memo - Magazine of European Medical Oncology

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My burning issues in the neoadjuvant treatment for breast cancer

Bergen, Elisabeth; Bartsch, Rupert

2017 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-017-0378-5pmid: 29606978

A combination of anthracyclines and taxanes remains the standard of care for neoadjuvant chemotherapy (NACT) resulting in increased breast conservation rate (BCR) and decreased recurrence rate [1]. Whether pathological complete response (pCR) could be an appropriate surrogate parameter for long-term survival is still a matter of debate. In patients with triple-negative breast cancer (TNBC) and HER2-positive breast cancer (BC), a six to nine times higher risk for relapse has been reported if no pCR was achieved [2, 3]. Within these aggressive subtypes the strongest association between pCR and long-term outcome could be observed [4]. However, a pooled analysis of recently conducted trials could only identify pCR as a surrogate endpoint for improved event-free survival (EFS) and overall survival (OS) on an individual patient level as opposed to the trial level [5]. Even in TNBC, demonstrating that an increased pCR converts into a significant survival benefit would require a study population markedly larger than calculated for previously conducted trials [6, 7].
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Adolescents and young adults with acute lymphoblastic leukemia and acute myeloid leukemia

Ampatzidou, Mirella; Kelaidi, Charikleia; Dworzak, Michael; Polychronopoulou, Sophia

2017 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-017-0345-1

At the therapeutic intersection between children and older adults, the treatment of adolescent and young adults (AYAs) with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) poses unique challenges due to their dismal outcome. In this brief review, we report on the biological features, clinical characteristics and treatment results of a pediatric and AYAs cohort of ALL and AML, treated in our department over a 15-year period. Additionally, we review the recent insights into disease biology, clinical, cytogenetic and molecular characteristics and differences between pediatric patients and AYAs with ALL and AML. In AYAs with ALL, most retrospective trials demonstrated a benefit of pediatric inspired regimens versus adult protocols. Translating the promising pediatric results to the AYAs subgroup, these patients can be successfully treated with risk-adjusted and minimal residual disease (MRD)-guided intensified chemotherapy, with survival rates that can surpass 70%. In AYAs the AML disease is genetically positioned more on the side of adult AML than on that of younger children, but also carries its own specific abnormalities, such as NUP98-NSD1. Toxicity may complicate all phases of treatment (induction and post-induction chemotherapy, hematopoietic stem cell transplantation-HSCT) and accounts for increased mortality, which counterbalances reduced cumulative incidence of relapse (CIR), in comparison with younger children. Intensification of supportive care while maintaining treatment intensity could further improve outcomes of AYAs with leukemia. Cooperative efforts between pediatric and adult hematologists are needed in order to further improve survival of AYAs with ALL and AML.
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LitStream Collection
Cell free nucleic acids as diagnostic and prognostic marker in leukemia

Eini, Maryam; Nojoumi, Seyed; Saki, Mohammad-Amin; Khosravi, Abbas

2017 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-017-0357-x

Nucleic acids in circulation, called cell free DNA (cfDNA) and cell free RNA (cfRNA), have recently been analyzed as suitable diagnostic and prognostic markers in cancer. There have also been several reports about the role of this type of marker in leukemia. The relevant literature was identified by a PubMed search (2000–2017) of English-language literature using the terms “cell free DNA”, “Leukemia” and Micro-RNA. Many quantitative and qualitative cfDNA biomarkers including copy number alteration, mutation, LOH and micro-RNA deregulated expression have been investigated in different studies, indicating promising results to distinguish patients from healthy individuals. The findings of this study indicate that nucleic acids in circulation have a high diagnostic and prognostic value in leukemic patients and, thus, have the potential to be used alongside the usual methods in the management of this disease.
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