Riccardo Righini

A metronomic schedule as salvage chemotherapy for upper gastrointestinal tract cancer

In recent years, metronomic chemotherapy, consisting of continuous administration of low doses of cytotoxic agents, has being used as rescue therapy for different tumours. The aim of this study was to retrospectively assess the efficacy and safety of low-dose metronomic, oral capecitabine in pretreated or frail patients with recurrent upper gastrointestinal tract cancer. Patients with pretreated upper gastrointestinal tract cancer or who were not candidates for standard chemotherapy because of toxicity concerns received capecitabine at 1500 mg per day continuously until disease progression or occurrence of toxicity. Forty-seven patients (25 oesophagogastric cancer, 22 pancreatobiliary cancer; 25 men, 22 women; median age 69 years, range 42–90) were included in the study. Forty-five percent of the patients had received at least two previous lines of treatment and the median number of previous treatments was 1 (range 0–5). Twelve (31.6%) patients achieved clinical benefit (one partial response, 11 stable disease), whereas nine (23.7%) patients were progression free for at least 6 months. In an exploratory analysis, there was a significant relationship between performance status and clinical benefit (hazard ratio=8.25; P=0.01). The median overall survival was 5 months. A good performance status was associated with a longer survival (hazard ratio=0.26; P<0.01). No severe toxicity or treatment-related death was reported. Metronomic capecitabine showed good safety and moderate activity in frail or pretreated patients with advanced, upper gastrointestinal tract cancer.

Gastric Metastases From Testicular Cancer: Case Report and Review of Literature

Testicular germ cell tumors represent approximately 1 % of all cancers in man and are the most common malignancy between 15and 35-year olds [1, 2]. Testicular malignancy has a common precursor and reflects a continuum of differentiation potential of early neoplastic germ cell. They are classified into seminomas (classic and spermatocytic) and non-seminomas (embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma). Seminomas are characterized by a more favorable clinical outcome compared to nonseminomas [3]. Pure seminomatous cancers account for 40 % of cases, while non-seminomatous and mixed tumors represent about 60 % of cases [1]. Approximately one half of patients with non-seminomatous germ cell tumors present at stage IV [2, 4]. Generally, these tumors metastasize to the retroperitoneal lymph nodes and, less commonly, to the lungs, liver, and brain [5]. Gastrointestinal metastases are very rare and may present with bowel obstruction or, less frequently, with hemorrhage [6]. We present the case of a 44-year-old man affected by a mixed testicular cancer, who began with symptoms related to bleeding from gastric metastasis.

A Synchronous Pancreatic Metastasis from Renal Clear Cell Carcinoma, with Unusual CT Characteristics, Completely Regressed after Therapy with Sunitinib

We present a case report of a 75-years-old woman affected by renal clear cell carcinoma with a synchronous pancreatic metastasis and a metachronous lung metastasis. This case has two peculiarities. First the pancreatic metastasis was treated just with medical therapy, that is, Sunitinib, instead of the surgical therapy that is mostly considered. Secondly, the pancreatic lesion showed different characteristics on the computed tomography scan compared to the usual pancreatic metastases from renal clear cell carcinoma. The pancreatic metastasis totally regressed after medical treatment and nowadays, four years after the diagnosis, the patient is disease-free.