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Purpose: Ovarian cancer may have a high percentage of residual disease after chemotherapy. It is questionable whether second or more lines of chemotherapy are needed in patients with slow-growing residual disease. In the present trial we compared the median survival of patients with residual or recurrent disease who received 1-2 lines of chemotherapy with those who received 3-9 lines., Methods: Two hundred and five patients with advanced stage IIIA, B, C and IV ovarian cancer were divided into two groups based on the number of chemotherapy lines they received. All patients had prior first-line chemotherapy; the criteria for recruitment in the study were: a) residual or recurrent disease and b) failure to respond to first-line therapy. Group A included patients who received 1 or 2 lines of chemotherapy and group B, 3-9 lines., Results: The median survival of group A was 76 months and of group B 53 months (p<0.001). Complete response (CR) was observed in 80 out of the 193 7lpar;41.45%) evaluable patients, partial response (PR) in 37 (19.17%), stable disease (SD) in 54 (27.987percnt;) and progressive disease (PD) in 22 (11.40%) patients., Conclusion: In ovarian cancer patients with advanced disease, multiple chemotherapy lines (3=9) offer no advantage over 1 or 2 lines, with respect to overall survival.

Oral topotecan has been recently brought into clinical practice at a dose of 2.3 mg/m(2) for 5 days, every 3 weeks. Published data show quite high myelotoxicity. The aim of this trial was to define the daily dose and treatment duration, which permits safe toxicity. The study was designed to begin at a low daily dosage of 1.5 mg/m(2) and was escalated by increasing the topotecan dose and the day-treatment duration. The plan was to end up with 2.3 mg/m(2) daily for 5 days. In cases of tolerability with the last dosage given, we would then continue testing a higher daily dosage. Treatment repetition was planned to be every 21 days. Dosage levels were 1.5, 2.0 and 2.3 mg/m(2) for 3 days, 2.0 and 2.3 mg/m(2) for 4 days, and 2.3 mg/m(2) for 5 days. Toxicity was scored according to the Common Toxicity Criteria. Thirty-two patients (27 male, five female, median age 60 years, range 46-77 years) with small-cell lung cancer were included. The patients on 1.5 and 2 mg/m(2) for 3 days showed no myelotoxicity. Four (25%) patients on 2.3 mg/m(2) 3-day treatment developed grade 3-4 neutropenia. Three of five patients (60%) treated for 4 days at a dose of 2.3 mg/m(2) developed grade 3-4 neutropenia and less than half (two of five, 40%) of these patients had thrombocytopenia. Eight patients (66.7%) on the 5-day treatment presented with serious grade 3-4 myelotoxicity. Two treatment-related deaths were observed in the 5-day group and one in the 4-day group. Granulocyte growth factor was applied in over 60% of the patients. In conclusion, a dose of 2.3 mg/m(2) for 5 days was intolerable. Dose-limiting toxicity was 2.3 mg/m(2) for 4 days without prophylactic granulocyte colony-stimulating factor administration. The safe duration of oral topotecan treatment and the maximum tolerated dose seem to be not longer than 3 days at a dose of 2.3 mg/m(2).

Purpose: To determine long-term survival and long-term stable disease in patients with atypical carcinoid tumor with liver metastases., Methods: From 1993 till 2008, the records of 56 patients with atypical carcinoid were reviewed. Nine of them who had liver metastases were analysed. All patients had carcinoid tumors confirmed histologically. Treatment, including chemotherapy and somatostatin, was given as palliative therapy of short duration., Results: The median survival of 9 patients was 50 months (range 12-156). Three of 9 (33.33%) patients died of disease, at 12, 48 and 50 months. The remaining 6 patients are alive after 36, 40, 108, 120, 156 and 156 months, practically without treatment and experiencing a high quality of life., Conclusion: Six of 9 (66.66%) patients are alive having received almost no treatment for many years.

In the past, it was believed that when advanced-stage prostate cancer became resistant to hormonal management, no chemotherapy should be administered, as survival was not prolonged. Mitoxanthrone and prednisone were mostly administered, while recently, other agents such as docetaxel or paclitaxel have been tested both with and without hormonal treatment. The objective of the present phase II study was to determine the survival and the response rate of patients after the chemotherapy was administered. Sixty-five patients with advanced prostate cancer were included. The inclusion criteria involved histological confirmation of adenocarcinoma and resistance to hormonal therapy. The majority of the patients had stage IVa or IVb disease and a performance status of 0-1 to 2. The treatment involved chemotherapy in combination with a luteinizing hormone-releasing hormone (LHRH) or dexamethasone or estramustine. The hormone treatment preceded the cytotoxic administration and no amelioration in the patients nor prostate serum antigen (PSA) reduction was observed. The initial cytotoxic agents administered were docetaxel 75 mg/m(2) in 25 patients, mitoxanthrone 10 mg/m(2) in 15 patients, epirubicin 75 mg/m(2) in 15 patients and paclitaxel 175 mg/m(2) in 10 patients, all repeated every 3 weeks. The response rate was documented by bone scan, CT scan of the abdomen (and occasionally of the chest) and by the PSA serum value. Clinical benefit was also estimated. Thirty-three (50.77%) patients achieved a partial response; stable disease was observed in 24 (36.92%) patients and disease progression in 8 (12.31%). Twenty-two (33.85%) experienced clinical benefit. A significant PSA reduction was seen in 35 (53.85%) patients. The median survival was 18 months and the range 3-84 months. One, 2, 3 and five-year survival was 75.38, 23.07, 12.30 and 4.66%, respectively. Toxicity was well-tolerated. Patients with hormone-resistant advanced prostate cancer do have good prospects for receiving substantial benefit with the addition of chemotherapy, as observed in the present trial.

A carcinoid tumor is a rare malignant disease which can be cured when localized and treated by surgery. Chemotherapy is not effective, and somatostatin is used for palliation. Rarely is the disease aggressive, and thus does not contribute to a shortening of patient survival. The aim of this study was to define the treatment and survival of patients with primary lung carcinoid tumors. Forty-three patients (26 males, 17 females; median age 43 years, range 11-73 years), from 1993 to 2007, were included in this study. All patients had histologically confirmed carcinoid tumors. The site of the disease at diagnosis was the lung in all 43 patients. All patients underwent surgery which involved mainly typical or sleeve lobectomy. Eight patients had a pneumonectomy. One patient had the primary tumor excised for palliation as there were metastases in the liver. Somatostatin palliative treatment was administered to 4 patients; 1 with liver and 3 with lung recurrence. Two of the 43 patients died within 2 years after surgery. The median survival was not reached as all patients, apart from 2, were alive after a median follow-up of 5 years (mean survival 159 months). As a rule, a carcinoid tumor is an extremely slow-growing disease with some rare exceptions. All of our patients had primary lung disease. All, apart from 2, were alive at the end of the study, and 93% were without recurrence for a duration of 6 months to 13 years. The patients with liver metastases who underwent no specific treatment had a median survival as long as 8 years.

Cisplatin-paclitaxel and cisplatin-etoposide combination therapies were compared in limited and extensive disease in patients with small-cell lung cancer. The primary objectives were to determine median and overall survival, time to tumor progression and tolerance and the secondary objective, the response rate. From January 2003 till July 2007, 108 patients were enrolled in the study. All patients had histologically- or cytologically-confirmed small-cell lung cancer. All patients were chemotherapy and radiotherapy naive. The patients were designated to receive six cycles: in the investigational Arm A, cisplatin, 80 mg/m(2) and paclitaxel 175 mg/m(2) were infused on day 1 (1 cycle) and repeated every 3 weeks. In the control Arm B, cisplatin, 80 mg/m(2) was administered on day 1 and etoposide, 120 mg/m(2) per day was given on days 1-3 (1 cycle), every 3 weeks. In Arm A, 6 (11.3%) patients achieved a complete response and 32 (58.1%), a partial response; in Arm B, 7 (12.7%) patients achieved a complete response and 32 (58.2%) a partial response. The median survival time in Arm A patients was 12 months and in Arm B, 13 months, p=0.354. The time to tumor progression (TTP) was 8 and 6 months for Arms A and B, respectively (p=0.060). Toxicity, although common in both Arms, was acceptable. Neutropenia, anemia and diarrhea were higher in the control Arm. The cisplatin-paclitaxel combination is not superior to cisplatin-etoposide with respect to survival, TTP, toxicity and response rate. The former combination could be applied as an alternative chemotherapy regimen for patients with limited or advanced small-cell lung cancer.

Advanced metastatic renal cancer is an incurable disease, unless a successful excision of metastatic lesions can be performed. No effective treatment has yet been found. In the last few years, targeting therapies have been developed. In the past, the main treatment was based on cytokines (interferon-alpha or interleukin-2). Our objective was to determine the median and overall survival in the 66 patients who were studied and reviewed. All had histologically confirmed advanced renal cancer. There were 41 male and 25 female patients, with a median age of 60 years. In 68.18% of the patients, the treatment was mainly interferon-alpha (IFN-alpha) given 3 times a week for a median time duration of 6 months (range 3-12 months). Four patients received interleukin-2 (IL-2) and 17 patients received chemotherapy, 15 of whom had hormonal treatment. Eleven patients underwent palliative radiation therapy (in the bone or brain). Seven patients received no treatment apart from supportive care. A partial response was achieved in 11.11% of the patients treated with IFN-alpha. No response was observed in patients treated with chemotherapy or hormonal therapy. The median survival of all the patients was 20 months (95% CI 14.96-25.04). These results are discussed in comparison with the survival results of modern targeting treatment studies. In the latter studies, despite the high response rates (31-40%), the survival was 16.4 months. Our data indicate that the response rate as a criterion is not adequate in determining drug effectiveness.

Background: Colorectal cancer is a non-aggressive slow-growing disease. Surgery is often considered for the management of metastases. Chemotherapeutical agents may offer tumor reduction but radical tumor remission can only be achieved by surgery. The aim of the present study was to show the evolution of patients with lung metastases from colorectal cancer, treated with surgery., Patients and Methods: Five hundred and seventy-nine (male 327, female 252, median age 60 years [range 30-87 years], disease stage IV) patients with colorectal cancer were evaluated. Histology showed adenocarcinoma with 94% moderate differentiation. Sixty-six patients (11.40%) had only lung metastasis (single or multiple deposits). Of these 66 patients, 57 were treated with surgery (pneumonectomy, lobectomy or nodule excision) and in 52/57 (91.23%) the tumor was removed., Results: In 29 patients (50.88%) the disease recurred 8 months after surgery, at the earliest; however, no recurrence was observed in 28 patients (49.12%) during 2-8 years of follow-up after the operation. Five-year survival was 32.69%., Conclusion: Metastectomy of lung metastasis from primary colorectal cancer may achieve long-term survival without recurrence in a large percentage of patients.

Background: Capecitabine (Xeloda) is a fluoropyrimidine which is transformed to 5-fluorouracil (5-FU) at the tumor site. The aim of the present study was to estimate the efficacy of this agent in pretreated patients with advanced breast and colorectal cancer, and to determine the response rate and adverse reactions., Patients and Methods: Forty-two patients (median age 65 years, range 27-80 years), 24 with breast cancer, 17 with colorectal cancer and one with a pancreatic islet tumor were included. Capecitabine was administered at a dose of 1200 mg/m2 twice daily for two weeks every 21 days. No other agent or supportive treatment was planned., Results: A partial response was observed in 29.16% of the patients with breast cancer and in 11.76% of the patients with colorectal cancer. Stable disease was observed in 58.33% and 70.59% of the breast cancer and colorectal patients, respectively. Adverse reactions were very mild with respect to myelotoxicity and GI tract toxicity. Grade 3 hand-foot syndrome was observed in three patients (7.14%). Hypertriglyceridemia, an unusual side-effect, was observed in 5/12 patients who were tested for serum cholesterol triglycerides., Conclusion: Capecitabine is a well tolerated treatment with low toxicity, rendering a partial response in 29.16% and 11.76% of patients with breast and colorectal cancer, respectively.

Background: Primary angiosarcoma of the heart is an extremely rare malignant disease., Patients and Methods: A 32-year-old female with primary angiosarcoma of the heart at an advanced stage with lung and bone metastases is presented. The tumor showed extensive expression of c-erb-B2 and a moderate expression of c-kit. Chemotherapy (cisplatin, epirubicin and ifosfamide) was administered. Herceptin as well as glivec were added to the above combination., Results: There was a good partial response and the lung deposits almost disappeared. The duration of response was 6 months., Conclusion: This case of angiosarcoma of the heart is presented because of the extreme rarity of this disease, and its responsiveness to chemotherapy in combination with imatinib and herceptin.