1. Intercalated chemotherapy and erlotinib for advanced NSCLC : high proportion of complete remissions and prolonged progression-free survival among patients with EGFR activating mutationsMatjaž Zwitter, Karmen Stanič, Mirjana Rajer, Izidor Kern, Martina Vrankar, Natalija Edelbaher, Viljem Kovač, 2014, original scientific article Abstract: Background. Pharmaco-dynamic separation of cytotoxic and targeted drugs might avoid their mutual antagonistic effect in the treatment of advanced non-small cell lung cancer (NSCLC). Patients and methods. Eligible patients were treatment-naive with stage IIIB or IV NSCLC. In addition, inclusion was limited to never-smokers or light smokers or, after 2010, to patients with activating epidermal growth-factor receptor (EGFR) mutations. Treatment started with 3-weekly cycles of gemcitabine and cisplatin on days 1, 2 and 4 and erlotinib on days 5 to 15. After 4 to 6 cycles, patients continued with erlotinib maintenance. Results. Fifty-three patients were recruited into the trial: 24 prior to 2010 (of whom 9 were later found to be positive for EGFR mutations), and 29 EGFR mutation-positive patients recruited later. Unfavourable prognostic factors included stage IV disease (51 patients - 96%), performance status 2%3 (11 patients - 21%) and brain metastases (15 patients - 28%). Grade 4 toxicity included 2 cases of neutropenia and 4 thrombo-embolic events. The 15 EGFR negative patients had 33% objective response rate, median progression-free survival (PFS) 6.0 months and median survival 7.6 months. Among 38 EGFR positive patients, complete response (CR) or partial response (PR) were seen in 16 (42.1%) and 17 (44.7%) cases, respectively. PET-CT scanning was performed in 30 patients and confirmed CR and PR in 16 (53.3%) and 9 (30.0%) cases, respectively. Median PFS for EGFR mutated patients was 21.2 months and median survival was 32.5 months. Conclusions. While patients with EGFR negative tumors do not benefit from addition of erlotinib, the intercalated schedule appears most promising for those with EGFR activating mutations.
Keywords: non-small cell lung cancer, EGFR activating mutations, gemicitabine, erlotinib
Published in DiRROS: 11.04.2024; Views: 75; Downloads: 14
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2. Malignant spinal cord compressionMirjana Rajer, Viljem Kovač, 2008, review article Abstract: Malignant spinal cord compression (MSCC) is a common and debilitating neurological complication of cancer. Because of the rapid progression of the neurological dysfunction, it is considered a medical emergency that demands a prompt diagnosis and treatment. Almost all of the MSCC are caused by an epidural compression from a tumour or a bony fragment from the collapsed vertebra affected by the metastasis. The most common of the tumours that metastasize to the spinal cord are breast and lung cancer, followed by lymphoma, myeloma, prostate cancer and sarcoma. Conclusions. The most common symptom of MSCC is pain, followed by muscular weakness and autonomic dysfunction. MRI provides the best information regarding MSCC, so all patientsshould have a MRI as soon as possible. If the MRI is contraindicated, patients should have the CT scan done. All patients with newly diagnosed MSCC should receive corticosteroids immediately, even before the definitive diagnosis is made. Other treatment options are surgery with postoperative radiotherapy, radiotherapy only, specific medical therapies according to the tumour type and symptomatic therapy, (mainly opiates). The decision of treatment modalities should be made according to the NOMS (neurological, oncological, mechanical and systemic) principles. In spite of the advances, the treatment is still palliative and many patients with MSCC have a poor prognosis and a short survival.
Published in DiRROS: 07.03.2024; Views: 108; Downloads: 24
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6. Quantitative analysis of fine needle aspiration biopsy samplesMirjana Rajer, Marko Kmet, 2005, original scientific article Abstract: The fine needle aspiration biopsy (FNAB) is one of the methods used in tumour evaluation. Since a certain number of tumour cells are needed for a complete diagnostic algorithem, we wanted to test how many cells remain in the needle and syringe after routine stains have been made and which factors influence this number. The remaining cells are used in ancillary diagnostic procedures. Material and methods. One hundred fifty two FNAB samples of tumours of the breast, thyroid and lymph nodes were included in our study. We counted the cells which were left in the needle and the syringe after the standard smears had been made. Buerker-Tuerks chamber was used for this purpose. Results. The number of cells depended on the organ from which the cells had been aspirated,on the type of tumour and, in the case of breast cancer, also on thelevel of experience of the FNAB performer. The percentage of samples with too few cells for all modern diagnostic methods (<5x105) is lowest in FNAB of lymph nodes (4.9%), followed by breast (16.7%) and thyroid (18%). Conclusions.We concluded that FNAB in the majority of cases grants a sufficient number of cells for the standard microscopic evaluation and also ancillary diagnostic procedures.
Published in DiRROS: 14.02.2024; Views: 121; Downloads: 26
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7. Mnenje za spremljanje bolnikov po preboleli covidni pljučniciMatjaž Turel, Natalija Edelbaher, Matjaž Fležar, Matevž Harlander, Peter Kecelj, Izidor Kern, Majda Kočar, Peter Kopač, Mitja Košnik, Robert Marčun, Igor Požek, Mirjana Rajer, Irena Šarc, Jurij Šorli, Dušanka Vidovič, Katarina Osolnik, 2021, original scientific article Abstract: Pljučnica je najpogostejši vzrok za težji potek okužbe z virusom SARS-CoV-2 in s hospitalizacijo. Potek covidne pljučnice je lahko različen; infiltrati, vidni na rentgenski sliki, se lahko resorbirajo spontano, včasih pa je potrebno zdravljenje s sistem-skimi glukokortikoidi. Ob odpustu iz bolnišnice zdravljenje običajno še ni končano, zato je Združenje pulmologov Slovenije v želji po enotnem obravnavanju bolnikov s covidno pljučnico izdelalo mnenje za obravnavo in sledenje bolnikov po od-pustu iz bolnišnice. Zavedamo se, da ob novi bolezni ne gre za dokončno priporočilo, saj bodo nova spoznanja o covidni pljučnici zanesljivo zahtevala obnavljanje priporočil.
Keywords: covid-19, mnenja, pljučnica, pulmologija, sistemski glukokortikoidi, covidna pljučnica
Published in DiRROS: 15.12.2021; Views: 1084; Downloads: 197
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