Monoclonal antibodies targeting EGFR and VEGF represent exciting therapeutic strategies that should be further evaluated both in combination with drugs acting on the same target at a different level and in combination with other antisignaling agents acting on different pathways.

Hormonal therapy is the preferred systemic treatment for recurrent or metastatic, post-menopausal hormone-receptor-positive breast cancer. Previous studies have shown that there is no cross-resistance between exemestane and reversible aromatase inhibitors. Exposure to hormonal therapy does not hamper later response to chemotherapy. Patients with locally advanced or metastatic, hormonal receptor positive or unknown, breast cancer were treated with oral anastrozole, until disease progression, followed by oral exemestane until new evidence of disease progression. The primary end point of the study was clinical benefit, defined as the sum of complete responses (CR), partial responses (PR) and 424 weeks stable disease (SD). In all, 100 patients were enrolled in the study. Anastrozole produced eight CR and 19 PR for an overall response rate of 27% (95% CI: 18.6 -36.8%). An additional 46 patients had long-term (424 weeks) SD for an overall clinical benefit of 73% (95% CI: 63.2 -81.4). Median time to progression (TTP) was 11 months (95% CI: 10 -12). A total of 50 patients were evaluated for the second-line treatment: exemestane produced one CR and three PR; 25 patients had SD which lasted X6 months in 18 patients. Median TTP was 5 months. Toxicity of treatment was low. Our study confirms that treatment with sequential hormonal agents can extend the period of time during which endocrine therapy can be used, thereby deferring the decision to use chemotherapy.

From January 2003 to April 2005 we studied 25 lymphoma patients (10 with HD, 4 with low-grade NHL, 6 with high-grade NHL and 5 with chronic lymphatic leukaemia; 14 men, 11 women, age range 28-79 years). After a baseline US study we rapidly injected 4.8 mL of the second-generation microbubble contrast agent SonoVue (Bracco, Italy). Contrast enhanced studies were carried out with the contrast-specific software named Contrast Tuned Imaging (Esaote, Italy) using a continuous, harmonic acquisition and a low acoustic pressure. The CS-US findings were correlated with results of standard tools, including CT, MRI, US follow up. CS-US revealed correctly 47 out of the 52 lesions identified by CT scan, in the absence of false positive findings (sensitivity = 90%; Specificity = 100%, in comparison to CT scan). Complete concordance in evaluating the lesion extension of the CS-US in respect to CT was 88%, while underestimate occurred in 9% and overestimate in 3% of cases. On the contrary, basic sonography defined correctly the dimensional alteration in 52% of the cases, underestimated in 35% and overestimated in 13%, thus showing significantly lower accuracy (chi-square = 30.0, p < 0.001). In our experience, CS-US was superior to conventional sonography even from a qualitative point of view.

No abstract

Anemia significantly affects quality of life of cancer patients, but the impact of hemoglobin levels on survival is still unclear. The aim of this retrospective study was to assess the prognostic role of pre-chemotherapy hemoglobin levels in patients with ovarian cancer. Two hundred twenty-two patients were divided in 3 groups based on baseline hemoglobin levels (< 10 gr/dl (54 pts., 24%); 10-11.9 gr/dl (87 pts., 39%), > or = 12 gr/dl (82 pts., 37%)). Correlations among baseline characteristics (age, ECOG performance status, stage, grading, histology, residual disease after primary surgery) and baseline hemoglobin level were analyzed. Poor performance status (p = 0.03), more advanced stage (p = 0.01), and sub-optimal residual disease (p = 0.002) were more frequent in patients with lower hemoglobin values. There was no significant correlation between baseline hemoglobin level and response rate to subsequent chemotherapy. Based on univariate analysis, hemoglobin categories were statistically significant predictors for time to progression (p = 0.0002) and overall survival (p < 0.0001). Based on multivariate analysis, patients with hemoglobin between 10 and 12 g/dl had a 1.45 hazard ratio (HR) for recurrence and a 1.35 HR of death compared with patients with normal hemoglobin. Patients with hemoglobin < 10 g/dl had a 2.02 HR of recurrence and a 2.49 HR of death compared with patients with normal hemoglobin. These findings show that hemoglobin level prior to chemotherapy is an independent predictor of progression-free survival and overall survival in patients treated for ovarian carcinoma.