Maintenance Metronomic Chemotherapy in Treatment of Metastatic Colorectal Cancer

Treatment of metastatic colorectal cancer (mCRC) is one of the most challenging and important problems in oncology at present moment. This article presents the interim results of treatment of patients with colorectal cancer, who were enrolled from 2016 till 2019 (n=60) with the use of maintenance metronomic chemotherapy. Metronomic regimen consisted of oral capecitabine 500 mg 3 times a day and oral cyclophosphane 50 mg daily. The control arm consisted of mCRC patients who received the same induction chemotherapy without maintenance from 2011 till 2015 (n=70). Median follow-up time was 18.5 months. Median progression-free survival (PFS) was 9.0 and 7.4 months in the maintenance and control arms respectively. Median overall survival (OS), counted from the beginning of induction chemotherapy, is currently 22.9 months in the maintenance arm, and 14.7 months in control. High expression levels of genes, encoding enzymes TS (thymidylate synthetase), DPD (dihydropyrimidine dehydrogenase) and receptor VEGFR1, low expression level of gene TP (thymidylate phosphorylase), as well as low levels of tumor markers CEA and СА 19-9 are the prognostic factors of sensitivity to metronomic chemotherapy given to colorectal cancer patients. Based on these data, we identified a group of patients who are recommended to use this method of treatment.

Reviewer Acknowledgements for Cancer and Clinical Oncology, Vol. 8, No. 1

Cancer and Clinical Oncology wishes to acknowledge the following individuals for their assistance with peer review of manuscripts for this issue. Their help and contributions in maintaining the quality of the journal is greatly appreciated. Cancer and Clinical Oncology is recruiting reviewers for the journal. If you are interested in becoming a reviewer, we welcome you to join us. Please find the application form and details at http://www.ccsenet.org/reviewer and e-mail the completed application form to [email protected]. Reviewers for Volume 8, Number 1 Aditya R Bele, University of Florida, USA Anand Kumar, Banaras Hindu University, India Behjatolah Monzavi-Karbassi, University of Arkansas for Medical Sciences, USA Hua Wang, Memorial Sloan Kettering Cancer Center, China Julita Kulbacka, Wroclaw Medical University, Poland Kartik Anand, Houston Methodist Cancer Center, USA Maral Mazloumi Tabrizi, Islamic Azad University, Iran Premila Leiphrakpam, University of Nebraska Medical Center, USA Vignesh Viswanathan, Stanford University, USA

Personal Loss and Grief Experiences of Healthcare Personnel in Pre- and Perinatal Care: A Review of Literature

Pre- and perinatal loss and grief tend to be referred to as complicated grief denoting the experience of ongoing trauma. It is considered a burden for the affected parents, their families and the helping professionals alike. Yet this phenomenon remains an underrepresented field in analytical studies. Our aim is to systematically review the literature that deals with personal grief caused by pre- and perinatal loss - as experienced by healthcare staff. We shall present a comprehensive view of relevant international and national attitudes including existing grief management options. The above-mentioned complex issue deserves greater attention, which should result in the establishment of dynamic, up-to-date support programmes on all professional levels.

The Changes of Expression Levels in Mir-181a and Mir-30d, and a Significant Correlation between Clinical Patient Data

Purpose: Colorectal cancer is known as the most common gastrointestinal cancers. As the age increases, the risk for this cancer also increases, so the only way to improve and hope for life in these patients is early diagnosis of the disease. So far, numerous molecular studies have been carried out on microRNAs in colorectal cancer. In addition, since some of them can be identified as cancer biomarkers. Therefore, in this study we have investigated the expression level of Mir-30d and Mir-181a as cancer biomarkers. Method: The changes of Mir-30d and Mir-181a expression levels in 60 colorectal tumor tissues and 60 adjacent tumor tissues, after RNA extraction and cDNA synthesis were surveyed using the Real Time-PCR method. Results: The results have reported a considerable reduction in the expression level of Mir-30d in tumor tissues, as well as a significant increase in the expression level of Mir-181a tumor expression in tumor tissues (P<0.05). In addition, the correlation between Mir-30d and Mir181a showed that there was a significant difference between the level of expression of mir-30d with age and TNM stage of CRC (P<0.05), whilst these correlations were not observed for Mir-181a (P>0.05).

Treatment of Recurrent Glioblastoma Multiforme (rGBM) with Antineoplaston AS2-1 in Combination with Targeted Therapy

Treatment of recurrent glioblastoma multiforme (rGBM) poses a difficult challenge. Therefore, the purpose of this report was to evaluate objective response (OR), progression-free survival (PFS), overall survival (OS), and the incidence of adverse events (AEs) in rGBM patients, age 19-70 years, who were treated with antineoplaston AS2-1 (Astugenal) plus targeted therapy. A retrospective analysis was performed. Tumor response was assessed by gadolinium-enhanced magnetic resonance imaging (MRI). Twenty-nine adult rGBM patients were treated between 9/11/2015 and 06/23/2018. Seven had no prior treatment with bevacizumab elsewhere, had radiologic evidence of rGBM, and had MRI assessment of tumor response. The median treatment time was 101 days (range: 55-208 days). OR was seen in six patients (85.7%) with complete disappearance of gadolinium enhancement in four patients (57.1%) and a 50% or greater reduction in gadolinium enhancement in two patients (28.6%). Progressive disease was seen in one patient (14.3%). The median time to first response was 29 days (range: 22-96 days) while the median duration of response was 141 days (range 55-739+ days). Six- and 12-month PFS was 57% and 19%, respectively while 6- and 12-month OS at was 86% and 54%, respectively. Treatment was well-tolerated with no patients experiencing grade 3 or 4 antineoplaston-related toxicity. Regarding response to treatment and toxicity, AS2-1 plus targeted therapy compares favorably with other reported rGBM therapies. Duration of response was shortened by the ill-advised decision of some patients to discontinue treatment after a tumor response was achieved.  

Reviewer Acknowledgements for Cancer and Clinical Oncology, Vol. 7, No. 2

Cancer and Clinical Oncology wishes to acknowledge the following individuals for their assistance with peer review of manuscripts for this issue. Their help and contributions in maintaining the quality of the journal is greatly appreciated. Cancer and Clinical Oncology is recruiting reviewers for the journal. If you are interested in becoming a reviewer, we welcome you to join us. Please find the application form and details at http://www.ccsenet.org/reviewer and e-mail the completed application form to [email protected]. Reviewers for Volume 7, Number 2 Aditya R Bele, University of Florida, USA Anand Kumar, Banaras Hindu University, India Chandra Sekhar Bathula, Washington State University, USA Dhaarini Murugan, Oregon Health and Science University, USA Hua Wang, Memorial Sloan Kettering Cancer Center, China Juan Luis Callejas Valera, UCSD/Moores Cancer Center, United States Kartik Anand, Houston Methodist Cancer Center, USA Kaushik Thakkar, Stanford University, USA Manal Mehibel, Stanford University, USA Mark G Trombetta, Drexel University College of Medicine, USA Mona Mostafa Mohamed, Cairo University, Egypt Rajesh Kumar, Cancer Center MGH/Harvard Medical School, USA Sunil Kumar, University of North Carolina at Chapel Hill, USA Wright Jacob, University of Glasgow, United Kingdom Xi Yang, Stanford University, USA

Factors That Influence Females’ Intention towards Breast Cancer Early Diagnosis

Despite the advanced medical technology nowadays, breast cancer incidence rate is still increasing worldwide. This is due to females lack of knowledge and awareness about the breast screening. Therefore, the objective of this study is to explore the factors that influence females’ intention towards breast cancer early diagnosis with health belief model and provide practical recommendations. To evaluate the proposed hypotheses in this study, 600 self-administrated questionnaires were distributed to Malaysian female who is 18 years old and above with the usage of non-probable sampling approach (convenience sampling approach). Given that, the findings demonstrate perceived barriers has the greatest impact towards females’ breast cancer early diagnosis intention, followed by perceived severity and perceived susceptibility. The contribution of this study is to evaluate the relationships between perceived severity, perceived susceptibility and perceived barriers towards females’ breast screening intention with the mediating variable of attitude. To support this, health believe model and theory of planned behaviour are employed in this research.

Preoperative Staging in Women with Known Breast Cancer: Comparison between Digital Breast Tomosynthesis (DBT) and Magnetic Resonance Imaging (MRI)

Objectives To prospectively evaluate the accuracy in tumor extent and size assessment of Digital Breast Tomosynthesis (DBT) and Magnetic Resonance Imaging (MRI) in women with known breast cancer, with pathological size as the gold standard. Methods From May 2014 to April 2016, 50 patients with known breast cancer were enrolled in our prospective study. All patients underwent MRI on a 3T magnet and DBT projections. Two radiologists, with 15 and 7 years of experience in breast imaging respectively, evaluated in consensus each imaging set unaware of the final histological examination. MR and DBT sensitivity, PPV and accuracy were calculated, using histology as the gold standard. McNemar test was used to compare MR and DBT sensitivity. Correlation and regression analyses were used to evaluate MRI vs Histology, DBT vs Histology and MRI vs DBT lesions tumor size agreement to histological results. Results On histological examination 70 lesions were detected. MRI showed 100% sensitivity, 96% PPV and 96% accuracy; DBT sensitivity was 81%, PPV 92% and accuracy 77%. McNemar test p-value was 0.0003. Lesions size Pearson correlation coefficient was 0.97 for MRI vs Histology, 0.92 for DBT vs Histology, (p-value<0.0001). MRI vs DBT regression coefficient was 0.83. Conclusions MRI confirmed to be the most accurate imaging technique in preoperative staging of breast cancer. However, DBT showed very good accuracy, sensitivity and tumor size assessment and could be a valid tool for preoperative staging when MRI is contraindicated.

Cost-Effectiveness of the Biozorb Device for Radiation Planning in Oncoplastic Surgery

Purpose: With the extent of breast tissue manipulation using oncoplastic surgical techniques, there lies a challenge in marking the tumor bed for adjuvant radiation therapy planning. Two competing techniques in doing so exist and involve the traditional placement of surgical clips in the surgical tumor bed or the newer technique of placing a Biozorb marker in the tumor bed. Our goal was to perform a cost-utility assessment to see which tumor bed marking approach is more cost-effective. Based on device list prices and clinical outcomes from a comprehensive literature review, we assessed if an approach either dominated or had an incremental cost-utility ratio of less than $50,000/QALY since either would signify cost-effectiveness. Results: From a cost comparison, the Biozorb marker ($1250) was far costlier than the clip applier device ($50). Our PRISMA search (Figure 1) reviewed 133 articles for clip placement and 42 articles for Biozorb placement in oncoplastic surgery with 2 clip placement articles and 3 Biozorb articles meeting criteria. The available data for either marking technique suggests reasonable tumor bed identification for adjuvant radiation treatment without clear clinical advantages supporting one technique over the other. Overall clinical equivalence in the setting of a clear cost advantage suggests dominant cost-effectiveness in favor of clips. Conclusion: Using surgical clips to identify the tumor bed in oncoplastic surgery is dominant and more cost-effective over the Biozorb technique as clips are relatively inexpensive while both techniques reasonably identify the tumor bed.

Questioning the Value of Evaluating Estrogen and Progesterone Receptors on Core Biopsy Specimens of Patients with Ductal Carcinoma in Situ (DCIS)

Purpose: To evaluate the value of estrogen and progesterone receptors on core biopsy specimens of patients with ductal carcinoma in situ. Introduction: The immunohistochemical determination of the estrogen receptor (ER) and progesterone receptor (PR) status is predictive of the response of patients with invasive cancer to hormonal therapy. The value of the receptor status prior to definitive surgery with either breast conservation or mastectomy for patients with ductal carcinoma in situ (DCIS) and no invasive component is less clear. Methods: We identified through the tumor registry 344 patients with breast cancer diagnosed from 2014 through 2015. Two hundred seventy-seven patients had invasive cancer at diagnosis. Results: Of the remaining 67 patients with DCIS or atypical hyperplasia alone on core biopsy, 15 (22%) patients were found to have invasive cancer at the time of definitive surgery. Forty-six patients without an invasive component had definitive surgery at the study institution, of which three had a component of higher grade DCIS than on the core biopsy. Fourteen patients (30%) underwent a mastectomy. Conclusion: A significant proportion (29%) of patients with DCIS alone on core biopsy had either an invasive component at the time of definitive surgery or a higher grade DCIS component. An additional 14/46 (30%) of patients chose mastectomy, for whom consideration of adjuvant endocrine therapy for contralateral risk reduction did not depend on the receptor status of the index DCIS. Cost savings could be realized if the determination of ER is deferred until after definitive surgery. Determination of PR on DCIS specimens can be omitted entirely.