BackgroundThe emerging new standard of care for metastatic clear cell renal carcinoma (mRCC) becomes a challenge when access to new drugs is limited. In Serbia, sunitinib and pazopanib are the only available first-line therapies. The second-line treatment for mRCC has never been and is still not available. We aimed to assess overall survival (OS) in patients with mRCC who received first-line sunitinib or pazopanib when access to second-line treatment was not available.MethodsThis retrospective observational study analyzed data from a nationally representative cohort of 759 patients who started on first-line sunitinib or pazopanib between 1 January 2012 and 30 June 2019, in 4 centers in Serbia. The data cut-off date was 31 December 2019. Key eligibility criteria were clear cell RCC histology, measurable metastatic disease, performance status 0 or 1, and the Memorial Sloan Kettering Cancer Center favorable or intermediate prognosis. The primary outcome was OS from the start of first-line treatment to death or data cut-off date.ResultsThe study population included 759 patients with mRCC who started with first-line sunitinib (n = 673; [88.7%]) or pazopanib (n = 86; [11.3%]). Overall, the mean age was 61.0 ± 9.7 years at treatment baseline, and 547 (72%) were men. mRCC was primarily diagnosed in 230 (30%) patients, and most of them underwent cytoreductive nephrectomy prior to systemic therapy (n = 181 [79%]). Additional treatment of metastases prior to and/or during treatment was used in 169 patients (22.3%). Grade 3 and 4 adverse events occurred in 168 (22.1%) and 47 patients (6.2%), respectively, and treatment was permanently stopped because of toxicity in 41 (6.9%). The OS was calculated from the start of first-line treatment, and the median follow-up was 14 months (range, 0–97). The median OS in the entire cohort was 17 months (95% CI, 14.6–19.4).ConclusionsWith only available sunitinib and pazopanib in first-line treatment, modest improvements are seen in the overall survival of patients with mRCC in real world clinical practice. In circumstances of limited availability of cancer medicines, our results can contribute to accelerating patient access to novel cancer therapies that have been shown to prolong survival in mRCC.

BACKGROUND: Ultrasonography and magnetic resonance imaging are the most important imaging techniques in the diagnostics of pancreatic carcinoma and disease staging; they are also very useful in monitoring and follow-up of treatment efficacy. The problems with imaging diagnostics arise in certain cases of pancreatic focal lesions - for example in the differentiation of focal chronic pancreatitis and pancreatic carcinoma. Our objectives were the evaluation of ultrasonography and magnetic resonance imaging reliability and determination of the importance of tumor antigen CA 19-9 in the diagnostics of pancreatic carcinoma. METHODS: Our investigation included patients with pancreatic focal mass suspected of malignancy. All patients were examined by ultrasonography, MR, and ultrasound-guided needle biopsy. Cytopathologic examination of biopsied samples was used to diagnose the disease. Oncomarker levels CA 19-9 were assayed in all patients. RESULTS: Magnetic resonance imaging and ultrasonography examination made possible the correct diagnosis of carcinoma in case of 17 patients; in three patients with focal chronic pancreatitis the diagnosis was false positive. No case of false-negative diagnosis was found. The tumor antigen CA 19-9 in serum was determined and it was clearly positive (above 45U/ml) in all patients (17) with pancreatic cancer. CONCLUSION: Imaging techniques gave good results in the evaluation of pancreatic pathology. However, when using imaging techniques differential diagnosis between focal chronic pancreatitis and pancreatic carcinoma seems to be major problem. Correlation of imaging technique and determination of tumor antigen CA 19-9 has an important role in the diagnostics of pancreatic carcinoma. Imaging techniques and identification of tumor antigen CA 19-9 are complementary methods in the examination and diagnostics of pancreatic carcinoma and they allow better precision of diagnosis of pancreatic focal lesions

Background: Ultrasonography (US) and magnetic resonance (MR) are the most important imaging techniques in the diagnostics of pancreatic carcinoma and disease staging; they are also very useful in monitoring and follow-up of treatment efficacy. The problems with imaging diagnostics arise in certain cases of pancreatic focal lesions - for example in the differentiation of focal chronic pancreatitis and pancreatic carcinoma. Our objectives were the evaluation of US and MR reliability and determination of the importance of oncomarker CA 19-9 in the diagnostics of pancreatic carcinoma. Methods: Our investigation included patients with pancreatic focal mass suspected of malignancy. All patients were examined by ultrasonography, MR, and ultrasound-guided needle biopsy. Cytopathologic examination of the bioptic samples was used to diagnose the disease. Oncomarker CA 19-9 was done in all patients. Results: MR imaging and US examination made possible the correct diagnosis of carcinoma in case of 17 patients; in three patients with focal chronic pancreatitis the diagnosis was false positive. No case of false negative diagnosis was found. The value of oncomarker CA 19-9 was determined and it was clearly positive (over 150 U/ml) in all patients. Conclusion Imaging techniques gave good results in the evaluation of pancreatic pathology. However, when using imaging techniques differential diagnosis between focal chronic pancreatitis and pancreatic carcinoma seems to be major problem. Correlation of imaging technique and identification of CA 19-9 has an important role in the diagnostics of pancreatic carcinoma. Imaging techniques and identification of oncomarker CA 19-9 are complementary methods in the examination and diagnostics of pancreatic carcinoma and they allow better precision of diagnosis of pancreatic focal lesions

BACKGROUND: Malignant fibrous histiocytoma is most common soft tissue sarcoma occurring in late adult life, most in the extremities and in the retroperitoneum, usually developing in deep fascia or skeletal muscle. Because of the aggressive nature of the tumor early and complete surgical removal is indicated. The overall survival rate of patients with malignant fibrous histiocytoma ranges from 36% to 58% at 5 years. Malignant fibrous histiocytoma in Vojvodina is still rare malignancy either in incidence or in mortality in both sexes. The population of Vojvodina is about 2 100 000. METHODS: We used a descriptive epidemiological method to analyze incidence and mortality from malignant fibrous histiocytoma in Vojvodina. This study is based on the Cancer Registry data for the ten-year period from 1993 to 2002. RESULTS: During the observed period 37 cases of malignant fibrous histiocytoma were reported (19 men and 18 women). The average age of patients was 50 years. The body site distribution differed between sexes and malignant fibrous histiocytoma was more common on the trunk (retroperitoneum) in men and on the lower limbs in women. The average annual incidence rate for the observed period was 1.82 per 1 000 000 for both sexes. The incidence rate changed irregularly over the observed period with the peak of 9 cases (4.55 per 1 000 000) in 2001. The overall linear trends of incidence and of mortality showed a slight increasing tendency in both sexes, but not significantly. Concerning mortality, the similar patterns were noticed. The mortality rate was 0.83 per 1 000 000. CONCLUSION: According to epidemiological data we obtained it can be concluded that Province of Vojvodina is not a region with an important risk for malignant fibrous histiocytoma; however, the increase of incidence appearing in both men and women should be taken into account very seriously in future

Metastases to distant organs are the principal cause of death from renal cell carcinoma (RCC). No commonly accepted therapy is available for disseminated RCC at present. The rationale for immunotherapy of RCC is based on the fact that there is no other therapy for advanced cases. Biologic therapies are the only current treatment modalities that have produced promising therapeutic results in metastatic RCC (mRCC). Therapy with cytokines usually has typical and sometimes severe side effects. Response rates and toxicity were higher with combined therapy. The administration of cytokines that augment the function of the immune system can be accomplished safely and without toxicity, provided a rational approach is used. The toxic effects that are frequently observed with combined therapy emphasize the need for careful selection of patients