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Background: We investigated the clinical outcome of patients with brain metastases (BMs) from human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (MBC) treated with lapatinib and capecitabine (LC). Patients and Methods: A total of 203 patients with HER2+ MBC, who had progressed after trastuzumab-containing chemotherapy, were retrospectively evaluated in 11 centers between September 2009 and May 2011. 85 patients who had developed BMs before the initiation of treatment with LC were included. All patients had received prior cranial radiotherapy. All patients were treated with the combination of lapatinib (1,250 mg/day continuously) and capecitabine (2,000 mg/m(2) on days 1-14 of a 21-day cycle). Results: The median follow-up was 10.5 months (range 1-38 months). An overall response rate of 27.1% was achieved, including complete response in 2 (2.4%) and partial response in 21 (24.7%) patients. Median progression-free survival was 7 months (95% confidence interval (CI) 5-9), with a median overall survival of 13 months (95% Cl 9-17). The most common side effects were hand-foot syndrome (58.8%), nausea (55.3%), fatigue (48.9%), anorexia (45.9%), rash (36.5%), and diarrhea (35.4%). Grade 3-4 toxicities were hand-foot syndrome (9.4%), diarrhea (8.3%), fatigue (5.9%), and rash (4.7%). There were no symptomatic cardiac events. Conclusion: LC combination therapy was effective and well-tolerated in patients with HER2+ MBC with BMs, who had progressive disease after trastuzumab-containing therapy., BACKGROUND: We investigated the clinical outcome of patients with brainmetastases (BMs) from human epidermal growth factor receptor 2-positive (HER2+)metastatic breast cancer (MBC) treated with lapatinib and capecitabine (LC).PATIENTS AND METHODS: A total of 203 patients with HER2+ MBC, who had progressed after trastuzumab-containing chemotherapy, were retrospectively evaluated in 11centers between September 2009 and May 2011. 85 patients who had developed BMsbefore the initiation of treatment with LC were included. All patients hadreceived prior cranial radiotherapy. All patients were treated with thecombination of lapatinib (1,250 mg/day continuously) and capecitabine (2,000mg/m(2) on days 1-14 of a 21-day cycle).RESULTS: The median follow-up was 10.5 months (range 1-38 months). An overallresponse rate of 27.1% was achieved, including complete response in 2 (2.4%) and partial response in 21 (24.7%) patients. Median progression-free survival was 7months (95% confidence interval (CI) 5-9), with a median overall survival of 13months (95% Cl 9-17). The most common side effects were hand-foot syndrome(58.8%), nausea (55.3%), fatigue (48.9%), anorexia (45.9%), rash (36.5%), anddiarrhea (35.4%). Grade 3-4 toxicities were hand-foot syndrome (9.4%), diarrhea(8.3%), fatigue (5.9%), and rash (4.7%). There were no symptomatic cardiacevents.CONCLUSION: LC combination therapy was effective and well-tolerated in patientswith HER2+ MBC with BMs, who had progressive disease after trastuzumab-containingtherapy.

Background: We retrospectively evaluated the efficacy and toxicity of paclitaxel plus doxorubicin as a second-line treatment in patients with urothelial carcinoma, who had not responded to a prior platinum plus gemcitabine combination. Patients and Methods: All patients received intravenous infusions of paclitaxel (175 mg/m(2)/h) and doxorubicin (50 mg/m(2)/30 min) on day 1. Chemotherapy courses were repeated every 21 days. Results: The median follow-up duration was 13.5 months (range 2.8-22.4 months). Complete and partial responses were observed in 2 (5.6%) and 10 (27.8%) patients, respectively. Median overall survival was 8.9 months (95% confidence interval (CI): 6.2-11.6). Median time to progression was 3.8 months (95% CI: 2.7-4.8). The most common hematologic toxicities were neutropenia (n = 21, 58.3%), thrombocytopenia (n = 10, 27.8%), and anemia (n = 9, 25%). The most common non-hematologic toxicities consisted of fatigue (n = 15, 41.7%), nausea/vomiting (n = 13, 36.1%), peripheral neuropathy (n = 11, 30.6%), and mucositis (n = 6, 16.7%). Dose reductions by 25-35% were performed in 6 (16.7%) patients because of grade 3/4 toxicity. Anthracycline-related heart failure did not occur. Conclusion: 3-weekly courses of cyclic paclitaxel plus doxorubicin were found to be effective and tolerable in patients with urothelial carcinoma, who had not responded to prior platinum- and gemcitabine-based chemotherapy.

We describe the case of an isolated bone marrow natural killer (NK) cell lymphoma with central nervous system (CNS) involvement mimicking a cerebral infarct. CNS involvement in isolated bone marrow lymphoma has not been reported previously.A 49-year-old man with complaints of fever, confusion, and agitation was presented. A bone marrow biopsy was performed to investigate the etiology of bicytopenia which was consistent with NK-cell lymphoma. Brain MRI findings were suggestive of a subacute infarct.Even if pathological signal changes of the brain without contrast enhancement resembling infarct are detected in patients with lymphoma on the magnetic resonance imaging, CNS involvement of the lymphoma should be kept in mind in the differential diagnosis.

Gastrointestinal stromal tumors (GIST) comprise a majority of tumors previously diagnosed as gastrointestinal leiomyomas, leiomyoblastomas, and leiomyosarcomas. Although GIST may be identified by light microscopy, pathologists commonly employ a panel of immunohistochemical markers to confirm the morphological impression including anti-CD34, smooth-muscle actin, desmin, S100, and CD-117. However, in CD- 117 negative cases, it becomes difficult to diagnose GIST. This is of great importance, since the use of imatinib mesylate has led to a dramatic improvement in survival rates of GIST patients besides improved quality of life.We report the case of a 67-year-old male patient diagnosed as having chemotherapy-resistant metastatic leiomyosarcoma. We reviewed the specimen for a possible diagnosis of c-kit negative GIST. Platelet derived growth factor receptor-alpha (PDGFRA) immunohistochemical stain was recommended. The specimen was positively stained for PDGFRA. Imatinib mesylate (400 mg/d) was started. The patient showed an excellent response after receiving imatinib treatment which was documented with 18 fluoro-deoxyglucose positron emission tomography and computed tomography (18F-FDGPET/ CT) prior to and after treatment.The importance of diagnosis of c-kit negative GIST is emphasized while stressing the importance of PDGFRA staining besides PET/CT response evaluation.

for 2 months. A control CT showed central necrosis of the le-sions which were essentially unchanged. However, the patientreported that the symptom of abdominal pain did no longerexist. The patient was advised to take imatinib mesylate for 2 more months. A subsequent CT scan again showed nochange in the diameter of the mass, so the RECIST criteriaagain failed to meet our expectations. As a consequence, wesuggested stopping imatinib. However,within 3 months of dis-continuing treatment, the patient was seen twice in the emer-gency room (ER) with gastric bleeding and abdominal pain.At the second ER visit, the patient insisted to start imatinibagain and said ‘Please, desist RECIST criteria in GIST, at leastin me. I was feeling well with no abdominal pain or gastricbleeding while using imatinib. Believe me, the size of the le-sion does not matter!’ The patient was restarted on imatinib.He was seen 2 years later in good condition but still withoutany change in the size of the mass. Hence, RECIST is a poorpredictor of clinical benefit in GIST.Gastrointestinal stromal tumour (GIST) is an extraordinaryand interesting disease both to physicians and patients.Every patient with GIST is a new experience for the medicaloncologist [1–5]. The Response Evaluation Criteria in SolidTumors (RECIST) are used in GIST. However, RECIST cri-teria show limitations in the response evaluation in imatinib-treated GIST [6, 7]. We report on an interesting patient withmetastatic GIST in whom RECIST failed to show a re-sponse. A 63-year-old male patient presented with abdominal pain,and was diagnosed with metastatic GIST in March 2002. Ab-dominal computed tomography (CT) revealed a 5-cm mass inthe lesser curvature of the stomach, and multiple metastaticlesions in the liver. As GIST is both chemo-and radioresistant,the patient was recommended to take imatinib mesylate.However, at that time, neither the drug nor positron emissiontomography (PET) CT were available in Turkey. The patientobtained the drug from the United States himself, and used it