EGFR expression in gallbladder carcinoma in North America.

BACKGROUND: Increased epidermal growth factor receptor (EGF receptor) expression has been noted in various cancers and has become a useful target for therapeutic interventions. Small studies from Asia and Australia have demonstrated EGFR over-expression in gallbladder cancer. We sought to evaluate the expression of EGFR in a series of 16 gallbladder cancer patients from North America. METHODS: Using tumor registry data, we identified 16 patients diagnosed with gall bladder carcinoma at our medical center between the years of 1998 and 2005. We performed a retrospective review of these patients' charts, obtained cell blocks from pathology archives and stained for EGFR and Her2/neu. RESULTS: Fifteen of sixteen patients were noted to over-express EGFR. Three were determined 1+, nine were 2+ and three were 3+. Eight patients had poorly differentiated adenocarcinoma, six had moderately differentiated and two had well-differentiated tumors. In this small series, there was a trend toward shorter survival and more poorly differentiated tumors in patients with greater intensity of EGFR expression. One patient was EGFR negative but 3+ for erb-2/Her 2-neu expression. No patient co-expressed EGFR and Her-2-neu. Median survival of patients in this series was 17 months. CONCLUSION: In view of our observations confirming the over-expression of EGFR in our patient population in North America, and the recent success of EGFR targeted therapies in other solid tumors that over-express EGFR, it may now be appropriate to evaluate agents targeting this pathway either as single agents or in combination with standard chemotherapy.

Gemcitabine-induced pulmonary toxicity: case report and review of the literature.

Gemcitabine is a pyrimidine analog with a similar chemical structure and mechanism of action, as cytarabine. It has been shown to be a highly active agent for non-small cell lung cancer, pancreatic cancer, urothelial cancer, breast cancer and ovarian cancer. Gemcitabine is relatively well tolerated and myelosuppression is the dose-limiting toxicity. Pulmonary toxicity with gemcitabine is relatively uncommon, but a well recognized entity, associated with significant morbidity and mortality. A high index of suspicion, early diagnosis and timely intervention with oxygen supplementation, steroids, and diuretics is necessary to manage patients with this complication.