https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)61121-X.pdf

Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines

For the capecitabine–fluorouracil comparison, the hazard ratio for death in the capecitabine group was 0.86 (95% confidence interval [CI], 0.80 to 0.99); for the oxaliplatin–cisplatin comparison, the hazard ratio for the oxaliplatin group was 0.92 (95% CI, 0.80 to 1.10). The upper limit of the confidence intervals for both hazard ratios excluded the predefined noninferiority margin of 1.23. Median survival times in the ECF, ECX, EOF, and EOX groups were 9.9 months, 9.9 months, 9.3 months, and 11.2 months, respectively; survival rates at 1 year were 37.7%, 40.8%, 40.4%, and 46.8%, respectively. In the secondary analysis, overall survival was longer with EOX than with ECF, with a hazard ratio for death of 0.80 in the EOX group (95% CI, 0.66 to 0.97; P = 0.02). Progression-free survival and response rates did not differ significantly among the regimens. Toxic effects of capecitabine and fluorouracil were similar. As compared with cisplatin, oxaliplatin was associated with lower incidences of grade 3 or 4 neutropenia, alopecia, renal toxicity, and thromboembolism but with slightly higher incidences of grade 3 or 4 diarrhea and neuropathy. Conclusions Capecitabine and oxaliplatin are as effective as fluorouracil and cisplatin, respectively, in patients with previously untreated esophagogastric cancer. (Current Controlled Trials number, ISRCTN51678883.)

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Capecitabine and oxaliplatin for advanced esophagogastric cancer.

Summary Background Phase I/II clinical trials of S-1 plus cisplatin for advanced gastric cancer have yielded good responses and the treatment was well tolerated. In this S-1 Plus cisplatin versus S-1 In RCT In the Treatment for Stomach cancer (SPIRITS) trial, we aimed to verify that overall survival was better in patients with advanced gastric cancer treated with S-1 plus cisplatin than with S-1 alone. Methods In this phase III trial, chemotherapy-naive patients with advanced gastric cancer were enrolled betweeen March 26, 2002, and Nov 30, 2004, at 38 centres in Japan, and randomly assigned to S-1 plus cisplatin or S-1 alone. In patients assigned to S-1 plus cisplatin, S-1 (40–60 mg depending on patient's body surface area) was given orally, twice daily for 3 consecutive weeks, and 60 mg/m 2 cisplatin was given intravenously on day 8, followed by a 2-week rest period, within a 5-week cycle. Those assigned to S-1 alone received the same dose of S-1 twice daily for 4 consecutive weeks, followed by a 2-week rest period, within a 6-week cycle. The primary endpoint was overall survival. Secondary endpoints were progression-free survival, proportions of responders, and safety. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00150670. Findings 305 patients were enrolled; seven patients were ineligible or withdrew consent, therefore, 148 patients were assigned to S-1 plus cisplatin and 150 patients were assigned to S-1 alone. Median overall survival was significantly longer in patients assigned to S-1 plus cisplatin (13·0 months [IQR 7·6–21·9]) than in those assigned to S-1 alone (11·0 months [5·6–19·8]; hazard ratio for death, 0·77; 95% CI 0·61–0·98; p=0·04). Progression-free survival was significantly longer in patients assigned to S-1 plus cisplatin than in those assigned to S-1 alone (median progression-free survival 6·0 months [3·3–12·9] vs 4·0 months [2·1–6·8]; p Interpretation S-1 plus cisplatin holds promise of becoming a standard first-line treatment for patients with advanced gastric cancer.

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(08)70035-4.pdf

S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial.

Purpose After curative resection, the prognosis of gastroesophageal adenocarcinoma is poor. This phase III trial was designed to evaluate the benefit in overall survival (OS) of perioperative fluorouracil plus cisplatin in resectable gastroesophageal adenocarcinoma. Patients and Methods Overall, 224 patients with resectable adenocarcinoma of the lower esophagus, gastroesophageal junction (GEJ), or stomach were randomly assigned to either perioperative chemotherapy and surgery (CS group; n 113) or surgery alone (S group; n 111). Chemotherapy consisted of two or three preoperative cycles of intravenous cisplatin (100 mg/m 2 ) on day 1, and a continuous intravenous infusion of fluorouracil (800 mg/m 2 /d) for 5 consecutive days (days 1 to 5) every 28 days and three or four postoperative cycles of the same regimen. The primary end point was OS. Results Compared with the S group, the CS group had a better OS (5-year rate 38% v 24%; hazard ratio [HR] for death: 0.69; 95% CI, 0.50 to 0.95; P .02); and a better disease-free survival (5-year rate: 34% v 19%; HR, 0.65; 95% CI, 0.48 to 0.89; P .003). In the multivariable analysis, the favorable prognostic factors for survival were perioperative chemotherapy (P .01) and stomach tumor localization (P .01). Perioperative chemotherapy significantly improved the curative resection rate (84% v 73%; P .04). Grade 3 to 4 toxicity occurred in 38% of CS patients (mainly neutropenia) but postoperative morbidity was similar in the two groups. Conclusion In patients with resectable adenocarcinoma of the lower esophagus, GEJ, or stomach, perioperative chemotherapy using fluorouracil plus cisplatin significantly increased the curative resection rate, disease-free survival, and OS. J Clin Oncol 29:1715-1721. © 2011 by American Society of Clinical Oncology

https://ascopubs.org/doi/pdf/10.1200/JCO.2010.33.0597

Perioperative Chemotherapy Compared With Surgery Alone for Resectable Gastroesophageal Adenocarcinoma: An FNCLCC and FFCD Multicenter Phase III Trial

Purpose In the randomized, multinational phase II/III trial (V325) of untreated advanced gastric cancer patients, the phase II part selected docetaxel, cisplatin, and fluorouracil (DCF) over docetaxel and cisplatin for comparison against cisplatin and fluorouracil (CF; reference regimen) in the phase III part. Patients and Methods Advanced gastric cancer patients were randomly assigned to docetaxel 75 mg/m2 and cisplatin 75 mg/m2 (day 1) plus fluorouracil 750 mg/m2/d (days 1 to 5) every 3 weeks or cisplatin 100 mg/m2 (day 1) plus fluorouracil 1,000 mg/m2/d (days 1 to 5) every 4 weeks. The primary end point was time-to-progression (TTP). Results In 445 randomly assigned and treated patients (DCF = 221; CF = 224), TTP was longer with DCF versus CF (32% risk reduction; log-rank P < .001). Overall survival was longer with DCF versus CF (23% risk reduction; log-rank P = .02). Two-year survival rate was 18% with DCF and 9% with CF. Overall response rate was higher with DCF (χ2 P = .01). Grade 3 to 4 treatment-r...

https://ascopubs.org/doi/pdf/10.1200/jco.2006.06.8429

Phase III Study of Docetaxel and Cisplatin Plus Fluorouracil Compared With Cisplatin and Fluorouracil As First-Line Therapy for Advanced Gastric Cancer: A Report of the V325 Study Group

Listeria monocytogenes infections may lead to a severe and potentially lethal disease. This occurs mainly in risk groups (elderly, immunocompromised
and newborns). Severe infections in people without any of these factors are rare. Here is reported the case of a 24-year old previously healthy female
patient, who presented with altered mental status (Glasgow Coma Scale score of 11, with worsening to 6 within a few hours), fever and meningeal signs.
The cerebrospinal fluid analysis was compatible with lymphocytic meningitis. Empirical therapy with Ceftriaxone and Acyclovir had been started. There
was clinical worsening, with rhombencephalitis viewed in MRI. Ampicilin was associated and Listeria was actively searched, turning out positive. Despite
all measures, the patient died in the Intensive Care Unit.
This report of a Listeria monocytogenes infection in a patient without risk factors reinforces the need of an early detection and effective treatment.

https://dialnet.unirioja.es/descarga/articulo/5544380.pdf

Listeria monocytogenes meningoencephalitis in an immunocompetent adult patient

Positron emission tomography (PET) using the radiolabeled glucose analogue 18F-FDG allows uncovering glycolysis processes within cancer cells and reveals high value in diagnosis, staging, relapse and therapeutic response evaluation in several malignancies. Breast cancer presents considerable variability when it comes to 18F-FDG uptake, which results in different sensitivity and specificity values related to this technique. 18F-FDG enters the cells through glucose transporters (GLUTs). Therefore, this study aims to determine the pattern of 18F-FDG uptake in various breast cancer cell lines with different hormonal and HER2 receptor’s expressions, and to set a correlation with the expression of GLUT’s 1 and 3.

The studies were performed in three different human breast cancer cell lines, MCF-7, HCC1806 and HCC1954. MCF-7 express estrogen and progesterone receptors (ER and PR), HCC1806 cells are triple negative and HCC1954 are negative for hormonal receptors, but overexpress HER2/neu. GLUT-1 and GLUT-3 expressions were assessed by flow cytometry.

Our results show that, besides HCC1806 and HCC1954 cells present higher GLUT-1 and GLUT-3 levels than MCF-7, we observe a higher 18F-FDG uptake in HCC1954 cells. In fact, HCC1806 cells show the lower 18F-FDG uptake comparing with other cell lines.

These results suggest that despite the dependability of GLUT-1 and GLUT-3 isoforms’ overexpression for 18F-FDG uptake, these receptors do not seem to be the unique responsible. Considering the absence of correlation between GLUT’s expression and 18F-FDG uptake, ER, PR and principally HER2/neu gains an apparent relevance in this process.

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GLUT expression and 18F-FDG uptake in breast cancer cell lines

We present the case of an 80-year-old patient hospitalized for the study of a lower limb bone lesion. The biopsy of this lesion was suggestive of liver
cancer metastasis. However, the study of the liver did not present any local lesion. In the event of an hepatoid tumor, a study of the digestive tract was
performed, without detection of neoplasia. By recurrent respiratory infections, it was hypothesized a tumoral lesion at this level, which was confirmed by
later thorax CT and biopsy.

/pdf/hepatoid-adenocarcinoma-of-the-lung-23xdks822w.pdf

Hepatoid Adenocarcinoma of the Lung

Adult Still’s disease (ASD) is a rare systemic inflammatory disorder of unknown etiology, typically characterized by a clinical triad (daily spiking high fevers, evanescent rash, and arthritis) and a biological triad (hyperferritinemia, hyperleucocytosis with neutrophilia and abnormal liver function test). There are no specific diagnostic tests for ASD, so the diagnosis of ASD remains one of exclusion and the differential diagnosis may be lengthy. We present a case of an adult-onset Still’s disease with previous admissions for fever of unknown origin with a 2-month history of fever and systemic symptoms. The patient posteriorly presented polyarthralgies and cutaneous rash. The study disclosed anemia, inflammatory markers and hepatic enzymes elevation, and negative serological and immunological studies. The introduction of corticotherapy resolved symptoms and laboratories alterations. Adult-onset Still disease is a heterogeneous and rare disease and the lack of serologic markers as a true gold standard makes diagnosis difficult. J Med Cases. 2017;8(7):224-226 doi: https://doi.org/10.14740/jmc2847w

Adriano Rodrigues

Papers

Phase III Study of Docetaxel and Cisplatin Plus Fluorouracil Compared With Cisplatin and Fluorouracil As First-Line Therapy for Advanced Gastric Cancer: A Report of the V325 Study Group

Listeria monocytogenes meningoencephalitis in an immunocompetent adult patient

GLUT expression and 18F-FDG uptake in breast cancer cell lines

Hepatoid Adenocarcinoma of the Lung

A Case Report of Still’s Disease in the Adult