Unique challenges and outcomes of young women with breast cancers from a tertiary care cancer centre in India

BackgroundYoung (≤40 years) breast cancers (YBC) are uncommon, inadequately represented in trials and have unique concerns and merit studying.MethodsThe YBC treated with a curative intent between 2015 and 2016 at our institute were analysed.ResultsThere were 1228 patients with a median age of 36 (12–40) years; 38 (3.1%) had Stage I, 455 (37.1%) - II, 692 (56.3%) –III, and remaining 43 (3.5%) Stage IV (oligo-metastatic) disease; 927 (75.5%) were node positive; 422 (34.4%) were Triple negatives (TNBC), 331 (27%) were HER-2 positive. There were 549 (48.2%) breast conservations and 591 (51.8%) mastectomies of which 62 (10.4%) underwent breast reconstruction. 1143 women received chemotherapy, 617 (53.9%) received as neoadjuvant and 142 (23.1%) had pathological complete response; 934 (81.9%) received adjuvant radiotherapy. At the median follow-up of 48 (0–131) months, 5-year overall and disease-free survival was 79.6% (76.8–82.5) and 59.1% (55.8–62.6). For stage I, II, III and IV, the 5-year overall-survival was 100%, 86.7% (82.8–90.6), 77.3% (73.4–81.2), 69.7% (52.5–86.9) and disease-free survival was 94% (85.9–100), 65.9% (60.3–71.5), 55% (50.5–59.5), and 29.6% (14–45.2) respectively. On multivariate analysis, TNBC and HER-2+ subgroups had poorer survival (p = 0.0035). 25 patients had BRCA mutations with a 5-year DFS of 65.1% (95% CI:43.6–86.6). Fertility preservation was administered in 104 (8.5%) patients; seven women conceived and 5 had live births. Significant postmenopausal symptoms were present in 153 (13%) patients.ConclusionMore than half of the YBC in India were diagnosed at an advanced stage with aggressive features leading to suboptimal outcomes. Awareness via national registry and early diagnosis is highly warranted. Menopausal symptoms and fertility issues are prevalent and demand special focus.     

Protroca: A Noninterventional Study on Prophylactic Lipegfilgrastim against Chemotherapy-Induced Neutropenia in Nonselected Breast Cancer Patients

BackgroundProtroca evaluated the efficacy and safety of primary and secondary prophylaxis of neutropenia with lipegfilgrastim (Lonquex®) in breast cancer patients receiving neoadjuvant or adjuvant chemotherapy (CT).Patients and MethodsOf the 255 patients enrolled, 248 patients were evaluable for the intent-to-treat (ITT) and 194 patients for the per-protocol set. Primary and secondary end points after lipegfilgrastim treatment were assessed.ResultsNine patients of the ITT set receiving lipegfilgrastim as primary prophylaxis (n = 222) had febrile neutropenia of grade 3–4 (5 patients) or infection of grade 3–4 (4 patients); 1/26 of those receiving secondary prophylaxis had an event. Dose reductions were performed in 9.5% of the patients. Postponement of cancer CT cycles for >3 days occurred in <15% of patients; 10.8% (92/851 AEs) and 8% (2/25 SAEs) of documented adverse events and serious adverse events, respectively, were related to lipegfilgrastim.ConclusionsApplication of lipegfilgrastim was effective as primary and secondary prophylaxis in the prevention of CT-induced neutropenia in breast cancer.     

50例多发性骨髓瘤患者外周血T细胞改变

多发性骨髓瘤伴有Ｔ细胞异常的５０例患者中，治疗前患者２３例，停药后复发者１２例，其末梢血ＯＫＴ＿３，ＯＫＴ＿４，ＯｋＴ＿４／ＯＫＴ＿８均低于正常对照（Ｐ＜０．００１），ＯＫＴ＿８相对增高，ＯＫＴ＿４下降与ＯＫＴ＿４／ＯＫＴ＿８比值降低在病情危重者尤甚。化疗可加深对Ｔ细胞亚群的抑制。中西医结合治疗的１６例息者ＯＫＴ＿４、ＯＫＴ＿８及ＯＫＴ＿４／ＯＫＴ＿８恢复正常水平。     

Ivermectin levels in human breastmilk

Summary Ivermectin levels were measured in breastmilk and plasma of 4 healthy mothers after an oral 150 g/kg dose. Mean ± S.D. plasma and milk values were 37.9±0.54 and 14.13±0.43 (ng/ml) respectively. Steady-state ivermectin levels in milk were low. Our results suggest that exclusion of lactating mothers from mass chemotherapy with ivermectin may be unnecessary.     

口腔颌面鳞癌术前诱导化疗二种方式临床疗效分析

目的 :探讨口腔颌面鳞癌术前诱导化疗二种方式应用的疗效、主要毒副反应差别 ,以及临床适应证。为术前诱导化疗的选择提供临床指导。方法 :本文回顾了 1 0 4例可评价近期疗效的口腔颌面鳞癌术前诱导化疗的病例。其中全身化疗 5 6例 ,颈外动脉插管化疗 48例。结果 :以肿瘤体积缩小 5 0 %以上作为化疗有效指标 ,全身化疗组有效率为 6 4.3%。颈外动脉插管化疗组有效率为79.2 % ,两组总有效率为 71 .2 % (P<0 .0 5 )。全身化疗组的主要毒副反应为胃肠反应、白细胞减少和脱发 ;颈外动脉插管化疗组主要为口腔粘膜溃疡、糜烂及灼痛感。结论 :作为术前诱导的全身化疗较适合于全身状况良好的患者 ,而颈外动脉插管灌注化疗较适合于全身状况稍差、无转移、肿瘤范围不广的患者。     

以大剂量阿糖胞苷为主的联合化疗在儿童急性白血病中的应用

目的 :探讨大剂量阿糖胞苷 ( HDAC)治疗儿童急性白血病的效果和不良反应。　方法 :应用 HDAC治疗 3例急性髓细胞白血病 (每次 2 .0 g/m2 ,每 12 h1次 ,共 6次为一个疗程 )和 4例高危型急性淋巴细胞白血病 (每次1.0 g/m2 ,每 12 h1次 ,共 8次为一个疗程 )共 16个疗程 ,九个疗程在 HDAC结束后使用惠尔血 ( 2～ 3μg/kg)皮下注射 ,连续 10～ 14天。　结果 :6例按计划完成 HDAC治疗 ,并继续用常规方案治疗者 ,在 2 0～ 42个月的随访期内无病生存 ,1例 AL L- L3型在一个疗程 HDAC后出现中枢神经系统白血病复发 ,骨髓仍缓解 ,7个月后放弃治疗 .骨髓严重抑制和感染是最主要的不良反应 ,加用惠尔血可使粒细胞缺乏的持续时间缩短 ,感染发生率降低。　结论 :以 HDAC为主的联合化疗方案可安全地用于儿童急性白血病的强化治疗 ,对降低复发、提高无病生存率有积极意义     

肠内营养支持治疗减轻晚期食管癌患者化疗不良反应

目的 评估肠内营养支持治疗对晚期食管癌患者一线化疗疗效及不良反应的影响.方法: 回顾性收集2014年7月至2016年12月于北京大学肿瘤医院接受一线化疗的118例不可手术切除的局部进展期或转移性食管癌患者资料,将患者分为两组,营养支持组(化疗同时予肠内营养支持)和对照组(单纯化疗).比较两组患者化疗前后各营养指标[KPS功能状态评分(Karnofsky performance status),体质量,体重指数(body mass index,BMI),血红蛋白,淋巴细胞数,总蛋白,白蛋白,甘油三酯,总胆固醇]的变化及化疗疗效,化疗不良反应的差异.结果: (1)对照组化疗后,患者体质量,BMI和血红蛋白水平均明显下降(P<0.001);营养支持组患者化疗后,患者体质量和BMI并无明显变化,仅血红蛋白有明显下降;两组患者化疗前后其他营养指标差异均无统计学意义.(2)与对照组相比,营养支持组化疗后3级以上血液学毒性发生率显著降低(15.4% vs. 42.1%,P=0.004),3级以上非血液学毒性发生率也有所降低但两组差异无统计学意义(0 vs. 9.2%,P=0.123).Logistic回归多因素分析显示,营养治疗是食管癌患者化疗后发生3级以上血液学毒性的独立影响因素(P=0.008,RR=6.048,95%CI:1.589~23.027).(3)两组患者化疗疗效差异无统计学意义.结论: 晚期食管癌患者在化疗同时予肠内营养支持治疗可改善患者营养状态,减轻化疗毒性和不良反应.     

高剂量与常规剂量表阿霉素联合化疗初治非小细胞肺癌对比研究

目的本实验为一前瞻性随机化对照研究,以高剂量表阿霉素-丝裂霉素-顺铂,常规剂量表阿霉素-丝裂霉素-顺铂作比较,初治非小细胞肺癌(NSCLC),评价其疗效及毒副作用.方法治疗NSCLC共40例.分高剂量组和常规剂量组(A、B)各20例.男性25例,女性15例.病理类型以腺癌为主(26例),Ⅲa期4例,Ⅲb期17例,Ⅳ期19例.全部为初治病人.结果高剂量组(A)总有效率(65%)高于常规剂量组(B)(45%),中位缓解期A组3.1个月,B组2.2个月;中位生存期A组8.7个月,B组7.1个月.表阿霉素的剂量限制毒性为心脏毒性和骨髓抑制,心脏毒性发生率A、B两组均为5%(1例),骨髓抑制A组较B组稍高,白细胞下降率各为65.0%和55.0%.结论高剂量表阿霉素为主的联合化疗治疗NSCLC的有效率比常规剂量组高,毒性相似,可以耐受,是值得推荐的高效低毒的一种给药途径.     

四类新药盐酸栈拉司琼注射液预防抗肿瘤药物所致呕吐的Ⅱ期临床观察

目的在肿瘤的治疗中化疗药物所引起的恶心、呕吐是极为常见的,通过对盐酸格拉司琼注射液预防肿瘤化疗所致呕吐的Ⅱ期临床研究,探讨该药的止吐疗效及毒性反应.方法对31例病人的观察,采用自身对照新药盐酸格拉司琼与恩丹西酮预防抗肿瘤药物(DDP及蒽环类药物)所致呕吐进行比较.结果格拉司琼对强致吐剂顺铂所引起的呕吐其总的缓解率＞90%,恩丹西酮对顺铂引起的呕吐其缓解率＞85%.两止吐药毒性反应主要为便秘,恩丹西酮致便秘发生率高达41%,而格拉司琼所致便秘发生率为16%.结论两药预防呕吐的疗效相当,但格拉司琼的副反应明显低于恩丹西酮