Inflammation is one of the early phases in the development of gastric cancer. Therefore, several studies have examined the association of polymorphisms in tumour-necrosis factor-A gene (TNF-A) with gastric cancer risk. This meta-analysis reviews and summarises published evidence for these associations. Searching several databases yielded 24 independent studies that reported on the associations between TNF-A polymorphisms and gastric cancer risk. We analysed available data for the most commonly investigated polymorphisms: TNF-A -308G4A (23 studies), TNF-A -238G4A (9 studies), and TNF-A -857C4T (5 studies). Summary odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated in the random-effects model using the DerSimonian -Laird method. Q-statistic and I 2 -statistic were calculated to examine heterogeneity, and funnel plots were plotted to examine small study effects. The overall ORs (95% CIs) for AG and AA genotypes vs GG genotype for TNF-A -308 were 1.09 (0.94 -1.27) and 1.49 (1.11 -1.99), respectively. For TNF-A -238, the corresponding ORs (95% CIs) were 1.05 (0.84 -1.33) and 1.25 (0.30 -5.26), respectively. The overall ORs (95% CIs) for CT and TT genotypes (vs CC) for TNF-A -857 were 1.06 (0.89 -1.27) and 1.57 (0.91 -2.70), respectively. The statistically significant association between TNF-A -308GG and gastric cancer was limited to western populations. This association showed little heterogeneity (I 2 ¼ 0) and remained consistently strong when analyses were limited to anatomic and histologic subtypes of gastric cancer, or limited to studies in which genotype frequencies were in Hardy -Weinberg equilibrium, or limited to larger studies. These same subgroup analyses did not change results associated with other polymorphisms. In conclusion, TNF-A -308AA genotype was associated with a statistically significant increased risk of gastric cancer, whereas other studied polymorphisms were not. The association between TNF-A -857TT genotype and gastric cancer was near significant, and may become significant if more studies are published.

AI therapy has become a standard of care for the treatment of most postmenopausal women with early-stage breast cancer. Emerging data have demonstrated potential overall survival advantages for AIs subsequent to and directly related to distant recurrence. When the economic burden to society is considered, it appears that all AIs are similarly beneficial on the basis of disease recurrence.

Treatment of heavily pretreated patients with metastatic breast cancer is challenging due to the combination of progressive disease and limited treatment options. As breast cancer in this setting is no longer curable, treatment goals include improvement/maintenance of quality of life, reduction of tumor-related symptoms, and prolonged survival. In the current review we discuss treatment options in late-line metastatic breast cancer, including newer chemotherapeutic agents such as eribulin, a recently approved non-taxane microtubule dynamics inhibitor whose mechanism of action is distinct from that of other tubulin-targeting agents. We also report on a 42-year-old woman with invasive ductal carcinoma (T4 N1 M1), positive for estrogen and progesterone receptors and negative for HER2, who had been heavily pretreated with radiation (to the bone metastases), hormonal therapy, and multiple systemic cytotoxic therapies-including a nanoparticle albumin-bound paclitaxel/bevacizumab/gemcitabine combination, and pegylated liposomal doxorubicin-none of which lasted for more than 4 months (due to progressive disease or toxicity). Upon receiving eribulin (in a clinical trial setting), she remained in stable disease for 21 months and generally tolerated eribulin well (except for thrombocytopenia, which resulted in mild, non-life-threatening gastrointestinal bleeding and was resolved with a dose reduction). This case is consistent with findings from phases 2 and 3 of eribulin in the setting of heavily pretreated metastatic breast cancer. It is discussed in the context of the current treatment goals and treatment modalities in the late-line metastatic breast cancer setting.

The objective of this study is to measure geographic variations in health care cost for the management of actinic keratosis (AK) and examine how health factors influence cost and variations. A retrospective analysis of the MarketScan medical claims database was performed to identify claims for AK. Costs of care, including visits, procedures, and medications were calculated and adjusted for inflation to 2012 USD. Quintiles of health care cost were calculated for geographic location and population density, then variation was represented as the ratio of mean annual costs in the most expensive over the least expensive quintile (Q5:Q1). The cohort includes 488, 324 patients, with a mean age of 53.1AE7.5 years, is 50.1% male and 16.6% have a history of skin cancer. In regression analyses, increasing age, male gender, history of skin cancer, and urban residence were associated (p<.0001) with increased annual cost.The Q5:Q1 for annual total cost for AK care was lowest for the West region (9.85) compared to 6 other regions with Q5:Q1 ranging from 11.28-13.17. However, when further stratified by urban-rural residence, rural areas in the mid-Atlantic have a similar ratio (9.6). Variability in cryotherapy was lowest in the West (7.44) and North Central (7.76) regions; stratified by rural-urban residence, rural areas of the Northeast (6.49) and West (6.80) had the lowest ratios. Variability in the cost of topical medications was higher, with Q5:Q1 ranging from 35.0 to 53.4 by the 7 regions. Ratios adjusted for patient age, gender, and comorbid skin cancer are pending. Geographic variability in spending for other diseases has not correlated with improved outcomes. There is considerable variation in AK management cost within regions and between regions. This may be due to differences in regional practice patterns. Future work should investigate the factors that influence variations and correlate this with patient and disease outcomes.