The GLP-1 receptor agonist Liraglutide is effective in reducing HbA1c in type 2 diabetic (T2D) patients. In addition, treatment with Liraglutide is associated with significant weight loss. In this study, we analyzed the inter-relationships between glycemic and weight effects of Liraglutide treatment in a population of type 2 diabetic outpatients. T2D patients initiating Liraglutide therapy since September 2010 to July 2012 at 3 outpatient clinics were enrolled and followed-up. We collected baseline information about anthropometric data, cardiovascular risk factors, diabetes duration, prevalence of complications and history of anti-diabetic medications. We collected HbA1c and body weight at baseline and every 4 months. A total of 166 patients were included, who were on average 56.6 ± 8.9 (mean ± SD) years old and had a baseline HbA1c of 8.7 ± 1.3 % and BMI 36.3 ± 6.4 kg/m(2). Mean follow-up was 9.4 ± 4.2 months (range 4-16). Patients lost on average 1.5 ± 1.3 % HbA1c and 4.0 ± 5.0 kg body weight. Most patients (73.5 %) improved HbA1c and loosed weight. Significant independent determinants of HbA1c drop were baseline HbA1c (r = 0.673; p < 0.001) and previous insulin therapy (r = -0.251; p < 0.001). The only independent determinant of weight loss was baseline BMI (r = 0.429; p < 0.001). Drop in HbA1c was unrelated to baseline BMI or weight loss. Weight loss was unrelated to baseline HbA1c or drop in HbA1c. Glycemic improvement and weight reduction obtained with Liraglutide treatment in T2D patients in a real-world setting are independent and possibly mediated by different mechanisms.

Serum levels of calcitonin (CT) and carcinoembryonic antigen (CEA) were evaluated in a group of 41 patients with histologically proven medullary thyroid carcinoma (MCT) before and sequentially after treatment for a period up to 7 years. Before thyroidectomy, CT levels were high in all patients, and significantly more elevated when metastases were present. On the other hand, CEA levels were high in most but not all the patients, and they also were found more frequently to be elevated in patients with metastases. After treatment, most of the patients without metastases showed persistently normal basal and pentagastrin stimulated CT and CEA levels. In some patients either without or with local metastases, postoperative CT levels, although considerably reduced, remained persistently above normal limits, whereas CEA levels became completely normal. This pattern may be due to the persistence of minute occult foci of the tumor, not sufficient to produce measurable amounts of CEA, which is not synthesized by all tumor cells. Most of the patients with metastases at diagnosis, showed still elevated CT and CEA levels after treatment. In the nonprogressive cases both markers decreased after adjunctive treatment or remained unchanged. In patients with progressive disease, an increase of CEA levels in the absence of a parallel increase of CT levels, which even decreased, was often observed. In one patient with progressive disease high CEA levels were seen for the first time when liver metastases had occurred. These data seem to suggest that, even though CEA production is not recognizable in all patients with MCT, in the CEA positive cases CEA levels may follow a nonparallel pattern and may have a distinct diagnostic meaning with respect to CT levels. In some cases, particularly in advanced disease, CEA may be a more useful marker of poor prognosis.

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Twenty-two advanced consecutive thyroid cancer patients with varying histologies were treated with the so called BAP regime which consisted of bleomycin (B) 30 mg a day for three days, adriamycin (A) 60 mg/m2 iv in day 5, and cisplatinum (P) 60 to mg/m2 iv in day 5. Patients with progressive, symptomatic recurrent or disseminated disease unresponsive to hormonal and/or isotopic treatment were eligible. Nine patients had an objective response: two long-lasting complete and seven partial responses were observed out of 21 evaluable patients. Stable disease was observed in four additional patients. The median duration of response was 12 months (range, 6-29). The total series experienced a median survival of 11 months (range, 1 to 57), with 2 patients actually disease free. Several histologic types of thyroid carcinoma responded, but the best responses were observed in medullary and anaplastic giant-cell carcinomas. Toxicity was reversible in all but one patient. Of the patients failing on BAP chemotherapy three responded to a four drug second line combination containing vincristine, fluorouracil, BCNU and methotrexate. BAP regime can achieve reasonable palliation, and probably increases survival, in poor-prognosis thyroid cancers.

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