Oncology
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For patients with refractory bone and soft tissue sarcoma (STS), treatment options have been limited. Ifosfamide is an alkylating agent with well-demonstrated efficacy against STS, and dose-dependent activity. The aim of this retrospective study was to evaluate the response rate, progression-free survival (PFS), progression-free rate (PFR), and median duration of response to high-dose ifosfamide (HDI) as at least second-line chemotherapy for patients with advanced bone sarcoma and STS. ⋯ HDI at a total dose of 14 g/m(2) with mesna is still an active salvage regimen, particularly in patients with synovial sarcomas.
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Sorafenib, a molecular-targeted agent that inhibits tumor cell proliferation and angiogenesis by inhibiting RAF serine-threonine kinase and VEGF, PDGF, Flt-3, c-Kit receptor tyrosine kinase, was approved in Europe and North America in 2007 and in Japan on May 20, 2009. In the 10 months since its approval, sorafenib has been prescribed for more than 3,700 patients with advanced hepatocellular carcinoma (HCC), and its efficacy has been confirmed in many cases. According to the consensus statements of the Japan Society of Hepatology in 2010, sorafenib is recommended for advanced HCC with extrahepatic spread or major vascular invasion such as invasion of the 1st branch of the portal vein or the main portal branch of the portal vein in patients with Child-Pugh A liver function. ⋯ Although cases of CR are rare, it seems that there might be racial differences in terms of gene mutations. Clinical trials for other molecular-targeted agents, including sunitinib, brivanib, or linifanib, are ongoing and their outcomes are eagerly awaited. According to a subanalysis of the SHARP study, it is expected that sorafenib in combination with resection, ablation, TACE or HAIC will markedly prolong the overall survival in early-, intermediate- and advanced- stage HCCs.
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Hepatocellular carcinoma (HCC) is common in Asia, and there were no effective chemotherapeutic agents for advanced HCC. Sorafenib, an oral multikinase inhibitor, has set a milestone in the management of HCC in that it is the first agent to significantly improve the overall survival in patients with advanced HCC in a double-blind, placebo-controlled, phase III study. Sorafenib is now approved in many Asian countries, and further clinical trials are underway. ⋯ Furthermore, sorafenib is expensive, which puts it beyond the reach of most Asian patients. Therefore, the development and customization of a rational approach based on cost, quality of life, and survival are urgently needed. Finally, a practical consensus guideline is needed based on clinical trials in Asia.
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A hepatocyte-specific contrast agent, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA), was approved in Japan in 2008. This contrast agent enhances the blood pool and also is hepatocyte specific: it is taken up by hepatocytes and excreted into the biliary tract. Approximately 50% of the administered dose of Gd-EOB-DTPA is taken up by normal hepatocytes and subsequently excreted into the biliary tract, while the remaining 50% is excreted via the kidney. ⋯ The differentiation of dysplastic nodules from early HCC has remained difficult, even for pathologists specialized in liver tumors, but Gd-EOB-DTPA MRI facilitates an objective diagnosis with accuracy close to that of HCC-specialized pathologists. In conclusion, Gd-EOB-DTPA MRI facilitates the diagnosis of hypervascular advanced HCC and the differentiation of early HCC and dysplastic nodules, which used to be difficult, even with CT during arterial portography, and offers a high accuracy rate. Thus, Gd-EOB-DTPA MRI will have a significant impact on diagnostic algorithm for HCC.