Maintenance of angiogenesis inhibition with aflibercept after progression to bevacizumab in metastatic colorectal cancer: real life study in the Valencian community

Introduction The second-line chemotherapy in metastatic colorectal cancer (mCRC) with FOLFIRI-aflibercept demonstrated an increase in survival compared with FOLFIRI in patients previously treated with oxaliplatin-based regimens. Few data are available in patients treated previously with bevacizumab. Our objective is to evaluate the efficacy and safety of FOLFIRI-aflibercept in second-line treatment in patients who have previously received bevacizumab. Patients and methods This is a observational, retrospective study of patients with mCRC treated with FOLFIRI-aflibercept in 2nd line in eight hospitals in the Valencian Community. Survival, response, and toxicity were analyzed. Result 122 patients with a median age of 61 years were included. 89% of patients had PS 0–1. The median of PFS (progression free survival) and OS (overall survival) was 5.45 (95% CI 4.74–6.15 months) and 10.15 (95% CI 7.47–12.82 months), respectively. Disease control rate 59.8%. The most common grade 3–4 adverse events were neutropenia (13,1%) and asthenia (9%). The presence of hypertension during treatment with FOLFIRI-aflibercept was associated with a survival benefit. Median of OS was 14.45 (95% CI 11.58–17.32) in patients with hypertension vs 7.78 (95% CI 5.02–10.54) in patients without hypertension (p = .001). Our results suggest that the presence of PS 0, primary tumor surgery, metachronous metastases, and the presence of only 1 metastatic location, are favorable prognostic factors associated with better OS. Conclusions Our results confirm the value of maintaining angiogenesis inhibition with FOLFIRI-aflibercept in mCRC after progression to a first-line treatment with bevacizumab. The development of hypertension during treatment is a possible predictive marker of response (AU)

Epidemiological pattern and time trends in testicular germ-cell tumors: a single institution 20-year experience.

INTRODUCTION: Recent studies have suggested a rise in the incidence of testicular germ-cell tumors (TGTs) in the last years, mainly due to an increase of early stage cases. We analysed the time trends in biological features of these patients in order to confirm this tendency in our environment. MATERIALS AND METHODS: The clinical records of 136 consecutive patients with TGTs treated at a single institution over a 20-year period (1984-2003) were retrospectively reviewed. Pathological, clinical, therapeutic and outcome data were collected. Patients were allocated into four consecutive 5- year intervals and their characteristics were compared by means of the chi-squared test. The survival analysis was performed with the method of Kaplan and Meier. RESULTS: A progressive increase in the incidence of new cases, and a more frequent diagnosis of stage I versus stage II-IV disease was confirmed within this time period. It was also observed a greater use of postorchiectomy chemotherapy, mainly due to an increase in the adjuvant indications. A significant decrease in the recurrence rate was noted. Ten-year overall survival was 86.5%. There was a trend for improved outcome, but the differences among the two decades were not statistically significant. CONCLUSIONS: A real increase in the incidence of TGTs and in the proportion of early stages was confirmed. This may be due to an epidemiological change or to an earlier diagnosis. This new pattern is associated with a more frequent use of adjuvant chemotherapy and with a reduction in the relapse rate.

Epidemiological pattern and time trends in testicular germ-cell tumors: a single institution 20-year experience

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Introduction. Recent studies have suggested a risein the incidence of testicular germ-cell tumors(TGTs) in the last years, mainly due to an increaseof early stage cases. We analysed the time trendsin biological features of these patients in order toconfirm this tendency in our environment.Materials and methods. The clinical records of136 consecutive patients with TGTs treated at asingle institution over a 20-year period (1984-2003)were retrospectively reviewed. Pathological, clinical,therapeutic and outcome data were collected.Patients were allocated into four consecutive 5-year intervals and their characteristics were comparedby means of the chi-squared test. The survivalanalysis was performed with the method ofKaplan and Meier.Results. A progressive increase in the incidence ofnew cases, and a more frequent diagnosis of stageI versus stage II-IV disease was confirmed withinthis time period. It was also observed a greater useof postorchiectomy chemotherapy, mainly due toan increase in the adjuvant indications. A significantdecrease in the recurrence rate was noted.Ten-year overall survival was 86.5%. There was atrend for improved outcome, but the differencesamong the two decades were not statistically significant.Conclusions. A real increase in the incidence of TGTsand in the proportion of early stages was confirmed.This may be due to an epidemiological change or toan earlier diagnosis. This new pattern is associatedwith a more frequent use of adjuvant chemotherapyand with a reduction in the relapse rate

Problemática asistencial del tratamiento combinado en los pacientes con tumores de cabeza y cuello localmente avanzados (réplica) / Health-care issues of combination treatment in patients with locally advanced head and neck tumors (reply)

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[Extra-pulmonary small-cell cancer: is its outcome similar to small cell lung cancer?]. / Carcinoma microcítico de localización extrapulmonar: es su curso similar a los microcíticos pulmonares?

INTRODUCTION: Extra-pulmonary small cell carcinoma (ESCC) is as a pathologic entity distinct from small cell lung carcinoma (SCLC). ESCC is considered a systemic disease in its origin, so the therapeutic approach is similar to SCLC with chemotherapy being considered in case of extensive and local disease. We present a retrospective comparison of ESCC and SCLC in our institution. MATERIAL AND METHODS: Using the tumour registry database of Hospital Universitario La Fe we reviewed 24 ESCC cases receiving attention between 1987 and 2003, and these were compared with a series of 341 patients with SCLC in the same institution. RESULTS: Of the 24 patients with ESCC 19 were men and 5 were women with an average age of 58 years (range 23 to 85). The most frequent site was the mediastinum with 58% having extensive disease. All patients but one received treatment. The therapeutic approaches were local and systemic in 13 patients, systemic alone in 6 and local alone in 4. Schedules based on platinum and etoposide were used. The median follow-up was 53 months (range 4 to 211). Median survival was 18.9 months; 30 in patients with local disease and 8 in those with extensive disease. In the SCLC series of patients, there were 336 men and 5 women; 62% having extensive disease. The median survival was 10 months; 12 months in those patients with local disease and 8 in those with extensive disease. CONCLUSIONS: The overall survival of patients with ESCC was slightly better than patients with SCLC. ESCC with local disease had a better survival outcome than SCLC with local disease. Chemotherapy is the cornerstone of the treatment, but sometimes local treatment could be sufficient.

[Extra-cranial anaplastic oligoastrocytoma development from a low-grade glioma]. / Afectación extracraneal de oligoastrocitoma anaplásico desarrollado sobre un glioma de bajo grado.

Oligodendrogliomas are primary brain tumours derived from oligodendroglial cells, or precursors, and represent 2%-5% of brain tumours. This type of glioma has a favourable prognosis compared to other brain tumours. The treatment is multidisciplinary and is based on three therapeutic arms: surgery, radiotherapy and chemotherapy. We present a patient who had received treatment previously for a lowgrade glioma and who subsequently developed an anaplastic oligoastrocytoma in the same zone together with skull and extra-cranial involvement in the disease progression.

Afectación extracraneal de oligoastrocitoma anaplásico desarrollado sobre un glioma de bajo grado / Extra-cranial anaplastic oligoastrocytoma development from a low-grade glioma

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Oligodendrogliomas are primary brain tumours derived from oligodendroglial cells, or precursors, and represent 2%-5% of brain tumours. This type of glioma has a favourable prognosis compared to other brain tumours. The treatment is multidisciplinary and is based on three therapeutic arms: surgery, radiotherapy and chemotherapy. We present a patient who had received treatment previously for a lowgrade glioma and who subsequently developed an anaplastic oligoastrocytoma in the same zone together with skull and extra-cranial involvement in the disease progression

Carcinoma microcítico de localización extrapulmonar: ¿es su curso similar a los microcíticos pulmonares? / Extra-pulmonary small-cell cancer: is its outcome similar to small cell lung cancer?

Introducción. Los carcinomas microcíticos extrapulmonares (CMEP) se han reconocido como entidad diferenciada del carcinoma microcítico broncopulmonar (CMBP). Se consideran una enfermedad sistémica desde el inicio y esto hace que su abordaje sea similar al de los CMBP debiendo considerarse siempre el empleo de quimioterapia tanto en enfermedad localizada como diseminada. Presentamos un estudio retrospectivo sobre los CMEP y los comparamos con los CMBP atendidos en nuestro centro. Material y métodos. Usando la base de datos del servicio de Oncología Médica del Hospital Universitario La Fe se localizan 24 CMEP atendidos entre los años 1987 y 2004. Se realiza una comparación indirecta entre éstos y una serie publicada de nuestro servicio de 341 pacientes afectos de CMBP, durante los años 1981 a 1992 Resultados. De los 24 pacientes diagnosticados de CMEP 19 son hombres y 5 mujeres, con una media de edad de 58 años (extremos 23 a 85). Predomina la localización mediastínica. Un 58% presenta enfermedad diseminada. Todos los pacientes menos uno recibieron algún tipo de tratamiento. El abordaje terapéutico fue local y sistémico en 11 pacientes, sólo sistémico en 6, y sólo local en 4. Predomina el uso de quimioterapia basada en platino y etopósido. La mediana de seguimiento potencial de la serie es de 53 meses (extremos 4 y 211), la mediana de supervivencia es de 18,9 meses; 30,8 meses en el estadio localizado y 8 en el estadio diseminado. En cuanto a la serie de CMBP, existe un claro predominio de hombres (336) sobre mujeres (5). Un 62% presenta enfermedad diseminada al diagnóstico. La supervivencia global de la serie es de 10 meses, 12 en enfermedad limitada y 8 en enfermedad extendida. Conclusiones. La supervivencia global de la serie de CMEP es superior a la de CMBP. Los CMEP obtienen mejor supervivencia en enfermedad localizada. La quimioterapia es la piedra angular del tratamiento. En determinadas situaciones puede ser suficiente un tratamiento exclusivamente local

Introduction. Extra-pulmonary small cell carcinoma (ESCC) is as a pathologic entity distinct from small cell lung carcinoma (SCLC). ESCC is considered a systemic disease in its origin, so the therapeutic approach is similar to SCLC with chemotherapy being considered in case of extensive and local disease. We present a retrospective comparison of ESCC and SCLC in our institution. Meterial and methods. Using the tumour registry database of Hospital Universitario La Fe we reviewed 24 ESCC cases receiving attention between 1987 and 2003, and these were compared with a series of 341 patients with SCLC in the same institution. Results. Of the 24 patients with ESCC 19 were men and 5 were women with an average age of 58 years (range 23 to 85). The most frequent site was the mediastinum with 58% having extensive disease. All patients but one received treatment. The therapeutic approaches were local and systemic in 13 patients, systemic alone in 6 and local alone in 4. Schedules based on platinum and etoposide were used. The median follow-up was 53 months (range 4 to 211). Median survival was 18.9 months; 30 in patients with local disease and 8 in those with extensive disease. In the SCLC series of patients, there were 336 men and 5 women; 62% having extensive disease. The median survival was 10 months; 12 months in those patients with local disease and 8 in those with extensive disease. Conclusions. The overall survival of patients with ESCC was slightly better than patients with SCLC. ESCC with local disease had a better survival outcome than SCLC with local disease. Chemotherapy is the cornerstone of the treatment, but sometimes local treatment could be sufficient