Eleonora Cerchiaro

Anastrozole-related acute hepatitis with autoimmune features: a case report.

BackgroundTwo cases of acute hepatitis occurring during treatment with anastrozole have previously been reported, but the underlying mechanisms of liver injury are still uncertain. We report the case of anastrozole-related acute hepatitis with some autoimmune features.Case presentationA 70-year-old woman developed acute hepatitis associated with serum antinuclear antibodies during anastrozole treatment; after drug withdrawal, liver function parameters rapidly improved and serum auto-antibodies were no longer detectable.ConclusionsAnastrozole-induced hepatotoxicity is a very rare event. Drug-drug interactions or metabolically-mediated damage might be involved, with a possible role of individual susceptibility. Our report suggests that an immune-mediated mechanism may also be considered in anastrozole-related liver injury.

Conversion Chemotherapy for Technically Unresectable Colorectal Liver Metastases: A Retrospective, STROBE-Compliant, Single-Center Study Comparing Chemotherapy Alone and Combination Chemotherapy With Cetuximab or Bevacizumab

Abstract The response rate of patients with unresectable liver-limited metastases of colorectal cancer can be improved by converting inoperable disease to operable disease. However, the benefits of conversion chemotherapy for survival are still controversial. Patients considered to have technically inoperable disease by a multidisciplinary team were retrospectively analyzed. Patients were stratified based on the treatment they received, into the chemotherapy only (G1), chemotherapy plus bevacizumab (G2), or chemotherapy plus cetuximab (G3) groups. The primary endpoint was the resection rate. The secondary endpoint was the overall survival (OS), according to both the treatment received and liver surgery status. In total, 104 patients were included: 30 in the G1, 39 in the G2, and 35 in the G3 groups. All G3 patients had the wild-type KRAS exon 2. The surgical resection rates for patients in the G1, G2, and G3 groups were 43.3% (13/30), 30.7% (12/39), and 51.4% (18/35), respectively. Disease-free survival did not show significant differences among the 3 groups. The median OS was 35.2 months in the G1, 28.8 months in the G2, and 42.1 months in the G3 (P = 0.25) groups. The OS was significantly higher in patients who underwent surgical resection than those who did not. The median OS was 28.4 months in patients who did not undergo resection, whereas it had not been reached after a median follow-up period of 37.5 months for patients who underwent surgical resection (events: 21/43). Our data confirmed that the conversion of initially inoperable disease to operable disease conferred a survival benefit, even in patients who relapsed after surgery. The addition of cetuximab to chemotherapy improved the objective response and resection rates, conferring a potential survival benefit even in patients whose diseases were not converted to operable disease, compared to chemotherapy alone or in combination with bevacizumab.

Real Benefit of Anthracycline-Based Chemotherapy in Elderly and Impaired Patients: a Retrospective Analysis

Non-Hodgkin Lymphoma (NHL) is a frequent cancer in elderly population. Comorbidities often influence the choice among different treatment options; particularly, concern about anthracyclines’ cardiotoxicity induces to select less effective chemotherapy regimens. The present retrospective study includes NHL patients treated in a single institution with and without antracyclines; clinical results have been analysed comparing both elderly (> 70 years) and not-elderly and impaired and not impaired population. 68 patients affected by NHL, diagnosed between 1996 and 2011, have been included. Median OS of whole population was 34 months; there was no significative difference in OS related to age or comorbidities among patients treated with anthracyclines-based regimens. Median OS of elderly patients not treated with anthracyclines resulted significantly lower, irrespectively of comorbidities (20 months); 94% of elderly patients who undergone anthracyclines-based regimen reported symptoms relief and performance status improvement, compared to 75% of elderly not treated with anthracyclines. Results of this retrospective analysis suggest that anthracyclines-based chemotherapy produces a significant improvement in OS and QoL,even in elderly or impaired patients. Comorbidities and age don’t seem absolute contraindications to anthracycline-based chemotherapy.

Novel Approaches of Treatment with Radium-223 Targeted Therapy

The role of radium-223 (Ra-223) in metastatic castration-resistant prostate cancer (mCRPC) with bone metastases and no visceral disease is well established in clinical practice. Treatment with Ra-223 is well tolerated and significantly improves overall survival and time to first symptomatic skeletal event. Several questions, however, remain open. Patient selection is critical, and treatment assessment is challenging. There is no standard imaging, and PSA has limited usefulness in this setting.

Bone Metastases in Prostate Cancer

Bone metastases occur in more than 80% of men with metastatic prostate cancer. Affecting the structural integrity of the bone, they can lead to skeletal complications and pain, with a negative impact on patient quality of life and survival. The last decade has witnessed tremendous advances in the treatment of metastatic PCa. New therapeutic options that prolong overall survival are now available. The optimization of bone metastasis management (and prevention of skeletal morbidities) is therefore of paramount importance to improve clinical outcome. Some issues are still debated, such as the most effective radiologic or nuclear medicine technique to diagnose and monitor bone disease, the ideal surrogate circulating marker to assess response or progression to treatment, patient selection, as well as the optimal sequencing or combination of available therapeutic options. Several healthcare professionals play a role in the treatment of metastatic PCa. The presence of a multidisciplinary team for the discussion of treatment strategies for each patient should be the standard of care.

Clinical staging of malignant pleural mesothelioma: current perspectives

Malignant pleural mesothelioma (MPM) is a disease with limited therapeutic options, the management of which is still controversial. Diagnosis is usually made by thoracoscopy, which allows multiple biopsies with histological subtyping and is indicated for staging purposes in surgical candidates. The recommended and recently updated classification for clinical use is the TNM staging system established by the International Mesothelioma Interest Group and the International Association for the Study of Lung Cancer, which is based mainly on surgical and pathological variables, as well as on cross-sectional imaging. Contrast-enhanced computed tomography is the primary imaging procedure. Currently, the most used measurement system for MPM is the modified Response Evaluation Criteria in Solid Tumors (RECIST) method, which is based on unidimensional measurements of tumor thickness perpendicular to the chest wall or mediastinum. Magnetic resonance imaging and functional imaging with 18F-fluoro-2-deoxy-D-glucose positron-emission tomography can provide additional staging information in selected cases, although the usefulness of this method is limited in patients undergoing pleurodesis. Molecular reclassification of MPM and gene expression or miRNA prognostic models have the potential to improve prognostication and patient selection for a proper treatment algorithm; however, they await prospective validation to be introduced in clinical practice.

DEBIRI plus capecitabine: a treatment option for refractory liver-dominant metastases from colorectal cancer

AIM This single institution Phase II study evaluated drug-eluting beads loaded with irinotecan (DEBIRI) plus capecitabine in pretreated patients with colorectal cancer liver metastases. PATIENTS & METHODS Forty patients with liver-limited or liver-dominant disease, who have failed at least two previous lines of chemotherapy, underwent either four DEBIRI at 2-week interval or two DEBIRI every 4 weeks for bilobar or single-lobe metastases, respectively. Capecitabine was given at 1000 mg/m2 twice daily on days 1-14 every 3 weeks. RESULTS Seven partial responses and 12 stable diseases were observed, achieving a disease control rate of 47.5%. Median progression-free survival and overall survival resulted 4 and 8 months, respectively. Grade 3 adverse events occurred in 6/40 points (15%) of patients. CONCLUSION DEBIRI plus capecitabine is a valid treatment option for heavily pretreated patients with colorectal cancer liver metastases.

DEBIRI and capecitabine in refractory prevalently liver metastases of colorectal cancer: A phase II study.

724 Background: Treatment options for metastatic colorectal cancer (mCRC) patients refractory to chemotherapy are limited and clinical outcome is poor. In mCRC patients with liver-dominant disease hepatic locoregional therapy might be a treatment option. In this pilot study we evaluated the safety, tolerance, and efficacy of drug-eluting beads irinotecan (DEBIRI) in combination with capecitabine in the treatment of patients with mCRC with predominally liver disease. Methods: Twenty patients affected by liver metastasis of colorectal cancer were included in this study. All patients had progression of disease after two or more lines of chemotherapy and liver was the major or the predominant site of disease. DEBIRI, beads loaded with 100 mg irinotecan, was administered biweekly via hepatic artery. All patients assumed capecitabine 1,000 mg/m2 twice daily on days 1 to 14 every 3 weeks, until disease progression. Primary endpoints were safety, tolerance and overall responce rate (ORR); secondary endpoints were...