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Background/aims: There is little information in the literature on the use of bevacizumab (BV) combination chemotherapy in multiple lines with regimens including irinotecan and oxaliplatin, in metastatic colorectal cancer (mCRC) patients with disease progression. The aim of this small retrospective institutional study is to compare the efficacy and safety of the continuation of BV in combination with various chemotherapeutic agents, within the framework of multiple line therapy in progressed mCRC patients., Methodology: Our retrospective study included 21 patients with mCRC that had received at least one course of irinotecan-based or oxaliplatin-based chemotherapy with BV before disease progression. BV treatment was continuously dispensed after disease progression. Subgroup analysis was performed in terms of age, site of metastases, spread and co-morbidity., Results: The median overall survival (OS) was 23+ months (range 4-51 months) with no statistically significant differences between the aforementioned subgroups of patients, except from the subgroup according to spread (p=0.044). Time to progression was 17 months. Anemia (all grades) was reported in 33.3% of the patients, while hemorrhage and thrombosis were reported in 28.6% and 14.3%, respectively., Conclusions: Multiple line treatment in advanced colorectal cancer, including BV combined with standard chemotherapy, may improve OS with an acceptable toxicity profile in patients with mCRC after disease progression.

Purpose: To assess the overall survival (OS) of metastatic hormone-refractory prostate cancer (mHRPC) patients when treated with zoledronic acid (ZOL) in combination with docetaxel-based chemotherapy (docetaxel combined with estramustine or oxaliplatin or gemcitabine)., Methods: A retrospective chart review of mHRPC patients in our clinic was performed. At the time of data collection, 23 patients with mHRPC were identified, of which 15 were still alive at data analysis. Survival data was analyzed through Kaplan-Meier methodology. OS stratification by prostatic specific antigen (PSA) response (50% and 80% decline) and multivariate analysis of prognostic variables were also conducted., Results: 182 cycles of chemotherapy (mean 8.27 cycles, range 1-23) were recorded. Median OS was 26 months (range 5-56; 95% CI: 4.0-48.0). No patient achieved complete response (CR), 5 (21.7%) showed partial response (PR), 2 (8.7%) minor response (MR), 7 (30.4%) stable disease (SD) and 9 (39.1%) progressive disease (PD). Twelve (52.2%) patients exhibited a decrease in PSA levels >50% (9 of 12 >80%). No association of age, PSA response, or tumor response with OS could be demonstrated. The most frequent toxicities were anaemia (52.1%) and neutropenia (26%)., Conclusion: In our clinical setting, ZOL and docetaxel- containing chemotherapy was a beneficial therapeutic scheme for the patients in terms of safety and survival.

Background/aims: Although research on new effective treatments against pancreatic cancer is intense, limited therapeutic schemes are currently approved. The aim of the present study was to record the efficacy and safety of gemcitabine-erlotinib plus docetaxel combination therapy in patients with advanced and/or metastatic pancreatic cancer., Methodology: Twenty-five chemotherapy naive patients with histologically confirmed unresectable pancreatic cancer and documented extrapancreatic metastases, received biweekly gemcitabine 1,500mg/m2 during a 28-day long cycle; daily erlotinib 100mg per os; and docetaxel 80mg/m2 as intravenous infusion administered every 15 days. Patients were monitored every 4 cycles for survival, adverse events and tumour response with Computed Tomography scans., Results: Patients received 153 cycles in total, with a median of 7.64 cycles (range, 1-24). The median overall survival was 10 months and 45% of the patients reached and surpassed 1-year survival. No grade IV toxicities were recorded. The only grade III recorded toxicities were thrombopenia (4 patients, 16%), anaemia (1 patient, 4%) and neutropenia (1 patient, 4%). Overall the most frequently experienced adverse events were grade I anaemia (18 patients, 72%) and grade II rash (13 patients, 52%)., Conclusions: Biweekly gemcitabine with erlotinib plus docetaxel administration is a practical alternative to pancreatic cancer treatment, presenting comparable results to weekly gemcitabine administration.

Melanoma, an aggressive, therapy-resistant malignancy of melanocytes, is the most serious type of skin cancer affecting young and middle-aged people. Therapy for early disease is predominantly surgical, with a minor benefit noted with the use of adjuvant therapy. Management of systemic melanoma is a challenge because of a paucity of active treatment modalities. The authors present the case of a patient with advanced-stage melanoma who underwent surgery for metastatic disease. He then received cisplatin-based combination chemotherapy, with disease stabilization. However, after different regimen modifications complete remission (CR) was finally achieved, until the disease progressed once more. Five years after surgery, the patient is still alive and continuing chemotherapy.

Cardiac neoplasms, whether primary or secondary, are more and more easily diagnosed in the present era. For the primary heart tumors, myxomas and sarcomas constitute the most common neoplasms, whereas for the secondary ones, lung cancer constitutes the most common primary location. Cardiac neoplasms may involve the endocardium, the myocardium, the epicardium, the valves or any combination of these. Their clinical manifestations are not specific and depend on their anatomic location and size. Diagnosis of cardiac neoplasms has become more feasible with the use of echocardiography and other imaging techniques (computed tomography and magnetic resonance). The major problem, however, still remains that most diagnoses are late, especially for malignant tumors. For resectable tumors, surgery remains the mainstay of treatment, whereas for metastatic disease palliative treatment remains the only therapeutic option. This paper reviews the types of heart tumors, their clinical symptoms, the diagnostic approaches and the therapeutic tools used by physicians.

Small-cell lung cancer is the most aggressive lung cancer, with a dismal prognosis. The authors present a case report of a patient with limited-stage small-cell lung cancer who underwent a thoracotomy for diagnostic purposes, with the diagnosis being made after surgical excision. Combination chemotherapy remains the cornerstone of treatment for both limited and extensive disease. Radiotherapy has been established as an adjunct to chemotherapy in limited-stage disease, while in extensive-stage disease it is mostly reserved for the treatment of brain metastases. As for surgery, the potential benefits of resection are predominantly seen in patients who present with a solitary pulmonary nodule. Since small-cell lung cancer becomes highly resistant to chemotherapy, second-line chemotherapeutic schemes are used for disease progression, with topotecan being the highlighted agent. Despite the unusual therapeutic approach, where surgery was preferred over the standard diagnostic and staging procedures, the patient's more than ten years' survival makes this case presentation a very interesting one.

Aims: To review the clinical features of gastrointestinal stromal tumours (GISTs), the role of surgery and its principles and molecular targeted therapies., Methods: A Medline-based literature search on relevant topics was performed in PubMed for key articles concerning the clinical features, biology and the novel strategies in the management, whether surgical and/or pharmaceutical, of gastrointestinal stromal tumours. Some information was obtained from Proceedings of the American Society for Clinical Oncology published recently., Results: Surgical resection, the first-line intervention for operable GISTs, was historically the only effective treatment. For residual, metastatic and/or inoperable disease, treatment options remain under intense and continuous scrutiny. However, their molecular genetics, i.e. the mutations of the genes coding for KIT or platelet-derived growth factor receptor alpha, two receptor tyrosine kinases, have been targeted for therapeutic intervention by imatinib mesylate -- a tyrosine kinase inhibitor., Conclusion: Treatment of GISTs with imatinib has led to dramatic improvements in progression-free and overall survival, thereby rendering its use in the preoperative and postoperative treatment under intense investigation. New investigational agents are being developed and participation in promising clinical trials remains a standard of care.

Objectives: To evaluate the safety profile and therapeutic value of the combination of estramustine, mitoxantrone, and vinorelbine in the treatment of hormone-refractory prostate cancer., Methods: Fifty-two patients with hormone-refractory prostate cancer were included in the study. Median age was 70 years (range, 49 to 100 years), World Health Organization performance status ranged from 0 to 2. The treatment schedule consisted of estramustine capsules (140 mg 3 times daily on days 1 to 3 and days 8 to 10 per os), intravenous mitoxantrone (12 mg/m2 on day 2), and intravenous vinorelbine (25 mg/m2 on day 2 and day 9), given in a 3-week cycle., Results: Thirty-one percent of patients with measurable soft-tissue disease demonstrated an objective response, which included six complete and ten partial responses in all involved organs (bone responses not included). Twenty-nine patients (56%) had a greater than 50% reduction in serum prostate-specific antigen level. The median duration of response was 6.9 months, and the median survival for all patients was 14.5 months., Conclusions: The combination of estramustine, vinorelbine, and mitoxantrone is safe, well tolerated, and relatively active in patients with hormone-refractory prostate cancer.

Background: Irinotecan (IRI) and oxaliplatin (OXA) are effective in the treatment of colorectal cancer. Previously untreated patients with advanced colorectal carcinoma (CRC) were randomly assigned to receive IRI plus leucovorin (LV)/5-fluorouracil (5-FU), or OXA plus LV/5-FU in order to compare the response rates, time-to-tumor progression, overall survival rates, and toxicity profiles of these two agents., Materials and Methods: From January 1999 to February 2002, 295 patients were randomized to receive either IRI/LV/5-FU or OXA/LV/5-FU. The treatment schedules consisted of weekly IRI 70 mg/m(2) or OXA 45 mg/m(2) plus LV 200 mg/m(2) followed immediately by intravenous bolus 5-FU 450 mg/m(2) for 6 weeks, followed by a 2-week rest period. Treatment was continued for up to four cycles or until disease progression, unacceptable toxicity or patient refusal., Results: There were no significant differences between the study arms in the overall response rate (33% with IRI/LV/5-FU versus 32% with OXA/LV/5-FU based on responses demonstrated on a single evaluation; 23% with IRI/LV/5-FU versus 22.3% with OXA/LV/5-FU based on responses confirmed according to WHO criteria) median time to progression (8.9 versus 7.6 months), and median overall survival (17.6 versus 17.4 months). Toxicity profiles (grades 3 and 4) were similar in the IRI and OXA arms (diarrhea 12.3% and 9.8%, neutropenia 8.2% and 4.9%, and febrile neutropenia 1.4% and 1.4%, respectively), with the exception of grade 3 sensory neuropathy, which almost exclusively occurred in the OXA arm (0% versus 5.6%; P=0.003, Fisher's exact test)., Conclusion: The IRI/LV/5-FU and OXA/LV/5-FU regimens demonstrated equally substantial efficacies and manageable toxicity profiles in the first-line treatment of patients with advanced CRC. However, IRI/LV/5-FU may be the preferable regimen to avoid significant neurotoxicity associated with OXA-LV/5-FU.

Objectives: To consider the safety profile and therapeutic value of the combination of estramustine and mitoxantrone in a bimonthly schedule to treat hormone-refractory prostate cancer. The survival of patients with prostate cancer who relapse after androgen ablation is limited and the therapeutic options are restricted., Methods: Twenty-nine patients with relapse after previous treatment were included in the study; however, 3 patients who refused to start treatment were not included in the analysis, leaving 26 eligible patients. The median age was 64 years (range 44 to 82), the World Health Organization performance status ranged from 1 to 3, and the mean prostate-specific antigen level was 103 ng/mL (range 1 to 620). The Gleason score ranged from 2 to 9. The patients received a total of 208 therapeutic cycles (mean 8, range 3 to 24). Every cycle consisted of oral estramustine 140 mg, 3 times a day continuously, and intravenous mitoxantrone 20 mg (total dose). The regimen was repeated every 2 weeks., Results: Twenty-seven percent of patients with measurable soft-tissue disease demonstrated an objective response, which included one complete and six partial responses. Thirteen patients (50%) had a greater than 50% reduction in serum prostate-specific antigen level. The median duration of response was 9.2 months, and the median survival for all patients was 15 months. The most common side effects were neutropenia and thrombocytopenia., Conclusions: The combination of estramustine and mitoxantrone is safe, well tolerated, and relatively active in patients with hormone-refractory prostate cancer. More patients are needed to partake in Phase III studies to establish the survival benefit that this combination may offer.

This study is related to the serious side effects of Doxorubicin-cardiotoxicity and serum lipid caused by the drug's cumulative effect. Studies were performed on experimental animals treated with intensive administration of Doxorubicin. Seventy five wistar rats were divided in two equal groups A and B. Group A was used for doxorubicin administration and B for doxorubicin and dextrazoxane. The drugs were administered weekly for twelve weeks at doses 0.2 mg/100 g BW for doxorubicin and 1.5 mg/100 g BW for dextrazoxane. Histological examination of the cardiac muscle, large vessels, liver and other organs and biochemical examination for serum lipids and liver enzymes were performed on certain weeks. Comparison of the findings of the two groups showed a) a reduction in doxorubicin cardiotoxicity by dextrazoxane and b) the addition of dextrazoxane to doxorubicin resulted in lowering the increase of serum lipids produced by doxorubicin. c) In vitro tests by chemiluminescence showed that dextrazoxane acts as a scavenger of oxygen free radicals.