The observation of single-agent gemcitabine maintenance therapy in patients with metastatic breast cancer

Objective： The aim of the study was to evaluate the efficacy and tolerability of single-agent gemcitabine in the maintenance treatment of histologically confirmed metastatic breast cancer cases. Methods： The 45 patients carried ef- ficacious chemotherapy were divided into maintenance therapy group （n = 23） and control group （n = 22） according to the different treatment methods. Patients in the maintenance therapy group received gemcitabine therapy until 6 cycles, disease progression or adverse effect intolerance. Within the control group, the patients were given best supportive care. Follow-up was made until disease progression, death or 2 years. The short-term clinical efficacy and adverse effects, progression-free survival （PFS） and median survival of recurrence （MSR） of these two groups were compared and analyzed. Results： Com- pared with the control group, the experiment group had higher response rate （RR; 73.9% vs 31.8%; P 〈 0.05）, and significantly progress of median PFS （13.1 vs 9.6 months; P 〈 0.05）. However, the progression of MSR had no statistically difference with the control group （23.3 vs 21.1 months; P 〉 0.05）. Most of the treatment-related adverse events were mild, and the most common adverse event was hematologic toxicity. The 3 cases occurred grades 3-4 neutropenia and 3 cases occurred grades 3-4 thrombocytopenia. The 1 patient stopped treatment because of grade 3 allergic reaction, and 4 patients required dose reduction for grade 4 adverse events. Other adverse effects were grades 1-2, and all were recovered after symptomatic treat- ment. There was no significant side effect which threatened the life. Conclusion： In the extension maintenance treatment, gemcitabine can consolidate the therapeutic effect in advance and significantly prolong median PFS of metastatic breast cancer patients. In conclusion, gemcitabine monotherapy with a favorable safety profile is an effective maintenance treatment in metastatic breast cancer patients.     

Clinical study of Shenqi Fuzheng injection decreasing side-effects of chemotherapy for patients with ovarian epithelial cancer

Objective： The aim of the study was to observe the clinical effects of Shenqi Fuzheng injection decreasing side- effects of chemotherapy for patients with ovarian epithelial cancer. Methods： The 36 cases of ovarian epithelial cancer in The Third Affiliated Hospital of SUN Yat-sen University （Guangzhou, China） from June 2010 to June 2013, were randomly divided into the study group and the control group. The study group contained 18 cases using Shenqi Fuzheng injection combined with TP （Taxol ＋ Carboplatin/cisplatin） chemotherapy, and the control group contained 18 cases only using TP chemotherapy without Shenqi Fuzheng injection. During and after chemotherapy, the side-effects and therapy effects were observed. Re- sults： The grade II of nausea and vomit were less in the study group than that in the control group, which was significantly dif- ferent （P 〈 0.05）. But there were no significantly differences in grade I of nausea and vomit between the two groups （P 〉 0.05）. There was less degree of decrease of lymphocyte in the study group than that in the control group, which was significantly different （P 〈 0.05）. But between two groups, there were no significant differences in the drop of white blood cells and red blood cells, the incidence of allergic reaction, liver and renal functions, nerve lesion and phalacrosis （P 〉 0.05）. There was no significant difference in chemotherapy effect between the two groups （P 〉 0.05）. Conclusion： Shenqi Fuzheng injection can in some degree relieve the side effects of TP chemotherapy for the patients with ovarian epithelial cancer, including relieving nausea and vomiting, protecting lymphocytes, and has no conflict effect on chemotherapy efficacy.     

Expression levels of CXCR4 and VEGF correlate with blood-borne metastatic progression and outcome in patients with osteosarcoma

Objective： We determine whether chemokine receptor CXCR4 and vascular endothelial growth factor （VEGF） expression related to the metastasis and survival outcome of patients with osteosarcoma. Methods： Tissue microarray （TMA） was used to detect the expression of CXCR4 and VEGF in 56 osteosarcoma patient samples. Two-year follow-up was performed to observe the metastatic behavior and overall survival of osteosarcoma patients. Results： There was a significant correlation between the expression levels of CXCR4 and VEGF in 56 osteosarcoma patient samples （P = 0.002）. Univariate analysis revealed the expression of CXCR4 and VEGF was not associated with age, gender and the level of ALP but associated with clinical stage. Conclusion： These data raises the possibility that VEGF could regulate the levels of CXCR4 to promote the migration of tumor cells to target organs. CXCR4 and VEGF expression are highly correlated with metastatic progression in patients with osteosarcoma and their immunohistochemical expression have predictive value for the metastatic development.     

Clinical application of intraperitoneal chemotherapy before surgery for ovarian cancer and its evaluation

Objective： To investigate the clinical efficacy of intraperitoneal chemotherapy before surgery for ovarian cancer. Methods： 60 patients with stages Ⅱ-Ⅳ of ovarian cancer were treated with intraperitoneal chemotherapy of CAP or TP regimen followed by a surgery treatment and another chemotherapy for 6 cycles. And then the efficiency of the therapy was evaluated by analyzing the changes of ascites, the serum CA-125 and CA-19-9 levels and the findings in the operation, and investigating the recurrence of cancer and the survival. Results： After 1-3 cycles of intraperitoneal chemotherapy, serum levels of CA-125 and CA-19-9 and carcinous ascites significantly reduced in all patients, ascites reduce was over 50% in 98.3% cases; all cases were successfully treated with cytoreduction and it was found during the operation that bulky tumor was reduced and looser so as to be easily isolated and removed; PFS of the patients was prolonged, while the toxicity and side-effects were not so serious as beyond the patient toleration. Conclusion： Intraperitoneal chemotherapy before surgery for ovarian cancer has an active efficacy in clinic, being able to improve conditions of surgery and increase the opportunity of maximal cytoreduction, and prolong survival of the patients, and should be a good selection for the treatment of advanced ovarian cancer.     

The efficacy of bevacizumab in Chinese patients with metastatic colorectal cancer and its effect in different line setting

Objective： We aimed to evaluate the effect of bevacizumab in the palliative treatment of Chinese metastatic colorectal cancer （mCRC） and its efficacy in different lines. Methods： Patients of mCRC treated with bevacizumab or not at Sun Yat-sen University Cancer Center from 2005 to 2013 were recruited as the study group and control group. The endpoints were objective response rate （ORR）, disease control rate （DCR）, overall survival （OS） and progression free survival （PFS）. The OS and PFS of first-, second- and third-line treatment groups were compared between study group and control group. Re- sults： The median PFS of the study and the control group were 8.2 months （7.0-9.4 months）, 5.7 months （4.7-6.6 months）, P = 0.001; OS were 26 months （5.4-130.5 months）, 18 months （16.6-19.4 months）, P 〈 0.001, respectively. The ORR and DCR of first-, second- and third-line were 30.3% （20/66）, 20% （6/30）, 17.6% （3/17） and 97% （64/66）, 86.7% （26/30）, 100% （17/17）. In the first-line chemotherapy group, the OS of the study group and the control group were 22.9 （5.4-96.7） months and 18 （16.6-19.4） months （P 〈 0.001）; PFS were 9.4 （8.4-10.4） months and 5.7 （4.7-6.6） months （P 〈 0.001）, respectively. While in the second- and third-line setting, only OS were statistically different, PFS had no significant difference. Conclusion： The combination of bevacizumab and chemotherapy had a promising short-term and long-term efficacy in Chinese mCRC patients than those without bevacizumab regimens, and the effect could be better reflected in the first-line treatment.     

Efficacy comparison between hepatic arterial infusion chemotherapy plus systemic chemotherapy used as first-line and non-first-line treatments for the patients of colorectal cancers with unresectable hepatic metastases

Objective： The combination of hepatic arterial chemotherapy （HAIC） and systemic chemotherapy （SYC） has potential effect on colorectal cancer （CRC） patients with unresectable hepatic metastasis. The aim of this retrospective study was to investigate the efficacy and safety of this combined therapeutic regimen on Chinese patients based on single institute experiences. Methods： All 54 patients of this retrospective analysis were diagnosed with CRC with unresectable liver metas tasis and received combined HAIC and SYC. Among the patients, 23 of them received HAIC plus SYC when they developed liver metastases as firstline treatment （Group 1）, and 31 patients received HAIC plus SYC as nonfirstline treatment （Group 2）. The different efficacy in two groups was analyzed by SPSS 19.0. Results： The overall response rate （ORR） were 52.2% and 25.8% respectively in Groups 1 and 2 （P = 0.047）, and the disease control rate （DCR） were 65.2% and 35.5% respec tively in Groups 1 and 2 （P = 0.031）. The median progressionfree survival （PFS） were 6.8 and 3.3 months （P = 0.002）, the median hepatic progressionfree survival （HPFS） were 8.8 and 3.7 months （P = 0.001）, and the median overall survival （OS） were 18.8 and 13.7 months （P = 0.121） in Groups 1 and 2, respectively. No fatal reaction was observed and no significant difference of adverse reaction was found in two groups. Grade 3/4 toxic effects included neutropenia （9.7% in Group 2 only）, gastrointestinal reaction （8.7% in Group 1 and 6.5% in Group 2）, stomatitis （6.5% in Group 2 only） and hyperbilirubinemia （4.3% in Group 1 only）. Conclusion： HAIC combined with SYC showed promising efficacy and safe profiles on CRC patients with unresectable liver metastases.     

Neoadjuvant intra-arterial infusion chemotherapy followed by surgery in patients with locally advanced cervical cancer

Objective： The aim of this study was to investigate the role of preoperative neoadjuvant intra-arterial infusion chemotherapy （NAIC） in treating locally advanced cervical caner. Methods： Nineteen locally advanced cervical cancer （LACC） patients from November 2003 to November 2005 were analyzed retrospectively. NAIC was administrated 2 courses every 2 weeks using a combination of 30 mg/m^2 bleomycin and 50 mg/m^2 cisplatin via bilateral femur artedes. The response to NAIC was assessed by pelvic examination and imaging diagnostics and histological analysis. Two weeks after NAIC radical hysterectomy with pelvic lymphadenectomy was performed. Results： Radical hysterectomy with pelvic lymphadenectomy were performed in 18 patients successfully. The mean tumor reduction rate was 73.04%. The overall clinical response rate of NAIC was 84.2% with 2 complete responses and 16 partial responses. Only 1 nonresponder. Six of 7 cases who had parametrial infiltration had a absence after chemotherapy, no significant change was observed in 1 case who followed by radiotherapy. Multivariate logistic regression analysis indicated that tumor volume prior to treatment was determining factor affecting the efficacy of NAIC in LACC. Conclusion： pre-operative NAIC inhibited the growth of LACC, minimized the size, eliminate effectively the pathologic dsk factors in the pelvic cavity, to improve the operability in cervical cancer patients with stage lib or above, considered inoperable.     

Oxaliplatin combined with S-1 capsule in the treatment of 62 cases with advanced gastric cancer

Objective： The aim of this study was to evaluate the efficacy and safety profile of DeFazio （S-l） combined with oxaliplatin against unresectable advanced or metastatic gastric cancer. Methods： Oxaliplatin was given intravenously at 130 mg/m2 for 2 h on dl and S-1 was administered bid. at 80 mg/m2/day on d1-14 followed by a 7-day rest during the 3-week schedule. Results： All 62 patients were assessed for efficacy and adverse events. The response and disease control rates were 47.3% and 80.8%, respectively. The median time to progression was 7.8 months, and the median overall survival was 11.6 months. The grade 3/4 adverse events were hematological toxicities, including neutropenia （11.3%）, thrombocytopenia （9.7%） and gastrointestinal reactions （6.5%）. Conclusion： The SOX regimen （oxaliplatin, 130 mg/m2 d l; S-1, 80 mg/m2/day, bid. d1-14, q3w） provide a favorable efficacy and safety profile in patients with advanced gastric cancer.     

The clinical significance of axillary sentinel lymph node biopsy in different clinical stages breast cancer patients after neoadjuvant chemotherapy

Objective： We aimed to study the success and false negative rate of sentinel lymph node biopsy （SLNB） in dif- ferent clinical stages breast cancer patients being carried out with neoadjuvant chemotherapy （NAC）, and the clinical signifi- cance of SLNB, we conducting this trial. Methods： One hunderd and thirty-seven cases were enrolled in this clinical research from March 2003 to March 2007. All of the patients＇ sentinel lymph nodes were detected with 99mTc-Dx and methylene blue. There were 61 patients with stage TI_2NoMo carried SLNB without NAC （group A）, 76 cases were carried out NAC 3-4 cycles before SLNB, including 39 T2_4N0_IMo cases （group B） and 27 T2-4N2_3M0 cases （group C）. The success and false negative rate of SLNB were analysed with chi-square test. Results： In group A, the successful and false negative rate of SLNB were 92.31% （36/39）, 8.57% （3/35）, and in group B and C were 92.31% （36/39）, 8.57% （3/35） and 74.07 % （20/27）, 18.52 % （5/27）, respectively. The successful rate of group C decreased and false negative rate increased significantly compared with group A and B （P 〈 0.05）, but group A and B had no significant difference （P 〉 0.05）. Conclusion： The SLNB can accurately predict lymph node status of axillary lymph node in N0-1 stage patients with NAC, but in N2-3 stage patients the success rate decreased and false rate increased negative significantly.