Outcome of docetaxel in treatment of metastatic hormone-sensitive prostate cancer and correlation with hemoglobin, albumin, lymphocyte and platelets score.

Introduction: We aimed to evaluate the outcome of treatment with docetaxel plus androgen deprivation therapy (ADT) in newly diagnosed patients with metastatic high tumor burden hormone-sensitive prostate cancer (mHSPC) and correlated the outcome with hemoglobin, albumin, lymphocyte and platelets (HALP) score. Material and methods: Six cycles of docetaxel plus ADT were given to 50 patients with high burden mHSPC. Baseline HALP score was calculated and disease outcome was tabulated; moreover, the prognostic impact of the HALP score in response to treatment and survival was calculated. Results: We found a significant association between high HALP score and response to treatment where a higher rate of complete response occurred in patients with a high HALP score than in patients with a low HALP score (53.8% vs. 5.4% respectively, p-value = 0.001). Patients with ≥ 12-month-duration castration-resistant prostate cancer (CRPC) had a significantly higher HALP score compared to patients with a lower HALP score (84.6% vs. 35.1% respectively, p-value = 0.002); 18-month-duration CRPC-free survival was significantly greater in patients with higher HALP score than patients with a lower HALP score (23.1% and 5.4% respectively, p-value < 0.001). Patients with a high HALP score had insignificantly higher mean overall survival than patients with a low HALP score (mean: 22.91 and 20.66 months respectively, p-value = 0.230). Conclusions: Our results confirmed the benefits of treatment with docetaxel plus ADT in high-burden mHSPC with accepted tolerance. HALP score was found to be an independent predictive factor for benefit from therapy; we can apply it as an easy way to stratify patients for appropriate selection of treatment for better tolerance and outcome.

Aggressive Care at the End of Life; Where Are We?

BACKGROUND: Although, efforts to encourage palliative care only for terminal patients, aggressive end-of-life care (EOL) care still common for those probably to die shortly. AIM: Multicenter experiences to investigate where did we stand in this era? PATIENTS AND METHODS: A retrospective study included patients with advanced solid tumors. The presence of one or more of the following indicators in the last month of life (LM) referred to aggressive EOL care: emergency department (ED) visits ≥ twice, admission to the hospital through ED, death in critical care units (CCUs), and palliative chemotherapy (PC) at the past 2 weeks before death. RESULTS: A total of 435 patients, 51.5% were men with a median age of 62 years (range: 17-108), were included in the study. Most of the patients (89.2%) belonged to Group II; they had attended ED at least twice (60%), approximately 53% admitted to the hospital through ED, 31% received PC-LM with 41% of them had at the past 2 weeks before death, 13% died in the CCUs, and more than half of them (53%) survived <2 weeks. Kaplan-Meier estimator revealed that median survival was 30 days in Group I versus 13 days in Group II (odds ratio: 1.63; 95% confidence interval: 1.20-2.21; P = 0.002). The median survival was statistically significantly associated with PC-LM ≥14 days and the admission mode. There was no statistically significant association with age, sex, and primary cancer sites. CONCLUSION: The majority of our patients continue with anticancer treatments they possibly do not need and associated with poor survival.

Comparing Health-Related Quality of Life among Breast Cancer Patients Receiving Different Plans of Treatment, Egypt.

The increased survival of breast cancer (BC) patients by earlier detection and improved treatment outcomes together with younger age at diagnosis, raised the concerns about Quality Of Life among survivors, suffering from treatment side effects. To measure QOL among BC Egyptian females, then to compare HRQOL scores in BC patients receiving different lines of treatment. A comparative cross-sectional study on a sample 142 BC survivor receiving different lines of treatment, using EORTC QLQ-C30, and a BC-specific scale (QLQBR23 scale). The emotional functioning had the lowest score (29.22 ± 8.1), the most prominent symptom was appetite loss (69.48 ± 15.6) and in QLQ-BC23 scale, the future perspectives had the lowest score among functioning scale (19.71 ± 4.9). While among the symptoms scale; the most annoying symptom was upset by hair loss (89.67 ± 15.5). A significant difference in emotional subscale between three lines of treatment (p = 0.000) with the hormone therapy had the highest Global QOL (41.17 ± 9.97) (p = 0.008). Significant inverse correlation between the level of Global QOL and presence of chronic disease in the chemotherapy group (p = 0.001) and stage of carcinoma in all lines of treatment. Moreover the results proved that age and stage of carcinoma were the significant predictors for Global QOL. Hormonal therapy group showed the best functional scale in all subdomains of QLQ-C30 and QLQ-BC23, while radiotherapy group showed the lowest scores in QOL-C30 and chemotherapy group in QLQ-BC23. Chemotherapy group shows the highest level of problematic Global QOL with appetite loss in QLQ-C30 and upset from hair loss in QLQ-BC23.

Immunohistochemical expression of cancer stem cell related markers CD44 and CD133 in endometrial cancer.

The goal of this study was to detect the presence of cancer stem cell markers CD44 and CD133 in immunohistochemically stained samples of endometrial cancer and correlate their expression with clinicopathological variables to identify the impact of CD44 or CD133 expression on tumor behavior and endometrial carcinogenesis. Marker expression was analyzed in 62 endometrial cancer samples (57 endometrioid carcinoma and 5 carcinosarcoma) and 15 proliferative endometrium samples. We detected CD133 and CD44 expression in 87.09% and 79.03% respectively of the studied endometrial cancers, and the expression was significantly different from the normal group. CD44 expression decreased with myometrial invasive depth and lymph-vascular space invasion (LVSI), and these inverse relationships were significant (p=0.034, p=0.019, respectively). CD133 was more expressed by early stage tumor (FIGO I-II) compared with those having FIGO III to IV stage disease (p=0.021). The most notable conclusion of the present study is that CD44 and CD133 might participate in early-stage endometrial cancer carcinogenesis, and their overexpression may facilitate the early diagnosis of endometrial cancers. Analysis of our results supports the hypothesis that CD44 expression tends to decrease as the disease becomes invasive and progressive. So, we concluded that CD44 down-regulation might warn of a more aggressive course and may have a link with poorly prognosis carcinosarcomas. Further examination of the expression and function of CD44 and CD133 with a greater number of carcinosarcomas is warranted.