Alexander Hann is performing clinical and basic research focusing on pancreatic cancer since his first year as a physician. His career has been started in 2009 at the University Hospital Marburg, Germany, were he studied the molecular mechanisms of pancreatic cancer. During his stay at the Katharinen hospital Stuttgart, Germany, from 2011 to 2015 he extended his research work to clinical studies. His main focus was the application of new chemotherapeutic approaches and the resulting survival benefit. Since 2015 he continued his wok involving clinical and basic research at the University Hospital Ulm, Germany.
Introduction: Chemotherapy regimens for pancreatic ductal adenocarcinoma (PDAC) have changed since the introduction of FOLFIRINOX. Due to toxicity, dosage and number of applied cycles are limited. In analogy to chemotherapy strategies in colon cancer we used a scheme of induction, maintenance and re-induction therapy in PDAC to alleviate such toxicities and increase the number of applied cycles. Here we report first experiences with this approach. Methods: We retrospectively identified all patients who received FOLFIRINOX for metastatic or locally advanced PDAC in our center using the induction and maintenance scheme from 2011 until February 2016. Response to therapy and toxicity of the treatment were assessed until September 2016. Progression free survival was assessed until progression during maintenance or treatment pause (PFS1) and until progression during re-induction therapy (PFS2). Results: 13 patients met the inclusion criteria. The median number of cycles of induction therapy including all three active substances or only 5FU/LV combined with Oxaliplatin was 6 (range 5-13). All patients had stable disease or partial response and received maintenance therapy consisting of 5FU/LV with a median cycle number of 6 (2-21). Re-induction due to progressive disease during treatment pause or maintenance therapy was applied in eleven patients using all three active substances or only 5FU/LV combined with Oxaliplatin, with a median of 4 (1-7) cycles of re-induction therapy. The median PFS1 was 10.6 months. The median PFS2 was 14.1 months. Conclusion: The use of induction treatment with FOLFIRINOX, followed by maintenance therapy with the option of treatment pause and re-induction in case of progressive disease is feasible in the palliative treatment of PDAC patients and might lead to a prolonged progression free survival with less toxicity.
Suchithra Poilil Surendran has completed her M.Sc. in Chemistry from Calicut University, India from 2011-2013. At present she is pursuing her PhD under Prof. Yong Yeon Jeong developing Hepatitis Mice model, therapy using nanoparticle as well as stem cell therapy and conducting pre-clinical testing at Clinical vaccine R& D centre of Chonnam National University Hwasun Hospital, South Korea.
One of the frequent manifestations of liver cirrhosis (LC) regardless of LC etiology is cytopenia, the severity of which is compounded with disease progression. However, the role of bone marrow hematopoiesis in developing cytopenia remains virtually unexplored. The aim of the study was to analyze the blood parameters and marrow aspirate smears in 19 patients with LC (15 men and 4 women, aged between 24 and 67 years, Me 47 years), including 11 cases with LC of viral etiology, 6 patients – of toxic and 2 – of an autoimmune etiology; Child-Pugh class A - 8 (42%), B - 7 (37%), С - 4 (21%) patients. Analysis of hematological parameters revealed that 40% were found to have anemia, 38% - leukopenia and 53% - thrombocytopenia. Twenty per cent of the patients had a combination of these three cytopenias. Bone marrow findings demonstrated that all lineages can appear dysplastic, and marrow failure correlated with blood parameters. Patients with anemia were revealed to have erythroid hyperplasia in association with morphological signs of dyserythropoiesis, such as the intererythroblastic cytoplasmic bridges, normoblast binuclearity etc. Patients with leukopenia showed delayed neutrophil differentiation (from the band to the segmented neutrophil) with a normal index of neutrophil maturation and the reduction of promyelocyte and myelocyte granulation. In patients with thrombocytopenia, demonstrating predominantly normal megakaryocyte numbers, precursors may demonstrate dysplastic features such as an altered ploidy, mononuclear or binuclear micromegakaryocytes, megakaryocytes with degenerative changes (vacuolization of cytoplasm, non-condensed nucleus chromatin). Thus, the bone marrow of patients with liver cirrhosis is characterized by signs of ineffective hematopoiesis and dysplastic changes of karyocytes.