Real-World Experience with Cemiplimab Treatment for Advanced Cutaneous Squamous Cell Carcinoma-A Retrospective Single-Center Study.

BACKGROUND: The systemic treatment of advanced cutaneous squamous cell carcinoma (cSCC) has seen significant developments in recent years. The anti-PD1 inhibitor cemiplimab has demonstrated efficacy in clinical trials, but real-world data are still limited. Here, we aimed to evaluate the efficacy and the safety of cemiplimab in a real-world clinical setting. METHODS: A retrospective analysis was carried out for all patients who received at least two doses of cemiplimab at our department between February 2020 and January 2023. Progression-free survival (PFS), overall survival (OS), the objective response rate (ORR), the disease control rate (DCR) and adverse events (AEs) were evaluated. RESULTS: Twenty-five patients were included with a median age of 78 (65-82) years. The median treatment duration was 48 (16-72) weeks. Five (20%) patients were immunocompromised. Sixteen patients (64%) developed AEs, including 36% serious AEs (SAEs) of grade ≥ 3. Six patients (24%) were withdrawn from treatment due to the occurrence of AEs. Among the 25 patients, 52% showed an objective response (3 complete and 10 partial responses), 76% had controlled disease and 24% experienced progression. Among the five immunocompromised patients, the ORR was 60%, while the DCR was 80%. CONCLUSIONS: This retrospective real-world study revealed that locally advanced or metastatic cSCC could be effectively treated with cemiplimab even in elderly, polymorbid and immunocompromised patients.

Concomitant radiochemotherapy of cervical cancer: is it justified to reduce the dosage of cisplatin?

PURPOSE: To review the experiences regarding the therapeutic response and side effects of concomitant radiochemotherapy of cervical cancer carried out with different cisplatin doses. PATIENTS AND METHODS: At the Municipal Center for Oncoradiology, Budapest, Hungary, 92 patients with cervical cancer were treated with concomitant radiochemotherapy in the period between July 2002 and March 2007. The total dose of high-energy external radiation (megavoltage) treatment was 50.4 Gy with a fraction dose of 1.8 Gy on the small pelvis. Before irradiation, cisplatin 40 mg/m(2), 30 mg/m(2), or 20 mg/m(2) was administered once a week. RESULTS: In 17 cases, the cisplatin dose was 30 mg/m(2); during radiochemotherapy the number of cisplatin treatments was equal to or more than four in 14 patients (82%). After administering 40 mg/m(2) cisplatin to 64 patients, chemotherapy in four or more treatments could only be applied in 37 cases (58%). Eleven patients received cisplatin at the dose of 20 mg/m(2); in ten (91%) of them, the number of treatments was four or more. By comparing the side effects, it can be stated that hematologic side effects (mostly leukopenia) grade 3 occurred in 12% of the patients receiving cisplatin 30 mg/m(2), and grade G3-4 in 16% of the 40-mg/m(2) cisplatin group. For cisplatin 30 mg/m(2), 82% of hematologic side effects were in the G1 range. There was no significant difference between the 20- and 30-mg/m(2) regimens. As for the gastrointestinal toxicity, similar side effects grade 1 were detected, which occurred in 58% and 38% of the patients receiving 30 mg/m(2) and 40 mg/m(2), respectively. CONCLUSION: On the basis of a detailed analysis, the correlation between the number of treatments, the therapeutic and the side effects could be verified. In the course of dose reduction, there was no significant difference when comparing the results of therapy, however, the quality of life was better if cisplatin 30 mg/m(2) was administered instead of 40 mg/m(2). If cisplatin 20 mg/m(2) was given, the results were significantly worse. On the basis of the own results, it can be stated that the optimal weekly dose of cisplatin is 30 mg/m(2).

[Experience with only preoperative radiotherapy of non-metastatic rectal tumours]. / Nem metastaticus rectumtumorok egyedüli preoperatív besugárzásával szerzett tapasztalataink.

INTRODUCTION: It is an accepted fact that the local recurrence rate can be decreased up to 50% for the metastatic rectum tumours irradiated only preoperatively. MATERIALS AND METHODS: 181 patients having rectum tumour were irradiated preoperatively with 36 or 40 Gy between 1990 and 2001. The classification was made according to the modified Astler-Coller pathological staging system. The radiation treatment was carried out with telecobalt unit or high energy photon of linear accelerator after computerized radiation treatment planning. RESULTS: The most important characterizing factor for the efficiency of the preoperative irradiation is the local recurrence rate that was found to be 21.56% in our investigation. The survival rate was significantly influenced by the age of the patient and the applied dose. CONCLUSION: Our statistical analysis was applied to investigate the efficiency of the only preoperatively irradiated patients. The results are in agreement with the reported contributions.

[Radiochemotherapy of cervical carcinoma. (Necessity of dose reduction in chemotherapy)]. / A méhnyakrák radiokemoterápiája (a kemoterápias dózisredukció szükségessége).

INTRODUCTION: The concurrent radiochemotherapy used in the treatment of high risk and locally advanced cervical cancer therapy seems to be standard practice. Studies carried out in 1999 and 2000, reported the results of five large-scale prospective randomized investigations using radiotherapy which showed progression-free and overall survival rate increase compared to use of solely radiotherapy (Gynecology Oncology Group (GOG) 123, South West Oncology Group (SWOG) 8797, Radiotherapy Oncology Group (RTOG) 9001, Gynecology Oncology Group (GOG) 85, Gynecology Oncology Group (GOG) 120). OBJECTIVES: The aim of the investigation was to report our early findings of cervical cancer radiotherapy detailing the arising radiogen toxicity. METHOD: This is a report of a study carried out at the Oncoradiology Centre of Budapest, (between July 2002 and March 2005) on 66 cervical cancer patients. In concurrent radiotherapy the total dose of high photon energy percutaneous radiotherapy (megavolt therapy) for the pelvic region was 50.4 Gy, in 1.8 Gy fractions and with the weekly dosage of 40 mg/m2 cisplatin prior to the radiotherapy. RESULTS: The planned cytostatic treatment could be carried out on 27 patients (41%) on five treatments. At the same time, the number of treatments on the other patients had to be reduced due to haematological toxicity in the following way: 4 treatments on 16 patients (24%), 3 treatments on 7 patients (11%), 2 treatments on 10 patients (15%) and once on 6 patients (9%). Altogether it was necessary to reduce the dosage from the planned protocol, on 44 patients (67%). The optimal radiotherapy time of 56 days as reported in the literature, was exceeded in 17 cases (26%) on account of the radiogen toxicity. CONCLUSIONS: On the basis of our own results it is not advisable to raise the cisplatin weekly dosage to above 20 mg/m2.

Perioperative brachytherapy for pretreated chest wall recurrence of breast cancer.

PURPOSE: To demonstrate the technical aspects of high-dose-rate afterloading (HDR-AL) brachytherapy for isolated local chest wall recurrence of breast cancer pretreated with mastectomy and axillary node dissection plus postoperative radiotherapy. CASE REPORT: A 63-year-old female patient with left ductal breast cancer, pT2pN1biM0, was reoperated for an isolated local chest wall recurrence 13 years after primary treatment (mastectomy, axillary dissection, and 50 Gy postoperative irradiation). Radical surgery would have involved extreme mutilation. Reoperative surgical margins of 3 mm width were involved, and four parallel afterloading catheters were placed intraoperatively in this histologically positive margin site. Perioperative HDR-AL (Ir-192 stepping source, 370 GBq activity, dose rate: reference air kerma rate at 1 m 40.84 mGy/h kg) was performed. Dose per fraction: 6 Gy to the reference line, two fractions per week, total dose 30 Gy. Follow-up after secondary treatment: 5 years. RESULTS: Firm local control and 5-year disease-free survival were obtained with perioperative HDR-AL therapy; staging procedures (clinical exam, MRI, abdominal ultrasound, and bone scan) showed no evidence of disease. The development of radiodermatitis did not exceed grade 2 level and healed spontaneously within 6 weeks. CONCLUSIONS: Isolated local chest wall relapse can be effectively controlled by wide surgical excision and perioperative reirradiation with HDR-AL. This technique may represent a treatment alternative to ultraradical surgery, with equal healing probability and a better quality of life. Small-volume irradiation of the postoperative scar can be performed with HDR-AL brachytherapy, and long-term local control can be achieved with a total dose of 30 Gy.

Results of ovary tumor treatment with abdominally administered (198)Au evaluated on the basis of long term follow up.

In the period between 1959 and 1980 165 patients previously operated with ovarian tumor were treated by intraperitoneally administered (198)Au in the Oncoradiological Centre of the Uzsoki Hospital. The stage distribution of the 158 patients with common epithelial histology was as it follows: Stage I/A 31; Stage I/B 9; Stage I/C 59; Stage II/A 19; Stage II/B 11; Stage II/C 7, Stage III/A 22. The five year survival result is the next: Stage I/A 90%; Stage I/B 78%; Stage I/C 58%; Stage II/A 26%; Stage II/B 27%; Stage II/C 14%; Stage III/A 18%. From the other 7 patients six had sex cord tumor and one lipid cell tumor. The number of the side effects is in good agreement with the data in literature. The use of (198)Au for intraperitoneal treatment of ovary tumors is not contemporary today because of gamma radiation of radiogold, but intraperitoneal radiation treatment should not be forgotten.

Early Experiences with Combined Treatment (Surgery and Brachytherapy) of Gynecological Recurrences Infiltrating the Pelvic Wall.

Neither the surgical nor the radiotherapeutic treatment of gynecological recurrences infiltrating the pelvic wall can be curative alone. The treatment of this group of patients is possible with the CORT (Combined Operative and Radiotherapeutic Treatment) method. As maximal as possible resection of the malignancy is done for patients having no distant metastases and the brachytherapy guiding tubes are implanted into the tumour bed on the pelvic wall. The brachytherapy is carried out postoperatively. An accurate analysis cannot be done because of the short follow up and the few cases. The authors do believe that the survival results of this poor prognostic group may improve by means of this method after proper selection of patients.