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Trifluridine/tipiracil (FTD/TPI) improved both overall and progression-free survival (OS, PFS) of patients with pre-treated metastatic colorectal cancer (mCRC) in the pivotal phase III RECOURSE trial. However, health-related quality of life (HRQoL) was not assessed directly. To this end and to generate post-authorisation data, the TALLISUR trial was conducted.In this prospective, multi-centre, Germany-wide, phase IV study, patients with pre-treated mCRC were given the choice to receive either FTD/TPI or best supportive care (BSC). A validated questionnaire, EORTC QLQ-C30, was employed to assess HRQoL. Secondary endpoints included OS, PFS and safety.Of 194 eligible patients, 185 decided to receive FTD/TPI and 9 to receive BSC. The low number of patients in the BSC-arm did not allow statistically meaningful analyses. On the other hand, treatment with FTD/TPI was associated with maintained HRQoL. Median OS was 6.9 months [95% confidence interval (CI) 6.1-8.2 months] and median PFS was 2.5 months (95% CI 2.1-2.9 months). The most frequent treatment-emergent adverse events were neutropenia (27.6%) and anaemia (22.7%). Febrile neutropenia occurred in 1.1%.Treatment of patients suffering from pre-treated mCRC with FTD/TPI was associated not only with prolonged survival and delayed progression but also with maintained HRQoL.

Die Uberwachung der Adharenz fur orale antineoplastische Therapien hamatologischer und onkologischer Erkrankungen stellt ein groses Problem insbesondere bei alteren und immobilen Patienten im landlichen Raum dar. Das Projekt „Mobiler Onkologischer Dienst“ (MOD) wurde zur Verbesserung der Versorgungssituation in der Region Landshut eingefuhrt. Die vorliegende Untersuchung dient der Evaluation dieses innovativen Versorgungsmodells bezuglich Patientenadharenz, okonomischer Aspekte und Patientenzufriedenheit. Fur jeden Besuch wurden allgemeine Kennzahlen, Medikation, Nebenwirkungen und Krankenhausaufenthalte durch die jeweilige MOD-Assistentin registriert. Die Patientenzufriedenheit wurde durch Fragebogen ermittelt. Durchschnittlich 32 Patienten wurden im Mittel 4‑ bis 5‑mal pro Quartal besucht. Der durchschnittliche zeitliche Aufwand pro Besuch und Patient betrug 63 min, der durchschnittliche Anfahrtsweg 20 km. Die Umfrage belegte eine sehr hohe Patientenzufriedenheit. Krankenhausaufenthalte durch therapieassoziierte Toxizitaten konnten weitestgehend vermieden werden. Die durch den MOD verabreichten und uberwachten Therapien verursachten Kosten von teilweise mehreren Tausend Euro pro Monat. Der MOD erreichte eine Reduktion der Fahrtkosten von 10–15 % gegenuber Taxen oder Fahrdiensten und um bis zu 60 % gegenuber Krankentransporten. Der zeitliche Aufwand fur die Patienten oder deren Angehorige konnte auf ein Viertel reduziert werden. Der MOD stellt ein effektives und kostensparendes Instrument zur Uberwachung der Patientenadharenz, Vermeidung von schwerwiegenden Nebenwirkungen und Krankenhausaufenthalten dar und fuhrt zu einer hohen Patientenzufriedenheit.

Korrektur zu 10.1038/s41375-020-0826-9

Summary Background & aims Weight loss and malnutrition are frequent problems in oncology patients. The aim of this study was to get a perspective of the current practice of parenteral nutrition (PN) care in an outpatient setting and to improve patient-centered nutritional care. Methods Fifty-three outpatient oncology centers participated in this observational study performed between July 2010 and March 2011. All participating centers entered data online into a web-based documentation form, containing a number of oncology patients, diagnoses, and detailed data about oncology patients receiving PN. Results Two cohorts were analyzed. First cohort consisted of all oncology patients in quarter 04/2010. Second cohort consisted of patients with PN during the whole studying period. In the first cohort 2.46% ( n = 626) of 25,424 oncology patients received PN. Most frequent diagnoses of patients receiving PN were gastric cancer ( n = 119) and colorectal cancer ( n = 104), however most stated diagnosis was "other" ( n = 163). In the second cohort ( n = 1137), a common indication for PN was impaired gastrointestinal passage ( n = 177), although here again most stated reason was "other" ( n = 924). In the course of the PN treatment, patients ( n = 1137) showed a stable or slowly increasing body mass index (from 21.6 ± 3.8 kg/m 2 to 21.8 ± 3.5 kg/m 2 ). Conclusion This is the largest study outlining the characteristics of oncology patients in the context of PN in German ambulatory centers. They confirm the important role of PN in the care of gastrointestinal cancer. Further studies have to be performed to identify if other indications than those mentioned in relevant guidelines can trigger initiation of PN.

Patients with advanced haematological malignancies in non-curative settings suffer from complex physical symptoms and psychosocial distress, comparable to patients with solid tumour entities. Nevertheless, numerous problems at the interface between haematology and palliative home care have been described. From January 2011 until October 2014, we performed a retrospective, multicenter analysis of all patients with haematological malignancies (ICD 10: C81-C95) being treated by the respective specialized palliative home care (SAPV) team. Three SAPV teams were surveyed. Disease entity, physical symptoms, psychosocial distress, number of hospital admissions, therapeutic interventions and other items were analysed descriptively. Of 3,955 SAPV patients, 1.8% (n = 73) suffered from haematological malignancies. Main problems were deterioration of general condition, pain or psychological problems. Thirty-seven percent developed new symptoms during SAPV, mainly pain, psychological distress or deterioration of general status. In 33%, patients were referred to hospital, mainly due to deterioration of general condition or pain. Seventy percent died within 3 months after beginning SAPV care; 83% died at home or in a nursing home. Patients suffering from advanced haematological malignancies were statistically underrepresented in SAPV, and SAPV was installed rather at the very last days of life. By far, more patients were able to die outside a hospital as compared to reference cohorts of haematological patients not being treated in SAPV. The spectrum of documented problems is comparable to other patient cohorts being treated in SAPV; therefore, the options and benefits of palliative home care should be incorporated in palliative haematological treatment concepts more vigorously and consequently.

Our aim was to investigate the impact of EREG and AREG mRNA expression (by RT-qPCR) in patients with metastatic colorectal cancer (mCRC). In addition, epidermal growth factor receptor (EGFR) expression (by immunohistochemistry) as well as RAS-and PIK3CA-mutations (by pyrosequencing) were assessed. Tumors of 208 mCRC patients receiving 5-fluorouracil/leucovorin plus irinotecan (FUFIRI) or irinotecan plus oxaliplatin (mIROX) within the FIRE-1 trial were analyzed for mutations. Molecular characteristics were correlated with response, progression-free survival (PFS), overall survival (OS). mRNA expression was evaluated using ROC-analysis in 192 tumors (AREG high n = 31 vs. low n = 161; EREG high n = 89 vs. low n = 103). High versus low AREG expression was associated with PFS of 10.0 versus 8.0 months (HR = 0.62, 95% CI: 0.402-0.940, p = 0.03) and OS of 24.6 versus 18.7 months (HR = 0.72, 95% CI: 0.476-1.078, p = 0.11). High versus low EREG expression correlated with prolonged PFS (9.4 vs. 6.8 months, HR = 0.62, 95% CI: 0.460-0.846, p = 0.002) and OS (25.8 vs. 15.5 months, HR = 0.48, 95% CI: 0.351-0.657, p0.001). The positive prognostic effect of high EREG expression was confirmed in a multivariate analysis and was neither affected by EGFR expression nor by mutations of RAS- and PIK3CA-genes. EREG expression appears as an independent prognostic marker in patients with mCRC receiving first-line irinotecan-based chemotherapy.

The Oncologic and Palliative Network Landshut is a problem-solving approach to structurally weak rural areas to improve an a dequate care of critically ill patients, especially by a close involvement of outpatient and inpatient care providers. These networks not only improve the medical and nursing care of patients, but can also be cost-effective.

Einfuhrung: Erlotinib (Tarceva®) ist ein oral wirksamer Tyrosinkinaseinhibitor, der den epidermalen Wachstumsfaktor (EGFR) hemmt. Ziel der vorliegenden Studie war die Beurteilung der Vertraglichkeit und Wirksamkeit einer Behandlung mit Erlotinib im klinischen Routinealltag bei Patienten mit fortgeschrittenem nicht-kleinzelligen Lungenkarzinom (NSCLC) nach Versagen einer vorangegangenen Chemotherapie. Methoden: In dieser prospektiven, nicht-interventionellen, multizentrischen Studie (ML20264) wurden u.a. Daten zu Ansprechrate, Ansprechdauer, Uberleben sowie unerwunschten Ereignissen (UE) einer Routinebehandlung mit Erlotinib bei Patienten mit fortgeschrittenem NSCLC dokumentiert. Ergebnisse: Daten von 941 Patienten wurden ausgewertet (Safety Set). Daten von 855 Patienten standen fur die Analyse der Wirksamkeit zur Verfugung bzw. von 312 Patienten mit >4 Behandlungszyklen. Mittleres Alter 65 Jahre, 61,5% Manner, 66,7% Raucher. Das mittlere Uberleben betrug 6,9 Monate (n=855) bzw. 11,4 Monate in der Gruppe mit >4 Zyklen (n=312). Die Ansprechrate war 16,7% bzw. 33,7% (>4 Zyklen). Bei 39,4% bzw. 52,9%(>4 Zyklen) der Patienten kam es zu einer Krankheitsstabilisierung (SD, stable disease); bei 30,3% bzw. 11,9% (>4 Zyklen) der Patienten kam es zu einer Krankheitsverschlechterung, Die Therapie mit Erlotinib wurde insgesamt gut vertragen. 6,7% der Patienten mussten die Therapie wegen eines UEs abbrechen. Die haufigsten UEs waren Rash (49,4%) und Diarrho (29,5%) mit leichtem bis mittlerem Schweregrad (Grad 1, 2). Bei

Three-weekly docetaxel is active in patients with advanced esophagogastric cancer but myelosuppression may make this schedule unsuitable for some patient groups such as elderly, pretreated, or poor performance status patients.Eligible patients were chemonaive with Karnofsky indexor =70% and/or had received prior platinum-based chemotherapy. Docetaxel 35 mg/m(2) was administered on days 1, 8, 15, 22, 29, and 36 of a 49-day cycle. The primary endpoint was disease stabilization rate.Of 46 patients (median age, 68.5 years; 47%or =70 years) included, 87% had Karnofsky indexor =70 and 50% had prior treatment. The safety profile was acceptable. Principal grade 3/4 toxicities were leukopenia (9%) and fatigue (14%). Fifteen patients experienced no progression foror =100 days (disease stabilization rate: 36%). Overall response rate was 9%; median overall survival was 7.0 months.Weekly docetaxel was well tolerated and achieved disease stabilization in one-third of difficult-to-treat patients.

A patient in an intensive care unit experienced severe esophageal bleeding caused by erosion of a lusorian artery. The lusorian artery is a rare variant of the right subclavian artery. It originates in the descending aortic arch and crosses behind the esophagus to the right, sometimes generating esophageal compression. The patient's condition required respirator therapy and placement of a duodenal tube. At the point of crossing over of the lusorian artery and the esophagus, the duodenal tube caused esophageal necrosis, leading to erosion of the lusorian artery. This resulted in extensive esophageal bleeding, which at last required surgical intervention. To attain proper treatment and to avoid unnecessary diagnostic and therapeutic approaches, a lusorian artery lesion has to be included in the differential diagnosis of upper gastrointestinal bleeding.

The long-term results of both pretreated and previously untreated patients with hairy cell leukemia (HCL) using uniformly a single 7-day course of 2-chlorodeoxyadenosine (2-CdA) by continuous infusion are reported. In addition, the probability of obtaining another response with this drug in patients who relapsed after 2-CdA treatment will be addressed. Forty-two consecutive patients (32 men, 10 women) with a median age of 56 years (range 32-75) at the time of initiation of 2-CdA treatment were analyzed. Ten patients were pretreated with either splenectomy (n=6) or interferon a (n=8) or deoxycoformycin (dCF) (n=3) or with all procedures in sequence. Two patients who did not respond to dCF did respond to 2-CdA. Median time to start of 2-CdA treatment of the ten pretreated patients was 47 months (10-160); 41 of the 42 (98%) achieved CR, and one patient reached a good partial response with a single cycle of 2-CdA. Ten of the 42 patients had no toxicities at all. Toxicities (WHO grades I-IV) were mainly of grades I and II; in one patient with a preexisting brain injury grade III neurotoxicity was seen, and one patient suffered a grade-IV infectious complication. Bone marrow biopsies were performed at the time of recovery of hematopoiesis, thereafter at 2- to 3-month intervals, then at 6 months, and finally annually in all 42 patients. Median follow-up is 32 months (2-72). Disease-free survival from start of 2-CdA treatment is 75% at 6 years; 6/42 patients relapsed. Three of these patients were treated with 2-CdA again. All three patients reached another CR (+1, +2, +13). Four of the 42 patients had a second malignancy (carcinomas of the bladder, breast, cervix, prostate gland) before receiving 2-CdA. One patient died in CR due to the second malignancy. 2-CdA is a safe and effective treatment of HCL, inducing complete remissions in the majority of patients with only a single cycle of 2-CdA and a paucity of toxicities. Responses are durable and long lasting. Patients relapsing following a treatment with 2-CdA seem to respond to this drug again.

The palliative care unit Landshut is one of the few centres accredited by the ESMO serving in a rural area (Lower Bavaria, Germany). It is part of the Network for Oncology and Palliative Care Medicine Landshut (Onkologisches und Palliativmedizinisches Netzwerk Landshut) which has been accredited 2010 by the ESMO as Designated Centre of Integrated Oncology and Palliative Care and the DGHO in 2011. The Network aims to improve the palliative care service with regard to the special needs of the rural cancer population. Data regarding palliative care of tumor patients in rural areas of Europe are lacking. In December 2010, a continuous data acquisition for patients on the palliative care unit located at the Hospital Landshut-Achdorf was started. We now present a cross sectional data analysis. Between December 2010 and March 2012, 499 patients were admitted for the first time to the palliative care unit. The majority of these patients were living outside the town boundaries, mainly in small villages. 84% of the patients were diagnosed with a solid tumour, 6% with a haematological malignancy, and 10% had a non-malignant disease. Before their first admission, 50% of the patients were treated with opioids, 44% of the patients had a central venous port system, 4% a gastric tube, and 10% had received parenteral nutrition. The most frequent symptoms leading to admission were reduced general health status (43%), uncontrolled pain (20%), dyspnoea (14%), nausea (8%), confusion (3%), and insufficient social support (3%). 48% of the patients died during the first admission. The mean time of hospitalization was 11 ± 7 days. After discharge from hospital, 37% were cared for by themselves or family members, 23% were visited by a community nurse or other nursing services, 19% were cared for by the outpatient palliative care program, 14% were admitted to a nursing home, 4% were transferred to another ward, and 3% to the hospice which had opened as recently as January 2012. Detailed data of the hospitalized palliative patients are presented and further discussed regarding the special needs of the growing rural palliative patient population. Disclosure All authors have declared no conflicts of interest.

Die Erfolge der Chemotherapie in Hamatologie und Onkologie werden durch eine Reihe von Nebenwirkungen erkauft, die durch die verwendeten Zytostatika selbst oder durch die Wirkung dieser Zytostatika auf proliferierende Gewebe (s. Abb. 4.1 – 4.4) (insbesondere Haut, Schleimhaut und Hamatopoese) verursacht werden.

Die Vorbereitung einer Chemotherapie erfordert sowohl bestimmte technische Voraussetzungen als auch eine genaue Schulung des Personals. Neben einem Zytostatikaplan mus bei entsprechender Indikation ein Plan zur selektiven Darmdekontamination erstellt werden, was insbesondere bei Patienten mit Leukamie und Agranulozytose erforderlich ist. Dabei sollte mit der Darmdekontamination (s. Abb. 6.1) bereits vor einer hochdosierten Chemotherapie begonnen werden, um eine endogene Infektion weitgehend ausschliesen zu konnen.

Die Beurteilung des Knochenmarks ist moglich anhand eines Aspirationspraparates, fur dessen Gewinnung mit Hilfe einer Punktionsnadel Knochenmark aspiriert (s. Abb. 5.1) wird und anhand eines Knochenzylinders, der neben der Beurteilung zellularer Elemente auch die der Knochenstruktur ermoglicht. Zur Gewinnung von Stanzzylindern stehen Jamshidi- und andere Punktionsnadeln (s. Abb. 5.2) zur Verfugung. Myelotomien (s. Abb. 5.3) mit Bohrzylindern sind nur bei besonderen Fragestellungen, wie z. B. Beurteilung von Osteoporose oder Osteomyelofibrose, erforderlich.

Die Plasmapherese oder der Austausch von Plasma mit einem speziellen Zellseparator hat ihren Einsatz z. B. bei Hyperviskositatssyndromen, Kryoglobulinamien, Autoimmunerkrankungen, Myasthenia gravis, Goodpasture-Syndrom und einigen familiaren Fettstoffwechselstorungen. Mit einem ahnlichen Zeilseparationssystem kann bei Leukamien mit hoher Zellzahl auch eine Zellreduktion vorgenommen werden (Leukapherese).

Selected key-steps in the biochemical pathways of DNA-synthesis and cytokinetic parameters were measured in human bone marrow cells: Thymidine kinase (TK), incorporation of nucleosides (thymidine = dTR and deoxyuridine = dUR), % cells in DNA-synthesis-phase of the cell division cycle (%S). 26 normal marrow and a total of 369 marrow specimens from patients with acute leukemia were assayed either at first diagnosis, during remission or at relapse. A significant 5-fold increase of TK was found in leukemic cells, thus, being a suitable marker for follow-up of these patients. The sensitivity to detect a high TK at primary diagnosis of acute leukemia is 83%. An increase of TK during remission can indicate an imminent relapse before an increase of blast cells can be detected in the bone marrow. The incorporation-rates of dTR and dUR were also significantly increased in leukemic cells. Patients who did not achieve complete remission after induction treatment had higher incorporation-rates. In contrast to the enhanced biochemical activity of DNA-metabolism, %S-phase-cells were significant lower in leukemic cell populations. %S-phase cells did not correlate with treatment results. An inhibition of DNA synthesis, estimated by the incorporation rates of dTR and dUR for more than 50% during the first 3-4 days after start of induction treatment corresponds with cytoreduction in the leukemic bone marrow which does not predict complete remission in all cases.

The effect of low-dose Ara C (LD-Ara C) (10 mg/m2 q 12 hr s.c.) for a minimum of 10 days was evaluated in 21 patients with acute myeloid leukemia (AML) and 15 patients with dysmyelopoietic syndromes (DMPS). Median age (range) for AML-patients was 47 yrs (19-89), and for DMPS-patients 60 (22-78). From the AML-group, 9 patients were either primary refractory or resistant to intensive re-induction treatment of relapse, 6 others had heavy pretreatment, 1 suffered from myelosclerosis. Five AML-patients had no pretreatment at first presentation and were started on LD-Ara C because of old age (3) or poor condition (2) including 1 patient with a secondary leukemia. DMPS included those with RAEB (8) and RAEB in transformation (7). 12 patients with AML and 4 with DMPS displayed a leukocytosis of greater than 10 X 10(9)/l. Three out of 21 AML-patients reached complete remission (CR), one of them twice, with partial remission (PR) at the third attempt with this type of treatment. Two other AML-patients reached a P.R. of 5 and 1 months duration respectively. Three patients experienced a transient response characterized by improved peripheral blood counts and cessation of transfusion requirements, one of them for 12 months. In 5 AML-patients no effect was seen and 8 pts. died. In the DMPS-group, 5/15 patients reached C.R., one patient twice with the same treatment, 1 patient reached a P.R., 1 improved, 6 showed no effect, and 2 died. In 13 patients final examination of the bone marrow was not performed after treatment because of either early death or obvious progression. Treatment was associated with significant, transient hematologic toxicity. Patients suffering from DMPS had prolonged aplasia and required more blood and platelet support than pts with AML. Responding leukemia patients had a rapid hematologic regeneration. Considering the poor prognosis of both of our treatment groups, this therapeutic approach proved to be of considerable benefit.