First line modified Folfirinox versus gemcitabine for advanced pancreatic cancer: A single institution retrospective experience

Background: Advanced pancreatic cancer (APC) is a highly lethal malignancy which has one of the worst treatment outcomes. Modified (m)FOLFIRINOX is an intense but a proven treatment approach with a survival benefit for APC. Although mFOLFIRINOX demonstrated survival benefit compared with gemcitabine monotherapy, the standard treatment in previous years, toxicity is a difficult aspect of this treatment. Methods: A retrospective analysis of patients referred to Medical Oncology Clinics of Ankara Oncology Research and Training Hospital with the diagnosis of inoperable locally advanced or metastatic pancreatic cancer and treated with mFOLFIRINOX or gemcitabine monotheraphy from March 2013 to April 2018 was performed. Results: Forty three patients and 37 patients were included in mFOLFIRINOX and gemcitabine groups, respectively. The mean age of the patients was 53.74 years (range: 32–69) and 65,7 years (range: 47–82) for mFOLFIRINOX and gemcitabine, respectively (95% CI, p < 0.001). All patients, except one, had ECOG performance status of 0 or 1 in mFOLFIRINOX group. In contrast, nine patients had ECOG performance status of 2 in the gemcitabine group (95% CI, p = 0.002). When the patients were evaluated for response, 11 (25.6%) and 6 (16.2%) had partial remission with mFOLFIRINOX and gemcitabine, respectively. Median PFS and OS was 5,73 (95% CI, 2,57-8,90) months and 8.77 (95% CI, 6.54–10.99) months with mFOLFIRINOX and 2,77 (95% CI, 2,29-3,24) months and 5.80 (95% CI, 3.08–7.92) months with gemcitabine, respectively. mFOLFIRINOX regimen was more toxic than gemcitabine regimen. The incidences of all-grade neutropenia, neuropathy, and emesis were more prominent in the mFOLFIRINOX group. Conclusion: mFOLFIRINOX is a difficult regimen for both patients and physicians with significant toxicity with a greater survival benefit. The survival benefit was modest in this real-life experience. Patient selection bias and small sample size of this retrospective study should be considered. Keywords: Pancreatic cancer, First-line therapy, mFOLFIRINOX, Gemcitabin

Primary hepatic Ewing sarcoma: a very infrequent case report

Ewing sarcoma (ES) is a member of small round cell tumors of which contains Wilms’ tumor, neuroblastoma, rhabdomyosarcoma and lymphoblastic lymphoma. ES occurs most commonly in the bone but infrequently occurs in the soft tissues without involvement of the bones. Primary involvement of the liver is even rarer. We report the case of 24-year-old female patient with abdominal pain. Abdominal computed tomography scan showed hepatic large cystic lesion. Liver biopsy showed tumoral cells with small narrow stoplasmic and hyper chromatic nucleus evaluated as small round cell tumor. Immunohistochemical study of the lesion revealed CD99 and bcl-2 positive, cytokeratin, LCA, CD138, chromogranin, synaptophysin, myoD1, terminal deoxynucleotidyl transferase and myoglobin negative the diagnosis primary hepatic ES. A research for any other tumor involvement by using positron emission tomography yielded only hepatic involvement revealed. The patient treated with vincristine-cyclophosphamide- adriamycin and ifosfamide-etoposide alternately chemotherapy then hepatic tumor regressed. Patient operated on hepatic wedge resection. She has continued on chemotherapy and she has been doing well at the sixth month of diagnosis

Short term real world safety data of pertuzumab use in HER2 targeted treatment of metastatic breast cancer

Introduction: With the development and widely use of HER2 targeted therapies, HER2 expressing metastatic breast cancer have no longer dismal prognosis as once expected. The combination of HER2 targeted therapies with chemotherapatic agents prolongs overall survival. Pertuzumab is a new monoclonal antibody molecule that binds to the extracellular portion of HER2 and works by inhibiting homo- and heterodimerization. The aim of this study is to document the real life data of toxicities seen in metastatic breast cancer patients treated with first line trastuzumab-pertuzumab combination therapy. Material and method: A retrospective review of 26 cases from the medical oncology patient registry was conducted to include the dates October 2016 through December 2017. The number of cycles of treatment and doses, adverse events, dose changes and course delays, reasons for treatment change and types of second line treatments are noted. The imaging and laboratory test results were obtained from the electronic registration system. The cumulative toxicity incidence was accepted as the primary endpoint. Results: The median age of the 26 cases was 54 years. The median cycle number of pertuzumab and docetaxel treatments were 9 and 7, respectively and the median duration of pertuzumab therapy was 6.75 months. As of the date of last follow-up, 80.7% of the cases were still under treatment. There was a total of 6 cases of delay in treatment, of which five were due to neutropenia, while in one case the cause was diarrhea. When the adverse events were examined, at least one side effect (excluding alopecia) was observed in 16 patients and 7 cases had no toxicity except alopecia. In terms of constitutional symptoms, eight of the 19 patients had grade 1 fatique, one case had itching, and three patients had asthenia. Hematologic toxicity was seen in twelve cases and all had at least grade 1 leukopenia. Grade 3-4 febrile neutropenia occurred only in one case. Left ventriculer ejection fraction was measured stable for all of the cases, none of them experienced any significant decrease. Conclusion: According to the results of this retrospective analysis, the use of pertuzumab-trastuzumab-docetaxel in the first line treatment of HER2 expressing metastatic breast cancer had good safety profile and had positive clinical results and paralleled with the results of the pivotal study. Keywords: Human epidermal growth factor, Epidermal growth factor receptor, Pertuzumab, Heterodimerizatio