Embolization in an adrenocortical carcinoma as palliative therapy

Background: With an annual incidence of 0.2% of new cases per 100,000 inhabitants, adrenocortical carcinoma is rare. In advanced tumor only palliative treatment modalities are practicable. Because of scarcity of the tumor, standard treatment has not been defined. The decision on therapy frequently depends on the individual situation. Tumor embolization and chemotherapy are amongst the possible options. Patient and Methods: We report on a case of a 32-year-old female patient with a large-volume hormonally active adrenocortical carcinoma and hematogenous liver metastases. This carcinoma was confirmed histologically by means of liver biopsy. Owing to the large tumor extent and metastatic spreading and also in view of the poor general condition of the patient, curative surgical therapy was not possible. For this reason, a local approach was chosen primarily with transarterial tumor embolization at the capillary level. Systemic chemotherapy was given afterwards. Results: Improvement of the patient's general condition, especially the pronounced pain symptoms, could be achieved for a short time by the embolization: both, the patient's clinical condition and the laboratory test parameters improved. However, a rapid tumor progression occured under chemotherapy, which was started after embolization. Conclusion: In advanced adrenocortical carcinoma, tumor embolization can lead to a stabilization of the disease and improvement of the symptoms as appraised by palliative criteria in some patients

Immunochemotherapy With Obinutuzumab or Rituximab for Previously Untreated Follicular Lymphoma in the GALLIUM Study: Influence of Chemotherapy on Efficacy and Safety

Purpose; The GALLIUM study (ClinicalTrials.gov identifier: NCT01332968) showed that obinutuzumab (GA101; G) significantly prolonged progression-free survival (PFS) in previously untreated patients with follicular lymphoma relative to rituximab (R) when combined with cyclophosphamide (C), doxorubicin, vincristine (V), and prednisone (P; CHOP); CVP; or bendamustine. This report focuses on the impact of chemotherapy backbone on efficacy and safety. Patients and Methods: A total of 1,202 patients with previously untreated follicular lymphoma (grades 1 to 3a), advanced disease (stage III or IV, or stage II with tumor diameter $ 7 cm), Eastern Cooperative Oncology Group performance status 0 to 2, and requiring treatment were randomly assigned 1:1 to G 1,000 mg on days 1, 8, and 15 of cycle 1 and day 1 of subsequent cycles or R 375 mg/m2 on day 1 of each cycle, for six to eight cycles, depending on chemotherapy (allocated nonrandomly by center). Responding patients received G or R for 2 years or until disease progression. Results: Baseline Follicular Lymphoma International Prognostic Index risk, bulky disease, and comorbidities differed by chemotherapy. After 41.1 months median follow-up, PFS (primary end point) was superior for G plus chemotherapy (overall hazard ratio [HR], 0.68; 95% CI, 0.54 to 0.87; P= .0016), with consistent results across chemotherapy backbones (bendamustine: HR, 0.63; 95% CI, 0.46 to 0.88; CHOP: HR, 0.72; 95% CI, 0.48 to 1.10; CVP: HR, 0.79; 95% CI, 0.42 to 1.47). Grade 3 to 5 adverse events, notably cytopenias, were most frequent with CHOP. Grade 3 to 5 infections and second neoplasms were most frequent with bendamustine, which was associated with marked and prolonged reductions in T-cell counts. Fatal events were more frequent in patients treated with bendamustine, possibly reflecting differences in patient risk profiles. Conclusion: Improved PFS was observed for G plus chemotherapy for all three chemotherapy backbones. Safety profiles differed, although comparisons are confounded by nonrandom chemotherapy allocation

Prognostic value of end-of-induction PET response after first-line immunochemotherapy for follicular lymphoma (GALLIUM): secondary analysis of a randomised, phase 3 trial

International audiencePET investigators from the GALLIUM study (2018). Prognostic value of end-of-induction PET response after first-line immunochemotherapy for follicular lymphoma (GALLIUM): secondary analysis of a randomised, phase 3 trial. The Lancet Oncology

Prognostic value of end-of-induction PET response after first-line immunochemotherapy for follicular lymphoma (GALLIUM): secondary analysis of a randomised, phase 3 trial

International audienc