Leiomyosarcoma of the stomach is a very rare malignancy that was not distinguished from the more frequent gastrointestinal stromal tumors until early 2000s. Here we report on a case of a metastatic disease that developed in a 47-year-old man 2 years after he was diagnosed with the primary tumor and treated with curative surgical excision and adjuvant doxorubicin. The primary and metastatic lesions were positive for smooth muscle markers α-smooth muscle actin and h-caldesmon and negative for CD117, DOG-1 and S100 by immunohistochemistry. Metastatic disease progressed on additional monotherapy with doxorubicin and docetaxel–gemcitabine combination, and stable disease was achieved upon treatment with pazopanib. Patient is surviving 35 months since diagnosis of the primary tumor and 11 months since diagnosis of metastatic disease.
Buparlisib (formerly BKM 120), an oral 2,6-dimorpholino pyrimidine derivative is a potent pan-PI3K inhibitor causing inhibition of PI3K downstream signaling including downregulation of p-Akt and p-S6R and apoptosis of cancer cells. Buparlisib is rapidly absorbed, has more than 90% bioavailability, good blood-brain barrier penetration and half-life of 40 h. Phase I trials have shown good disease control rate with tolerable toxicity profile at the recommended doses of 100 mg. The most common adverse events noted with buparlisib are rash, hyperglycemia, derangement of liver functions and psychiatric events. Several clinical trials with buparlisib alone or in combination with chemotherapy and targeted therapies are underway. Buparlisib has not yet been approved for regular use. Further randomized trials are required before buparlisib is approved for treatment of breast cancer.
PurposeOsteosarcoma (OS) is a relatively chemosensitive primary bone tumor, with the
peak age of onset occurring in late childhood and early adolescence. The
treatment paradigm of nonmetastatic OS has typically been multimodality
therapy, including neoadjuvant and adjuvant chemotherapy with definitive
surgery. Over the years, various permutations and combinations of
chemotherapeutic agents have been used. However, the majority of recent
trials have still used high-dose methotrexate as the backbone, with
cisplatin and doxorubicin (MAP). In the last decade, various strategies
targeted to improving outcomes in OS have included the addition of a fourth
drug to the three-drug MAP regimen, changing therapy according to
histopathologic response and the addition of immunotherapies. Through this
review, we sought to underscore a few pertinent issues related to
chemotherapy in nonmetastatic OS, with special reference to challenges
confronted in Indian settings.MethodsWe reviewed the literature, focusing on studies comparing high-dose
methotrexate and non–high-dose methotrexate–containing
regimens. In addition, this review focuses on
non–methotrexate-containing triple-drug therapy.ResultsAlthough a high-dose methotrexate regimen has become standard of care in
developed countries, there are few data to suggest that it is superior to a
non–high-dose methotrexate regimen.ConclusionDeveloping countries with lack of infrastructure and logistics for high-dose
methotrexate might resort to non–high-dose
methotrexate–containing regimens with a simultaneous focus on early
detection, decreasing abandonment, multidisciplinary clinics, improved
surgery, and meticulous pathologic evaluations.
ImportanceThe Cancer Aging Research Group (CARG) toxicity score is used to assess toxicity risk in geriatric patients receiving chemotherapy.ObjectiveThe primary aim was to validate the CARG score in geriatric patients treated with curative intent chemotherapy in predicting grade 3–5 toxicities.DesignThis was a longitudinal prospective observational study.SettingTata Memorial Hospital, Mumbai, India, a tertiary cancer care referral centre.ParticipantsPatients, aged ≥65 years, with gastrointestinal, breast or gynaecological stage I–III cancers being planned for curative intent chemotherapy. A total of 270 patients were required for accrual in the study.Exposure(s)Total risk score ranged from 0 (lowest toxicity risk) to 19 (highest toxicity risk).Main outcome(s) and measure(s)The primary endpoint of the study was to evaluate whether the CARG risk score predicted for grade 3–5 toxicities.ResultsThe study cohort of 270 patients had a mean age of 69 (65–83) years, with the most common cancers being gastrointestinal (79%). Fifty-two per cent of patients had atleast one grade 3–5 toxicity. The risk of toxicity was increased with an increasing risk score (42% low risk, 51% medium risk and 79% high risk; p<0.001). There was no association between either Eastern Cooperative Oncology Group (ECOG) performance status (p=0.69) or age-adjusted Charlson Comorbidity Index (p=0.79) risk categories and grade 3–5 chemotherapy toxicities.Conclusions and relevanceThis study validates the CARG risk score in predicting for grade 3–5 toxicities in geriatric oncology patients receiving curative intent chemotherapy and can be considered as the standard of care before planning chemotherapy in every elderly patient.Trial registration numberCTRI/2016/10/007357; Results.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.