Safety and efficacy of transdermal fentanyl in patients with cancer pain: phase IV, Turkish oncology group trial

We have performed a prospective evaluation of the efficacy, safety and convenience of the transdermal therapeutic system - fentanyl (TTS-F) in Turkish cancer patients when it was newly available in Turkey. Ninety-nine patients with historically confirmed malignancy and pain entered the study; the mean age was 55.1 (16-58) years. The study duration was 28 days. Transdermal therapeutic system - fentanyl was used in opioid-naive or pre-treated patients. Most patients reported a decrease in pain severity. Use of rescue medication decreased from day 4 to day 28. The majority of patients rated patch convenience of use as excellent. A total of 22.2% of patients experienced adverse events that were either probably related or very likely to be related to the study drug. The majority of the adverse events mentioned were related to the digestive system. Eighteen serious adverse events were reported by 13 patients. Six events were doubtfully related, and 12 events were not related to the study drug. Four patients died during the trial. None of these deaths was attributed to the study drug. In conclusion, the trial showed that TTS-F is easily managed, effective and will help to enable the appropriate opioid administration to patients who are suffering from cancer pain in Turkey

Impact Of Acetylsalicylic Acid On The Clinicopathological Characteristics And Prognosis Of Patients With Invasive Breast Cancer

Background: The impact of acetylsalicylic acid (ASA) on the clinicopathological characteristics of breast cancer has not yet been elucidated in detail; we therefore aimed to investigate the effects of ASA on the clinicopathological characteristics of patients with breast cancer. Patients and Methods: Patients diagnosed with breast cancer were retrospectively analyzed. Breast cancer patients who were taking ASA at the time of breast cancer diagnosis were enrolled as ASA users (n = 84); matching patients with the same age who were not taking ASA were included as control group (n = 890). Results: The median age was 56 (range 34-82) years in both groups. ASA users had a significantly lower incidence of grade II-III tumors compared to non-users (P = 0.02). The other clinicopathological characteristics and treatment histories were similar in both groups. In patients using ASA, the disease-free survival (DES) rate was 97.3%, 89.4%, and 79.9% and in non-users it was 94.1%, 81.8%, and 70.9% in the 1rst, 3rd, and 5th year, respectively (P = 0.01). In aspirin users, the overall survival rate was 95.0%, 90.6%, and 87.6% and in non-users it was 98.1%, 91.2%, and 85.5% in the 1rst, 3rd, and 5th year, respectively (P = 0.50). Conclusion: Using ASA at the time of breast cancer diagnosis was associated with significantly improved DES in breast cancer patients.WoSScopu

The Association Between Body Mass Index and Immunohistochemical Subtypes in Breast Cancer

Background:Body mass index (BMI) is defined as a poor prognostic factor in patients with breast cancer(BC). However, there are controversial results regarding the various effects of BMI on BC, hence the exactpathophysiology of the relation between obesity and BC is still under debate, and remains unclear. Thispaper aims to investigate the association between BMI at presentation and BC subtypes defined accordingto the immunohistochemical classification in both premenopausal and postmenopausal patients with BC.Patients and methods:This study is a retrospective and explorative analysis of the 3767 female BC pa-tients from a single center. All patients' BMI at the time of initial diagnosis and tumor demographics wererecorded. BMI was stratified into 3 groups as normal-weighted (BMI<25 kg/m2), over-weighted(BMI¼25e29.9 kg/m2), and obese (BMI 30 kg/m2). Immunohistochemical classification of thetumors was categorized into 4 groups as follows; luminal-like, HER2/luminal-like, HER2-like, and triple-negative according to the ER/PR and HER2 status. Distribution of Immunohistochemical subtypes, tumorcharacteristics, and overall survival (OS) analysis were evaluated according to the BMI groups in bothpremenopausal and postmenopausal patients.Results:Median BMI of premenopausal and postmenopausal patients was 25.5 (kg/m2) and 28.8 (kg/m2),respectively (P<0.001). In parallel with the increasing age, patients were more obese at diagnosis inboth premenopausal (P<0.001) and postmenopausal period (P<0.001). Triple-negative subtype wassignificantly more frequent in premenopausal patients with BMI 30 kg/m2compared to BMI<30 kg/m2(P¼0.007). Additionally, premenopausal patients with BMI 30 kg/m2had less common luminal-likesubtype (P¼0.033) and more frequently presented with higher tumor stage (P¼0.012) and tumorgrade (P¼0.004) compared to patients with BMI<25 kg/m2. On the other hand, premenopausal patientswith BMI<25 kg/m2had significantly more ER-positive tumors (P<0.001) and lower stages of disease(P¼0.01) compared to their counterparts with BMI 25 kg/m2. Premenopausal obese patients withtriple-negative (P¼0.001) and luminal-like subtype (P¼0.002) had significantly shorter OS durationcompared to overweight counterparts. HER2/luminal-like subtype was found to be significantly greaterin postmenopausal overweight patients (P¼0.005). However, BMI had no any other significant effect onsurvival and immunohistochemical subtypes in postmenopausal patients. Multivariate analysis revealedthat triple-negative subtype, grade III tumor, BMI 30 kg/m2,T3e4(P<0.001), nodal involvement,metastatic disease, and lymphovascular involvement were significantly associated with poorer OS.Conclusion:Our data indicated that BMI was an independent factor in patients with BC, with an asso-ciation indicating a decreased incidence for luminal-like subtype and increased incidence for triple-negative subtype among premenopausal patients. However, this significance was not found inpostmenopausal patients. Accordingly, a plausible etiological heterogeneity in BC might play a roleamong immunohistochemical subtypes in every life stage of womenScopu

Serum 25-Hydroxy Vitamin D Status Is Not Related To Osteopenia/Osteoporosis Risk in Colorectal Cancer Survivors

Background: The incidence of colorectal cancer increases with vitamin D deficiency as shown in recently published studies. In addition, prospective investigations have indicated that low vitamin D levels may be associated with increased mortality of colorectal cancer, especially in stage III and IV cases. However, the exact incidence of vitamin D deficiency and the relation between vitamin D deficiency and osteopenia/osteporosis is still not known. The aim of this study is to identify severity of vitamin D deficiency and absolute risk factors of osteopenia/osteoporosis in colorectal cancer survivors. Materials and Methods: A total of 113 colorectal cancer survivors treated with surgery and/or chemotherapy +/- radiotherapy were recruited from medical oncology outpatient clinics during routine follow-up visits in 2012-2013. Bone mineral densitometry (BMD) was performed, and serum 25-OH vitamin D levels were also checked on the same day of the questionnaire. The patients was divided into 2 groups, group A with normal BMD and group B with osteopenia/osteoporosis. Results: The median age of the study population was 58 (40-76). Thirty (30.0%) were female, whereas 79 (70.0%) were male. The median follow-up was 48 months (14-120 months). Vitamin D deficiency was found in 109 (96.5%); mild deficiency (20-30 ng/ml) in 19 (16.8%), moderate deficiency (10-20 ng/ml) in 54 (47.8%) and severe deficiency (< 10 ng/ml) in 36 (31.9%). Osteopenia was evident in 58 (51.4%) patients whereas osteoporosis was noted in 17 (15.0%). Normal BMD was observed in 38 (33.6%). No apparent effects of type of surgery, presence of stoma, chemotherapy, radiotherapy and TNM stage were found regarding the risk of osteopenia and osteoporosis. Also, the severity of the vitamin D deficiency had no effect in the risk of osteopenia and osteporosis (p=0.93). In female patients, osteopenia/osteoporosis were observed in 79.5% patients as compared to 60.7% of male patients (p=0.04). Conclusions: In our study, vitamin D deficiency and osteopenia/osteoporosis was observed in 96.5% and 66.4% of colorectal cancer survivors, respectively. There is no defined absolute risk factor of osteopenia and osteoporosis in colorectal cancer survivors. To our knowledge, in the literature, our study is the first to evaluateall the risk factors of osteopenia and osteoporosis in colorectal cancer survivors.WoSScopu