Aleksandar Tepavac

Adjuvant chemotherapy and radiotherapy in the treatment of non-small cell lung cancer (NSCLC)

Lung cancer is one of the most common human malignancies and remains the leading cause of cancer related deaths worldwide. Many recent technological advances led to improved diagnostics and staging of lung cancer. With development of new treatment options such as targeted therapies there might be improvement in progression free survival of patients with advanced stage non-small cell lung cancer (NSCLC). Improvement in overall survival is still reserved for selected patients and selected treatments. One of the mostly investigated therapeutic options is adjuvant treatment. There are many open issues in selection of patients and administration of appropriate adjuvant treatment.

Clinical Characteristics, Tumor, Node, Metastasis Status, and Mutation Rate in Domain of Epidermal Growth Factor Receptor Gene in Serbian Patients with Lung Adenocarcinoma

Objective: Mutation rate in domain of EGFR gene varies between populations of lung cancer patients. Primary aim of this study was to analyze clinical and pathological characteristics, and tumor, node, metastasis status and stage of diseases, in relation to mutation status. Methods: After histological confirmation of lung adenocarcinoma tissue obtained during bronchoscopy was consecutively sent for EGFR testing. Genomic DNA extraction was performed with the QIAamp DNA FFPE Tissue kit. Clinical data for multivariate analysis were extracted from hospital based-lung cancer registry. Results: Among 360 tested patients, there was 67.8% males and 32.2% females, aged 61 ± 9.8 years. Majority of patients were smokers (57.0%) with Eastern Cooperative Oncology Group 1 performance status (92.2%). Mutation in EGFR gene was detected in 42 (11.7%) patients. Deletion in exon 19 was detected in 24 (6.7%) patients, mutation in exon 21 in 17 (4.7%), and mutation in exon 18 in one patient (0.3%). Patients were mostly diagnosed in stage IV adenocarcinoma (74.4%). Statistically significant differences were determined in relation to smoking (p < 0.001), T descriptor (size; p = 0.019) and gender (p = 0.002). Conclusions: Mutation rate in domain of EGFR gene in investigated lung cancer population is in range with reported data in Caucasian race. Smoking, T descriptor and gender were found to be related to the EGFR status.

Paraneoplastic dermatomyositis associated with adenocarcinoma of the lung

The association of dermatomyositis and lung cancer has been recognized a long time ago. The case of a 57-year old patient with lung adenocarcinoma and dermatomyositis as the first sign of the illness is presented. The occurrence of dermatomyositis should be considered as a potential presentation of paraneoplastic syndromes, particularly in patients at risk for lung cancer.

AB 96. Chemotherapy for lung cancer

In the Institute for Pulmonary Diseases of Vojvodina application of chemotherapy is implemented according to the latest recommendations of the National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO) and the recommendations of the national Ministry of Health Guidelines Republic of Serbia. According to these recommendations as adjuvant chemotherapy for Non Small Cell Lung Cancer (NSCLC) cisplatin doublets are used (etoposide/vinorelbine, gemcitabine) or paclitaxel/carboplatin. For the first-line treatment in advanced and metastatic NSCLC standard regimen is cisplatin or carboplatin in combination with the gemcitabine/etoposide/vinorelbine or paclitaxel. In EGFR mutated patients gefitinib or erlotinib are the first options. In some clinical studies bevacizumab is used in the first line as well as erlotinib single. For the second-line treatment docetaxel/cisplatin is in standard use and erlotinib single in patients who had haematological side effects in the first line chemotherapy. Pemetrexed in combination with cisplatin is standard treatment for malignant pleural mesothelioma. In SCLC patients cisplatin/etoposide is first line treatment. Depends on disease-free survival as the second-line chemotherapy cisplatin/etoposide or topotecan are protocols could be applied. Prophylactic cranial irradiation is recommended for patients with the limited and extensive stage SCLC with any response rate to therapy. We participate, as the other institutions, in some clinical studies to the appropriate procedures for implementation.