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Background: If detected and treated early, breast cancer has a chance of being cured. Therapy has progressed utilizing multiple chemotherapeutic regimens with great efficacy and minimal toxicity. Objective: To improve the outcome of patients with early breast cancer by clarifying the most effective adjuvant therapy regimen. Subjects and methods: In a clinicopathological retrospective study, we included 854 patients with non-metastatic breast cancer patients treated at Medical Oncology Department, Maadi Armed Forces Medical Complex and Medical Oncology Department, Zagazig University; from January 2015 to December 2018. Results: Most of our study population 505 patients (59.1%) received adjuvant chemotherapy protocol of (4 AC (Adriamycin and Cytoxan) + 4 taxanes), while the 2nd most common used protocol was 6FAC (Fluorouracil, Adriamycin, and Cytoxan), which was received by 17.7% of patients, on the other hand some patients received 4AC, 3AC+3 taxanes and 4TC protocols. Percentage of our patients who were still alive after 4 years of diagnosis were 86.5% (739 patients). Disease recurrence or metastasis occurred in 317 patients (37.1%) during follow up period ranged from 13-84 months, while 537 patients (62.9%) didn't experience either recurrence or metastasis to time of study. Conclusion: Early breast cancer is considered potentially curable disease. Disease recurrence or metastasis occurred in 37.1% of our patients. Survival rate after 4 years of diagnosis was 86.5%. The FAC protocol has been used in just 17.7% of our patients, but DFS rate of those patients who received FAC was the highest (73.5%), even superior to AC+Taxanes. [ABSTRACT FROM AUTHOR]

Febrile neutropenia occurring during chemotherapy was reported to be a predictor of survival in breast cancer patients. We assessed the incidence of febrile neutropenia induced by chemotherapy. Data from a retrospective study on the application of chemotherapy protocols in breast cancer patients was reviewed. Analyzing the data, we can see that out of 81 patients who received chemotherapy, 43 were diagnosed with neutropenia and 4 or 9.3% of those patients were diagnosed with neutropenia again despite prophylaxis with Granulocyte-colony stimulating factor (G-CSF). In 4 or 9.3% of patients, further administration of that chemotherapy protocol had to be stopped due to severity of neutropenia and complications they caused. During the treatment, grade IV neutropenia was diagnosed in 27 or 63% of patients while grade I neutropenia was diagnosed in 2 or 4.65% of patients. Anemia associated with neutropenia was also diagnosed in 7 or 16.3% of patients while pancytopenia was diagnosed in 4 or 9.3% of patients, and thrombocytopenia associated with neutropenia was diagnosed in only one patient. The hazard ratio of febrile neutropenia presence compared to the absence of such toxicity was adjusted. The cox model was 0.75 (confidence interval 95% 0.54-0.95; P=0,0189) for grade I neutropenia, 0.63 (0.50-0.78; P<0,0001) for grade II neutropenia and 0.71 (0.51-0.98; P=0.3888) for grades III and IV neutropenia. These results suggest that the occurrence of neutropenia during chemotherapy is an independent predictor of increased survival in breast cancer patients, while the absence of such toxicity indicates that the drug doses are not sufficient. Monitoring of febrile neutropenia in patients treated with chemotherapy may contribute to improved drug efficacy and better survival rate. [ABSTRACT FROM AUTHOR]

The article provides the review of literature on the issue of neurotoxic complications of chemotherapy in children. The data search was carried out in the PubMed, CyberLeninka, RSCI databases and others. There are many works devoted to studying the distribution, structure, and clinical features of chemo-induced neurological disorders in modern literature. In general, analysis of literature has shown that the incidence of neurotoxic complications varies widely depending on the research methods and used chemo-ther-apeutic drugs. Manifestations of chemotherapy-induced neurological disorders are quite diverse and accompanied by the central and peripheral nervous system damage. However, it has been shown that the platinum-based drugs have effective ototoxic effect with the damage of the auditory nerve. The Vincristine often causes peripheral polyneuropathy. Methotrexate and Ifosfamide cause metabolic encephalopathy. Cytarabine’s neurotoxicity is the damage of the cerebellum. The addition of neurological symptoms leads to decrease in the quality of life of patients. Some studies present the results of study of the causes and pathogenetic manifestations of neurotoxic reactions, changes in the genome associated with the development of specific toxic effects are identified. Despite the fact that many pathogenetic mechanisms of chemotherapy-induced neurotoxic complications have been revealed, the significance of laboratory predictors for prognosing and early assessment of these complications has not been essentially established yet, thus, there is the need for further study of this topic.

ObjectiveApart from cystectomy, few treatment options exist for the management of bacillus Calmette-Guerin refractory non-muscle invasive bladder cancer (NMIBC). We report a multi-institutional experience with sequential intravesical combination chemotherapy using gemcitabine and mitomycin C (MMC) for NMIBC in the treatment of high-risk patients.MethodsWe performed a retrospective review of patients who received 6 weekly treatments with sequential intravesical gemcitabine (1g) and MMC (40 mg) chemotherapy for NMIBC. Gemcitabine was administered first and retained for 90 minutes and then drained. MMC was then administered directly after and retained for an additional 90 minutes. Forty-seven patients received treatment from 3 academic tertiary referral centers between 2000 and 2010.ResultsForty-seven patients (median age 70, range 32-85; 36 males, 11 females) who previously failed a median of 2 intravesical treatments were reviewed. Complete response, 1-year, and 2-year recurrence-free survival rates for all patients were 68%, 48%, and 38%, respectively. Median recurrence-free survival for all patients was 9 months (range 1-80). Fourteen of 47 patients (30%) remained free of recurrence with a median time to follow-up of 26 months (range 6-80 mo). Ten patients required cystectomy.ConclusionSequential intravesical combination chemotherapy using gemcitabine and MMC appears to be a useful treatment for patients with high-grade NMIBC as well as those with prior bacillus Calmette-Guerin failure. Further prospective studies are warranted.

Background: Medical practitioners are increasingly using artificial intelligence (AI) chatbots for easier and faster access to information. To our knowledge, the accuracy and availability of AI-generated chemotherapy protocols has not yet been studied. Methods: Nine simulated cancer patient cases were designed and AI chatbots, ChatGPT version 3.5 (OpenAI) and Bing (Microsoft), were used to generate chemotherapy protocols for each case. Results: Generated chemotherapy protocols were compared with the original protocols for nine simulated cancer patients. ChatGPT's overall performance was 5 out of 9 on protocol generation, and Bing's was 4 out of 9; this was statistically nonsignificant (p = 1). Conclusion: AI chatbots show both potential and limitations in generating chemotherapy protocols. The overall performance is low, and they should be used carefully in oncological practice.

Nodal peripheral T-cell lymphomas are a rare group of neoplasms derived from post-thymic and activated T lymphocytes. A review of scientific articles listed in PubMed, Lilacs, and the Cochrane Library databases was performed using the term "peripheral T-cell lymphomas". According to the World Health Organization classification of hematopoietic tissue tumors, this group of neoplasms consists of peripheral T-cell lymphoma not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL), anaplastic large cell lymphoma-anaplastic lymphoma kinase positive (ALCL-ALK+), and a provisional entity called anaplastic large cell lymphoma-anaplastic lymphoma kinase negative (ALCL-ALK-). Because the treatment and prognoses of these neoplasms involve different principles, it is essential to distinguish each one by its clinical, immunophenotypic, genetic, and molecular features. Except for anaplastic large cell lymphoma-anaplastic lymphoma kinase positive, which has no adverse international prognostic index, the prognosis of nodal peripheral T-cell lymphomas is worse than that of aggressive B-cell lymphomas. Chemotherapy based on anthracyclines provides poor outcomes because these neoplasms frequently have multidrug-resistant phenotypes. Based on this, the current tendency is to use intensified cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) regimens with the addition of new drugs, and autologous hematopoietic stem cell transplantation. This paper describes the clinical features and diagnostic methods, and proposes a therapeutic algorithm for nodal peripheral T-cell lymphoma patients. [ABSTRACT FROM AUTHOR]

Background: Recently it has been reported a benefit effect with the use of metformin in patients with malignant disease. Our objective was to evaluate the effect of adding metformin to chemotherapy regimen over the percentage of early relapse in acute lymphoblastic leukemia. Methods: A prospective, longitudinal and experimental study was performed in patients with de novo acute lymphoblastic leukemia enrolled in the Hospital General de México. They were divided in two groups: first group received chemotherapy + metformin (850 mg three times a day); second group only received standard chemotherapy. The sample was randomized 3:1 in favor of the second group. Results: 93 patients were included (73 treated with chemotherapy + metformin and 20 received standard chemotherapy), with 303 ± 53 days of follow-up. Complete remission was higher in the group without metformin (81.3 % [n = 61] versus 70 % [n = 14]), which also presented more patients with relapse (47.9 % versus 25 %). Overall survival at one year was of 68 % and free survival disease was 64%, without significant differences between groups. Absence of metformin was the only variable of adverse prognostic considered significant (p = 0.55). Cox regression showed that adding metfomin reduced 56 % the risk of relapse. Conclusions: The adding metformin to the treatment of leukemias showed that was useful in our research. However, randomized and double-blind studies must be designed in order to express final recommendations about its use. [ABSTRACT FROM AUTHOR]

Spontaneous and chemotherapy-induced sister chromatid exchanges (SCES) and lymphocyte proliferation rate index (PRI) in cultured peripheral lymphocytes were evaluated in 30 patients with diagnosed breast cancer before and after adjuvant chemotherapy and in 30 healthy women with no known familial history of breast cancer. Before chemotherapy, the breast cancer patients had a significantly increased background level of SCE, and lowered PRI as compared with the healthy women. Marked inter-individual variations were observed in both endpoints among the patients. Significantly elevated frequency of SCE and depressed PRI were recorded in blood samples collected after the first cycle of chemotherapy, with high inter-individual variations in the responses to the chemotherapy. FAC (5-fluorouracil, adriamycin and cyclophosphamide) protocol was the most genotoxic of the protocols studied, but also AC (adriamycin, cyclophosphamide) and CMF (cyclophosphamide, methotrexate and 5-fluorouracil) clearly increased SCE. All protocols significantly retarded lymphocyte proliferation in vitro. Our findings indicate that both SCE and PRI may serve as sensitive biomarkers for the routine detection of critical lesions produced by the administration of antineoplastic drugs in the clinical setting, as well as for possible screening of high-risk individuals among patients who have successfully completed chemotherapy. [ABSTRACT FROM AUTHOR]

The sensitivity of the alkaline comet assay for the evaluation of baseline and treatment-induced DNA damage in white blood cells of breast cancer patients receiving adjuvant chemotherapy according to three conventional anthracycline- and cyclophosphamide-containing protocols was investigated. Additionally, baseline DNA damage in cancer patients was compared with the levels of DNA damage recorded in healthy women. Altogether 30 patients with diagnosed breast cancer and 30 female blood donors with no known familial history of breast cancer participated in the study. Alkaline comet assay was performed according to standard protocol and DNA migration in peripheral blood leukocytes was measured by a computer-based image analysis system. For each subject the frequency of “damaged” cells, i.e., long-tailed nuclei (LTN) with tail length exceeding 95th percentile for the considered parameter among controls, is also reported. Breast cancer patients had significantly increased background levels of DNA damage in their peripheral blood leukocytes as compared to healthy women. Prior to the chemotherapy, a majority of patients showed a statistically significant increase in the number of LTN compared to healthy blood donors. Marked interindividual variations in baseline DNA damage among patients were recorded, some of them related to the disease stage and status. The present study confirmed the alkaline comet assay as a sensitive technique able to detect significantly elevated DNA migration in blood cells of patients already one hour after completion of the first cycle of chemotherapy. Administration of antineoplastic drugs in three chemotherapy protocols studied induced a similar increase of primary DNA damage in nontarget cells. The evaluation of the LTN frequencies indicates the best response to the protocol containing cyclophosphamide, methotrexate and 5-fluorouracil (CMF). Our results point to the significance of simultaneous evaluation of DNA migration and frequency of LTN in the same subject and approved the use of alkaline comet assay as a suitable method for the routine detection of critical DNA lesions produced after administration of antineoplastic drugs in the clinical settings. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to investigate the epidemiological and clinical characteristics as well as the therapeutic results in patients with locoregional (LR) relapse after treatment of nasopharyngeal carcinoma (NPC). Methods: We retrospectively reviewed the medical records of patients with local and/or regional recurrent NPC over 13 years (2003-2015). Results: Twenty-five patients were treated for local or/and local–regional recurrence of NPC. The rate of LR relapse was 7.2%. The mean age of the patients was 46 ± 13.9 years. The median time to relapse was 25 months. The recurrence was nasopharyngeal in 17 patients, nasopharyngeal and neck lymph nodes in 7 patients, and neck lymph nodes in 1 patient. Fifteen relapsed patients had a locally advanced disease (rT3-rT4). Patients who had initially T1 or T2 tumor had a locally advanced relapsed disease (rT3rT4) in 27.3% and patients whose disease was initially classified as T3 or T4 had a locally advanced relapsed disease (rT3T4) in 85.7% (P =.005, Fisher test). Twelve patients had chemotherapy after relapse. Chemotherapy was followed by concurrent chemoradiotherapy in 3 patients and by radiotherapy (RT) in 4 patients. Nine patients had concurrent chemoradiotherapy and 1 patient had exclusive RT. The overall survival (OS) at 1 year, 3 years, and 5 years was, respectively, 58%, 18%, and 10%. The OS was significantly higher in patients with good performance status at the time of relapse (World Health Organization = 1; P =.01) and in patients with late relapse (after 2 years; P =.03). Conclusions: Locoregional relapse rate in our study was 7.2%. Locoregional reirradiation was the mainstay treatment modality in relapsed NPC. Relapsed NPC had a poor prognosis with a 5-year survival rate of 18%. The OS was significantly higher in patients with good performance status and in patients with late relapse (after 2 years). [ABSTRACT FROM AUTHOR]

A clinical decision support system is able to provide oncologists with suitable treatment options at the moment of decision making regarding which chemotherapy protocol is the best to apply to a particular oncological case. The National Cancer Institute has created a Guidelines Committee that establishes therapeutical options for each clinical case. The Health Informatics Department has developed Oncotherapy, a knowledge database that incorporates information provided by the Guidelines Committee. Oncotherapy includes a tailored information repository to provide oncologists in the public health system with the chemotherapy protocols available given three types of data: clinical diagnosis, clinical stage and therapy criteria. The protocol selected by the treating oncologist is sent back to Oncotherapy, which may create new knowledge that can be incorporated into the knowledge database. In this way, the system supports making the best decision according to the chemotherapy protocol options available. Furthermore, it can warn of errors that could result from mistakenly chosen therapies. [ABSTRACT FROM AUTHOR]