapy used CAM methods more than those receiving adjuvant therapy. As far as quality of life was concerned, symptoms such as nausea and vomiting, dyspnea, and diarrhea were more common among CAM users. CONCLUSION: It is important and necessary that health professionals working in oncology clinics are made aware of the common use of CAM methods so that they can provide the necessary communication between patients and other health professionals on these treatment modalities.

HINTERGRUND: Ziel dieser Studie war es, die Anwendung komplementär- und alternativmedizinischer (CAM) Methoden sowie Faktoren, die deren Einsatz bei Brustkrebspatienten beeinflussen, zu untersuchen. PATIENTEN UND METHODEN: Die vorliegende beschreibende Querschnittsstudie wurde mit 135 chemotherapeutisch behandelten Brustkrebspatientinnen durchgeführt. ERGEBNISSE: 30.4% der Patientinnen gaben an, eine oder mehrere CAM-Methoden anzuwenden. Am häufigsten wurden kräutermedizinische Methoden eingesetzt (97.6%). Zwischen Benutzern und Nicht-Benutzern von CAM betanden statistisch signifikante Unterschiede bezüglich der Zeit seit Erstdiagnose, dem aktuellen Krankheitsstadium und der derzeitig angewendeten Therapieform. Mit wachsender Zeitspanne seit Erstdiagnose nahm auch der Anteil an CAM-Benutzern zu. Palliativ behandelte Patientinnen im fortgeschrittenen oder rezidivierten Stadium wendeten CAM häufiger an als adjuvant behandelte Patientinnen. In Bezug auf die Lebensqualität waren Symptome wie Übelkeit und Erbrechen, Dyspnoe und Durchfall unter CAM-Benutzern weiter verbreitet. SCHLUSSFOLGERUNG: Es ist wichtig und notwendig, dass sich in der Onkologie tätige Mediziner der Existenz von CAM-Methoden bewusst werden, so dass sie die nötige Kommunikation zwischen Patienten und Angehörigen anderer Gesundheitsberufe hinsichtlich dieser Behandlungsmodalitäten bereitstellen können.

Epidemiology and survival of hepatocellular carcinoma in Turkey: outcome of multicenter study.

OBJECTIVE: Hepatocellular cancer (HCC) is one of the important health problems in Turkey. We aimed to determine the clinical and demographic features of HCC in the Turkish population and to evaluate the prognostic and survival features. METHOD: Two hundred and twenty-one patients with HCC from five hospitals in Turkey are included in this study. RESULTS: In 44.4% of the 221 patients with hepatitis B virus and in 21.3% of the 221 patients with hepatitis C virus were found to be responsible for HCC etiology. It has been shown that HCC developed on cirrhosis basis in 74.2% of the patients. HCC was presented with single solitary nodule in 69.2% of the patients. Non-liver metastasis was present in 12.5% of the patients. In 21.7% of the patients, alpha-fetoprotein (AFP) levels were above the diagnostics level of 400 ng/ml. The median overall survival (OS) of 221 patients was 14 months. The median OS of the patients with Child-Pugh A class was significantly longer than that with Child-Pugh B and C classes. The OS of the individuals with normal AFP levels was also longer than that with high AFP levels. The OS of the patients with Stage I HCC according to tumor node metastasis (TNM) classification, the female patients and the treated patients group was found to be significantly good. CONCLUSIONS: In conclusion, the viral etiology (hepatitis B and C infections) in Turkish population is found to be an important factor in HCC development. The Child-Pugh classification, AFP levels, TNM classification, being female and treatment were determined to be important prognostic factors in HCC patients.

Irinotecan combined with infusional 5-fluorouracil and high-dose leucovorin for the treatment of advanced gastric carcinoma as the first-line chemotherapy.

BACKGROUND: Because of insufficient activity and high toxicity of current chemotherapy regimens in advanced gastric cancer (AGC), there is a need for newer regimens. METHODS: Twenty-five chemonaive patients with AGC have been treated with FOLFIRI regimen consisting of irinotecan 180 mg/m(2) over 30 min on day 1 combined with leucovorin 200 mg/m(2) over 2 h followed by 5-fluorouracil 400 mg/m(2) as bolus and 600 mg/m(2) as a 22-hour infusion on day 1 and 2. The treatment was administered every 14th day until progression or intolerable toxicity. RESULTS: Twenty-five patients (17 male, 8 female; 22 patients with PS 0-1 and 3 patients with PS 2), median age 54 (range 25-77), received a total of 230 courses of chemotherapy (median 9; range 1-18). Objective responses were observed in 9 patients (36%), all being partial. Median progression-free survival, 1- and 2-year progression-free survival rates were 8.6 months, 28.4% and 15.3%, respectively. Median overall survival, 1- and 2-year overall survival rates were 11.6 months, 48.0% and 17.8%, respectively. As serious adverse events, grade 3-4 neutropenia was observed in 5 patients (20.0%), grade 3 diarrhea in 4 patients (16.0%). No treatment-related death occurred. CONCLUSION: FOLFIRI regimen is an active regimen with acceptable toxicity for the treatment of AGC.

Gemcitabine combined with infusional 5-fluorouracil and high-dose leucovorin for the treatment of advanced carcinoma of the pancreas.

BACKGROUND: 5-Fluorouracil (5-FU) and gemcitabine are the major active drugs in the treatment of pancreatic cancer. METHODS: Twenty-two patients with advanced pancreas cancer were treated with a new chemotherapy regimen consisting of infusional 5-FU and high-dose leucovorin with gemcitabine (GEMFUFOL). RESULTS: A total of 200 cycles of chemotherapy were administered. The response rate was 27.3%, all responses being partial. The median survival time and 1-year survival rate were, respectively, 13 months and 60.4%. The toxicity was very low and severe hematological toxicity was exceptional. CONCLUSION: The GEMFUFOL regimen can be an active regimen for the treatment of advanced pancreatic cancer and has a low toxicity.

The development of pulmonary adenocarcinoma in a patient with Job's syndrome, a rare immunodeficiency condition.

The hyperimmunoglobulin E (HIE) (Job's) syndrome often has it onset in childhood and is characterized by markedly elevated serum IgE levels, chronic dermatitis and recurrent pyogenic infections. Lymphoid malignancies have most commonly been associated with this syndrome while the first case in the literature of carcinoma associated with HIE syndrome was a squamous cell carcinoma of the vulva, described by Clark et al. in 1998. We observed a male patient with Job's syndrome diagnosed at age three who presented with bone pain and a metastatic epithelial tumor of the bone revealed by biopsy. Diagnostic procedures aimed at detecting the primary site showed multiple mediastinal lymph nodes with lung and liver metastases on computed tomography scans and an extradural spinal metastasis at the upper thoracic level on magnetic resonance imaging. Although the patient refused a bronchoscopic procedure, a diagnosis of pulmonary adenocarcinoma was established on the basis of sputum cytology and the clinical aspects of tumor extent. Intravenous corticosteroids and palliative radiotherapy were given for the spinal metastasis. Palliative chemotherapy could not be started because of the patient's poor performance status as well as nosocomial fungal pneumonia and pseudomonal urogenital infection with bacteremia. Despite the antifungal and broad-spectrum antimicrobial treatments, the patient died of pseudomonal sepsis.

Rapid tumor lysis syndrome in a patient with metastatic colon cancer as a complication of treatment with 5-fluorouracil/leucoverin and irinotecan.

Tumor lysis syndrome is a potentially fatal complication of anti-cancer therapy that is usually seen in patients with bulky, rapidly proliferating, treatment-sensitive tumors such as hematological malignancies, but it rarely occurs in a variety of solid tumors such as colorectal carcinoma. Combination chemotherapy with infusional 5-fluorouracil/leucoverin and irinotecan has been recently accepted as the first treatment option for metastatic colorectal cancer. We present a case of tumor lysis syndrome in a patient with metastatic colon carcinoma that occurred 72 hrs after the initial course of a combination chemotherapy with irinotecan and 5-fluorouracil/leucoverin. Despite the immediate treatment with aggressive hydration by a sodium bicarbonate infusion, followed by forced diuresis and uricolytic therapy, he died of a sudden cardiac arrest complicated by acute renal failure. Our case indicates that administration of 5-fluorouracil/leucoverin and irinotecan for bulky tumors of colorectal origin with a rapid doubling time may induce an acute tumor lysis syndrome, which necessitates frequent laboratory monitoring and a close follow-up of the patient as well as prompt initiation of appropriate therapeutic measures.