BACKGROUND: Increased epidermal growth factor receptor (EGF receptor) expression has been noted in various cancers and has become a useful target for therapeutic interventions. Small studies from Asia and Australia have demonstrated EGFR over-expression in gallbladder cancer. We sought to evaluate the expression of EGFR in a series of 16 gallbladder cancer patients from North America. METHODS: Using tumor registry data, we identified 16 patients diagnosed with gall bladder carcinoma at our medical center between the years of 1998 and 2005. We performed a retrospective review of these patients' charts, obtained cell blocks from pathology archives and stained for EGFR and Her2/neu. RESULTS: Fifteen of sixteen patients were noted to over-express EGFR. Three were determined 1+, nine were 2+ and three were 3+. Eight patients had poorly differentiated adenocarcinoma, six had moderately differentiated and two had well-differentiated tumors. In this small series, there was a trend toward shorter survival and more poorly differentiated tumors in patients with greater intensity of EGFR expression. One patient was EGFR negative but 3+ for erb-2/Her 2-neu expression. No patient co-expressed EGFR and Her-2-neu. Median survival of patients in this series was 17 months. CONCLUSION: In view of our observations confirming the over-expression of EGFR in our patient population in North America, and the recent success of EGFR targeted therapies in other solid tumors that over-express EGFR, it may now be appropriate to evaluate agents targeting this pathway either as single agents or in combination with standard chemotherapy.Key words: gallbladder cancer, endothelial growth factor receptor (EGFR), differentiation, survival, her-2-neu IntroductionApproximately 5000 cases of gallbladder cancer are diagnosed in the United States per year. Higher rates are seen in Latin American countries such as Mexico, Chile and Bolivia, roughly correlating with the higher incidence of cholelithiasis. Various chemotherapy agents, including 5-FU and Gemcitabine, have been evaluated for the management advanced disease but thus far results have been disappointing [1][2][3][4].5 FU plus LV has been the backbone of randomized clinical trials done in the past, demonstrating a RR of 32% and OS of 6months.[5] Combination therapy with 5FU and cisplatin have shown RRs of 10%-40% and median OS better than those observed with 5-FU alone. [5][6][7][8][9][10][11][12] Single agent gemcitabine has been extensively evaluated in patients with metastatic biliary tract tumors with RRs in the range of 0%-30%, with median OS times in the range of 5-14 months.[13-18]Gemcitabine combinations with cisplatin, oxaliplatin or capecitabine have been tested in several clinical trials, which have demonstrated RRs 21%-53% and median OS times 5-15 months; these results are somewhat better than those from single-agent gemcitabine studies. [19][20][21][22][23] A pooled analysis of 112 trial using gemcitabine-based combination regimens confirmed superiority to single agent therapy. Howe...

These exploratory data suggest a positive influence of a palliative resection performed during the disease course of patients with advanced CRC. The increased frequency of utilization and the more prolonged duration of C in the surgically treated patients may in part contribute to this improved survival. This may also be reflective of performance status at the time of diagnosis. Future trials enrolling patients with advanced CRC should prospectively stratify for surgical intervention to further clarify the influence of this modality on the outcome of systemic therapy in this disease.

Gemcitabine is a pyrimidine analog with a similar chemical structure and mechanism of action, as cytarabine. It has been shown to be a highly active agent for non-small cell lung cancer, pancreatic cancer, urothelial cancer, breast cancer and ovarian cancer. Gemcitabine is relatively well tolerated and myelosuppression is the dose-limiting toxicity. Pulmonary toxicity with gemcitabine is relatively uncommon, but a well recognized entity, associated with significant morbidity and mortality. A high index of suspicion, early diagnosis and timely intervention with oxygen supplementation, steroids, and diuretics is necessary to manage patients with this complication.

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Intravenous gammaglobulins are used for the treatment of various auto-immune hematological disorders. Renal failure is a relatively rare, but an increasingly recognized side effect of gammaglobulin therapy. Although the renal failure is usually reversible, renal replacement therapy is required occasionally. A high index of suspicion, early recognition and appropriate intervention can prevent this complication. We herewith describe two patients with an immune hematological disorder, who developed acute renal failure after treatment with intravenous gammaglobulins. A brief review of the possible risk factors, pathophysiology and management of this complication is provided.