An extremely rare neoplasm, histiocytic sarcoma: A report of two cases with an aggressive clinical course

Histiocytic sarcoma (HS) is an extremely rare malignant neoplasm accounting for less than 1% of all hemato-lymphoid neoplasms. Sixty percent of all cases are metastatic at presentation and the prognosis is poor. Two cases of HS with an aggressive clinical course are presented. The first case was a 58-year-old man admitted to our hospital with back pain and paresthesia of the lower extremities. Magnetic resonance imaging (MRI) of the thoracic spine revealed a mass measuring 48 × 15 mm between the T2‒T5 paravertebral area, entering the spinal channel via the neural foramen and compressing the spinal cord. The mass was completely resected and pathological and immunohistochemical staining confirmed the diagnosis of HS. After three cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) and two cycles of carboplatin/paclitaxel, the patient died due to disease progression after 9 months. The second case is a 48-year-old man who presented with fever and weight loss, and complained of back pain for 2 months. Thoracic vertebral MRI revealed a lesion destructing the T6, T7 and T9 vertebral corpus and a mass measuring 2.5 × 2 cm near the T6‒T7 transverse process. Total-body fluorodeoxyglucose positron emission tomography (FDG-PET) imaging revealed bilateral inguinal hypermetabolic lymph nodes measuring 10 × 14 mm and osteolytic destructive bone lesions on the vertebral colon and pelvic bones. Pathological and immunohistochemical staining of bone marrow aspirate confirmed the diagnosis of HS. After three cycles of ifosfamide, carboplatin, etoposide (ICE) chemotherapy, the patient died due to disease progression after 3 months. Conclusions: HS is an extremely rare malignant neoplasm of the monocytic/macrophage lineage, with no standardized chemotherapy regimen for multisystemic disease. Metastatic patients have a more aggressive clinical course than those with unifocal disease

Physician-reported ECOG-PS versus patient-reported (self) ECOG-PS: Which one is a better predictor of survival in cancer?

The aim of this study is to determine the discrepancy and agreement between Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores evaluated by doctors and patients and examine the factors that influence the performance evaluation of doctors and patients. This study is a prospective and descriptive case-control study. General, demographic, and oncologic data of the patients were collected. e-control study. General, demographic, and oncologic data of the patients were collected. Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression surveys were conducted to determine patients' levels of anxiety and depression, and at the same time, both the doctors and the patients were asked to determine their performance status. As a result, the discrepancy in performance evaluation between the patient and the doctor, the factors affecting this discrepancy, and its effect on progression and survival were examined. 277 patients were included. 146 (52.7%) were male, and 131 (47.3%) were female. The most common cancers were breast cancer (17.7%, n=49) and lung cancer (17.3%, n=48). It was found that the doctors' assessment of patient performance increased the progression risk by 3.1 times (HR: 3.080, 95% CI: 1,671-5,675) in ECOG-PS 2 compared to ECOG-PS 0 and by 5 times (HR: 4.980, 95% CI 1.405-17.646) in ECOG-PS 3 compared to ECOG-PS 0. Our study determined a weak agreement between the doctor and patient in terms of performance assessment. The most significant reason for this discrepancy was found to be due to the levels of depression or anxiety in patients. In conclusion, it was demonstrated that the performance evaluations determined by doctors are more accurate and meaningful in terms of progression and survival results compared to those determined by patients. [Med-Science 2023; 12(3.000): 827-52

Efficacy and safety of trastuzumab emtansine in older patients with HER2-positive advanced breast cancer: a real-world study

Introduction: Ado-trastuzumab emtansine (T-DM1) is an antibody-drug conjugate and its survival advantage has been shown in advanced human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, clinical trials underrepresent patients > 65 years of age, leading to a lack of information in this population. We analyzed the real-world outcomes of older women who were treated with T-DM1 therapy. Methods: We performed a multicenter, observational, retrospective analysis of patients aged > 65 years treated with T-DM1. A total of 93 patients from 10 cancer centers were involved in the study. Our goal was to determine the survival, response rates, and toxicity profile in T-DM1-treated patients, as well as the factors that influence survival. Results: Median follow-up was 12.2 months. Objective response rate was 29%. Median progression-free survival (PFS) and overall survival (OS) were 8.47 and 15.0 months, respectively. In multivariate analysis, Eastern Cooperative Oncology Group Performance Score 2 was found to be an independent prognostic factor for worse PFS (hazard ratio [HR] 1.81, p = 0.032) and OS (HR 2.33, p = 0.006). Any adverse event (AE) was seen in 92.5% of patients; grade 3 or 4 AEs were seen in 30.1%. Dose reduction or treatment discontinuation rates were 11.8% and 6.5%, respectively. Conclusion: The efficacy of T-DM1 was acceptable and it was generally well-tolerated among older patients with advanced HER2-positive breast cancer