Magdalena Krakowska

Lack of CD151/integrin α3β1 complex is predictive of poor outcome in node-negative lobular breast carcinoma: opposing roles of CD151 in invasive lobular and ductal breast cancers.

Background:The proposed involvement of CD151 in breast cancer (BCa) progression is based on findings from studies in invasive ductal carcinoma (IDC). The IDC and invasive lobular carcinoma (ILC) represent distinct disease entities. Here we evaluated clinical significance of CD151 alone and in association with integrin α3β1 in patients with ILC in context of the data of our recent IDC study.Methods:Expression of CD151 and/or integrin α3β1 was evaluated in ILC samples (N=117) using immunohistochemistry. The findings were analysed in relation to our results from an IDC cohort (N=182) demonstrating a prognostic value of an expression of CD151/integrin α3β1 complex in patients with HER2-negative tumours.Results:Unlike in the IDCs, neither CD151 nor CD151/α3β1 complex showed any correlation with any of the ILC characteristics. Lack of both CD151 and α3β1 was significantly correlated with poor survival (P=0.034) in lymph node-negative ILC N(−) cases. The CD151−/α3β1− patients had 3.12-fold higher risk of death from BCa in comparison with the rest of the ILC N(−) patients.Conclusions:Biological role of CD151/α3β1 varies between ILC and IDC. Assessment of CD151/α3β1 might help to identify ILC N(−) patients with increased risk of distant metastases.

Synchronous primary ovarian and endometrial cancers: a series of cases and a review of literature.

Synchronous cancers account for 0.7-1.8% of all gynecologic cancers. Among them, synchronous ovarian and endometrial cancers are predominant (40-53%). Patients with synchronous cancers have better prognosis than those with single disseminated cancer. We present 10 patients with synchronous ovarian and endometrial cancers who were treated at the Chemotherapy Department of the Medical University of Lodz in 2009-2013. The most often reported symptom of the disease was abnormal vaginal bleeding (6 patients). The range of the patients’ age was 48-62 and the median age was 56. Five patients had stage I of ovarian cancer, single patients had stage IIA, IIB and IIIB, 2 patients had stage IIIC. Three patients had I, 5 – II, and 2 – III stage of endometrial cancer. All patients had endometrioid type of endometrial cancer, 7 of them had also the same histological type of ovarian cancer. All patients had adjuvant chemotherapy because of ovarian cancer, none of them had adjuvant radiotherapy. One patient was lost to follow up. For other patients a median follow up was 13 months (range: 3-53 months). One patient experienced relapse, all patients are alive. Synchronous ovarian and endometrial cancers are usually diagnosed at an earlier stage, have lower histological grade and better prognosis than single cancers. The most common histological type of both endometrial and ovarian cancers is endometrioid carcinoma. The first symptoms reported by our patients and the course of the disease were concordant with data from the literature.

Secondary cancer in a survivor of Hodgkin's lymphoma: A case report and review of the literature

Hodgkin’s lymphoma (HL) is one of the most curable malignant diseases in adults. However, HL patients have a higher risk of developing second malignancies compared with the general population. The population of adult cancer survivors is growing, thus, the long-term effects of cancer treatment, including secondary cancer development, have become an increasingly important concern in the field of oncology. The current study presents the case of a female HL survivor who developed two secondary malignancies within 29 years of follow-up. Furthermore, a review of the literature was conducted, which focused on secondary breast and gastrointestinal cancers in HL survivors.

The role of preoperative systemic treatment in patients with breast cancer

The goal of preoperative pharmacotherapy in patients with breast cancer is to enable breast conserving surgery in stage T3N0-1M0 or radical mastectomy in patients with primary inoperative tumors (T1-4N0-3M0). The choice of optimal treatment should be based not only on risk factors resulting from the stage but also on predicted cancer responsiveness to the treatment. The breast cancer subtypes defined by immunohistochemical profile (expression of ER, PR, HER2 and Ki67) are characterized by different responsiveness to therapy. Complete response confirmed by histopathological evaluation after neoadjuvant chemotherapy is a positive prognostic factor in some breast cancer subtypes. This marker is not of value in postmenopausal patients with ER/PR+ HER2– tumors, who are candidates for neoadjuvant hormone therapy. These patients have a good prognosis if in a histopathological report after surgery there are features such as pT1, pN0, Ki67 < 3%, and ER Allred score ≥ 3. The goal of the paper is to present current knowledge about preoperative pharmacotherapy of breast cancer.

The prognostic impact of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio in patients with advanced colorectal cancer treated with first-line chemotherapy

Introduction Colorectal cancer is the second most frequently diagnosed malignancy and one of the leading causes of cancer-related death in Poland. Many reports of different types of cancer have indicated that blood count parameters may serve as a source of prognostic or predictive information. Aim To assess the association between these parameters and clinical outcome in patients with advanced colorectal cancer. Material and methods We retrospectively analysed a database of 295 patients with advanced colorectal cancer treated with first-line palliative chemotherapy at our institution from January 2008 to December 2012. Blood-based parameters were measured before the first cycle of treatment. Results The median progression-free survival (PFS) was 6.7 months, and the median overall survival was 17.6 months. A high neutrophil-to-lymphocyte ratio (NLR) and a high platelet-to-lymphocyte ratio (PLR) were associated with a shorter survival (hazard ratio (HR): 1.88, p < 0.0001 for the NLR and HR: 1.39, p = 0.0054 for the PLR), but for the PLR, we observed only a not significant trend toward a worse PFS (HR = 1.25, p = 0.07 for the PLR and HR = 1.55, p = 0.0004 for the NLR). A high lymphocyte-to-monocyte ratio (LMR) was associated with a better prognosis (HR = 0.58, p ≤ 0.0001) and a longer PFS (HR = 0.73, p = 0.011). Conclusions The blood-based parameters are readily available, reliable, and low-cost biomarkers, which can be easily incorporated into routine practice to predict the prognosis in patients with advanced colorectal cancer.

New treatment options for patients with metastatic colorectal cancer in Poland

The spectrum of reimbursed molecular targeted agents for patients with metastatic colorectal cancer has been increased in Poland since July 2017. Following the Ministry of Health initiative, a team with the National Consultant in Clinical Oncology has prepared a new form of drug program. FOLFIRI combined with cetuximab or bevacizumab in the first line and aflibercept in the second line of treatment are now available as therapeutic options. In addition, by changing the eligibility criteria, the population of patients eligible for monotherapy with anti-EGFR antibody used in the third line was increased. Unfortunately, due to the fact that the manufacturers did not make the appropriate refund requests, not all the assumptions were taken into account in the current form of the program. For example, panitumumab plus FOLFOX chemotherapy in the first line is still not reimbursed, and bevacizumab therapy should not be restricted to patients with RAS mutations. Despite this, the new program for treating patients with advanced colorectal cancer actually brings us closer to treatment standards in other countries and facilitates compliance with current medical knowledge.

Palliative systemic treatment of patients with pancreatic cancer — should reimbursement of nab-paclitaxel change the current management paradigm?

Pancreatic cancer is associated with poor prognosis. In the majority of patients the disease is diagnosed at an inoperable stage, so palliative chemotherapy is the only possible management. In a highly clinically and biochemically selected subpopulation two chemotherapy multi-drug schemes: FOLFIRINOX regimen and combination of nab-paclitaxel with gemcitabine, are more effective than gemcitabine alone, being the current standard of treatment. As there is a lack of direct comparison between doublet and triplet chemotherapies and the prognosis of patients enrolled to ACCORD 11 and MPACT clinical trials is similar, an attempt at indirect analysis was undertaken. It seems that chemotherapy with the use of FOLFIRINOX regimen prolongs overall survival significantly more and mainly has a beneficial impact on quality of life. In the authors’ opinion, the possibilities of using chemotherapy containing nab-paclitaxel and gemcitabine are quite limited. In patients with worse performance status monotherapy with gemcitabine or best supportive care should remain a standard of management.

Bisphosphonates for the treatment of patients with cancer

Bisphosphonates inhibit osteoclasts activity and therefore reduce bone resorption. The main application of bisphosphonates in patients with cancer involves treatment of hypercalcemia, prevention of cancer treatment-induced bone loss, and decrease of the risk of skeletal-related events in patients with breast cancer or prostate cancer and bone metastases. For some time now there has been an increasing amount of data indicating that treatment with bisphosphonates improves survival of patients with early breast cancer. The activity is restricted to postmenopausal women or premenopausal patients whose treatment involves gonadotropin agonist.

A retrospective evaluation of associations between chronic obstructive pulmonary disease, smoking, and efficacy of chemotherapy and selected laboratory parameters in patients with advanced non-small cell lung cancer

Aim of the study To was to determine the impact of chronic obstructive pulmonary disease (COPD) and active smoking on the efficacy of chemotherapy and complete blood count (CBC) in patients with non-small cell lung cancer (NSCLC). Material and methods The retrospective evaluation included 50 patients with stage IIIB–IV NSCLC, who started cisplatin-based chemotherapy. Peripheral blood CBC values were collected for testing before chemotherapy and after the first and third cycles. Results COPD was diagnosed in 49% of patients, while 42% of those enrolled were current smokers. Current smoking (p = 0.92) and COPD (p = 0.91) status did not affect the response to treatment. The non-COPD population presented a significantly higher pretreatment absolute lymphocyte count (ALC) than the COPD population (2.31 vs. 1.81 × 109/l; p = 0.0374). Also, only the non-COPD group demonstrated an elevated absolute monocyte count (AMC) following the first and third cycles of chemotherapy (p = 0.004). In current smokers, pretreatment values for white blood cells (WBC), absolute neutrophil count (ANC), and platelets (PLT) were higher than in the ex-smoker population (WBC 9.94 vs. 8.7 (× 109/l); p = 0.01; ANC 6.47 vs. 5.61 (× 109/l); p = 0.037; PLT 316 vs. 266 (× 109/l); p = 0.049). Ex-smokers demonstrated AMC level elevation after the first cycle of chemotherapy and PLT level elevation after the third cycle, while current smokers also demonstrated an early decrease in LMR. Conclusions COPD and smoking induce chronic systemic inflammation and oxidative stress, which influence the results of standard laboratory tests, but do not change the response rate of lung cancer on chemotherapy.

Paraneoplastic Cushing’s syndrome in a patient with small cell lung cancer: case report

We discuss the case of small-cell lung cancer patient with clinical features of paraneoplastic Cushing’s syndrome. The primary symptoms included electrolyte imbalance, glucose intolerance, and increased oedemas of the lower extremities. In January 2016, the patients performance status was 2 in ECOG scale and antineoplastic treatment with carboplatin and etoposide was initiated. Following the 2nd chemotherapy cycle symptoms of paraneoplastic syndrome significantly were alleviated and performance status improved (grade 1), allowing a change of chemotherapy protocol to a more standard one (cisplatin and etoposide). At the time of the subsequent chemotherapy cycles the patents good general condition was maintained. Use of causative treatment allowed achievement of significant clinical improvement and recovery of laboratory values.