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Objectives: The combination of irinotecan and raltitrexed is safe and active in 5-fluorouracil-refractory, metastatic colorectal cancer (CRC), with the advantage of its convenient three-weekly schedule. The aim of this multicenter phase II study was to assess its efficacy and toxicity in first-line treatment. Methods: Between May 2000 and March 2001, 62 previously untreated patients received irinotecan (350 mg/m2) plus raltitrexed (3 mg/m2), with courses repeated every 21 days. Objective response was assessed every three courses, and treatment maintained until tumor progression or unacceptable toxicity. Results: A total of 331 cycles were administered, with a median of five cycles per patient (range, 1–16). Seventeen patients achieved a partial response and 2 a complete response, for an overall intention-to-treat response rate of 30% (95% confidence interval, 18–44%). The incidence of grade 3–4 toxicity per patient was diarrhea (27%), emesis (13%), anemia (12%), neutropenia (9%), and asthenia (7%). Three patients (5%) died from treatment-related adverse events (diarrhea plus neutropenia). The median potential follow-up is now 37 months. Median survival was 12.2 months, and median time to progression was 6.3 months. Conclusions: The combination of irinotecan plus raltitrexed is an easy comfortable schedule for patients with metastatic CRC, but both efficacy and toxicity results seem suboptimal for first-line treatment.

Introduction. Despite significant advances in the palliative care of cancer patients with terminal disease, a considerable proportion of them still die at hospital. The causes of this fact are multiple including sociocultural, familial, and sanitary reasons.

Background Oxaliplatin has been introduced to the clinical setting in combination with 5-fluorouracil/folinic acid (5-FU/FA) in an attempt to improve the response rate against colorectal cancer. It is unclear the optimum schedule of combination. In order to evaluate the response rate and toxicity profile of the combination of oxaliplatin with 5-FU/FA, according to the Mayo Clinic schedule, we evaluated our patients in a retrospective analysis.

Colorectal cancer (CRC) is one of the most common malignant tumors in adults. Twenty-five percent of patients are not amenable to surgical resection because they have locally advanced or metastatic disease. For these patients, median survival time is between 4 and 13 months, and chemotherapy is used mainly with palliative intent. We conducted this study to evaluate potential prognostic factors for time to progression and survival. A retrospective review of 91 patients with metastatic CRC treated with bolus 5-fluorouracil-based chemotherapy (Mayo Clinic schedule) was performed. Univariate and multivariate analyses of clinical prognostic factors were carried out. Median follow-up time was 53 months (range, 17-107 months). Median time to disease progression was 9.6 months, and median survival time was 15.4 months. Actuarial 5-year survival was 17%. In the univariate analyses, factors predictive of time to progression were visceral metastases, elevated alkaline phosphatase (AP) levels, performance status (PS), and elevated carcinoembryonic antigen (CEA) and CA 19-9 levels. Multivariate analyses confirmed the independent prognostic value of PS and AP levels. In the univariate analyses for survival, significant prognostic factors were visceral metastases, hypoalbuminemia, elevated lactate dehydrogenase levels, elevated AP levels, PS, and elevated CEA and CA 19-9 levels. In the multivariate analyses, only PS, elevated CEA and CA 19-9 levels, and liver involvement retained prognostic significance. This study confirms the prognostic value of PS for both time to progression and survival. AP levels are significantly related to time to progression. Additional factors influencing survival time are elevated tumor marker levels and the existence of liver metastases.

A retrospective study analyzing non-Hodgkin's lym-phoma (NHL) diagnosed in patients in our center above 65 years of age between the years 1977–1991 is reported. Histological classification has been completed following the criteria of the Working Formulation. Of 521 patients, 427 were candidates for evaluation. Those above 65 years of age comprised the subject of our study, with a total of 95 cases.

BACKGROUND:Metastatic renal cell carcinoma (MRCC) has been characteristically unresponsive to chemotherapy. In lieu of an effective regimen, interleukin-2 (IL-2) and interferon alfa are considered drugs of choice to treat this cancer. Subcutaneous IL-2 is safe and well tolerated, with a mortality rate OBJECTIVE:To report a case of cutaneous and hematologic toxicity in a patient treated with IL-2.CASE SUMMARY:A 67-year-old woman received radiotherapy and immunotherapy for cancer that had metastasized to the bone and lungs. IL-2 was part of the regimen. After 5 days of treatment with IL-2, the patient developed a hemorrhagic lesion that progressed to toxic epidermal necrolysis, as well as grade 4 pancytopenia. She died 10 days after treatment was begun. At the time of death, leukocytes were 0.3 × 103/mm3, platelets 10 × 103/mm3, and hemoglobin 6.8 mg/dL.DISCUSSION:Cutaneous IL-2 adverse effects are frequent, but generally mild and reversible. The adverse hematologic effects are usually transitory and pancytopenia is not frequent. The severity of cutaneous and hematologic toxicity experienced by our patient has rarely been reported.CONCLUSIONS:The use of IL-2 in bedridden patients with performance status >2 must be given on an individualized basis. If radiotherapy over extensive areas of the body is needed, the use of IL-2 must be postponed until radiotherapy is completed.

Background: This observational study evaluated the efficacy and safety of treatment with bevacizumab plus chemotherapy until disease progression (PD) in Spanish patients with metastatic colorectal cancer (mCRC). Methods: This multicentre, retrospective, observational analysis included patients receiving bevacizumab plus fluoropyrimidine-based chemotherapy as first-line treatment for mCRC who then developed PD. All patients received treatment in hospital oncology departments and none received bevacizumab as part of a clinical trial. Patients discontinuing treatment with bevacizumab for reasons other than PD were excluded. The primary endpoint was PFS; secondary endpoints were overall response rate (ORR) and safety. Results: Overall, 165 patients were evaluable for analysis: median age 63.0 years; male/female 62%/38%; ECOG performance status 0/1/2 55%/43%/2%. Median duration of bevacizumab treatment was 8.7 months. ORR was 48.5% (6 complete and 74 partial responses) and disease control rate was 74%. Median progression-free survival (PFS) was 8.4 months (95% CI 7.2-9.6). Patients receiving oxaliplatin- or irinotecan-based regimens had median PFS of 9.2 and 7.7 months, respectively; those receiving treatment not containing either oxaliplatin or irinotecan had a median PFS of 6.1 months. KRAS status did not have a statistically significant effect on PFS (9.5 vs. 7.8 months for KRAS wild-type vs. mutant tumours, respectively; p=0.647) or ORR (44.8% vs. 52.6%, respectively; p=0.391). The most common grade 3/4 adverse events were: diarrhoea (7%), paraesthesia (7%), neutropenia (3%), cutaneous toxicity (2%), and thrombocytopenia (2%). Conclusions: Treatment with bevacizumab plus standard chemotherapy is an effective and well-tolerated option for patients with mCRC who continue treatment until PD.

The combination of irinotecan and raltitrexed is safe and active in 5-fluorouracil-refractory, metastatic colorectal cancer (CRC), with the advantage of its convenient three-weekly schedule. The aim of this multicenter phase II study was to assess its efficacy and toxicity in first-line treatment.Between May 2000 and March 2001, 62 previously untreated patients received irinotecan (350 mg/m(2)) plus raltitrexed (3 mg/m(2)), with courses repeated every 21 days. Objective response was assessed every three courses, and treatment maintained until tumor progression or unacceptable toxicity.A total of 331 cycles were administered, with a median of five cycles per patient (range, 1-16). Seventeen patients achieved a partial response and 2 a complete response, for an overall intention-to-treat response rate of 30% (95% confidence interval, 18-44%). The incidence of grade 3-4 toxicity per patient was diarrhea (27%), emesis (13%), anemia (12%), neutropenia (9%), and asthenia (7%). Three patients (5%) died from treatment-related adverse events (diarrhea plus neutropenia). The median potential follow-up is now 37 months. Median survival was 12.2 months, and median time to progression was 6.3 months.The combination of irinotecan plus raltitrexed is an easy comfortable schedule for patients with metastatic CRC, but both efficacy and toxicity results seem suboptimal for first-line treatment.

The gastric adenocarcinoma is a high lethality tumour and has a great tendency to the recurrence. Liver and peritonea are the places where the metastases are most frequently localised. We introduce the case of a woman diagnosed of gastric adenocarcinoma who showed isolated skin metastasis. There were an important number of recurrences (always in the skin). She was treated with radical surgery and later treated with different citostatic schedules. The patient died 13 years after metastasis were diagnosed. With this case we wanted to pay attention about the role of the biologic prognostic factors of the gastric carcinoma. The molecular biology of these tumours can to explain the different evolution of the disease. Biologic prognostic factors can separate the gastric carcinoma into different kind of disease.

Introduction Ewing's sarcoma is a highly malignant small round-cell tumor arising primarily from bone. Adults with this neoplasm have a poorer survival than that of children. The Spanish Society of Paediatric Oncology (SEOP) recommends that high-risk patients be treated with a combination of 5 different drugs (EVAIA schedule). The objective of this study is to evaluate response, overall survival, dose intensity and toxicity of the SSOP protocol in adult patients with high-risk Ewing's sarcoma.