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Introduction Several studies show that mutational profiles could influence treatment decisions in patients with metastatic CRC (mCRC). KRAS mutational status was the first step in biomarkers development in the era of molecular targeted therapies. Recently, NRAS mutational status was identified as an independent prognostic factor for the response to treatment with anti-EGFR moAbs. The aim of this observational study was to assess the feasibility of the KRAS/NRAS mutational analysis in patients with metastatic colorectal cancer in Greece and to identify any correlations with known clinical characteristics and histopathologic features. Methods From January 2014 until September 2014 all patients registered to the GIC-SG database with newly diagnosed metastatic disease from colon or rectal cancer were included and tumor samples were analyzed for kras/nras mutations in 9 different certified laboratories in Greece. Results Samples from 510 patients were analyzed. Mutations’ distribution was as follows: 173 (33,9%) KRAS exon 2, 10 (2%) KRAS exon 3, 25 (4,9%) KRAS exon 4, 22 (4,3%) NRAS exon 2, 11 (2,2%) NRAS exon 3 and 3 (0,6%) NRAS exon 4. The only factor significantly associated with RAS mutational status was primary tumor location, with right sided tumors exhibiting higher rates of mutations. Discussion The incidence and distribution of KRAS or NRAS exon 2-4 mutations are in accordance with those reported in the literature. The most significant clinical or pathological parameter revealed from the analysis is the location of the primary tumor.

The plants of the Colchicum family were known during the archaic period in Greece for their deleterious properties. Later on, they were used for the treatment of podagra. The treatment was introduced by the ancient Greek physicians and passed on to the Byzantine and Arabian physicians to endure until nowadays. The first plant was most probably named "Medea" from the notorious Colchican witch. As the most common member of the family blossoms in autumn, the plant was named Colchicum autumnale. Various nominations were also used, such as Ephemeron, Hermodactyl, Anima articulorum and Surugen. Our article discusses them, while at the same time presents the most notable authorities who have used Colchicum plants in herbal medicine and toxicology.

The current state of the SARS-CoV-2 pandemic is an equilibrium between expanding vaccine coverage on the one hand, and emergence of variants of concern which compromise vaccine effectiveness and enhance viral transmission on the other. Inequity in vaccine distribution, primarily an ethical issue, challenges this equilibrium, as industrialized countries prepare to administer a third booster dose to their population. Solid tumor cancer patients typically respond well to initial full vaccination and someone could argue that they should not be prioritized for an adjuvant third dose, since protection from severe disease has largely been achieved with the two-dose regimen. Nevertheless, their immune status is dynamic and not all of them exhibit an adequate immune response. A booster third dose is necessary for the inadequate responders, while it will result in better protection of all patients from mild disease as well, which if presented could have ominous consequences due to their overall frailty, and their need to adhere to strict therapeutic schemes. International scientific and public health communities should develop approaches that allow for wide immediate vaccination coverage of the developing world, in parallel with administration of adjuvant doses to solid tumor cancer patients (and other at-risk categories) of the developed nations, in order to avoid prolonging the pandemic, which will be prospectively against cancer patients' best interest.

Background The advanced lung cancer inflammation index [ALI: body mass index × serum albumin/neutrophil-to-lymphocyte ratio (NLR)] reflects systemic host inflammation, and is easily reproducible. We hypothesized that ALI could assist guidance of non-small-cell lung cancer (NSCLC) treatment with immune checkpoint inhibitors (ICIs). Patients and methods This retrospective study included 672 stage IV NSCLC patients treated with programmed death-ligand 1 (PD-L1) inhibitors alone or in combination with chemotherapy in 25 centers in Greece and Germany, and a control cohort of 444 stage IV NSCLC patients treated with platinum-based chemotherapy without subsequent targeted or immunotherapy drugs. The association of clinical outcomes with biomarkers was analyzed with Cox regression models, including cross-validation by calculation of the Harrell's C-index. Results High ALI values (>18) were significantly associated with longer overall survival (OS) for patients receiving ICI monotherapy [hazard ratio (HR) = 0.402, P < 0.0001, n = 460], but not chemo-immunotherapy (HR = 0.624, P = 0.111, n = 212). Similar positive correlations for ALI were observed for objective response rate (36% versus 24%, P = 0.008) and time-on-treatment (HR = 0.52, P < 0.001), in case of ICI monotherapy only. In the control cohort of chemotherapy, the association between ALI and OS was weaker (HR = 0.694, P = 0.0002), and showed a significant interaction with the type of treatment (ICI monotherapy versus chemotherapy, P < 0.0001) upon combined analysis of the two cohorts. In multivariate analysis, ALI had a stronger predictive effect than NLR, PD-L1 tumor proportion score, lung immune prognostic index, and EPSILoN scores. Among patients with PD-L1 tumor proportion score ≥50% receiving first-line ICI monotherapy, a high ALI score >18 identified a subset with longer OS and time-on-treatment (median 35 and 16 months, respectively), similar to these under chemo-immunotherapy. Conclusions The ALI score is a powerful prognostic and predictive biomarker for patients with advanced NSCLC treated with PD-L1 inhibitors alone, but not in combination with chemotherapy. Its association with outcomes appears to be stronger than that of other widely used parameters. For PD-L1-high patients, an ALI score >18 could assist the selection of cases that do not need addition of chemotherapy., Highlights • ALI is prognostic and predictive for patients with advanced NSCLC treated with immunotherapy monotherapy, but not chemo-immunotherapy. • Its association with outcomes is stronger than that of other parameters (PD-L1 TPS, NLR, lung immune prognostic index, EPSILoN). • For PD-L1-high patients, an ALI score >18 could assist the selection of cases that do not need addition of chemotherapy.

To evaluate the predictive value of genes involved in resistance to platinum-taxane chemotherapy in patients with epithelial ovarian cancer (EOC). Microdissected formalin-fixed tumoral samples from 187 EOC patients' primary tumors (90 and 97 samples from matched patients in the experimental and validation sets, respectively) were analyzed. All specimens were analyzed for ATP7b, BRCA1, BRCA2, PARP1, UIMC1(RAP80), HOXA9, DAXX, TXN (TRX1), THBS1 (TSP1) and PRR13 (TXR1) mRNA expression by quantitative real-time PCR. Most of the patients (172 out of 187) received front-line carboplatin-paclitaxel regimen. Expression levels were correlated with overall (OS) and progression-free (PFS) survival by multivariate analysis. Patients with high TXN and THBS1 expression presented longer PFS (P=0.001 and P

Background: CureCancer is a patient-centered/patient-driven digital tool integrated in the routine oncology practice Patients self-create their medical profile, record their symptoms and communicate them to health care professionals (HCPs) We aimed to assess the tool’s feasibility and patients’ satisfaction Methods: 14 Centers participated, starting from 02 2020 COVID-19 epidemic period was included Patients signed consent to upload their data, report their symptoms and complete 2 questionnaires Results following the completion of the 1st questionnaire are reported Results: 78 patients were enrolled and 68 (87%) uploaded their data to date;60 of 68 (88%), 30 males and 30 females, median age 53 years, completed the 1st questionnaire Thirty-seven (61 6%) were University graduates Cancer types included breast cancer (21 6%), Head/Neck cancer, pancreatic cancer and other cancers Ten patients reported “other”, 4 reported multiple cancers, 28 had metastatic disease and 45 active treatment Registration and use of the platform was reported as “very to very much” easy by 52 (86 6%) and 50 (83 3%) patients, respectively File uploading was “very to very much” easy for 33 (55%) patients;49 (81 6%) preferred the digital way and 50 (83 3%) will introduce it to others Patients highlighted that CureCancer improved communication with HCPs, increased their sense of safety, facilitated treatment adherence and interventions at distance, particularly when outside the Cancer Center and during the COVID-19 pandemic, reduced the number of visits, time and out-of-pocket expenses Benefits liked best were easy data access, improved communication and sense of safety Conclusions: CureCancer use was feasible, increased communication with HCPs, patients’ sense of safety, treatment adherence and medical interventions at distancing, reduced visits and saved time and money Continuing integration of CureCancer to embed PROs in routine cancer care is expected to improve treatment outcomes within or outside the Cancer Center and in pandemics and to reduce costs Legal entity responsible for the study: Hellenic Society of Medical Oncology Funding: Has not received any funding Disclosure: All authors have declared no conflicts of interest

Background: An everyday clinical practice dilemma in the 20–30% of metastatic colorectal cancer (CRC) patients that have not been operated on their primary tumour, is, under which specific histopathology and molecular circumstances, an endoscopic biopsy could be considered adequate to provide a representative RAS/BRAF molecular status to guide treatment. Methods: A consecutive series of 193 paired biopsy and primary CRC tumour samples between August 2008 and 2010 available in the Department of Pathology archives, University Hospitals, KU Leuven were retrieved. For a pair to be included, in the endoscopic biopsy, 20% of invasive adenocarcinoma cells should be present and enough slides to yield an extracted DNA concentration of ⩾5 ng μl−1, and no

A major challenge in metastatic colorectal cancer (mCRC) is the identification of specific biomarkers that are likely to predict which patients will benefit from a specific treatment, especially in recent years, that available options have substantially increased with the introduction of novel targeted therapies. To this date, a number of studies have shown that a tumor mutational profile influences outcome in mCRC patients treated with an anti-epidermal growth factor receptor (anti-EGFR)-targeting agent and should, therefore, be used to guide treatment decision. Despite our undeniable progress toward a more personalized treatment approach, we are not yet there. Prognostic and predictive markers have been identified, but their influence in distinct patient populations has not been fully elucidated. Reality seems to be more complex; clinical performance status of the patients and existing comorbidities and our treatment goal, alongside the tumor and patient mutational profile and molecular signature, will guide our initial and subsequent treatment choices.

BACKGROUND: Although colon cancer (CC) with microsatellite instability (MSI) has a more favorable prognosis than microsatellite stable (MSS) CC, the impact varies according to clinicopathological parameters. We studied how MSI status affects prognosis in a trial-based cohort of stage II and III CC patients treated with 5-fluorouracil (5-FU)/leucovorin or FOLFIRI. MATERIALS AND METHODS: Tissue specimens of 1254 patients were tested for 10 different loci and were classified as MSI-high (MSI-H) when three or more loci were unstable and MSS otherwise. Study end points were overall survival (OS) and relapse-free survival (RFS). RESULTS: In stage II, RFS and OS were better for patients with MSI-H than with MSS CC [hazard ratio (HR) 0.26, 95% CI 0.10-0.65, P = 0.004 and 0.16, 95% CI 0.04-0.64, P = 0.01). In stage III, RFS was slightly better for patients with MSI-H CC (HR 0.67, 95% CI 0.46-0.99, P = 0.04), but the difference was not statistically significant for OS (HR 0.70, 95% CI 0.44-1.09, P = 0.11). Outcomes for patients with MSI-H CC were not different between the two treatment arms. RFS was better for patients with MSI-H than with MSS CC in the right and left colon, whereas for OS this was significant only in the right colon. For patients with KRAS- and BRAF-mutated CC, but not for double wild-type patients, RFS and OS were significantly better when the tumors were also MSI-H. An interaction test was statistically significant for KRAS and MSI status (P = 0.005), but not for BRAF status (P = 0.14). CONCLUSIONS: Our results confirm that for patients with stage II CC but less so for those with stage III MSI-H is strongly prognostic for RFS and OS. In the presence of 5-FU treatment, stage II patients with MSI-H tumors maintain their survival advantage in comparison with MSS patients and adding irinotecan has no added benefit. CLINICALTRIALSGOV IDENTIFIER: NCT00026273.

A major challenge in metastatic colorectal cancer (mCRC) is the identification of specific biomarkers that are likely to predict which patients will benefit from a specific treatment. To this date, a number of studies have shown that a tumour's mutational profile influences treatment outcome in patients with mCRC and should, therefore, be used to guide treatment decision. For more than 5 years now, we know that patients with tumours harbouring mutations in exon 2, codons 12 and 13 of the KRAS oncogene gain no benefit from the administration of anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (moAbs), Cetuximab and Panitumumab. It has just recently being elucidated that KRAS mutations outside codons 12 and 13 and mutations in the NRAS gene confer resistance to Cetuximab and Panitumumab, as well. Thus, since June 2013, the analysis of exons 2, 3 and 4 of KRAS and NRAS has been incorporated in daily clinical practice to improve patients’ selection for anti-EGFR moAbs treatment. Nevertheless, even if patients’ outcome under anti-EGFR moAbs therapy is improved with better selection based on Ras mutational status, more research is needed in this field; the matter is far from being resolved, since there are still a minority of wt RAS patients who do not respond upfront to such a treatment.

Background Clinical trials evaluating treatment with cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) in combination with aromatase inhibitors (AI) or fulvestrant have shown promising clinical benefit in patients with advanced breast cancer. We evaluated real-world clinical outcomes and toxicity rates in patients with advanced breast cancer who received treatment with CDK4/6i in routine clinical practice. Methods We retrospectively reviewed medical records of patients with advanced hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer treated at Departments of Oncology-affiliated with the Hellenic Cooperative Oncology Group (HeCOG). All patients received hormonal therapy in combination with CDK4/6i as first-, second- or third-line of treatment and beyond. The primary end point was progression-free survival (PFS). Results From 07/2015 to 03/2019, 191 women were treated with CDK4/6i combined with endocrine therapy (median age: 52.2 years, postmenopausal 87, 45.5%); 86 (45%) patients received CDK4/6i in combination with AI and 105 (55%) with fulvestrant. CDK4/6i were administered as first-line treatment in 65 (34%) patients, second-line treatment in 39 (20.4%) and third-line and beyond in 83 (43.5%) patients. The median follow-up was 54.3 months (95%CI 43.0-61.2). The median PFS for patients who received first-line treatment was 18.7 months, second-line treatment 11.5 months and ≥3 lines of treatment 7.5 months. The median overall survival since the initiation of CDK4-6i treatment was 23.2 months (95% CI 20.4-30.3). The most common adverse events were neutropenia (100 patients, 52.4%) and fatigue (24, 12.6%). Grade 3-4 adverse events occurred in 55 (28.8%) patients, while 2 (1.0%) patients permanently discontinued treatment due to toxicity. Conclusions Among patients with HR-positive advanced breast cancer treated with CDK4/6i combined with endocrine, the estimated PFS was comparable to previously reported data. Treatment was well tolerated, with a low drug discontinuation rate. Legal entity responsible for the study Hellenic Cooperative Oncology Group. Funding Hellenic Cooperative Oncology Group (HeCOG). Disclosure E. Fountzilas: Travel / Accommodation / Expenses: K.A.M ONCOLOGY / HEMATOLOGY; Travel / Accommodation / Expenses: Merck; Shareholder / Stockholder / Stock options: Deciphera. G. Aravantinos: Advisory / Consultancy: Novartis; Advisory / Consultancy: Bristol-Myers Squibb; Advisory / Consultancy: Roche Hellas; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Sanofi; Advisory / Consultancy: Amgen; Advisory / Consultancy: Genesis Pharma; Advisory / Consultancy: Merck; Advisory / Consultancy: Pfizer. G. Fountzilas: Advisory / Consultancy: Pfizer; Advisory / Consultancy: Sanofi; Advisory / Consultancy: Roche; Honoraria (self): AstraZeneca. E. Razis: Honoraria (self), Advisory / Consultancy: Novartis; Travel / Accommodation / Expenses: Genesis Pharmaceuticals; Travel / Accommodation / Expenses: Pfizer; Travel / Accommodation / Expenses: Roche; Travel / Accommodation / Expenses: , Bristol-Myers Squibb; Travel / Accommodation / Expenses: Genekor. All other authors have declared no conflicts of interest.

Background: We conducted an open-label, pilot phase II trial to evaluate the efficacy and safety of FOLFOXIRI plus cetuximab as first-line treatment of patients with metastatic colorectal cancer (mCRC). Methods: Thirty patients with KRAS wild-type mCRC

Background: State health insurance authorities in Greece do not reimburse genetic testing for cancer predisposition. The Hellenic Society of Medical Oncology has launched and carries out a national program covering genetic testing for BRCA1/2 mutations detection, with the financial support of pharmaceutical industry. Aim: This analysis evaluates how, during this program, access to genetic testing transformed the oncologists' therapeutic approach toward their ovarian cancer patients and how the results impacted treatment decisions concerning PARP inhibitors. Adoption of testing by healthy relatives and timing of testing in the disease continuum were also evaluated. Methods: Adult patients with high-grade epithelial ovarian carcinoma, irrespectively of family history or age at diagnosis were eligible for this program. Genetic counseling was recommended before testing, and both were offered at no financial cost. First degree family members of pathogenic mutation carriers were also offered free counseling and testing. Results: From March 2015 through January 2018, 708 patients were enrolled and tested. One hundred and forty seven (20.7%) mutation carriers were identified, 102 (14.4%) in BRCA1 and 45 (6.3%) in BRCA2 gene. Testing was more often pursued at initial diagnosis (61%) than at recurrence (39%), as recorded for 409 patients with available relevant information. During the 1st year of the program, average monthly tests performed were 25.1, while during the 3rd year this number increased to 34.3 tests per month. Among patients who tested positive for deleterious BRCA1/2 mutations, relapse was reported in 58 patients, 94.8% of which (n= 55) received treatment with the PARP inhibitor olaparib as per its indication. Family members of 21 patients (14.3%), out of the 147 who tested positive, received genetic counseling and testing for the mutation identified in the context of the program. Conclusion: Free access to genetic testing for BRCA1/2 for ovarian cancer patients and genetic consultation facilitates testing uptake, affects common clinical practice & has major impact on patients and their families. Still, diffusion of genetic information and broader testing of family members require further efforts by the oncological community.

Background and context: W4O-Hellas (Women for Oncology-Hellas, a network of women professionals in oncology) and K.E.F.I. (an association of cancer patients) joined forces to create the “Hellenic Alliance for Metastatic Breast Cancer”, a project awarded through the SPARC initiative. The project is consisting among others, on creating, promoting and maintaining a Web-based platform of education, information, communication, advocacy and support for MBC patients in Greece. Aim: The aim of the platform is to provide education at patients and caregivers on various aspects concerning the disease, from diagnosis to palliative care, the available medical facilities, social services, benefits and allowances, clinical trials and issues concerning quality of life and psychological support. Strategy/Tactics: The development of an innovative Web-based tool was included in the “Hellenic Alliance for Metastatic Breast Cancer” project. It was overseen by a steering committee with W4O-Hellas and K.E.F.I. representatives, journalists, health economics advisors and state representatives. A support team was also created, to run and update the platform. Program/Policy process: The platform (“w4life.gr” reading “women for life” or “life for women with stage 4 disease”) is functional since June 2016 and was officially presented to the public on November 2016. The site´s structure is consisting of the main sections and an online forum. The sections contain information about the disease, the access to doctors, medical facilities, social services and patient groups, quality of life, nutrition and exercise issues, patient guidance and clinical trials available in Greece. The online forum is accessible 24 hours per day, and provides information and update about the network´s actions and upcoming seminars and forums. There is also a patient support direct line available on weekdays and access to other useful links. An online survey measuring quality of life data are running through the platform and the results will be presented in the near future. Since last year, a mobile application was also created aiming to an easier and user friendly access. Outcomes: By March 2018, the platform had 27,018 page views, 10,416 users who completed 13,020 sessions, with average session duration 2:23 minutes and bounce rate 74.54%. w4life received two awards from the Boussias-Health Care Business Awards-2017. The Gold Award, in the e-Health category digital applications for information and integrated patient care and a Silver Award for actions aimed at information, awareness, and prevention. What was learned: During the severe Hellenic socioeconomic crisis we have found that an alternative approach, as the above described, of dedicated oncologists toward their patients is needed, easy to use, helpful and sustainable and can provide important information and comfort to women with mBC their families and caregivers.

BACKGROUND: The significance of BRAF mutations, microsatelite instability (MSI) status and cyclin D1 expression in patients with metastatic colorectal cancer (mCRC) was evaluated. METHODS: Primary tumours from 144 patients treated for mCRC were assessed for BRAF (V600E) mutation, MSI status and cyclin D1. The data were correlated with progression-free survival (PFS) and overall survival (OS). RESULTS: BRAF mutations were detected in 10 (out of 22, 45%) patients with MSI-H tumours compared with 2 (out of 122, 1.6%) in those with microsatellite stable tumours (P

The zygomycetes are a class of fungi that can cause a variety of infections in humans. Rhinocerebral mucormycosis is a rare disease and usually affects diabetic or immunosuppressed patients. The disease progresses rapidly and is usually fatal despite aggressive surgical and medical therapy. We report the management of two cases of rhino-sinusal and orbital mucormycosis in diabetic patients on treatment with corticosteroids, and mild renal impairment, successfully treated with a combination of aggressive surgical debridement and liposomal amphotericin B.

The purpose of this study is to report the results of a tension-free repair technique using expanded polytetrafluoroethylene Gore-Tex Mycro Mesh in patients with inguinal hernias. Over 3 years, 104 patients have undergone the aforementioned procedure for 118 hernias (85 indirect and 33 direct) in our clinic. Ninety-three of the patients were operated for the first time, whereas the remainder of them were operated for hernia recurrence. Fourteen patients had bilateral hernias, and six had incarcerated ones. The median patient's age was 53 years. Eighty-three patients were operated under general and 21 under local or epidural anesthesia. One hundred and two patients were offered a one-day surgery procedure, but three were readmitted with wound infection. Two of these patients were conservatively cured, and the third was submitted to mesh removal. Two patients developed hematoma in the scrotum and were discharged a week later after the absorption of the hematoma. All of the patients except the one who was submitted to mesh removal returned to normal life within a week after the operation. During the follow-up period, none of our patients experienced hernia recurrence. Our results are in accordance with those of the world literature. We perform the tension-free hernia repair by using the expanded polytetrafluoroethylene mesh in our patients because we believe it is a safe procedure without significant postoperative morbidity and with no hernia recurrences.

Repairing an incisional ventral hernia is a major challenge for a surgeon. The high recurrence rates observed during hernia repair by tissue approximation led to development of tension-free procedures by using prosthetic materials. The purpose of this study is to report the results of a tension-free repair technique using expanded polytetrafluoroethylene Gore-Tex Dual Mesh (Gore-Tex Soft Tissue Patch, W.L. Gore and Associates Inc, Flagstaff, AZ) in patients with primary or recurrent incisional ventral hernias. Over 3 years, 52 patients with incisional hernias have undergone this procedure in our clinic. Fourteen of them had recurrent hernias which had been primarily repaired by Mayo hernioplasty. Six of our patients had irreducible hernias preoperatively. Twenty-five patients had hernias on midline incisions, and the rest of them had hernias on transverse abdominal incisions. The median patient age was 65 years, and all were operated on under general anesthesia. The majority of the patients had 4 to 6 days of hospitalization. A subcutaneous seroma developed in eight patients. They all were treated by multiple paracentesis. Four of our patients experienced wound infection and were treated by mesh removal. None of the patients presented with cardiovascular or pulmonary complications. During the follow-up period, no other hernia recurrence, except the cases with mesh removal, has been noticed. The tension-free incisional hernia repair using expanded polytetrafluoroethylene mesh is, to our experience, a safe and easy procedure with no major morbidity or recurrence.

In 1872, the Hungarian born dermatologist Moriz Kaposi that was practicing in Vienna first described a rare endemic disease that bears his name, among elderly persons of Central European or Mediterranean origin named "idiopathic multiple pigmented sarcoma of the skin". Ten years later the Italian dermatologist Tommaso de Amicis confirms Kaposi's findings. For more than a century the disease was known as a rare low grade malignancy till the 1980s AIDS epidemic.

At the beginning of the 20th century, Professor Jean-Louis Faure, one of the leading surgeons of the innovative Parisian Medical School, published an exhaustive work on uterine cancer. He was the first to perform in France the procedure of total abdominal hysterectomy by median section of the uterus contributing to the evolution of cancer surgery.

Colorectal cancer is typically associated with advanced age, with an estimated median age at onset which reaches 70 years of age in the western population. Limited data are available regarding the differences in genetic and epigenetic alterations in colonic carcinogenesis between younger and older patients. Some studies suggest that mutation status in critical genes, such as KRAS, BRAF, or PIK3CA/PTEN, is different, depending of the age at diagnosis of colorectal cancer. These data provide the evidence that distinct genetic mechanisms are implicated in the somatic development of colorectal cancer in younger and older patients.

The diagnosis of metastatic cancer in peritoneal fluid is of great importance for the patient and the attending physician. A cytopathologist's responsibility is twofold: (1) to accurately identify malignant cells; (2) to interpret tumor type and if possible the site of its origin even in the absence of complete clinical history of other clues. The difficulty in the diagnosis of metastatic neoplasms in peritoneal fluid is due to 2 factors: (1) abnormal mesothelial cells or macrophages may simulate cancer cells, or may conceal tumor cells; and (2) peritoneal fluid constitutes a natural and hitherto inadequately explored medium of cell culture, in which neoplastic cells may proliferate free of the boundaries imposed upon them by the framework of organs and tissues. Immunocytochemistry (ICC) and molecular techniques are essential to establish an accurate diagnosis. From a great many points of view malignant peritoneal fluid is suitable for continuous study of cancer cells, thus providing knowledge about biologic aspects of human solid tumors.

The name Aretaeus of Cappadocia has been linked with diabetes more than that of any other physician of antiquity, his texts forming a sophisticated synthesis of the previous knowledge on this disease copiously supplemented by his own observations. Gifted with a unique faculty for observing pathologic phenomena, he was able to elaborate upon earlier texts enriching them with his own original findings and numerous thoughtful reflections. Among the many diseases he dealt with, Aretaeus has bequeathed to us an outstandingly vivid and accurate description of diabetes.

Continuous administration of oral vinorelbine, given 3 times a week (metronomic), is feasible and exceptionally well tolerated at doses up to 50 mg with clinical activity against refractory tumors. In this phase II study oral metronomic vinorelbine and bevacizumab were evaluated as salvage therapy in women with pretreated metastatic breast cancer (MBC).Patients received oral vinorelbine (50 mg 3 times a week) and bevacizumab (10 mg/kg) biweekly in cycles of 28 days. The primary endpoint was objective response rate (ORR). A preplanned analysis was performed when the first 13 patients were evaluated for tumor response.One patient (7.7%) achieved partial response (PR) and 6 (46.1%) stable disease (SD). The combination was very well tolerated but, as per protocol, the study was closed prematurely due to lack of efficacy.The combination of oral metronomic vinorelbine and bevacizumab has good tolerance but minimal activity in terms of objective responses in pretreated patients with MBC.

Background: It is known that 15% of patients with breast cancer present with locally advanced disease without distant metastases. This phase II trial is aimed at investigating the activity of epirubicin and mitoxantrone combination as induction intra-arterial chemotherapy (IAC) in locally advanced breast cancer patients.

Background: We address the prognostic and predictive value of KRAS, PIK3CA and BRAF mutations for clinical outcomes in response to active agents in the treatment of metastatic colorectal cancer (mCRC). Methods: We determined KRAS, BRAF and PIK3CA mutations in tumours from 168 patients treated for mCRC at two institutions. All patients received 5-FU-based first-line chemotherapy and treatment outcome was analysed retrospectively. Results: KRAS, BRAF and PIK3CA mutations were present in 62 (37%), 13 (8%) and 26 (15%) cases, respectively. Multivariate analysis uncovered BRAF mutation as an independent prognostic factor for decreased survival (hazard ratio (HR) 4.0, 95% confidence interval (CI) 2.1–7.6). In addition, patients with BRAF-mutant tumours had significantly lower progression-free survival (PFS: HR 4.0, 95% CI 2.2–7.4) than those whose tumors that carried wild-type BRAF. Among 92 patients treated using chemotherapy and cetuximab as salvage therapy, KRAS mutation was associated with lack of response (P=0.002) and shorter PFS (P=0.09). BRAF (P=0.0005) and PIK3CA (P=0.01) mutations also predicted reduced PFS in response to cetuximab salvage therapy. Conclusions: These results underscore the potential of mutational profiling to identify CRCs with different natural histories or treatment responses. The adverse significance of BRAF mutation should inform patient selection and stratification in clinical trials.

To determine the dose-limiting toxicities (DLTs) and the maximum tolerated doses (MTDs) of weekly high dose 5-fluorouracil (5FU) continuous infusion and leukovorin (LV) alternatively combined with oxaliplatin and irinotecan in patients with advanced tumors of the gastrointestinal (GI) tract.Patients received a fixed dose of LV (500 mg/m(2)) over 2 h infusion on weeks 1 to 4 and escalated doses of: oxaliplatin (starting dose 65 mg/m(2): 120 min i.v. infusion on weeks 1 and 3); irinotecan (starting dose 80 mg/m(2); 90 min i.v. infusion on weeks 2 and 4) and 5FU (starting dose 1500 mg/m(2); 22 h continuous i.v. infusion, on weeks 1 to 4), in cycles of 5 weeks. DLTs were evaluated during the fi rst cycle.Twenty-eight patients were treated on 8 dose levels and all but two patients received the regimen at least as second-line treatment. The DLT level was reached at the oxaliplatin dose of 90 mg/m(2), irinotecan dose of 110 mg/m(2), LV dose of 500 mg/m(2) and 5FU dose of 1750 mg/m(2); the recommended MTDs were 85 mg/m(2) for oxaliplatin, 110 mg/m(2) for irinotecan, 1750 mg/m(2) for 5FU and 500 mg/m(2) for LV. Grade 3 or 4 diarrhea and grade 3 nausea/vomiting were the dose-limiting events. Diarrhea was the most common toxicity of the regimen, occurring in 12 (42.8%) patients. Hematological toxicity was mild and there were no treatment- related deaths.This weekly regimen showed a favorable toxicity profile and merits further investigation in patients with advanced/metastatic tumors of the GI tract.

Purpose: The study aimed to determine the maximum tolerated doses (MTDs) and identify the dose-limiting toxicities of the biweekly administration of pemetrexed plus gemcitabine in patients with solid tumors. Patients and Methods: Patients with advanced malignancies were treated with escalated doses of gemcitabine and pemetrexed (starting doses 1,250 and 300 mg/m2, respectively) both given on days 1 and 15 in cycles of 4 weeks. Results: Forty-one patients were treated at 7 dose levels. The MTD was reached at the dose of 1,750 mg/m2 for gemcitabine and 450 mg/m2 for pemetrexed. Dose-limiting events were grade IV neutropenia, febrile neutropenia and treatment delay due to grade III hematological toxicities. One partial response in a pretreated patient with ovarian cancer was observed, while 4 other patients experienced stable disease. Conclusions: The biweekly administration of gemcitabine plus pemetrexed at the recommended MTDs is safe, well tolerated and demonstrates antitumor activity which merits further evaluation in phase II studies.

Tumor angiogenesis is considered a multi-pathway process, while p21(WAF1/CiP1) is a CDK inhibitor involved in cell division and survivaL Herein the tumor environment effect on endothelial p21(WAF1/Cip1) expression is examined.The EA.hy 926 endothelial cell line and tumor-conditioned medium (TCM) from the MDA-MB-468 breast cancer cell line were used. Endothelial cells grown alone and in TCM were immunostained for p21(WAF1/Cip1) and analyzed by RT-PCR Forty-four cases of breast cancer and forty-three cases of normal breast tissue were immunostained for p21(WAF1/Cip1).Endothelial p21(WAF1/Cip1) is transcriptionally down-regulated under the influence of TCM. Moreover, it seems that breast cancer tumor endothelium does not express p21(WAF1/Cip1).P21(WAF1/Cip1) plays a major role in angiogenesis, since tumor cells seem to down-regulate endothelial p21(WAF1/Cip1), compared to endothelial cells grown in serum-free medium. The verification of the tissue culture experiment results by immunohistochemistry on tissue sections indicates p21(WAF1/Cip1) as a target of modern molecular therapy.

with lung cancer, elderly had some epidemiologic characteristics that differ from younger ones. These could suggest that elderly lung cancer women had a different natural history and potentially different tumor biology, considering a different molecular event for carcinogenesis. Although stages were similar at diagnostic; excluding surgery, elderly were significantly undertreated. This date is similar for all elderly lung patients. Survival was also poor for elderly and this significant association with stage could be related to this undertreatment. These findings deserve further analysis to evaluate causes for undertreatment, improving understanding of this devastating disease, predominantly in elderly women

Approximately 20% of patients with breast cancer present with locally advanced disease without distant metastases. This phase II double-center trial aimed at investigating the activity of epirubicin (Farmorubicin)--mitoxantrone (Onkotrone/Novantrone) combination as first-line intra-arterial chemotherapy (IAC) in locally advanced breast cancer patients.Thirty-six patients with locally advanced disease and no prior exposure to anthracyclines received the following regimen: epirubicin (Farmorubicin) 30 mg/mq and mitoxantrone (Onkotrone/Novantrone) 10 mg/mq by IAC short infusion on day 1, every 3 weeks for up to six cycles. Prior to IAC an arteriogram of subclavian, internal mammary and lateral thoracic arteries was obtained in all patients, followed by infusion of a blue dye solution into the arteries to determine the most appropriate vessel that supplies the tumor area.Objective responses, confirmed at least 4 weeks after the first documentation, were observed in 25 patients (70%; 95%CI, 62% to 80%): 3 CR, 22 PR. Although three of the patients showed complete tumor regression, operative removal or toilet mastectomy became feasible in 25 patients since tumor shrinkage ranged over 75%. A total of 25 mastectomies were carried out for 36 patients. Four patients had bulky tumors (13 cm tumor diameter), while 8 patients had ulcerated tumors, two of which presented with complete infiltration of normal breast tissue. The median time to progression and median overall survival were 11 and 27 months, respectively. The time to local response was 3 weeks and time to mastectomy was 9 weeks. Transient neurological disorders developed in six patients and skin chemical burns with painful inflammatory reactions were encountered in ten patients. No systemic toxicity was observed in terms of bone marrow depression and hair loss. No cardiotoxicity was observed. In all specimens necrosis was reported (complete 3 cases, partial 16 and minimal 6).A combination of epirubicin (Farmorubicin) and mitoxantrone (Onkotrone/Novantrone) as IAC appears to be a safe and well tolerated treatment for locally advanced breast cancer without clinical evidence of distant metastases. When combined with surgery it offers interesting results in terms of local control and allows a high rate of mastectomies in otherwise inoperable cases.

Aim: More women doctors choose oncology as a career but few are in leadership posts. Following the successful ESMO W4O initiative, a Forum of Women in Oncology in Greece was developed within HeSMO under the auspices of ESMO. Is a professional network of women in all oncology specialties to identify common problems, advocate for solutions and support women in oncology but also women with cancer through educative, awareness and fundraising actions. Methods: A questionnaire adapted from the ESMO survey, was distributed to women members of the Hellenic Societies of Medical, Radiation and Surgical Oncology and other women oncology professionals. Results: HeSMO has 245 members, 19% women. There is increasing number of female young members (GYMO 161 members, 33.5% women) but women Board representation is very limited (1 woman in 7 Board members). Analysis of the initial 60 questionnaires most from women HeSMO members (78%) is presented; responses from all oncology societies will be included in the final presentation. Responders are certified oncologists (85%), 52% in public and university hospitals, 44% in private, 70% mothers usually of 2-3 kids (65%). Most have 1- 10 publications but their name is rarely first or last. Women participate in national conferences (86% in 1-10/yr) but less often in international (55% never) and fewer as invited speakers/ chairs. Women representation at work teams is increasing (38% majority women), but the team leader is usually man (79%). Key professional satisfaction factors are relationship with patients (87%), intellectual stimulation (70%) and fighting a challenging disease (51%), similar to the ESMO survey. More than 1/3 (34%) believe women offer multi-tasking ability and smoother communication (20%). Work-family balance is the main challenge to career progression (63%). More than 1/3 (38%) propose mentorship programs, dedicated posts in boards, women oncologists' network and flexible training. Conclusions: This survey on women oncologists in Greece, the 1st such national effort in Europe, reveals increasing presence of women in oncology workforce but under-representation in leadership similar to the ESMO report. The W4O initiatives identify common problems but also advocate national/ international actions to bridge career inequalities, promote work-family balance, recognize and develop women oncology leaders. Disclosure: All authors have declared no conflicts of interest.

Aim To evaluate the usefulness of the BRAFV600E detection in the daily clinical practice, it's clinical correlations and prognostic/predictive values in a prospective database of patients with mCRC. Patients and methods 442 mCRC patients treated with systemic chemotherapy ± biologics at the Medical Oncology Department of the University Hospital of Heraklion from 1-07-07 were prospectively analyzed. The BRAF mutation was assessed by RT-qPCR using the allelic discrimination method. The laboratory findings were correlated with patients' clinical-pathologic characteristics and the treatment outcome. Results The median age was 68 years of age (21-89) while 37% of them were > 65 old; 61% were male, in 71% of them the primary tumor was located in the colon and in 29% in the rectum 48% of the tumors were low grade and 21% presented mucinous features. Salvage cetuximab or panitumumab therapy was administered to 228 patients with KRASwt tumors. The BRAF mutation was detected in 32 (7.5%) patients. Statistically significant higher incidence of the BRAF mutation was observed in patients with ECOG-PS 2 (p = 0.0001), > 65 years old (p = 0.001), primaries located in the right colon (p = 0.004), lowgrade tumors (p = 0.001) and in those with mucinous features (p = 0.021). Patients whose tumors harbored the BRAF mutation had a reduced progression-free survival (PFS) (4.1 months) compared with the wild-type (wt) (11.4 months, p Conclusion Our results document the unfavorable prognostic value of the BRAFV600E mutation and advocate in favor of its predictive value towards anti-EGFR moAbs therapy. Disclosure All authors have declared no conflicts of interest.