Surender Beniwal

617PDA PHASE III TRIAL COMPARING FOLFIRINOX VERSUS GEMCITABINE FOR METASTATIC PANCREATIC CANCER

compared with 7.4 months in the gemcitabine group (hazard ratio for death, 0.48; 95% confidence interval [CI], 0.41 to 0.68; P < 0.001). Median progression-free survival was 5.6 months in the FOLFIRINOX group and 3.1 months in the gemcitabine group (hazard ratio for disease progression, 0.44; 95% CI, 0.29 to 0.49; P < 0.001). The objective response rate was 29.6% in the FOLFIRINOX group versus 8.3% in the gemcitabine group (P < 0.001). More adverse events were noted in the FOLFIRINOX group; 4.8% of patients in this group had febrile neutropenia. At 6 months, 29% of the patients in the FOLFIRINOX group had a definitive degradation of the quality of life versus 59% in the gemcitabine group (hazard ratio, 0.45; 95% CI, 0.29 to 0.68; P < 0.001). Conclusions: As compared with gemcitabine, FOLFIRINOX was associated with a survival benefit at the cost of increased toxicity. Thus, FOLFIRINOX is an option for the treatment of patients with metastatic pancreatic cancer having good performance status.

Cancer related fatigue: A ubiquitous problem yet so under reported, under recognized and under treated

Background: Cancer related fatigue (CRF) is a problem that is highly under reported, under recognized and thus, under treated. About 80% of patients receiving chemotherapy/radiotherapy experience CRF, making it the most common side effect of cancer treatment. Functional assessment of chronic illness therapy fatigue (FACIT-F) version-4 is a 13 item questionnaire that has been used to measure the level of fatigue of cancer patients during their daily activities over the past 7 days. Materials and Methods: 92 patients of age 18 years and above attending the oncology Out Patient Department (OPD) of a regional cancer center were recruited in this study and were given FACIT-F questionnaire. The relevant sociodemographic parameters were obtained from the medical records of the patients. The internal consistency of the 13 items was measured using the Cronbach′s alpha. Results: The Cronbach alpha coefficient for FACIT-F scale in our study was found to be 0.74. Kendall′s coefficient of concordance was estimated to be 0.080. The correlation between Eastern Cooperative Oncology Group (ECOG) performance status and mean score of FACIT-F was studied, Pearson correlation coefficient was estimated to be 0.271 (P = 0.009). Conclusions: FACIT-F is a brief, simple, easy to administer and patient friendly tool to measure the fatigue in last 7 days. CRF should be given adequate attention from the beginning of the treatment to improve the quality of life of cancer patients.

Isolated clival metastasis as the cause of abducens nerve palsy in a patient of breast carcinoma: A rare case report

Metastatic lesions to the clivus have been reported in various cancers including lung cancer, prostate carcinoma, skin melanoma, and hepatocellular carcinoma. There have been only a few reports of breast cancer presenting with isolated clival metastasis. We report a case of 35-year-old lady, who was known case of breast carcinoma presented with diplopia as the only sign of clival metastasis. The etiology was established by magnetic resonance imaging which showed an enhancing lesion in the clivus. The diagnosis of clival metastasis from breast cancer was confirmed by transsphenoidal biopsy.

A case of CD68 negative histiocytic sarcoma of axilla masquerading as metastatic breast cancer.

Histiocytic sarcoma is a malignant proliferation of cells showing morphological and immunophenotypic features of mature tissue histiocytes. Most of the cases in the literature have reported CD68 positivity. We report a case of histiocytic sarcoma whose presentation mimicked a metastatic breast cancer. A 40-year-female patient presented with a 13 × 11 cm left axillary mass in close proximity to the left breast. Tru-cut biopsy from the lesion suggested the diagnosis of a lymphoid neoplasm. Complete excision of the axillary mass was done. On simple microscopy, numerous mature small lymphocytes were seen dispersed in the follicles. Immunohistochemistry revealed CD31- and CD163-positive cells, which stained negative for CD68, CD1a, cytokeratin and S100; thus, confirming the diagnosis of histiocytic sarcoma.

Management of uveal tract melanoma: A comprehensive review.

Uveal tract melanoma is the most common primary intraocular malignancy in adults, accounting for about 5-10% of all the melanomas. Since there are no lymphatic vessels in the eye, uveal melanoma can only spread hematogenously leading to liver metastasis. A wide variety of treatment modalities are available for its management, leading to dilemma in selecting the appropriate therapy. This article reviews the diagnostic and therapeutic modalities available and thus, can help to individualize the treatment plan for each patient.

Metronomic therapy with oral 6-mercaptopurine in elderly acute myeloid leukemia: A prospective pilot study.

Introduction: Acute myeloid leukemia (AML) in elderly patients differs biologically from that in younger patients and is known to have unfavorable chromosomal rearrangements, higher resistance, and lower tolerance to chemotherapy. In such circumstances, instead of giving full-blown chemotherapy, palliative metronomic chemotherapy (MCT) could be a treatment option. Patients and Methods: We performed a prospective pilot study of old AML patients (age >60 years) not amenable to curative treatment. Thirty-two patients were enrolled into the study and were treated with daily oral 6-mercaptopurine 75 mg/m 2 . The following inclusion criteria were used: age >60 years, nonpromyelocytic AML, the absence of uncontrolled comorbidities, and patient not amenable to curative treatment. Overall survival (OS) was calculated using Kaplan-Meier method and Cox regression analysis were used to calculate the hazards ratio of significant factors. Results: The median age of the patients was 69 years (range: 61-86 years) with male: female ratio of 2.5:1. About 59.4% of patients had Eastern Cooperative Oncology Group performance status of 2 while rest had the status of 3. The median OS was 6 months (95% confidence interval [CI]: 4.4-7.6). Males had median OS of 7 months (95% CI: 5.4-8.6) versus females with OS of 3 months (95% CI: 1.5-4.4; P = 0.008). There was no survival difference on the basis of baseline hemoglobin or French-American-British class. There were no Grade 4 toxicities and no episode of febrile neutropenia. Conclusions: MCT with oral 6-mercaptopurine is an attractive treatment option in elderly AML patients who are not amenable to curative therapy with minimal toxicities.

Ibrutinib: A comprehensive review of a promising drug

Ibrutinib is a recent Food and Drug Administration-approved drug for the treatment of lymphoid malignancies: mantle cell lymphoma and chronic lymphocytic leukemia (CLL). It is a Brutons tyrosine kinase (BTK) inhibitor which increases the apoptotic susceptibility of malignant lymphocytes and also causes tissue redistribution of lymphocytes. Strong biological rationale makes BTK an ideal target for therapy of CLL and other B-cell malignancies. We are presenting a comprehensive review of this promising drug, highlighting its metabolism, safety profile, trials, and approved uses.

Posterior reversible encephalopathy syndrome in non-Hodgkin′s lymphoma: Not necessarily reversible!

Posterior reversible encephalopathy syndrome (PRES) is a rare clinicoradiological entity that is an increasingly recognized complication of pediatric cancer treatment. However, there have been very few reports of PRES in association with non- Hodgkin′s lymphoma (NHL) and reported incidence is only 0.06%. The available literature and case reports on PRES were studied in depth, and the important conclusions were taken into account for writing athe review. We describe a case of PRES in a boy of 15 years with NHL on cyclophosphamide, doxorubicin, vincristine and prednisolone combination chemotherapy who presented with generalized seizures and reversible blindness. Magnetic resonance imaging of the brain revealed characteristic findings of the syndrome establishing the diagnosis. However, despite transient improvement of the symptoms, the patient succumbed to respiratory failure. The authors conclude that PRES is a rare entity especially in NHL patients that must be recognized early and should be managed aggressively as it may prove to be fatal also.

Neurofibromatosis with chronic myeloid leukemia in an elderly male: An unusual association

Neurofibromatosis is a genetic disorder of neural crest-derived cells that predominantly affect growth and development of neural tissues. We report a case of 64-year-old patient, had several soft tissue cutaneous nodules (neurofibroma) on the body including the face, head, and neck, extremities and multiple hyperpigmented macules on trunk and back (Café-au-lait pigmentation), who was accidentally diagnosed as chronic myeloid leukemia, on routine investigation for surgical management. He did not have any systemic manifestation either of diseases.

Kikuchi-Fujimoto disease: A diagnostic and therapeutic challenge

Kikuchi-Fujimoto disease (KFD) is a rare, benign, self-limiting disorder that generally presents with cervical lymphadenopathy. Recognition and early diagnosis of this condition is very critical as it can be easily mistaken for tuberculosis, lymphoma or systemic lupus erythematosus. It predominantly affects young adults (mean age 20-30 years), with a slight preponderance in females. There have been very rare reports of KFD in childhood or elderly. We report case of a 9-year-old female child who presented with fever and cervical lymphadenopathy. Examination of other systems and laboratory investigations were normal. Biopsy of the cervical node showed features suggestive of histiocytic necrotizing lymphadenitis (KFD). CD20, CD3 and CD68 stained positive while CD15 and CD30 were negative, thus confirming the diagnosis. The child was treated with steroids and complete remission occurred in few weeks. Although the incidence of KFD is rare, clinicians should be aware of this condition as early recognition and diagnosis of the disease will minimize unnecessary investigations and cytotoxic treatments.