EGFR mutated (exon 21) metastatic lung adenocarcinoma in female patient treated with erlotinib — case report

Poniżej przedstawiono przypadek chorej z zaawansowanym rakiem gruczołowym płuc, u której przeprowadzono typową diagnostykę histologiczną i molekularną, a następnie leczono ją inhibitorem kinazy tyrozynowej dla receptora EGFR, erlotynibem.We present the case of advanced lung cancer female patients after histological and molecular diagnostic procedures, treated with EGFR tyrosine kinase inhibitor, erlotinib

Diagnosis and treatment of progressive multifocal leukoencephalopathy

Progressive multifocal leukoencephalopathy (PML) is a rare but a very serious complication associated inter alia with the use of new biological and immunomodulatory agents that cause long-lasting immunosuppression. This also applies to rituximab, commonly used for treatment of B-cell non-Hodgkin lymphoma (NHL) patients. PML may develop during, as well as after, completion of treatment with rituximab. Diagnosis of PML is not easy and poses a significant challenge for the clinician due to similarity of symptoms that occur with lymphoma infiltration of central nervous system (CNS). The paper summarizes the most recent information on the epidemiology, clinical course and treatment of PML with particular attention to patients with NHL. It also discusses recommendations of the American Academy of Neurology, published in April 2013, on the diagnosis and detection of PML in the context of their use in everyday clinical practice

Kikuchi-Fujimoto disease: report of two new Polish cases and review of the current literature

Kikuchi-Fujimoto disease (KFD, histiocytic necrotizing lymphadenitis) is benign and self-limited cervical lymphadenopathy with accompanied mild fever. Disorder mostly affects young adults, rarely children mainly in Asia. The etiology of KFD is unknown but it is thought to be an autoimmune or inflammatory process triggered by viral infection in susceptible individuals. The minimal criteria required for the diagnosis of KFD include the presence of paracortical clusters of plasmacytoid dendritic cells admixed with karyorrhectic bodies and crescentic histiocytes. KFD does not require specific treatment except from antipyretics and anti-inflammatory medications. Here we present two new cases of KFD described in Poland together with the review of current literature

Retrospective analysis of eff ectiveness and toleration of treatment with platinum derivative and pemetrexed in patients with advanced (stage IIIB and IV) non-small non-squamous cell lung cancer in a few oncology centers

Wstęp. Badanie Scagliottiego i wsp. zapoczątkowało stosowanie w leczeniu raka płuca schematów chemioterapiistosownie do konkretnego rozpoznania histologicznego: w raku o utkaniu innym niż płaskonabłonkowe — w połączeniuz cisplatyną pojawił się pemetreksed.Cel pracy. Retrospektywna ocena skuteczności i tolerancji paliatywnej chemioterapii z użyciem dwulekowegoschematu zawierającego pochodną platyny i pemetreksed w rutynowej praktyce klinicznej w okresie przed wprowadzeniemprogramu lekowego.Materiał i metody. Do badania włączono 50 chorych na zaawansowanego (stopień kliniczny IIIB lub IV) raka niedrobnokomórkowegoo utkaniu innym niż płaskonabłonkowe. W całej grupie przeprowadzono analizę odpowiedzii tolerancji leczenia. Czas wolny od progresji określono u 45 chorych, u których nie stosowano innego leczenia przedprogresją oraz u których czas do progresji lub zgonu (ewentualnie utraty z obserwacji) był znany.Wyniki. Chorzy otrzymali od 1 do 5 cykli leczenia, a 34 chorych (68%) — zalecane 3–4 cykle. U żadnego chorego nieuzyskano całkowitej remisji pod wpływem leczenia. U 8 chorych (16%) odnotowano częściową remisję, a u 29 chorych(58%) — stabilizację choroby. Progresja w trakcie leczenia wystąpiła u 13 chorych (26%). Korzyść kliniczną odniosło17 chorych (34%). Mediana czasu wolnego od progresji wyniosła w ocenianej grupie 19 tygodni (3–92 tyg.). Wśródchorych leczonych cisplatyną mediana czasu do progresji wyniosła 19,8 tygodnia (3–92 tyg.). Tolerancja leczenia byładobra, nie odnotowano powikłań zagrażających życiu. Wystąpiło 10 przypadków neutropenii, 1 małopłytkowość,niedokrwistość pojawiła się u 7 chorych, odnotowano też 6 przypadków powikłań niehematologicznych.Wnioski. Korzyść kliniczną odniosła około jedna trzecia chorych, a mediana czasu wolnego od progresji była krótszaod uzyskanego we wspomnianym badaniu rejestracyjnym dla pemetreksedu. Leczenie było dobrze tolerowane.Celowe byłoby przeprowadzenie prospektywnego badania obserwacyjnego w celu rzetelnej oceny efektywnościi tolerancji rutynowego leczenia schematem zawierającym pemetrekset.Background. The Scagliotti trial initiated the use of chemotherapy in non-small cell, non-squamous lung cancerchemotherapy with pemetrexed.Purpose. Retrospective analysis of eff ectiveness and toleration of palliative chemotherapy with platinum derivativeand pemetrexed.Materials and methods. The study population was 50 patients with stage IIIB/IV non-small cell non-squamous lungcancer who had been treated with platinum derivate and pemetrexed. Response and toxicity were analyzed in allgroups. Progression-free survival was assessed for 45 patients who had not received any other treatment beforedisease progression and whose date of progression or death was known.Results. Patients received 1 to 5 cycles of chemotherapy, but 34 (68%) had recommended 3 to 4 cycles. No patientachieved complete remission. 8 (16%) had a partial response and stabilization was reached in 29 (58%). Progression ofthe disease occurred in 13 patients (26%). Clinical benefi t was achieved in 17 patients (34%). Median progression-freesurvival was 19 weeks (range 3–92 weeks), and for patients treated with cisplatin 19.8 weeks (3–92 weeks). Treatmenttoleration was good. No life threatening side eff ects were reported. Toxicity was as follows: 10 cases of neutropenia,1 of thrombocytopenia, 7 of anemia, and 6 of non-hematological toxicities were also reported.Conclusions. Clinical benefi t was achieved in one-third of patients. Progression-free survival was shorter than fornon-squamous cell cancer patients treated with cisplatin and pemetrexed in the Scagliotti trial. Treatment was welltolerated. For better assessment of treatment eff ectiveness and toxicity a observational study would be useful

Phase III trial comparing paclitaxel poliglumex (CT-2103, PPX) in combination with carboplatin versus standard paclitaxel and carboplatin in the treatment of PS 2 patients with chemotherapy-naive advanced non-small cell lung cancer

Free to read at publisher's site. INTRODUCTION: Performance status (PS) 2 patients with non-small cell lung cancer (NSCLC) experience more toxicity, lower response rates, and shorter survival times than healthier patients treated with standard chemotherapy. Paclitaxel poliglumex (PPX), a macromolecule drug conjugate of paclitaxel and polyglutamic acid, reduces systemic exposure to peak concentrations of free paclitaxel and may lead to increased concentrations in tumors due to enhanced vascular permeability. METHODS: Chemotherapy-naive PS 2 patients with advanced NSCLC were randomized to receive carboplatin (area under the curve = 6) and either PPX (210 mg/m/10 min without routine steroid premedication) or paclitaxel (225 mg/m/3 h with standard premedication) every 3 weeks. The primary end point was overall survival. RESULTS: A total of 400 patients were enrolled. Alopecia, arthralgias/myalgias, and cardiac events were significantly less frequent with PPX/carboplatin, whereas grade ≥3 neutropenia and grade 3 neuropathy showed a trend of worsening. There was no significant difference in the incidence of hypersensitivity reactions despite the absence of routine premedication in the PPX arm. Overall survival was similar between treatment arms (hazard ratio, 0.97; log rank p = 0.769). Median and 1-year survival rates were 7.9 months and 31%, for PPX versus 8 months and 31% for paclitaxel. Disease control rates were 64% and 69% for PPX and paclitaxel, respectively. Time to progression was similar: 3.9 months for PPX/carboplatin versus 4.6 months for paclitaxel/carboplatin (p = 0.210). CONCLUSION: PPX/carboplatin failed to provide superior survival compared with paclitaxel/carboplatin in the first-line treatment of PS 2 patients with NSCLC, but the results with respect to progression-free survival and overall survival were comparable and the PPX regimen was more convenient. © 2008International Association for the Study of Lung Cancer