Evaluation of treatment response for breast cancer:are we entering the era of "biological complete remission"?

Breast cancer is one of the most common malignancies in women. The post-operative recurrence and metastasis are the leading causes of breast cancer-related mortality. In this study, we tried to explore the role of circulating tumor cell （CTC） detection combination PET/CT technology evaluating the prognosis and treatment response of patients with breast cancer; meanwhile, we attempted to assess the concept of ＂biological complete remission＂ （bCR） in this regard. A 56-year-old patient with breast cancer （T2N1M1, stage IV left breast cancer, with metastasis to axillary lymph nodes and lungs） received 6 cycles of salvage treatment with albumin-bound paditaxd plus eapecitaabine and trastuzumah. Then, she underwent CTC detection and PET/CT for efficacy evaluation. CTC detection combination PET/CT is useful for the evaluation of the biological efficacy of therapies for breast cancer. The bCR of the patient appeared earlier than the conventional clinical imaging complete remission and promised the histological （pathological） complete remission. The integrated application of the concepts including bCR, imageological CR, and histological CR can achieve the early and prognosis of breast cancer. accurate assessment of biological therapeutic reponse and

THE STUDY ON POST-REMISSION THERAPIES IN PATIENTS WITH APL AFTER COMPLETE REMISSION INDUCED BY ALL-TRANS RETINOIC ACID

As to determine the effect of post-remission therapy in prolonging survival and duration of remission after complete remission, 50 patients with APL In complete remission Induced by retinolc acid (RA) were divided into three groups randomly: (A) 30 cases, treated by alternate chemotherapy with RA; (B) 10 cases, with RA alone; (C) 10 cases, only with chemotherapy.The survival curves showed mat Group A had the survival time more than 1 year In 87. 4 %, more than 2 year in 80.7%. 26/30 cases were survival and still in remission, the survival curve tend to be a plateau at 16 months. In Group B more than 1 year in 45. 7%. In Group C, more than 1 year In 50%. (Keplan-Meler x2 = 8. 93 P <0. 01).This result showed that the alternate chemotherapy with RA for post- Induction remission therapy could be useful to Improve long-term survivors and to prolong the duration of remission.

Haploidentical hematopoietic stem-cell transplantation for acute myeloid leukemia in first relapse after complete remission by standard induction chemotherapy

Objective To investigate the therapeutic effects of haploidentical hematopoietic stem - cell transplantation ( Haplo - PBSCT) for acute myeloid leukemia in first relapse after complete remission by standard induction chemotherapy. Methods Eighty - nine cases of AML in first relapse after complete remission by standard DA

Pathological Complete Remission in Young Colon Cancer Patient with a Large Liver Metastasis after FOLFOX-4/Bevacizumab Treatment-A Case Report

Introduction. Pathological complete remission of liver metastases is a rare colon cancer treatment outcome with increased 5-year survival of 76%. Case report. Metastatic colorectal cancer patient with pathological complete remission of large hepatic metastasis after palliative chemotherapy in combination with bevacizumab is presented. Solitary liver metastasis measuring 8 cm was observed in computed tomography (CT) scan before combined treatment. The best radiological response during treatment with FOLFOX-4 and bevacizumab therapy was partial remission and patient underwent partial hepatectomy. Since the operation material was free of viable adenocarcinoma cells the effect of FOLFOX-4 in combination with bevacizumab treatment was interpreted as the pathological complete remission. Conclusion. Use of combination chemotherapy and targeted therapy with the aim to reduce initially unresectable liver metastasis is the best option to achieve complete pathological remission and significantly prolong survival.

Effect of Rituximab Versus Mycophenolate Mofetil or Cyclophosphamide as Control in Lupus Nephritis:A Meta-Analysis

Objective:To evaluate the effects of rituximab versus mycophenolate mofetil or cyclophosphamide as control in lupus nephritis by meta-analysis.Methods:A systematic search was carried out up to January 2022,obtaining 7 studies involving 645 participants with lupus nephritis at the commencement of the investigation;198 of them were treated with rituximab,while 447 were treated with mycophenolate mofetil or cyclophosphamide.We determined the odds ratio(OR)and mean difference(MD)with 95%confidence index(CI)to compare rituximab’s efficacy to that of mycophenolate mofetil or cyclophosphamide as control in lupus nephritis using random-or fixed-effects model by dichotomous or continuous techniques.Results:The rituximab group showed significantly higher complete renal remission rate(OR=2.52;95%CI 1.30-4.91,P=0.006)and total renal remission rates(OR=2.22;95%CI 1.36-3.63,P=0.001)than the control group.However,there was no significant difference in terms of end Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)score(MD-1.16;95%CI-2.88-0.57,P=0.19),proteinuria(MD-0.31;95%CI-0.70-0.09,P=0.013),and serum creatinine(MD 0.01;95%CI-0.04-0.07,P=0.64)between the rituximab group and the control.Conclusion:Rituximab exhibited significantly greater complete renal remission rate and total renal remission rates,with no significant difference in terms of shorter-end SLEDAI,proteinuria,and serum creatinine,compared with the control in individuals with lupus nephritis.

COMBINATION CHEMOTHERAPY WITH COBDP IN MALIGNANT LYMPHOMA: AN ANALYSIS OF 64 CASES

From February 1986 to February 1989, 64 patients with malignant lymphoma were treated with COBDP regimen. Of these patients, there were 7 cases with Hodgkin's disease and 57 cases with non Hodgkin's lymphoma. Clinical staging showed 7 stage Ⅰ , 5 stage Ⅱ, 22 stage Ⅲ and 30 stage Ⅳ . The COBDP regimen was carried out as : Cyclophosphamide 600 mg iv on days 1,8; vincristine 2 mg iv on days 1,8; Pingyanymycin long im on days 1, 4, 8, 11; cis-dichlorodiamineplatinum 20 mg iv drip on day 1 - 5 and prednisone 10 mg po tid on day 1 -14. Treatment results showed 39% (25 cases) achieving complete remission (CR) , 52% (33 cases) partial remission (PR) , giving an over-all response rate of 91 % (CR+PR). There was a significant difference in the CR of the untreated patients (56%) and that of the treated ones (28%) (P< 0.05) .However, between two groups of patients, no statistical significance was observed in the median CR duration (> 12 months, vs >9 months) and the median surrivals of the CR patients (> 16. 5 months, vs > 15 months) (P< 0.05). The median survival after CR was significantly longer than that after PR (P<0. 05). The side effects were: anorexia, nausea; vomiting, alopecia and leucopenia without montality or pulmonary complication. The authors believe that COBDP regimen mayserve as the first line attack against walignant lymphomas.

Outcomes of reduction hepatectomy combined with postoperative multidisciplinary therapy for advanced hepatocellular carcinoma

BACKGROUND The prognosis of advanced hepatocellular carcinoma(HCC)that is not indicated for curative hepatectomy remains poor,despite advances in the treatment of HCC,including the development of tyrosine kinase inhibitors(TKIs).The outcomes of reduction hepatectomy and multidisciplinary postoperative treatment for advanced HCC that is not indicated for curative hepatectomy,including those of recently treated cases,should be investigated.AIM To examine the outcomes of combination treatment with reduction hepatectomy and multidisciplinary postoperative treatment for advanced HCC that is not indicated for curative hepatectomy.METHODS Thirty cases of advanced HCC that were not indicated for curative hepatectomy,in which reduction hepatectomy was performed between 2000 and 2018 at the Department of Gastroenterological Surgery I,Hokkaido University Graduate School of Medicine,were divided into postoperative complete remission(POCR)(+)and POCR(-)groups,depending on whether POCR of all evaluable lesions was achieved through postoperative treatment.The cases in the POCR(-)group were subdivided into POCR(-)TKI(+)and POCR(-)TKI(-)groups,depending on whether TKIs were administered postoperatively.RESULTS The 5-year overall survival rate and mean survival time(MST)after reduction hepatectomy were 15.7%and 28.40 mo,respectively,for all cases;37.5%and 56.55 mo,respectively,in the POCR(+)group;and 6.3%and 14.84 mo,respectively,in the POCR(-)group(P=0.0041).Tumor size,major vascular invasion,and the number of tumors in the remnant liver after the reduction hepatectomy were also found to be related to survival outcomes.The number of tumors in the remnant liver was the only factor that differed significantly between the POCR(+)and POCR(-)groups,and POCR was achieved significantly more frequently when≤3 tumors remained in the remnant liver(P=0.0025).The MST was 33.52 mo in the POCR(-)TKI(+)group,which was superior to the MST of 10.74 mo seen in the POCR(-)TKI(-)group(P=0.0473).CONCLUSION Reduction hepatectomy combined with multidisciplinary postoperative treatment for unresectable advanced HCC that was not indicated for curative hepatectomy was effective when POCR was achieved via multidisciplinary postoperative therapy.To achieve POCR,reduction hepatectomy should aim to ensure that≤3 tumors remain in the remnant liver.Even in cases in which POCR is not achieved,combined treatment with reduction hepatectomy and multidisciplinary therapy can improve survival outcomes when TKIs are administered.

The percentage of peripheral blood blasts on day 7 of induction chemotherapy predicts response to therapy and survival in patients with acute myeloid leukemia

Background Rapid clearance of peripheral blood blasts （PBBs） predicts complete remission （CR） and survival in patients with acute myeloid leukemia （AML）.We aimed to explore the correlation between induction therapy response,outcome,and the PBB percentage.Methods Forty-six consecutive patients with de novo AML （excluding acute promyelocytic leukemia） were enrolled in this study.Flow cytometry was performed to identify cells with a leukemia-associated aberrant immunophenotype in the initial bone marrow aspirate and in peripheral blood on day 7 of induction therapy.Results The PBB percentage on day 7 （D7PBBP） was significantly lower in patients who achieved CR （0.03% （0.0%,0.45%）） than in those who did not （10.85% （1.13%,19.38%）; u =-3.92,P 〈0.001）.The CR rate was significantly higher among patients with a D7PBBP of 〈0.945% （84.62%,22/26） than among those with a D7PBBP of 〉0.945% （25.0%,5/20;Х^2 =16.571,P 〈0.001）.D7PBBP was significantly correlated with overall survival （OS; r=-0.437,P=0.003） and relapsefree survival （RFS; r=-0.388,P=0.007）.OS and RFS were significantly higher in patients with a D7PBBP of 〈0.43% than in those with a D7PBBP of 〉0.43% （P 〈0.001 and P=0.039,respectively）.D7PBBP was also found to be an independent prognostic indicator in multivariate analysis for both OS （P=-0.036） and RFS （P=0.035）.Conclusion D7PBBP may be an important risk factor for the achievement of complete remission,for overall survival,and for relapse-free survival.