The association of the expression of miR-122-5p and its target ADAM10 with human breast cancer.

MicroRNAs can regulate many biological functions. miR-122-5p has a tumor suppressor function through different molecular pathways. Also, our second hit, ADAM10, targeted by miR-122-5p, is a major determinant of HER2 shedding causing that trastuzumab cannot bind to HER2 receptors. Therefore, our analysis upon ADAM10 expression and miR-122-5p was a good point to understand molecular mechanism of breast cancer. In our study, we investigated the expression profiles of miR-122-5p and its target ADAM10 in 71 breast cancer patients. Immunohistochemical analysis of ER, PR and HER2 gene products was used to categorize tumors in patients. Expression data and immunohistochemical findings were evaluated to comment on the relationship between miR-122-5p and ADAM10. ADAM10 expression was higher in tumor than that of normal tissue but miR-122-5p expression was lower in tumor than that of normal tissue. The expression pattern in HER2+ patients was reverse of the overall result. It can be explained like that miR-122-5p expression increases especially in HER2+ cancer cell to suppress ADAM10 shedding activity on HER2 receptor. However, increase in expression of tumor suppressor miR-122-5p is not enough to inhibit ADAM10. All in all, we can think miR-122-5p as potential regulator of ADAM10 and trastuzumab resistance. Since if we increase miR-122-5p activity together with trastuzumab administration, then HER2+ breast cancer cells may overcome trastuzumab resistance by inhibiting ADAM10 shedding activity on HER2 receptors and increase the efficiency of trastuzumab.

A cross-sectional survey of the diagnosis and management of bone metastasis in breast cancer patients in Turkey.

PURPOSE: This study aimed to report the practice of managing breast cancer with bone metastasis in Turkey and to determine the adherence to the British Association of Surgical Oncology (BASO) guidelines. METHODS: This multicenter, cross-sectional epidemiological survey was conducted in 38 centers across Turkey. Data from 1,026 breast cancer patients with bone metastases (mean age 54.0 ± 11.9 years) were analyzed. RESULTS: Over 30 % of patients had a diagnosis of metastatic breast cancer (stage IV) at the time of primary diagnosis. The imaging modalities used for diagnosing bone metastases were bone scintigraphy (57.8 %), radiography (22.8 %), and bone survey (4.4 %). Tumor markers were detected in 94.9 %, and markers of bone metabolism were measured in 90.4 % of patients. A total of 3.5 % of patients underwent surgery for bone metastasis, 26.4 % underwent palliative chemotherapy (most commonly docetaxel + capecitabine), and 56.5 % endured radiotherapy. Most patients (96 %) also received bisphosphonate. Radiography, bone scintigraphy, and CT were the main imaging tools used for postoperative follow-up of bone metastasis. Our results were >95 % in line with the BASO guidelines for the management of bone metastasis, except that interventional procedures, such as biopsy, were applied less frequently in our survey. CONCLUSIONS: The diagnosis and management practices of breast cancer with bone metastasis in Turkey were generally compatible with international guidelines. However, the awareness and knowledge of physicians on the current guidelines should be increased, and equipment for the appropriate interventional procedures should be provided in every clinic to obtain optimal and standard management of bone metastases.

Correlation between Rho-kinase pathway gene expressions and development and progression of glioblastoma multiforme.

Glioblastoma multiforme (GBM) is the most common and the most aggressive primary malignant tumor of the brain. Prognostic factors in GBM can be sorted as age, tumor localization, tumor diameter, symptom period and type, the extent of surgery, postoperative tumor volume, and adjuvant radiotherapy and/or chemotherapy status. Besides the interactions between actin microfilaments, microtubules, and intermediate filaments, environmental factors and intracellular signals which regulate them affect the cell invasion. Rho proteins and therefore Rho-kinase activation play important role at these changes. The aim of this study is to evaluate the relationship between the Rho-kinase pathway gene expressions and prognosis in GBM. Ninety-eight patients diagnosed as GBM between 2001 and 2010 were enrolled into the study. RNA was obtained from the paraffinized tumor tissue of the patients with formalin-fixed, paraffin-embedded RNA isolation kit and the mRNA expressions of 26 genes were investigated. There was a statistically significant negative correlation between the ages at the diagnosis and survival. There was a significant relationship between the overexpression of Rho-kinase pathway-related genes LIMK1, CFL1, CFL2, and BCL2 and low expression of MAPK1 gene and the survival of the patients. These results demonstrate for the first time that there is a marked contribution of Rho-kinase pathway-related genes to the progression and survival of the GBM. The expression of these genes may be related to response of multimodal therapy or these parameters could be used to determine possible unresponsive patients before treatment.

Bevacizumab + capecitabine as maintenance therapy after initial bevacizumab + XELOX treatment in previously untreated patients with metastatic colorectal cancer: phase III 'Stop and Go' study results--a Turkish Oncology Group Trial.

OBJECTIVE: It was the aim of this study to evaluate maintenance therapy with bevacizumab + capecitabine following induction with bevacizumab + capecitabine + oxaliplatin (XELOX) versus bevacizumab + XELOX until progression as first-line therapy in metastatic colorectal cancer (mCRC). METHODS: Patients received either bevacizumab (7.5 mg/kg) + XELOX (capecitabine 1,000 mg/m(2) twice daily on days 1-14 + oxaliplatin 130 mg/m(2) on day 1 every 3 weeks) until disease progression (arm A) or the same doses of bevacizumab + XELOX for 6 cycles followed by bevacizumab + capecitabine until disease progression (arm B). The primary endpoint was progression-free survival (PFS); secondary endpoints included overall survival (OS), objective response rate (ORR) and safety. RESULTS: One hundred and twenty-three patients were randomized. Treatment compliance was similar in both groups. Median PFS was significantly longer for arm B than for arm A (11.0 vs. 8.3 months; p = 0.002). There was no significant difference between the two arms for ORR (66.7 vs. 59.0%; p = 0.861) or median OS (23.8 vs. 20.2 months; p = 0.100). Tolerability was acceptable in both treatment arms; the most frequent grade 3/4 treatment-related adverse events (arm B vs. arm A) were fatigue (6.6 vs. 16.1%), diarrhoea (3.3 vs. 11.3%), anorexia (3.3 vs. 11.3%), and neuropathy (1.6 vs. 8.1%). CONCLUSIONS: Maintenance therapy with bevacizumab + capecitabine can be considered an appropriate option following induction bevacizumab + XELOX in patients with mCRC instead of continuation of bevacizumab + XELOX.

Prognostic factors in gastrointestinal stromal tumors: multicenter experience of 333 cases from Turkey.

BACKGROUND/AIMS: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal tract. In an attempt to survey the approximate incidence, clinicopathological characteristics, and immunophenotypic features of GISTs in Turkey, we conducted a clinicopathological and immunohistochemical analysis of GISTs. METHODOLOGY: Three hundred and thirty-three patients with GIST from nine institutions in Turkey were retrospectively evaluated. RESULTS: Between January 2001 and March 2011, a total of 333 patients with GISTs were included; of these, 204 (61.2%) were male and 129 (38.8%) were female. The median age was 55 years (range; 22-102 years). At the median follow-up of 26 months (range; 4-166 months), the 1-, 3- and 5-year OS rates of the 333 patients were 96.9%, 85.8% and 78.5%, respectively. The 5-year DFS rate was 40%. The 5-year OS rate and median OS time for the patients with R0 resection were significantly higher than for patients with metastatic diseases (79.7 vs. 75.7% and not reached vs. 115 months, respectively, p=0.04). CONCLUSION: Although our results should be confirmed by prospective studies, we believe that they contribute to the literature because the study included both resectable and metastatic or unresectable GIST patients and multicenter findings from Turkey.

Relationship between hopelessness, loneliness, and perceived social support from family in Turkish patients with cancer.

PURPOSE: Life-threatening diseases such as cancer can create hopelessness and loneliness by altering the lifestyle of the patient and family. Perceived social support may facilitate coping with illness. The aim of this study was to investigate the relationship between hopelessness, loneliness, and perceived social support from family in Turkish patients with cancer. METHODS: This study involved 188 patients with cancer. The data were collected using a questionnaire that determined the sociodemographic features, the Beck Hopelessness Scale, the UCLA Loneliness Scale, and Perceived Social Support from Family Scale. Data were evaluated with Mann-Whitney U and Kruskall-Wallis and Spearman product moment correlation coefficients. RESULTS: The mean scores of hopelessness (0-20), loneliness (20-80), and perceived social support from family (0-20) were 6.8 ± 0.4, 35.8 ± 0.8, and 15.2 ± 0.2, respectively. A statistically positive relationship existed between hopelessness and loneliness. A negative relationship between loneliness, hopelessness, and perceived social support from family was found (p < 0.05). Cancer patients who had family history of cancer and long disease duration had low social support from family. The hopelessness score was significantly higher in female, older, illiterate, and village-dwelling cancer patients. CONCLUSIONS: In cases where the perceived social support levels were determined to be high; the cancer patients were not hopeless or lonely. We found that decreased social support was associated with increased loneliness and hopelessness. The present evaluation indicates that although the levels of perceived social support of patients from their families may be sufficient to prevent loneliness or hopelessness, these parameters need to be evaluated periodically to maintain the patients' well-being.

Paclitaxel plus doxorubicin chemotherapy as second-line therapy in patients with advanced urothelial carcinoma pretreated with platinum plus gemcitabine chemotherapy.

BACKGROUND: We retrospectively evaluated the efficacy and toxicity of paclitaxel plus doxorubicin as a second-line treatment in patients with urothelial carcinoma, who had not responded to a prior platinum plus gemcitabine combination. PATIENTS AND METHODS: All patients received intravenous infusions of paclitaxel (175 mg/m(2)/h) and doxorubicin (50 mg/m(2)/30 min) on day 1. Chemotherapy courses were repeated every 21 days. RESULTS: The median followup duration was 13.5 months (range 2.8-22.4 months). Complete and partial responses were observed in 2 (5.6%) and 10 (27.8%) patients, respectively. Median overall survival was 8.9 months (95% confidence interval (CI): 6.2-11.6). Median time to progression was 3.8 months (95% CI: 2.7-4.8). The most common hematologic toxicities were neutropenia (n = 21, 58.3%), thrombocytopenia (n = 10, 27.8%), and anemia (n = 9, 25%). The most common nonhematologic toxicities consisted of fatigue (n = 15, 41.7%), nausea/vomiting (n = 13, 36.1%), peripheral neuropathy (n = 11, 30.6%), and mucositis (n = 6, 16.7%). Dose reductions by 25-35% were performed in 6 (16.7%) patients because of grade 3/4 toxicity. Anthracycline-related heart failure did not occur. CONCLUSION: 3-weekly courses of cyclic paclitaxel plus doxorubicin were found to be effective and tolerable in patients with urothelial carcinoma, who had not responded to prior platinum- and gemcitabine-based chemotherapy.

Peripheral blood guanylyl cyclase c (GCC) expressions are associated with prognostic parameters and response to therapy in colorectal cancer patients.

Guanylyl cyclase C (GCC) is expressed exclusively in normal intestinal mucosal cells, primary and metastatic colorectal cancers (CRC). The aim of this study was to determine the possible association between the GCC expressions in peripheral blood, prognostic parameters and response to chemotherapy in CRC patients. Fourty-nine metastatic CRC patients and 41 healthy controls with similar age and sex were included to this study. Peripheral blood GCC expressions are measured by the reverse transcriptase-polymerase chain reaction (RT-PCR) method. Interstingly, no GCC expression was measured in healthy controls but GCC expressions of the patients were detectable. Although there was a significant reduction in GCC expressions in 30 patients with regression (from 5.46 ± 4.12 to 0.06 ± 0.03, p < 0.0001), marked increase in GCC expressions was observed in 19 patients with progression following chemotherapy (from 0.43 ± 0.19 to 1.38 ± 0.52, p = 0.0174). Significant correlation was found between the GCC expressions and carbohydrate antigen 19-9 (CA19-9) levels (p = 0.0041) in 30 patients with regression before chemotherapy. Marked correlation was also detected between the GCC expressions and carcinoembryonic antigen (CEA) levels (p = 0.0072) in 19 patients with progression before chemotherapy. The results of the present study suggest that peripheral blood GCC expressions along with CEA and CA19-9 can be used to determine the early respose to chemotherapy in patients with metastatic CRC. These findings imply that higher expression of GCC in peripheral blood seems to be an indicator of good therapeutic response to chemotherapy and remission. Monitoring the peripheral blood GCC expressions may allow employing different treatment options to metastatic CRC patients.

Another cause of pancytopenia in a patient receiving temozolomide.

OBJECTIVE: To report pancytopenia caused by temozolomide, a second-generation alkylating agent. CLINICAL PRESENTATION AND INTERVENTION: A 22-year-old patient presenting with seizures and confusion was seen in the emergency room. Cranial magnetic resonance imaging revealed a mass. After surgery, the patient was diagnosed with glioblastoma multiforme and was given temozolomide at 150 mg/m(2) on days 1 through 5 every 4 weeks. During the last cycle of temozolomide, grade 3 thrombocytopenia persisted. Possible causes of pancytopenia including vitamin B(12) deficiency were investigated. CONCLUSION: This case report shows that vitamin B(12) deficiency can be a potential cause of pancytopenia and it should be kept in mind for patients receiving chemotherapy.

Association between the Thr431Asn polymorphism of the ROCK2 gene and risk of developing metastases of breast cancer.

The objective of this study was to analyze the genotype distributions and allele frequencies for ROCK2 Thr431Asn and Arg83Lys polymorphisms among breast cancer patients. In this case-control study, 223 patients with breast cancer were recruited and divided into two groups according to metastases (n = 128) and without metastases (n = 95). Genomic DNA from the patients and the control cases (n = 150) was analyzed by real-time PCR using a Light-Cycler. Neither genotype distributions nor the allele frequencies for the Arg83Lys polymorphism showed a significant difference between the groups. Although no marked changes were observed with nonmetastatic group, a statistically significant association was found between the control and metastatic group for the Thr431Asn polymorphism. Although homozygous carriers of the Thr431Thr genotype were more frequent, heterozygous carriers of the Thr431Asn genotype were less frequent among the metastatic patients than among controls. There was also an increase in Thr431 allele (60.5% in patients vs. 51.7% in controls) and decrease in Asn431 allele frequencies (48.3% in control vs. 39.5% in metastatic patients) in metastatic groups (p = 0.036). Our results demonstrate that Thr431Asn polymorphism of the ROCK2 gene could be a risk factor for the metastases of the breast cancer, and may help in predicting the prognosis.

Leech therapy for symptomatic relief of cancer pain.

OBJECTIVE: Most patients with advanced stage cancer report moderate to severe pain. The leech (Hirudo medicinalis) is commonly used in traditional medicine for relief of localized pain. DESIGN: We report a case of severe pain related to advanced stage cancer successfully treated by self-applied leeches. SETTING AND PATIENTS: A 62-year-old male patient with synchronous renal cell carcinoma and leiomyosarcoma was admitted with severe pain in the lumbar region. The pain was refractory to radiotherapy, and systemic and epidural analgesic infusion. RESULTS: Two months the patient came to the clinic in good condition free of pain. The patient reported outpatient self-treatment with seven leeches to the lumbar region in the interim that resulted in complete healing of pain. CONCLUSIONS: This is the first report indicating possible activity of leeches in cancer pain.

Docetaxel combined with oral etoposide as second-line treatment for advanced gastric carcinoma after failure of platinum- and fluoropyrimidine-based regimens.

BACKGROUND: Platinum, antracyline, and fluoropyrimidine combination chemotherapy has been widely used as a first-line treatment for advanced gastric cancer (AGC). In the present study, we determined the efficacy and the safety of docetaxel and oral etoposide as second-line combination chemotherapy after failure of commonly used combination regimens in AGC. METHODS: Patients with histologically proven gastric cancer and measurable metastatic disease received docetaxel 75 mg/m(2) as a 1-h intravenous infusion on day 1, and oral etoposide 50 mg/m(2) once daily on days 1-5, every 3 weeks until disease progression or unacceptable toxicities. RESULTS: Between June 2006 and September 2008, 32 patients, of median age 60 years (range 32-77 years) were included in the study. Overall response rate was 9.4% and 31.3% of patients achieved a stable disease. Median progression-free survival was 3 months (95% CI, 2.5-3.5). Median overall survival was 6 months (95% CI, 3.8-8.2) with 16.9% 1-year survival rate. Grade 3-4 toxicities included neutropenia (28.8%), febrile neutropenia (18.8%), thrombocytopenia (3.1%), nausea and vomiting (15.6%), diarrhea (9.4%), and mucositis (6.2%). CONCLUSION: Docetaxel and oral etoposide combination was moderately effective and safe in appropriately selected AGC patients after failure of platinum- and fluoropyrimidine-based combination regimens.

'Time is a GIFT in GIST'--the medical and paramedical perspective of a case with metastatic gastrointestinal stromal tumor.

UNLABELLED: Few recent developments in oncology have generated comparable interest as have the dramatic successes in the therapy of gastrointestinal stromal tumors (GIST) with imatinib mesylate. Imatinib, a selective tyrosine kinase inhibitor, is currently the standard of care first-line treatment for unresectable or metastatic GIST, improving survival time and delaying disease progression. The authors report a 50-year-old male patient referred as relapsed chemotherapy-resistant CD117- leiomyosarcoma. After learning about the failure of chemotherapy, the patient became depressive and considered committing a suicide. We performed a second CD117 staining. As the second analysis was found to be positive, the diagnosis of leiomyosarcoma was changed to GIST. Imatinib 600 mg/day was started. The result with imatinib was appraised as a partial response/stable disease after the chemotherapy failure. The patient's depressive mood was also improved after imatinib. The medical and paramedical perspectives of the case are presented to emphasize the importance of immunohistochemical staining and its inhibition by a novel tyrosine kinase inhibitor in GIST. All nonepithelial tumors, particularly nonepithelial abdominal tumors of leiomyoblastic appearance should be considered to be GIST unless an experienced pathologist who does CD117 staining routinely confirms a different diagnosis. Interestingly, depression due to chemotherapy failure was also alleviated with imatinib. According to a recent study, median time to progression was 24 months, and overall survival was 57 months, reaching 5 years with imatinib. CONCLUSION: time is a GIFT in GIST.

A case of metachronous triple primary urogenital cancer: urinary bladder, prostate, and renal cancer.

BACKGROUND: Multiple primary malignant tumors are rarely seen. Tobacco is one of the factors in their etiology. We report the case of a heavy smoker with metachronous triple primary cancer occurring in the prostate, kidney and urinary bladder. CASE REPORT: A 70-year-old man with prostate cancer presented with the complaint of hematuria. Computed tomography (CT) showed increased wall thickness of the urinary bladder with an enlarged prostate. After the trans-urothelial resection operation pathological diagnosis was consistent with transitional cell carcinoma of the urinary bladder. After 9 months of follow-up, the control CT showed metastatic lesions in the right and left kidneys and in the right lung. Bilateral partial nephrectomy was performed. Interestingly, renal cell carcinoma (RCC) was diagnosed. Rightsided video-assisted thoracoscopic surgery was also performed. The results of the histopathological examination were consistent with metastatic RCC. CONCLUSIONS: Although the patient presented with triple carcinoma, there was no familial cancer history suggesting a genetic association. The patient was a heavy smoker, and tobacco usage may be the underlying cause of the detected cancers. This is one of the rare cases in the published literature with triple primary urogenital cancer.

Cytokine concentrations are not predictive of bacteremia in febrile neutropenic patients.

Assay of cytokines and C reactive protein (CRP) in different periods of febrile neutropenia may be helpful for early defining the risk in severe infections. We determined serum interleukin-6 (IL-6), interleukin-8 (IL-8), soluble interleukin-2 receptor (sIL-2R), tumor necrosis factor alpha (TNF-alpha), interleukin-1 beta (IL-1beta), and CRP in 22 previously untreated patients with various malignancies. Samples were obtained in four different clinical periods of febrile neutropenia; prior to chemotherapy, afebrile neutropenic period after chemotherapy, febrile neutropenic period, and recovery period. When compared to sex-and age-matched group of healthy subjects, IL-6, IL-8, sIL-2R, and CRP levels were found to be elevated in all periods. The highest levels were encountered in the febrile neutropenic period. For predictivity purposes, the afebrile neutropenic period was the most important period. Serum sIL-2R, IL-6, IL-8 and CRP levels were elevated in this period. IL-8 levels showed the most stable elevation through different stages of febrile neutropenia. Serum IL-8 levels were found to have the most reliable and stable elevation in different clinical stages of febrile neutropenia. Nevertheless, IL-8 is not able to discriminate among risk groups and cannot be used as a predictive factor.

Gemcitabine combined with uracil-tegafur in patients with advanced pancreatic cancer.

The aim of the study was to evaluate the efficacy and tolerability of gemcitabine and uracil-tegafur (UFT) combination in patients with advanced pancreatic carcinoma, retrospectively. Thirty-one patients, including 27 with metastatic disease, were treated with gemcitabine at a dose of 1000 mg/m2 in 30 minutes on days 1 and 8, and oral UFT 300 mg/m2 on days 1-14, as the first-line regimen in advanced stage. The cycle was repeated every 21 days. A total of 116 cycles of chemotherapy were administered, with a median of 3 cycles per patient (range 1-13). The objective response rate was observed in 6 (19.3%) patients with 1 (3.2%) complete response, and 5 (16.1%) partial responses. The median response duration was 4 (range, 3-14) months. Eight (25.8%) patients had a standard deviation of more than 3 months. Median overall survival was 8 months (95% CI, 6-10 months) and median time to progression was 4.2 months (95% CI, 1-6 months). This combination was generally well tolerated. There were no life-threatening side effects. Most common toxicities were of hematologic and gastrointestinal nature. In conclusion, this regimen was well tolerated and seemed to have a moderate activity in the palliative treatment of advanced pancreatic carcinoma.

Isolated bone marrow natural killer cell lymphoma with central nervous system involvement mimicking a cerebral infarct.

BACKGROUND: We describe the case of an isolated bone marrow natural killer (NK) cell lymphoma with central nervous system (CNS) involvement mimicking a cerebral infarct. CNS involvement in isolated bone marrow lymphoma has not been reported previously. CASE REPORT: A 49-year-old man with complaints of fever, confusion, and agitation was presented. A bone marrow biopsy was performed to investigate the etiology of bicytopenia which was consistent with NK-cell lymphoma. Brain MRI findings were suggestive of a subacute infarct. CONCLUSION: Even if pathological signal changes of the brain without contrast enhancement resembling infarct are detected in patients with lymphoma on the magnetic resonance imaging, CNS involvement of the lymphoma should be kept in mind in the differential diagnosis.

Markers of bone turnover in patients with lung cancer.

INTRODUCTION: Bone metastases may change the primary treatment modality, especially if the bone is the only site of metastasis in patients considered to be in the early stage of lung cancer. It is usually diagnosed by imaging techniques. However, the diagnostic yields of imaging methods are limited. Some bone markers such as propeptides of type-1 collagen, pyridinoline cross-links and deoxypyridinoline (D-PYD) cross-links, serum osteocalcin, alkaline phosphatase are thought to be useful in the detection of bone metastasis in lung cancer. Thus, we aimed to determine the clinical usefulness of bone turnover markers in the assessment of bone metastases in patients with lung cancer. MATERIAL AND METHODS: Urinary D-PYD, calcium, and serum osteocalcin, calcium and total alkaline phosphatase (T-ALP) were measured in 60 lung cancer patients. Patients were evaluated by technetium 99 (99Tc) bone scintigraphy. The comparisons of measured values in patients with and without bone metastasis were done by using appropriate statistical methods. RESULTS: Fifty-four males and six females were included into study. Twenty-two patients had bone metastases, while 38 did not. Forty-two patients were nonsmall-cell lung cancer, whereas 18 were small-cell carcinoma. Urinary D-PYD level was the unique value that was statistically significantly higher in patients with bone metastases than that level in patients without bone metastasis (p < 0.05). CONCLUSION: Our study suggests that urinary measurement of D-PYD might be helpful in detecting bone metastasis in lung cancer. The high urinary D-PYD level may be an early sign of occult metastases in patients with no bone metastasis assessed by scintigraphic techniques.

Synchronous Hodgkin's disease and gastric adenocarcinoma.

BACKGROUND: Adenocarcinoma is the most frequent pathological type of stomach cancer. Hodgkin's lymphoma is a lymphoproliferative disease arising from lymphoid tissue which is characterized by Reed-Sternberg cells. Synchronous occurrence of these two malignancies has not been reported in the English literature so far. CASE: Here we present a 52-year-old male complaining of epigastric pain and fever diagnosed as stomach adenocarcinoma and Hodgkin's lymphoma. CONCLUSION: It is thought that this case is the first of a synchronous stomach adenocarcinoma and Hodgkin's lymphoma encountered in the English literature. It should be kept in mind that second malignancies can be seen in mass lesions in patients diagnosed with cancer.

Gemcitabine plus capecitabine combination in metastatic breast cancer patients previously treated with anthracyclines and taxanes.

BACKGROUND: Treatment of patients with metastatic breast cancer (MBC) exposed to anthracyclines and taxanes is challenging. Effective and well-tolerated regimens are required. Gemcitabine plus capecitabine combination was assessed in MBC patients pretreated with anthracyclines and taxanes. PATIENTS AND METHODS: A total of 31 patients treated between November 2004 and September 2005 were retrospectively evaluated in 4 institutions. The median age was 48 years (range 29-77). The patients were given gemcitabine 1,000 mg/m(2) on days 1 and 8, and capecitabine 1,500 mg/m(2) twice daily on days 1-14 every 3 weeks. RESULTS: A total of 160 cycles of chemotherapy were administered with a median of 5 cycles per patient (range 2-12). Three patients achieved a partial response (10%) and 8 patients (26%) stable disease. The median time to disease progression was 6 months (95% CI 5-7), with a median survival of 18 months (95% CI 15-21) at a median follow-up of 16 months (range 2-28). One-year and 2-year survival rates were 67 and 28%, respectively. Grade 3-4 toxicities were as follows: neutropenia (n = 11, 35%), nausea and vomiting (n = 4, 13%), hand-foot syndrome (n = 2, 6%), anemia (n = 2, 6%), thrombocytopenia (n = 2, 6%) and asthenia (n = 1, 3%). CONCLUSION: The combination of gemcitabine plus capecitabine was a tolerable regimen with a mild but comparable survival efficacy to similar regimens in patients with MBC after anthracyclines and taxanes.