IntroductionChondrosarcoma is well-known to be primarily resistant to conventional radiation and chemotherapy.Case presentationWe present the case of a 32-year-old Caucasian man with clear cell chondrosarcoma who presented with symptomatic recurrence in his pelvis and metastases to his skull and lungs. Our patient underwent systemic therapy with sunitinib and then consolidation with proton beam radiation to his symptomatic site. He achieved complete symptomatic relief with a significantly improved performance status and had an almost complete and durable metabolic response on fluorine-18-fluorodeoxyglucose positron emission tomography.ConclusionsOur findings have important clinical implications and suggest novel clinical trials for this difficult to treat disease.
Antiangiogenic therapy has shown promise in the treatment of patients with hepatocellular carcinoma (HCC). Bevacizumab, sorafenib, and sunitinib showed efficacy in patients with HCC; and sorafenib is approved by the FDA for treatment of this cancer. In practice, the clinical benefit of these agents has been heterogeneous; and in patients who do respond, the benefit is modest and/or short-lived. Recent advances in the molecular understanding of tumor angiogenesis along with the rapid development of targeted drug discovery have made it possible to explore novel combination therapy for HCC. We review the clinical trial results, discuss possible molecular mechanisms of resistance, and suggest novel combinations with antiangiogenic therapy.
Antiangiogenic therapy has shown promise in the treatment of patients with hepatocellular carcinoma (HCC). Bevacizumab, sorafenib, and sunitinib showed efficacy in patients with HCC; and sorafenib is approved by the FDA for treatment of this cancer. In practice, the clinical benefit of these agents has been heterogeneous; and in patients who do respond, the benefit is modest and/or short-lived. Recent advances in the molecular understanding of tumor angiogenesis along with the rapid development of targeted drug discovery have made it possible to explore novel combination therapy for HCC. We review the clinical trial results, discuss possible molecular mechanisms of resistance, and suggest novel combinations with antiangiogenic therapy.
Induction chemotherapy yields significant response in locally advanced squamous cell carcinoma of oral cavity. Pre-treatment biomarkers can help to predict response to chemotherapy. The neutrophil-lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) are cost-effective and simple parameters that can predict response to chemotherapy. This study aims to find the correlation between NLR, PLR and response to induction chemotherapy in oral cavity malignancies. Materials and Methods: Details of 32 patients with locally advanced squamous cell carcinoma of oral cavity who received induction chemotherapy from Jan 2017-March 2019 were collected and the following were recorded. Pre-treatment total leukocyte count, neutrophil, lymphocyte and platelet counts. Post induction chemotherapy, reduction in size of tumour. Patients were categorised into complete, partial and non-responders.The mean NLR and PLR, and the significance in variation of NLR and PLR between the three groups was calculated and the statistical significance analysed. Results: The mean NLR is significantly low in both partial (2.62) and complete response groups (2.4) compared to the patients with static response (5.6). The mean PLR is also low in responders (124) when compared to the static group (180), but it is not statistically significant. With a cut-off value of 3.95 for NLR and 153 for PLR, response could be predicted with high positive predictive value. When both the ratios are combined the predictive value is further increased as shown in this study. Conclusion: Pre-treatment NLR and PLR are reliable biomarkers of the systemic immunologic phenotype of the cancer patients. They predict the response to chemotherapy in patients with oral cavity malignancy.
4299 Despite extensive research in adult acute myeloid leukemia, refractory and relapsed disease remain challenging to treat. The development of CECA (cyclophosphamide, etoposide, carboplatin, cytosine arabinoside) was promising as it provided another therapeutic option for reinduction (Kornblau, et al. Leuk Lymphoma. 1998 Jan;28:371–5). In addition, in this particular subset of patients, at the time of discovery of refractory (PrR) or relapsed (Rel) disease, the next question we face relates to stem cell transplantation. Thus, the importance of achieving complete responses (CR) becomes even more imperative. However, the reported CR rate by Kornblau et al was 12% in a study including 25 patients. We believe that patients treated with CECA at our institution have greater response rates. Furthermore, there has not been any subsequent published study regarding efficacy of CECA in refractory or relapsed AML. With these questions in mind, we performed a retrospective study of adult patients at our institution with AML who have received the CECA regimen for reinduction to determine response rates and ability to proceed to stem cell transplantation. A total of 50 adult AML patients (14 PrR and 36 Rel) received CECA for reinduction between 1999 and 2009. Median age of patients is 53 (range 24–77). 18 patients (36%) overall achieved CR (defined as less than 5% blasts in a normal or hypercellular marrow lasting at least 28 days after reinduction and peripheral blood count recovery) or CRi (CR without count recovery). Of these 18 patients, 5 had PrR and 13 had Rel. The median number of induction regimens prior to CECA was 2. In the relapsed setting, the median number of days from most recent induction regimen to CECA is 140 days. Of patients who achieved CR, 11 (61%) proceeded to allogeneic stem cell transplantation. Median number of days from CECA to transplant was 65 days. Mean progression-free survival (PFS) of patients who achieved CR was 118 days. Mean overall survival (OS) is 222 days in patients who achieved CR versus 100 days in patients who did not achieve CR. Early toxicity from CECA (defined as an adverse event within 28 days from start of chemotherapy) was fairly common and included bacteremia/sepsis (n=12), fungal pneumonia (n=7), bleeding (n=5, 2 GI, 2 pulmonary, 1 intra-abdominal), acute renal failure (n=5), cutaneous fungal infections (n=2), C. difficile colitis (n=1), and mucositis (n=1). There were 4 deaths within 28 days of therapy. The CECA regimen for reinduction has activity in patients with refractory or relapsed AML, even after receiving several prior induction cycles. The key factor is the ability of CECA to facilitate stem cell transplantation in greater than half of patients who achieve CR. The toxicity profile appears to be reasonable in this population. Our institutional experience with CECA has shown promising results. Outcomes in a large population of patients and when utilized earlier in the disease course may be even greater and warrants further evaluation. Disclosures: No relevant conflicts of interest to declare.
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