Pharmacoeconomic and clinical implications of sequential therapy for metastatic renal cell carcinoma patients in Central and Eastern Europe

Introduction: The incidence and mortality rates of kidney cancer in the Central and Eastern European (CEE) region are among the highest in the world. Access to second and subsequent lines of metastatic renal cell carcinoma (mRCC) therapies is highly varied in the region. Despite the increasing body of evidence supporting the clinical benefit of multiple lines of treatment, access to treatment beyond first line is restricted in many of these countries.Areas covered: The adoption of targeted therapies for the first-line treatment of mRCC in the region was slow and faced many obstacles. In order to evaluate the current status of treatment beyond the first-line setting in the CEE region, this review examines the availability and reimbursement of mRCC drugs and clinical practice in institutions that treat patients with mRCC.Expert opinion: This review highlights the need to raise awareness among physicians, payers and regulators on clinical trial and cost-effectiveness data regarding the treatment of mRCC beyond the first line. The obstacles to mRCC drug access highlighted in this review need to be overcome to ensure that patients are receiving the best treatment available

Prognostic factors in patients with aggressive non-Hodgkin's lymphoma without complete response to first-line therapy

This study was conducted to retrospectively identify the prognostic factors that specifically predict survival rates of patients with aggressive non-Hodgkin's lymphoma who did not achieve a complete response (CR) to first-line therapy. Prognostic factors in terms of survival were analyzed in 76 adult patients with non-Hodgkin's lymphoma who had failed to achieve CR to first-line chemotherapy (CT) regimens administered at Istanbul University, Institute of Oncology, between February 1989 and October 1998. A total of 41 patients were female, and median age was 60 y (range, 18-87 y). Twenty-seven patients (35%) had primary refractory disease (stable disease + progressive disease). A partial response (PR) was demonstrated in 49 (65%). In all, 92% had been administered anthracycline on the basis of computed tomography findings. Of 27 patients with primary refractory disease, 20 died because of initial CT toxicity or disease progression. A total of 10 patients with primary refractory disease underwent second-line CT. CR was observed in only I of those patients. Of the 49 patients who had a PR to first-line therapy, 31 died because of disease progression. Of those patients, 14 underwent second-line CT. Four patients were observed to have a CR. Median overall survival (OS) in all patients was established at 15 mo (range, 11-19 mo), and 5-y OS was 25%. On the other hand, median OS in patients with primary refractory disease was 7.6 mo (range, 5.7-9.4 mo) and was observed to be 17.8 mo (range, 9.4-26.1 mo) in patients with a PR. The difference in survival rates between patients with primary refractory disease and those with a PR was significant (P=.005). Although median OS was 18.1 mo (range, 8.4-27.8 mo) in patients with intermediate-grade histology, it was 6.1 mo (range, 1-11.7 mo) in patients with high-grade histology (P=.001). As a result of univariate analysis, significant prognostic factors associated with OS included histologic grade (intermediate/high) (P=.001), response to initial therapy (primary refractory disease/PR) (P=.005), performance status (0-2/2-4) (P=.024), and International Prognostic Index risk groups (low/low intermediate/intermediate-high/high risk) (P=.004). Multivariate analysis revealed that independent prognostic parameters associated with OS included response to initial therapy (P=.009) and histologic grade (P=.001). Although prognosis is rather poor in patients with high histologic grade and primary refractory disease, patients with a PR have a slightly better prognosis

Predictive Value of Marker Half-life in Relapsed and Nonrelapsed Nonseminomatous Germ Cell Testicular Tumor Patients Undergoing Chemotherapy

Background: The aim of this study was to investigate the influence of a marker half-life (MHL) on relapse in nonseminomatous germ cell testicular tumor patients

Successful use of docetaxel for emergency treatment of disseminated intravascular coagulation due to hormone-refractory metastatic prostate cancer

Disseminated intravascular coagulation (DIC) is a fatal presentation of metastatic adenocarcinoma of the prostate. A 59-year old male presented with a 2-week history of fatigue, red urine, and bruises on his body. Physical examination and ultrasonography showed that the patient had an enlarged prostate. Laboratory analysis was consistent with DIC. The patient's PSA level was 90 ng mL−1. Bone scintigraphy showed diffuse metastasis. Histopathological analysis of a biopsy specimen showed prostate adenocarcinoma. Acute DIC improved rapidly following initiation of leuprolide and bicalutamide hormone therapy. The patient's PSA dropped from 90 to 0.01 ng mL−1 after 1 month of treatment. The patient had recurrence of the initial complaints and elevated PSA while receiving leuprolide treatment in first year. As the patient's clinical condition deteriorated, we initiated docetaxel-containing chemotherapy. The patient's symptoms became less severe and his abnormal laboratory findings began to normalize after 2 weeks of the chemotherapy, and they completely resolved returned to normal after 2 months. In conclusion, docetaxel-containing chemotherapy in a patient with metastatic prostatic carcinoma and DIC was effective, despite a low platelet count and bleeding