1. Association between PIK3CA activating mutations and outcomes in early-stage invasive lobular breast carcinoma treated with adjuvant systemic therapyDomen Ribnikar, Valentina Jerič Horvat, Ivica Ratoša, Zachary Veitch, Biljana Grčar-Kuzmanov, Srdjan Novaković, Erik Langerholc, Eitan Amir, Boštjan Šeruga, 2023, original scientific article Abstract: The aim of the study was to evaluate the independent prognostic role of PIK3CA activating mutationsand an association between PIK3CA activating mutations and efficacy of adjuvant endocrine therapy (ET) in patientswith operable invasive lobular carcinoma (ILC).Patients and methods.A single institution study of patients with early-stage ILC treated between 2003 and 2008 wasperformed. Clinicopathological parameters, systemic therapy exposure and outcomes (distant metastasis-free sur-vival [DMFS] and overall survival [OS]) were collected based on presence or absence of PIK3CA activating mutationin the primary tumor determined using a quantitative polymerase chain reaction (PCR)-based assay. An associationbetween PIK3CA mutation status and prognosis in all patient cohort was analyzed by Kaplan-Meier survival analysis,whereas an association between PIK3CA mutation and ET was analyzed in estrogen receptors (ER) and/or progester-one receptors (PR)-positive group of our patients by the Cox proportional hazards model.Results. Median age at diagnosis of all patients was 62.8 years and median follow-up time was 10.8 years. Among365 patients, PIK3CA activating mutations were identified in 45%. PIK3CA activating mutations were not associatedwith differential DMFS and OS (p = 0.36 and p = 0.42, respectively). In patients with PIK3CA mutation each year oftamoxifen (TAM) or aromatase inhibitor (AI) decreased the risk of death by 27% and 21% in comparison to no ET, re-spectively. The type and duration of ET did not have significant impact on DMFS, however longer duration of ET hada favourable impact on OS.Conclusions. PIK3CA activating mutations are not associated with an impact on DMFS and OS in early-stage ILC.Patients with PIK3CA mutation had a statistically significantly decreased risk of death irrespective of whether theyreceived TAM or an AI.
Keywords: invasive lobular carcinoma, PIK3CA mutation, endocrine therapy
Published in DiRROS: 25.07.2024; Views: 561; Downloads: 147
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2. Outcome of severe infections in afebrile neutropenic cancer patientsKsenija Strojnik, Ksenija Mahkovic Hergouth, Barbara Jezeršek Novaković, Boštjan Šeruga, 2016, original scientific article Abstract: In some neutropenic cancer patients fever may be absent despite microbiologically and/or clinically confirmed infection. We hypothesized that afebrile neutropenic cancer patients with severe infections have worse outcome as compared to cancer patients with febrile neutropenia. Patients and methods. We retrospectively analyzed all adult cancer patients with chemotherapy-induced neutropenia and severe infection, who were admitted to the Intensive Care Unit at our cancer center between 2000 and 2011. The outcome of interest was 30-day in-hospital mortality rate. Association between the febrile status and in-hospital mortality rate was evaluated by the Fishers exact test. Results. We identified 69 episodes of severe neutropenic infections in 65 cancer patients. Among these, 9 (13%) episodes were afebrile. Patients with afebrile neutropenic infection presented with hypotension, severe fatigue with inappetence, shaking chills, altered mental state or cough and all of them eventually deteriorated to severe sepsis or septic shock. Overall 30-day in-hospital mortality rate was 55.1%. Patients with afebrile neutropenic infection had% a trend for a higher 30-day in-hospital mortality rate as compared to patients with febrile neutropenic infection (78% vs. 52%, p = 0.17).
Keywords: afebrile infection, neutropenia, hypothemia, cancer patients
Published in DiRROS: 30.04.2024; Views: 700; Downloads: 306
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6. Impact of comorbidity on the outcome in men with advanced prostate cancer treated with docetaxelAndrej Žist, Eitan Amir, Alberto Ocaña, Boštjan Šeruga, 2015, original scientific article Abstract: Men with metastatic castrate-resistant prostate cancer (mCRPC) may not receive docetaxel in everyday clinical practice due to comorbidities. Here we explore the impact of comorbidity on outcome in men with mCRPC treated with docetaxel in a population-based outcome study. Methods. Men with mCRPC treated with docetaxel at the Institute of Oncology Ljubljana between 2005 and 2012 were eligible. Comorbidity was assessed by the age-adjusted Charlson comorbidity index (aa-CCI) and adult comorbidity evaluation (ACE-27) index. Hospital admissions due to the toxicity and deaths during treatment with docetaxel were used as a measure of tolerability. Association between comorbidity and overall survival (OS) was tested using the Cox proportional hazards analysis. Results. Two hundred and eight men were treated with docetaxel. No, mild, moderate and severe comorbidity was present in 2%, 32%, 53% and 13% using aa-CCI and in 27%, 35%, 29% and 8% when assessed by ACE-27. A substantial dose reduction of docetaxel occurred more often in men with moderate or severe comorbidity as compared to those with no or mild comorbidity. At all comorbidity levels about one-third of men required hospitalization or died during treatment with docetaxel. In univariate analysis a higher level of comorbidity was not associated with worse OS (aa-CCI HR 0.99; [95% CI 0.87%1.13], p = 0.93; ACE-27: HR 0.96; [95% CI 0.79%1.17], p = 0.69).
Keywords: metastatic castration-resistant prostate cancer, prostate cancer, comorbidity, chemotherapy
Published in DiRROS: 22.04.2024; Views: 612; Downloads: 146
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10. Aggressive anticancer treatment in the last 2 weeks of lifeNena Golob, Teja Oblak, Luka Čavka, Maša Kušar, Boštjan Šeruga, 2024, original scientific article Abstract: Background: There is a concern that terminally ill cancer patients may be aggressively treated due to the rapidly growing possibilities of anticancer treatment. The aim of this study was to evaluate the use of anticancer treatment at the end of life (EoL). Materials and methods: This retrospective study included adult patients with advanced solid cancers who were treated at the Institute of Oncology Ljubljana and died of cancer between January 2015 and December 2019. A multiple logistic regression model was used to assess an association between the aggressiveness of anticancer treatment (i.e. systemic therapy, radiotherapy and surgery) in the last 2 weeks of life and year of death, age at death, sex, prognosis of cancer and enrolment into the specialist palliative care (SPC). Results: We included 1736 patients in our analysis. Overall, 13.7% of patients were enrolled into the SPC and 14.4% received anticancer treatment in the last 2 weeks of life. The odds of receiving anticancer treatment significantly increased over time [odds ratio (OR) 1.15, 95% confidence interval (CI) 1.04-1.27]. There was an increased use of novel systemic therapy (e.g. small-molecule targeted therapy and immunotherapy) at the EoL. Older patients had significantly lower odds to receive anticancer treatment in the last 2 weeks of life as compared to younger patients (OR 0.96, 95% CI 0.95-0.98). As compared to patients receiving only a standard oncology care, those also enrolled into the SPC had significantly lower odds for anticancer treatment in the last 2 weeks of life (OR 0.22, 95% CI 0.12-0.43). Conclusions: Terminally ill cancer patients have increased odds for receiving anticancer treatment, especially novel systemic therapies, in the last 2 weeks of life. Younger patients and those not enrolled into the SPC are at particular risk for anticancer treatment at the EoL
Keywords: systemic therapy, aggressive treatment, anticancer drugs, palliative care
Published in DiRROS: 18.04.2024; Views: 623; Downloads: 294
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