In this homogeneous group of patients with NSCLC, there is no correlation between response to treatment and CEC baseline levels. The increase in CEC numbers after the first cycle could be a negative predictive factor.
The administration of gemcitabine, associated with oral tegafur and leucovorin, has activity against advanced pancreatic cancer, with an adequate toxicity profile.
Intestinal obstruction is very common in cancer patients and occurs in 80% of cases with malignant aetiology. Hence, aggressive treatment is needed in most cases. The occlusion can be caused by luminal obstruction, paralysis of the intestinal muscle or carcinomatosis with mesentery involvement. The clinical case we present is that of a patient diagnosed as having lung cancer and who was admitted with paralytic ileus following treatment with vinorelbine; a vinca alkaloid whose main characteristic toxicities include neutropenia and peripheral neuropathy. Also, on rare occasions, the drug can cause paralysis of the ileum due to autonomic neuropathy. Hence, before administering aggressive treatment to an occlusive syndrome, cases that could benefit from conservative treatment should be ruled out.
Lung cancer represents one of the most common malignant diseases. Many investigations are used in the staging study including, most recently, PET. We present a case of cystic cerebral metastases (with no oedema) from a small cell carcinoma which were not detected by PET.
Lung cancer is one of the most common malignant diseases. Many tests and techniques are used in the staging of this disease, including positron emission tomography. This is probably the most recently introduced test and is capable of providing information on all the structures affected by malignancy. We present a case of a false positive result due to increased splenic uptake of the tracer.
Our objective was to determine the association between C-reactive protein (CRP) levels at initiation of anemia treatment and response in solid tumor patients with chemotherapy (CT)-induced anemia. This was a multicenter, prospective, observational study which included adult patients with solid tumor initiating treatment for CT-induced anemia. Data were collected up to 16 weeks, or until premature discontinuation. We included 98 patients (median age 62.5 years, 64 % males, 57 % with ECOG 0-1, 85.7 % at stages III-IV and 54.1 % undergoing palliative CT). Mean (SD) Hb levels at baseline were 10.3 (0.9) g/dL (85.7 % < 11 g/dL) and median (Q1; Q3) CRP was 16.4 mg/L (3.9; 77.8) (68 % ≥ 5 mg/L). A total of 96 % of patients initiated erythropoiesis-stimulating agents (ESA) and iron supplementation; 4 % initiated iron monotherapy. After a median of 85 days, 65 % of patients had Hb ≥ 11 g/dL (in absence of transfusion) (mean change: +0.86 g/dL, 95 % confidence interval (CI) 0.53-1.19). A total of 8 patients required transfusion. A significant correlation (r = -0.39, p = 0.003) was observed between baseline CRP and final Hb levels. In the multivariate linear regression analysis, the independent predictors of higher final Hb levels were a high baseline Hb (adjusted ß = +0.69 g/dL for each g/dL of baseline Hb, 95 % CI 0.17-1.21) and a low log baseline CRP (-0.62 for each log mg/L, 95 %CI -1.22 to -0.02). Our results suggest that, in patients with solid tumors and CT-induced anemia, high CRP levels at treatment initiation predict a poor response to treatment with ESA and iron, independently from anemia severity at therapy initiation and from other patient and disease characteristics.
5-Fluorouracil-induced gastro-intestinal toxicity predominantly affects the upper and the lower gastro-intestinal tract. Although 5-fluorouracil (5-FU) can cause severe small-bowel toxicity, this has been reported only in 6 patients with colon carcinoma receiving 5-FU-based therapy. The presentation was extensive ulceration and inflammation of the small bowel with no involvement of the colon. We report another case of this toxicity, and discuss the diagnosis and mechanisms by which 5-FU can induce small-bowel toxicity.
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