Metronomic chemotherapy preserves quality of life ensuring efficacy in elderly advanced non small cell lung cancer patients

Metastatic non small cell lung cancers (NSCLC) are diseases with poor prognosis and platinum-based doublet chemotherapy still remains their standard cure. Elderly patients often present comorbidities that limit the utilization of this chemotherapy; therefore these patients should have a first-line treatment with low toxicity and capable to preserve the quality of life (QoL) but, at the same time, to ensure the best possible response. Furthermore, a first-line treatment allows patients to be fit for further treatments, prolonging overall survival. At this regard, metronomic chemotherapy can be an optimal choice for elderly, able to improve QoL and to obtain an optimal palliation. We retrospectively studied a cohort of 41 elderly advanced NSCLC patients with different histotypes, treated with metronomic chemotherapy (weekly carbo-paclitaxel or vinorelbine as single agent) as first choice and we analyzed the tolerability, the impact on QoL and the efficacy of these schedules: no toxicity of 3 and 4 grade was observed, together to a clinical benefit of 43%. We administered FACT-L test to evaluate QoL at baseline and after 4 months and found a significant improvement in all FACT-L parameters: physical, social, emotional and functional, confirming a QoL improvement. At a median follow-up of 20.2 months the progression free survival was of 6 months and the overall survival was of 15 months. These results suggest that metronomic chemotherapy can be an effective choice of treatment for elderly NSCLC patients and further trials with more patients are needed to confirm this proposal

Novel schedule for treatment of inflammatory breast cancer

Inflammatory breast cancer (IBC) is the most aggressive form of this tumor, with the clinical and biological characteristics of a rapidly proliferating disease. This tumor is always diagnosed at advanced stages, atleast stage IIIB (locally advanced), so its management requires an integrated multidisciplinary approach with a systemic therapy followed by surgery and radiation therapy. Patients with IBC usually have a worse prognosis but the achievement of a pathologic complete response after neoadjuvant chemotherapy may have good rates of overall survival. We present the case of a 47 year old women with IBC, luminal B and with high proliferative index; she was successfully treated with a sequential schedule of chemotherapy (anthracyclines dose-dense/carboplatin+ taxane/Cyclophosphamide Methotrexate Fluorouracil), hormone-therapy, complementary radiotherapy and finally surgery until the achievement of a complete clinical and pathological response. Luminal B inflammatory breast cancer with high proliferation index can benefit from sequential schedules of neoadjuvant chemotherapy and hormonal treatment and this can result in pathological complete response

Modelling chemotherapy resistance in palliation and failed cure

The goal of palliative cancer chemotherapy treatment is to prolong survival and improve quality of life when tumour eradication is not feasible. Chemotherapy protocol design is considered in this context using a simple, robust, model of advanced tumour growth with Gompertzian dynamics, taking into account the effects of drug resistance. It is predicted that reduced chemotherapy protocols can readily lead to improved survival times due to the effects of competition between resistant and sensitive tumour cells. Very early palliation is also predicted to quickly yield near total tumour resistance and thus decrease survival duration. Finally, our simulations indicate that failed curative attempts using dose densification, a common protocol escalation strategy, can reduce survival times