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Lambertini M, Ceppi M, Cognetti F, Cavazzini G, De Laurentiis M, De Placido S, Michelotti A, Bisagni G, Durando A, Valle E, Scotto T, De Censi A, Turletti A, Benasso M, Barni S, Montemurro F, Puglisi F, Levaggi A, Giraudi S, Bighin C, Bruzzi P, Del Mastro L. Dose-dense adjuvant chemotherapy in premenopausal breast cancer patients: A pooled analysis of the MIG1 and GIM2 phase III studies. Eur J Cancer 2016; 71:34-42. [PMID: 27951450 DOI: 10.1016/j.ejca.2016.10.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/11/2016] [Accepted: 10/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND No evidence exists to recommend a specific chemotherapy regimen in young breast cancer patients. We performed a pooled analysis of two randomised clinical trials to evaluate the efficacy of adjuvant dose-dense chemotherapy in premenopausal breast cancer patients and its impact on the risk of treatment-induced amenorrhoea. PATIENTS AND METHODS In the MIG1 study, node-positive or high-risk node-negative patients were randomised to 6 cycles of fluorouracil/epirubicin/cyclophosphamide every 2 (dose-dense) or 3 (standard-interval) weeks. In the GIM2 study, node-positive patients were randomised to 4 cycles of dose-dense or standard-interval EC or FEC followed by 4 cycles of dose-dense or standard-interval paclitaxel. Using individual patient data, the hazard ratio (HR) for overall survival by means of a Cox proportional hazards model and the odds ratio for treatment-induced amenorrhoea through a logistic regression model were calculated for each study. A meta-analysis of the two studies was performed using the random effect model to compute the parameter estimates. RESULTS A total of 1,549 patients were included. Dose-dense chemotherapy was associated with a significant improved overall survival as compared to standard-interval chemotherapy (HR, 0.71; 95% confidence intervals [CI], 0.54-0.95; p = 0.021). The pooled HRs were 0.78 (95% CI, 0.54-1.12) and 0.65 (95% CI, 0.40-1.06) for patients with hormone receptor-positive and -negative tumours, respectively (interaction p = 0.330). No increased risk of treatment-induced amenorrhoea was observed with dose-dense chemotherapy (odds ratio, 1.00; 95% CI, 0.80-1.25; p = 0.989). CONCLUSION Dose-dense adjuvant chemotherapy may be considered the preferred treatment option in high-risk premenopausal breast cancer patients.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy; Department of Medicine, BrEAST Data Centre, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.
| | - Marcello Ceppi
- Epidemiology Unit, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Francesco Cognetti
- Department of Medical Oncology, Istituto Regina Elena per lo Studio e la Cura dei Tumori, Roma, Italy.
| | | | - Michele De Laurentiis
- Medical Oncology, Istituto Nazionale Tumori-IRCCS Fondazione Pascale, Napoli, Italy.
| | - Sabino De Placido
- Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy.
| | - Andrea Michelotti
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di oncologia, dei trapianti e delle nuove tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
| | - Giancarlo Bisagni
- Medical Oncology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
| | - Antonio Durando
- Breast Unit, Azienda Ospedaliera Universitaria Città della Salute e delle Scienze, Torino, Italy.
| | - Enrichetta Valle
- Medical Oncology, ASL8-Ospedale Oncologico A. Businco, Cagliari, Italy.
| | | | - Andrea De Censi
- S.C. Oncologia Medica, Medical Oncology Unit, E.O. Ospedali Galliera, Genova, Italy.
| | | | - Marco Benasso
- Medical Oncology, Ospedale San Paolo, Savona, Italy.
| | - Sandro Barni
- Medical Oncology, Azienda Ospedaliera, Caravaggio, Treviglio, Bergamo, Italy.
| | - Filippo Montemurro
- Investigative Clinical Oncology, Fondazione del Piemonte per l'Oncologia/Candiolo Cancer Center (IRCCS), Candiolo, Torino, Italy.
| | - Fabio Puglisi
- Department of Oncology, Azienda Ospedaliera di Udine, Udine, Italy.
| | - Alessia Levaggi
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Sara Giraudi
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Claudia Bighin
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Paolo Bruzzi
- Epidemiology Unit, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
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Kotwinski P, Smith G, Cooper J, Sanders J, Ma L, Teis A, Kotwinski D, Mythen M, Pennell DJ, Jones A, Montgomery H. Body Surface Area and Baseline Blood Pressure Predict Subclinical Anthracycline Cardiotoxicity in Women Treated for Early Breast Cancer. PLoS One 2016; 11:e0165262. [PMID: 27911951 PMCID: PMC5135038 DOI: 10.1371/journal.pone.0165262] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/07/2016] [Indexed: 01/06/2023] Open
Abstract
Background and Aims Anthracyclines are highly effective chemotherapeutic agents which may cause long-term cardiac damage (chronic anthracycline cardiotoxicity) and heart failure. The pathogenesis of anthracycline cardiotoxicity remains incompletely understood and individual susceptibility difficult to predict. We sought clinical features which might contribute to improved risk assessment. Methods Subjects were women with early breast cancer, free of pre-existing cardiac disease. Left ventricular ejection fraction was measured using cardiovascular magnetic resonance before and >12 months after anthracycline-based chemotherapy (>3 months post-Trastuzumab). Variables associated with subclinical cardiotoxicity (defined as a fall in left ventricular ejection fraction of ≥5%) were identified by logistic regression. Results One hundred and sixty-five women (mean age 48.3 years at enrollment) completed the study 21.7 months [IQR 18.0–26.8] after starting chemotherapy. All received anthracyclines (98.8% epirubicin, cumulative dose 400 [300–450] mg/m2); 18% Trastuzumab. Baseline blood pressure was elevated (≥140/90mmHg, mean 147.3/86.1mmHg) in 18 subjects. Thirty-four subjects (20.7%) were identified with subclinical cardiotoxicity, independent predictors of which were the number of anthracycline cycles (odds ratio, OR 1.64 [1.17–2.30] per cycle), blood pressure ≥140/90mmHg (OR 5.36 [1.73–17.61]), body surface area (OR 2.08 [1.36–3.20] per standard deviation (0.16m2) increase), and Trastuzumab therapy (OR 3.35 [1.18–9.51]). The resultant predictive-model had an area under the receiver operating characteristics curve of 0.78 [0.70–0.86]. Conclusions We found subclinical cardiotoxicity to be common even within this low risk cohort. Risk of cardiotoxicity was associated with modestly elevated baseline blood pressure–indicating that close attention should be paid to blood pressure in patients considered for anthracycline based chemotherapy. The association with higher body surface area suggests that indexing of anthracycline doses to surface area may not be appropriate for all, and points to the need for additional research in this area.
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Affiliation(s)
- Paul Kotwinski
- Department of Cardiology, North and East Hertfordshire NHS Trust, Stevenage, United Kingdom
- Institute for Human Health and Performance, University College London, London, United Kingdom
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom
- * E-mail:
| | - Gillian Smith
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom
| | - Jackie Cooper
- Centre for Cardiovascular Genetics, University College London, London, United Kingdom
| | - Julie Sanders
- Institute for Human Health and Performance, University College London, London, United Kingdom
- Barts Heart Centre, St Bartholemew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Louise Ma
- Institute for Human Health and Performance, University College London, London, United Kingdom
| | - Albert Teis
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom
- Cardiovascular Imaging Unit, Cardiology Department, Germans Trias i Pujol University Hospital, Badalona. Barcelona, Spain
| | - David Kotwinski
- Institute for Human Health and Performance, University College London, London, United Kingdom
- The Anaesthetic Department, Derriford Hospital, Plymouth, United Kingdom
| | - Michael Mythen
- Department of Anaesthesia and Critical Care, University College London Hospital, London, United Kingdom
- UCL Institute of Cardiovascular Science and NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Dudley J. Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom
| | | | - Hugh Montgomery
- Institute for Human Health and Performance, University College London, London, United Kingdom
- UCL Institute of Cardiovascular Science and NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
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Vasyuk YA, Shkolnik EL, Nesterov VV, Shkolnik LD, Varlan GV. [Cardiooncology: Current Aspects of Prevention of Anthracycline Toxicity]. Kardiologiia 2016; 56:72-79. [PMID: 28290807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Anthracyclines including doxorubicin, epirubicin, daunorubicin, aclarubicin are extensively used as chemotherapeutic agents for treatment of hematological and other malignancies. In cancer therapy anthracyclines are often used in combinations with other chemotherapeutic drugs and agents for molecularly targeted therapy. Anthracyclines are effective and powerful antineoplastic drugs with wide spectrum of application but active use of preparations of this group is limited because of such side effects as cardiotoxicity, myelotoxicity, thromboembolism, alopecia, etc. Cardiotoxicity is the most severe side effect of anthracycline administration. Clinical studies have shown that it is progressive and irreversible. Therefore, early detection and prevention of anthracycline cardiotoxicity has become an important trend in cardiology.
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Affiliation(s)
- Y A Vasyuk
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- City Clinical Hospital of brothers Bakhrushins of Moscow Health Departmen, Russia
| | - E L Shkolnik
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- City Clinical Hospital of brothers Bakhrushins of Moscow Health Departmen, Russia
| | - V V Nesterov
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- City Clinical Hospital of brothers Bakhrushins of Moscow Health Departmen, Russia
| | - L D Shkolnik
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- City Clinical Hospital of brothers Bakhrushins of Moscow Health Departmen, Russia
| | - G V Varlan
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- City Clinical Hospital of brothers Bakhrushins of Moscow Health Departmen, Russia
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Leinert E, Singer S, Janni W, Harbeck N, Weissenbacher T, Rack B, Augustin D, Wischnik A, Kiechle M, Ettl J, Fink V, Schwentner L, Eichler M. The Impact of Age on Quality of Life in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Comparative Analysis From the Prospective Multicenter Randomized ADEBAR trial. Clin Breast Cancer 2016; 17:100-106. [PMID: 27884722 DOI: 10.1016/j.clbc.2016.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/13/2016] [Accepted: 10/12/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Elderly breast cancer patients are affected by poorer quality of life (QoL) compared to younger patients. Because QoL has a relevant impact on guideline-adherent treatment, elderly breast cancer patients are often undertreated, especially with regard to adjuvant chemotherapy, and overall survival is decreased. Thus, understanding the impact of chemotherapy on QoL in elderly patients is crucial. This study compared QoL in patients aged < 65 years and 65 to 70 years receiving adjuvant chemotherapy as a secondary outcome in the prospective randomized multicenter ADEBAR trial. PATIENTS AND METHODS Patients with lymph node-positive breast cancer were prospectively randomized for either sequential anthracycline-taxane or epirubicin/fluorouracil/cyclophosphamid chemotherapy (FEC) therapy. QoL was assessed at baseline (t1), before cycle 4 FEC, and cycle 5 epirubicin/cyclophosphamid-docetaxel (EC-DOC) (t2), 4 weeks after chemotherapy (t3), and 6 weeks after radiation (t4) using the European Organization for Research and Treatment for Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Breast Cancer-Specific Module (QLQ-BR23). We compared patients aged < 65 years and 65 to 70 years with respect to QoL and discontinuation of chemotherapy. RESULTS A total of 1363 patients were enrolled onto the ADEBAR trial, with 16.7% of the patients aged 65 to 70 years. In elderly patients, Eastern Cooperative Oncology Group performance status was higher and global health status and physical functioning were lower at baseline. Global health status decreased between t1 and t3 by 7 points in patients < 65 years and by 11 points in patients 65 to 70 years, and physical functioning decreased in the same period by 13.4 points in patients aged < 65 years and by 15.9 points in patients 65 to 70 years. In both groups, at t4 global health status exceeded baseline by 6 points, and physical functioning was 1.3 points under baseline in patients < 65 years old and 3 points under baseline in patients 65 to 70 years. There was a trend to more fatigue in elderly patients and to more nausea and vomiting while receiving chemotherapy in younger patients at t3. There was a higher dropout rate in patients aged 65 to 70 years (25.7%) than in patients aged < 65 years (16.2%). CONCLUSION There were only small or trivial differences in QoL in patients aged < 65 years versus 65 to 70 years who were receiving adjuvant chemotherapy, although the dropout rate from chemotherapy was notably higher in elderly breast cancer patients.
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Affiliation(s)
- Elena Leinert
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany.
| | - Susanne Singer
- Insitute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Nadia Harbeck
- Breast Cancer Center, University of Munich, Munich, Germany
| | - Tobias Weissenbacher
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Doris Augustin
- Breast Center of Eastern Bavaria, DONAUISAR Hospital, Deggendorf, Germany
| | | | - Marion Kiechle
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Lukas Schwentner
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Martin Eichler
- Insitute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
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Lin XJ, Lao XM, Shi M, Li SP. Changes of HBV DNA After Chemoembolization for Hepatocellular Carcinoma and the Efficacy of Antiviral Treatment. Dig Dis Sci 2016; 61:2465-76. [PMID: 27105647 DOI: 10.1007/s10620-016-4167-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 04/13/2016] [Indexed: 02/07/2023]
Abstract
Unlike systemic chemotherapy for hematological malignancies with hepatitis B virus (HBV) infection, transarterial chemoembolization (TACE) for HBV-related hepatocellular carcinoma (HCC) has only recently been reported to cause HBV reactivation and subsequent hepatitis. Most patients with HBV-related HCC have an underlying disease with liver fibrosis or cirrhosis, and TACE may potentially induce HBV reactivation and liver decompensation. Currently, there are no clinical guidelines for managing TACE-caused HBV reactivation. In this review, we summarize the changes of HBV status and liver function after TACE and the effect of antiviral treatment before, during, or after TACE.
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Affiliation(s)
- Xiao-Jun Lin
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
- State Key Laboratory of Southern China, Guangzhou, 510060, Guangdong, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xiang-Ming Lao
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
- State Key Laboratory of Southern China, Guangzhou, 510060, Guangdong, People's Republic of China.
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, People's Republic of China.
| | - Ming Shi
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
- State Key Laboratory of Southern China, Guangzhou, 510060, Guangdong, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Sheng-Ping Li
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
- State Key Laboratory of Southern China, Guangzhou, 510060, Guangdong, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, People's Republic of China
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Vargas-Neri JL, Castelán-Martínez OD, de Jesús Estrada-Loza M, Betanzos-Cabrera Y, Rivas-Ruiz R. [Anthracycline-induced cardiotoxicity: report of fatal cases]. Rev Med Inst Mex Seguro Soc 2016; 54:404-408. [PMID: 27100990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Anthracyclines are effective drugs in pediatrics cancer treatment. However, anthracycline-induced cardiotoxicity (AIC) is a serious adverse drug reaction that affects the survival in patients treated for childhood cancer. CLINICAL CASES Case 1: Nine-year-old girl with stage IV Hodgkin lymphoma with 12 epirubicin doses and a cumulative dose of 576 mg/m2. After last chemotherapy dose, the patient was admitted with systemic inflammatory response, asthenia and adinamia. Echocardiography: LVEF of 22%, SF 11% and moderate mitral regurgitation. Patient died 2 days after diagnosed with dilated cardiomyopathy secondary to anthracyclines. Case 2: Fifteen-year-old girl with stage IV Burkitt lymphoma with two epirubicin doses and a cumulative dose of 90 mg/m2. After the last cycle, the patient developed several infectious foci. Echocardiography: LVEF of 49%, SF 20% and dilated left ventricle with septal flattening. Patient died 13 days after diagnosis of dilated cardiomyopathy by anthracyclines. CONCLUSION AIC is a problem in pediatric patients receiving anthracyclines, monitoring is essential to detect the onset of cardiac damage to provide an intervention to prevent heart failure progress.
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Affiliation(s)
- Jessica Liliana Vargas-Neri
- Departamento de Farmacología, Centro de Investigación y de Estudios Avanzados, Instituto Politécnico Nacional, Ciudad de México, México.
| | | | | | - Yadira Betanzos-Cabrera
- Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social
| | - Rodolfo Rivas-Ruiz
- Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social; Centro de Adiestramiento en Investigación Clínica (CAIC), División de Investigación en Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social/ Facultad de Medicina, Universidad Nacional Autónoma de México
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Fan C, Georgiou KR, McKinnon RA, Keefe DMK, Howe PRC, Xian CJ. Combination chemotherapy with cyclophosphamide, epirubicin and 5-fluorouracil causes trabecular bone loss, bone marrow cell depletion and marrow adiposity in female rats. J Bone Miner Metab 2016; 34:277-90. [PMID: 26056019 DOI: 10.1007/s00774-015-0679-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 04/19/2015] [Indexed: 12/16/2022]
Abstract
The introduction of anthracyclines to adjuvant chemotherapy has increased survival rates among breast cancer patients. Cyclophosphamide, epirubicin and 5-fluorouracil (CEF) combination therapy is now one of the preferred regimens for treating node-positive breast cancer due to better survival with less toxicity involved. Despite the increasing use of CEF, its potential in causing adverse skeletal effects remains unclear. Using a mature female rat model mimicking the clinical setting, this study examined the effects of CEF treatment on bone and bone marrow in long bones. Following six cycles of CEF treatment (weekly intravenous injections of cyclophosphamide at 10 mg/kg, epirubicin at 2.5 mg/kg and 5-flurouracil at 10 mg/kg), a significant reduction in trabecular bone volume was observed at the metaphysis, which was associated with a reduced serum level of bone formation marker alkaline phosphatase (ALP), increased trends of osteoclast density and osteoclast area at the metaphysis, as well as an increased size of osteoclasts being formed from the bone marrow cells ex vivo. Moreover, a severe reduction of bone marrow cellularity was observed following CEF treatment, which was accompanied by an increase in marrow adipose tissue volume. This increase in marrow adiposity was associated with an expansion in adipocyte size but not in marrow adipocyte density. Overall, this study indicates that six cycles of CEF chemotherapy may induce some bone loss and severe bone marrow damage. Mechanisms for CEF-induced bone/bone marrow pathologies and potential preventive strategies warrant further investigation.
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Affiliation(s)
- Chiaming Fan
- School of Pharmacy and Medical Sciences, and Sansom Institute for Health Research, University of South Australia, City East Campus, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Kristen R Georgiou
- School of Pharmacy and Medical Sciences, and Sansom Institute for Health Research, University of South Australia, City East Campus, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Ross A McKinnon
- School of Pharmacy and Medical Sciences, and Sansom Institute for Health Research, University of South Australia, City East Campus, GPO Box 2471, Adelaide, SA, 5001, Australia
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Bedford Park, SA, 5042, Australia
| | - Dorothy M K Keefe
- School of Pharmacy and Medical Sciences, and Sansom Institute for Health Research, University of South Australia, City East Campus, GPO Box 2471, Adelaide, SA, 5001, Australia
- SA Cancer Service, SA Cancer Clinical Network, SA Health, Adelaide, SA, 5000, Australia
- Centre of Cancer Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Peter R C Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Cory J Xian
- School of Pharmacy and Medical Sciences, and Sansom Institute for Health Research, University of South Australia, City East Campus, GPO Box 2471, Adelaide, SA, 5001, Australia.
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Abstract
Spontaneous cell-cell fusion has been recognized to be an important mechanism for tissue and organ development and repair. In cancer, cell fusion is critically involved in tumourigenesis, metastasis and drug resistance, as illustrated by in vitro experiments. However, there has been no direct detection of tumour cell fusion or hybridization in an in vivo tumour environment, and the features of hybridized cells under selective pressures, such as chemotherapy, are unknown. Here, we expressed two fluorescent marker proteins in the human breast cancer cell line SKBR3 to detect tumour cell hybridization in vivo and performed a xenograft chemotherapy experiment in mice to evaluate the chemotherapeutic response of the hybrids. The mice treated by epirubicin showed that chemotherapy promoted tumour cell hybridization in vivo, which elicited the production of more hybrids in the outer section of the tumour. These results provide the first in vivo evidence of tumour cell fusion and indicate that chemotherapy may contribute to a poor prognosis by enriching for fused cells, which are more malignant. It is therefore necessary to reassess chemotherapy strategies.
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Affiliation(s)
- Bingyu Yan
- State Key Laboratory of Biocontrol, College of Ecology and Evolution, Sun Yat-sen University, #135 Xinggang West, Guangzhou, 510275, China
| | - Jianguo Wang
- State Key Laboratory of Biocontrol, College of Ecology and Evolution, Sun Yat-sen University, #135 Xinggang West, Guangzhou, 510275, China
| | - Li Liu
- State Key Laboratory of Biocontrol, College of Ecology and Evolution, Sun Yat-sen University, #135 Xinggang West, Guangzhou, 510275, China.
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Cainap C, Nagy V, Seicean A, Gherman A, Laszlo I, Lisencu C, Nadim AH, Constantin AM, Cainap S. Results of third-generation epirubicin/cisplatin/xeloda adjuvant chemotherapy in patients with radically resected gastric cancer. J BUON 2016; 21:349-359. [PMID: 27273944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy and toxicity of a third-generation chemotherapy regimen in the adjuvant setting to radically operated patients with gastric cancer. This proposed new adjuvant regimen was also compared with a consecutive retrospective cohort of patients treated with the classic McDonald regimen. METHODS Starting in 2006, a non-randomized prospective phase II study was conducted at the Institute of Oncology of Cluj-Napoca on 40 patients with stage IB-IV radically resected gastric adenocarcinoma. These patients were administered a chemotherapy regimen already considered to be standard treatment in the metastatic setting: ECX (epirubicin, cisplatin, xeloda) and were compared to a retrospective control group consisting of 54 patients, treated between 2001 and 2006 according to McDonald's trial. RESULTS In a previous paper, we reported toxicities and the possible predictive factors for these toxicities; in the present article, we report on the results concerning predictive factors on overall survival (OS) and disease free survival (DFS). The proposed ECX treatment was not less effective than the standard suggested by McDonald's trial. Age was an independent prognostic factor in multivariate analysis. N3 stage was an independent prognostic factor for OS and DFS. N ratio >70% was an independent predictive factor for OS and locoregional disease control. The resection margins were independent prognostic factors for OS and DFS. CONCLUSION The proposed treatment is not less effective compared with the McDonald's trial. Age was an independent prognostic factor in multivariate analysis. N3 stage represented an independent prognostic factor and N ratio >70% was a predictive factor for OS and DFS. The resection margins were proven to be independent prognostic factors for OS and DFS.
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Affiliation(s)
- Calin Cainap
- Prof. Dr. Ion Chiricuta" Institute of Oncology, Department of Medical Oncology, Cluj-Napoca, Romania
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Sharma M, Tuaine J, McLaren B, Waters DL, Black K, Jones LM, McCormick SPA. Chemotherapy Agents Alter Plasma Lipids in Breast Cancer Patients and Show Differential Effects on Lipid Metabolism Genes in Liver Cells. PLoS One 2016; 11:e0148049. [PMID: 26807857 PMCID: PMC4726544 DOI: 10.1371/journal.pone.0148049] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/12/2016] [Indexed: 11/18/2022] Open
Abstract
Cardiovascular complications have emerged as a major concern for cancer patients. Many chemotherapy agents are cardiotoxic and some appear to also alter lipid profiles, although the mechanism for this is unknown. We studied plasma lipid levels in 12 breast cancer patients throughout their chemotherapy. Patients received either four cycles of doxorubicin and cyclophosphamide followed by weekly paclitaxel or three cycles of epirubicin, cyclophosphamide and 5’-fluorouracil followed by three cycles of docetaxel. Patients demonstrated a significant reduction (0.32 mmol/L) in high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (apoA1) levels (0.18 g/L) and an elevation in apolipoprotein B (apoB) levels (0.15 g/L) after treatment. Investigation of the individual chemotherapy agents for their effect on genes involved in lipoprotein metabolism in liver cells showed that doxorubicin decreased ATP binding cassette transporter A1 (ABCA1) via a downregulation of the peroxisomal proliferator activated receptor γ (PPARγ) and liver X receptor α (LXRα) transcription factors. In contrast, ABCA1 levels were not affected by cyclophosphamide or paclitaxel. Likewise, apoA1 levels were reduced by doxorubicin and remained unaffected by cyclophosphamide and paclitaxel. Doxorubicin and paclitaxel both increased apoB protein levels and paclitaxel also decreased low density lipoprotein receptor (LDLR) protein levels. These findings correlate with the observed reduction in HDL-C and apoA1 and increase in apoB levels seen in these patients. The unfavourable lipid profiles produced by some chemotherapy agents may be detrimental in the longer term to cancer patients, especially those already at risk of cardiovascular disease (CVD). This knowledge may be useful in tailoring effective follow-up care plans for cancer survivors.
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Affiliation(s)
- Monika Sharma
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Jo Tuaine
- Southern Blood and Cancer Service, Dunedin Hospital, Dunedin, New Zealand
| | - Blair McLaren
- Southern Blood and Cancer Service, Dunedin Hospital, Dunedin, New Zealand
| | - Debra L. Waters
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Katherine Black
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Lynnette M. Jones
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
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Gitsova S, Kovachev S. [Chemotherapy for Malignancy During Pregnancy - Literature Review.]. Akush Ginekol (Sofiia) 2016; 55:25-30. [PMID: 29370503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In today's dynamic development of modern life, we can unfortunately see more and more often cases of malignant diseases during pregnancy. Therapy of these conditions in pregnant women is a challenge to the doctors, due to concerns for the mother's health, but also the possible risks for the foetus. An additional difficulty is the fact that there are no common algorithms for the treatment. Of great importance is the ges'tation period, because in its different parts, the risks vary in grade. It is believed that up to 10-12th ges.tation week chemotherapy should not be included. The optimal time for the last course is 35th gestation week or three weeks to the due date. The purpose of this review is to examine the benefits and risks of the treatment of malignant diseases during pregnancy for both the mother and the fetus.
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Rahal S, Boher JM, Extra JM, Tarpin C, Charafe-Jauffret E, Lambaudie E, Sabatier R, Thomassin-Piana J, Tallet A, Resbeut M, Houvenaeghel G, Laborde L, Bertucci F, Viens P, Gonçalves A. Immunohistochemical subtypes predict the clinical outcome in high-risk node-negative breast cancer patients treated with adjuvant FEC regimen: results of a single-center retrospective study. BMC Cancer 2015; 15:697. [PMID: 26466893 PMCID: PMC4607139 DOI: 10.1186/s12885-015-1746-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 10/09/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anthracycline-based adjuvant chemotherapy improves survival in patients with high-risk node-negative breast cancer (BC). In this setting, prognostic factors predicting for treatment failure might help selecting among the different available cytotoxic combinations. METHODS Between 1998 and 2008, 757 consecutive patients with node-negative BC treated in our institution with adjuvant FEC (5FU, epirubicin, cyclophosphamide) chemotherapy were identified. Data collection included demographic, clinico-pathological characteristics and treatment information. Molecular subtypes were derived from estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) status and Scarff-Bloom-Richardson (SBR) grade. Disease-free survival (DFS), distant disease-free survival (DDFS) and overall survival (OS) were estimated using the Kaplan-Meier Method, and prognostic factors were examined by multivariate Cox analysis. RESULTS After a median follow-up of 70 months, the 5-year DFS, DDFS and OS were 90.6 % (95 % confidence interval (CI): 88.2-93.1), 92.8 % (95 % CI: 90.7-95) and 95.1 % (95 % CI, 93.3-96.9), respectively. In the multivariate analysis including classical clinico-pathological parameters, only grade 3 maintained a significant and independent adverse prognostic impact. In an alternative multivariate model where ER, PR and grade were replaced by molecular subtypes, only luminal B/HER2-negative and triple-negative subtypes were associated with reduced DFS and DDFS. CONCLUSIONS Node-negative BC patients receiving adjuvant FEC regimen have a favorable outcome. Luminal B/HER2-negative and triple-negative subtypes identify patients with a higher risk of treatment failure, which might warrant more aggressive systemic treatment.
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Affiliation(s)
- S Rahal
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
| | - J M Boher
- Department of Biostatistics, Institut Paoli-Calmettes, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
| | - J M Extra
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
| | - C Tarpin
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
| | - E Charafe-Jauffret
- Department of Biopathology, Institut Paoli-Calmettes, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
- Aix-Marseille University, Marseille, France.
| | - E Lambaudie
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
| | - R Sabatier
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
- Aix-Marseille University, Marseille, France.
| | - J Thomassin-Piana
- Department of Biopathology, Institut Paoli-Calmettes, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
| | - A Tallet
- Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France.
| | - M Resbeut
- Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France.
| | - G Houvenaeghel
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
- Aix-Marseille University, Marseille, France.
| | - L Laborde
- Data Management and Analysis Center, Institut Paoli-Calmettes, Marseille, France.
| | - F Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
- Aix-Marseille University, Marseille, France.
| | - P Viens
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
- Aix-Marseille University, Marseille, France.
| | - A Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
- Aix-Marseille University, Marseille, France.
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Earl HM, Hiller L, Dunn JA, Blenkinsop C, Grybowicz L, Vallier AL, Abraham J, Thomas J, Provenzano E, Hughes-Davies L, Gounaris I, McAdam K, Chan S, Ahmad R, Hickish T, Houston S, Rea D, Bartlett J, Caldas C, Cameron DA, Hayward L. Efficacy of neoadjuvant bevacizumab added to docetaxel followed by fluorouracil, epirubicin, and cyclophosphamide, for women with HER2-negative early breast cancer (ARTemis): an open-label, randomised, phase 3 trial. Lancet Oncol 2015; 16:656-66. [PMID: 25975632 DOI: 10.1016/s1470-2045(15)70137-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The ARTemis trial was developed to assess the efficacy and safety of adding bevacizumab to standard neoadjuvant chemotherapy in HER2-negative early breast cancer. METHODS In this randomised, open-label, phase 3 trial, we enrolled women (≥18 years) with newly diagnosed HER2-negative early invasive breast cancer (radiological tumour size >20 mm, with or without axillary involvement), at 66 centres in the UK. Patients were randomly assigned via a central computerised minimisation procedure to three cycles of docetaxel (100 mg/m(2) once every 21 days) followed by three cycles of fluorouracil (500 mg/m(2)), epirubicin (100 mg/m(2)), and cyclophosphamide (500 mg/m(2)) once every 21 days (D-FEC), without or with four cycles of bevacizumab (15 mg/kg) (Bev+D-FEC). The primary endpoint was pathological complete response, defined as the absence of invasive disease in the breast and axillary lymph nodes, analysed by intention to treat. The trial has completed and follow-up is ongoing. This trial is registered with EudraCT (2008-002322-11), ISRCTN (68502941), and ClinicalTrials.gov (NCT01093235). FINDINGS Between May 7, 2009, and Jan 9, 2013, we randomly allocated 800 participants to D-FEC (n=401) and Bev+D-FEC (n=399). 781 patients were available for the primary endpoint analysis. Significantly more patients in the bevacizumab group achieved a pathological complete response compared with those treated with chemotherapy alone: 87 (22%, 95% CI 18-27) of 388 patients in the Bev+D-FEC group compared with 66 (17%, 13-21) of 393 patients in the D-FEC group (p=0·03). Grade 3 and 4 toxicities were reported at expected levels in both groups, although more patients had grade 4 neutropenia in the Bev+D-FEC group than in the D-FEC group (85 [22%] vs 68 [17%]). INTERPRETATION Addition of four cycles of bevacizumab to D-FEC in HER2-negative early breast cancer significantly improved pathological complete response. However, whether the improvement in pathological complete response will lead to improved disease-free and overall survival outcomes is unknown and will be reported after longer follow-up. Meta-analysis of available neoadjuvant trials is likely to be the only way to define subgroups of early breast cancer that would have clinically significant long-term benefit from bevacizumab treatment. FUNDING Cancer Research UK, Roche, Sanofi-Aventis.
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Affiliation(s)
- Helena M Earl
- University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, and Cambridge Breast Cancer Research Unit Cambridge, Cambridge, UK.
| | - Louise Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Clare Blenkinsop
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Louise Grybowicz
- Cambridge Clinical Trials Unit-Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Anne-Laure Vallier
- Cambridge Clinical Trials Unit-Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Jean Abraham
- University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, and Cambridge Breast Cancer Research Unit Cambridge, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Elena Provenzano
- NIHR Cambridge Biomedical Research Centre, and Cambridge Breast Cancer Research Unit Cambridge, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Ioannis Gounaris
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Cancer Research UK Cambridge Institute, Cambridge, UK
| | - Karen McAdam
- Peterborough City Hospital, Edith Cavell Campus, Peterborough, UK
| | - Stephen Chan
- Nottingham University Hospital (City Campus), Nottingham, UK
| | | | - Tamas Hickish
- Royal Bournemouth Hospital, Bournemouth University, Bournemouth, UK
| | - Stephen Houston
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Daniel Rea
- City Hospital, Dudley Road, Birmingham, UK
| | - John Bartlett
- Ontario Institute for Cancer Research, MaRS Centre, Toronto, Ontario, Canada; Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - Carlos Caldas
- University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, and Cambridge Breast Cancer Research Unit Cambridge, Cambridge, UK; Cancer Research UK Cambridge Institute, Cambridge, UK
| | - David A Cameron
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
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Lee YR, Kang MH, Park HM. Anthracycline-induced cardiomyopathy in a dog treated with epirubicin. Can Vet J 2015; 56:571-574. [PMID: 26028676 PMCID: PMC4431152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An 8-year-old American cocker spaniel dog was diagnosed with dilated cardiomyopathy. Four years earlier, the dog had been diagnosed with multicentric lymphoma and had received 4 cycles of multi-agent chemotherapy, including doxorubicin and epirubicin. The total cumulative dose of epirubicin was 168 mg/m(2). Dilated cardiomyopathy was considered a consequence of epirubicin toxicity.
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Affiliation(s)
| | | | - Hee-Myung Park
- Address all correspondence to Dr. Hee-Myung Park; e-mail:
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Del Mastro L, De Placido S, Bruzzi P, De Laurentiis M, Boni C, Cavazzini G, Durando A, Turletti A, Nisticò C, Valle E, Garrone O, Puglisi F, Montemurro F, Barni S, Ardizzoni A, Gamucci T, Colantuoni G, Giuliano M, Gravina A, Papaldo P, Bighin C, Bisagni G, Forestieri V, Cognetti F. Fluorouracil and dose-dense chemotherapy in adjuvant treatment of patients with early-stage breast cancer: an open-label, 2 × 2 factorial, randomised phase 3 trial. Lancet 2015; 385:1863-72. [PMID: 25740286 DOI: 10.1016/s0140-6736(14)62048-1] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Whether addition of fluorouracil to epirubicin, cyclophosphamide, and paclitaxel (EC-P) is favourable in adjuvant treatment of patients with node-positive breast cancer is controversial, as is the benefit of increased density of dosing. We aimed to address these questions in terms of improvements in disease-free survival. METHODS In this 2 × 2 factorial, open-label, phase 3 trial, we enrolled patients aged 18-70 years with operable, node positive, early-stage breast cancer from 81 Italian centres. Eligible patients were randomly allocated in a 1:1:1:1 ratio with a centralised, interactive online system to receive either dose-dense chemotherapy (administered intravenously every 2 weeks with pegfilgrastim support) with fluorouracil plus EC-P (FEC-P) or EC-P or to receive standard-interval chemotherapy (administered intravenously every 3 weeks) with FEC-P or EC-P. The primary study endpoint was disease-free survival, assessed with the Kaplan-Meier method in the intention-to-treat population. Our primary comparisons were between dose schedule (every 2 weeks vs every 3 weeks) and dose type (FEC-P vs EC-P). This study is registered with ClinicalTrials.gov, number NCT00433420. FINDINGS Between April 24, 2003, and July 3, 2006, we recruited 2091 patients. 88 patients were enrolled in centres that only provided standard-intensity dosing. After a median follow-up of 7·0 years (interquartile range [IQR] 4·5-6·3), 140 (26%) of 545 patients given EC-P every 3 weeks, 157 (29%) of 544 patients given FEC-P every 3 weeks, 111 (22%) of 502 patients given EC-P every 2 weeks, and 113 (23%) of 500 patients given FEC-P every 2 weeks had a disease-free survival event. For the dose-density comparison, disease-free survival at 5 years was 81% (95% CI 79-84) in patients treated every 2 weeks and 76% (74-79) in patients treated every 3 weeks (HR 0·77, 95% CI 0·65-0·92; p=0·004); overall survival rates at 5 years were 94% (93-96) and 89% (87-91; HR 0·65, 0·51-0·84; p=0·001) and for the chemotherapy-type comparison, disease-free survival at 5 years was 78% (75-81) in the FEC-P groups and 79% (76-82) in the EC-P groups (HR 1·06, 0·89-1·25; p=0·561); overall survival rates at 5 years were 91% (89-93) and 92% (90-94; 1·16, 0·91-1·46; p=0·234). Compared with 3 week dosing, chemotherapy every 2 weeks was associated with increased rate of grade 3-4 of anaemia (14 [1·4%] of 988 patients vs two [0·2%] of 984 patients; p=0·002); transaminitis (19 [1·9%] vs four [0·4%]; p=0·001), and myalgias (31 [3·1%] vs 16 [1·6%]; p=0·019), and decreased rates of grade 3-4 neutropenia (147 [14·9%] vs 433 [44·0%]; p<0·0001). Addition of fluorouracil led to increased rates of grade 3-4 neutropenia (354 [34·5%] of 1025 patients on FEC-P vs 250 [24·2%] of 1032 patients on EC-P; p<0·0001), fever (nine [0·9%] vs two [0·2%]), nausea (47 [4·6%] vs 28 [2·7%]), and vomiting (32 [3·1%] vs 15 [1·4%]). INTERPRETATION In patients with node-positive early breast cancer, dose-dense adjuvant chemotherapy improved disease-free survival compared with standard interval chemotherapy. Addition of fluorouracil to a sequential EC-P regimen was not associated with an improved disease-free survival outcome. FUNDING Bristol-Myers Squibb, Pharmacia, and Dompè Biotec.
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Affiliation(s)
- Lucia Del Mastro
- Department of Medical Oncology, IRCCS AOU San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Sabino De Placido
- Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | - Paolo Bruzzi
- Epidemiology Unit, IRCCS AOU San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | | | - Corrado Boni
- Medical Oncology, IRCCS Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | | | - Antonio Durando
- Breast Unit, Azienda Ospedaliera Universitaria Città della Saute e delle Scienze, Torino, Italy
| | | | - Cecilia Nisticò
- Department of Medical Oncology, Istituto Regina Elena per lo Studio e la Cura dei Tumori, Roma, Italy
| | - Enrichetta Valle
- Medical Oncology, ASL8-Ospedale Oncologico, A Businco, Cagliari, Italy
| | - Ornella Garrone
- Department of Medical Oncology, Ospedale di Insegnamento S Croce e Carle, Cuneo, Italy
| | - Fabio Puglisi
- Department of Oncology, Azienda Ospedaliera di Udine, Udine, Italy
| | - Filippo Montemurro
- Investigative Clinical Oncology, Fondazione del Piemonte per l'Oncologia/Candiolo Cancer Center (IRCCS), Candiolo, Torino, Italy
| | - Sandro Barni
- Medical Oncology, Azienda Ospedaliera, Caravaggio, Treviglio, Bergamo, Italy
| | - Andrea Ardizzoni
- Medical Oncology, Azienda Ospedaliera Universitaria, Parma, Italy
| | - Teresa Gamucci
- Medical Oncology, ASL Frosinone, Ospedale SS, Trinità, Sora, Frosinone, Italy
| | | | - Mario Giuliano
- Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | - Adriano Gravina
- Medical Oncology, Istituto Nazionale Tumori-IRCCS Fondazione Pascale, Napoli, Italy
| | - Paola Papaldo
- Department of Medical Oncology, Istituto Regina Elena per lo Studio e la Cura dei Tumori, Roma, Italy
| | - Claudia Bighin
- Department of Medical Oncology, IRCCS AOU San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Giancarlo Bisagni
- Medical Oncology, IRCCS Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | - Valeria Forestieri
- Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | - Francesco Cognetti
- Department of Medical Oncology, Istituto Regina Elena per lo Studio e la Cura dei Tumori, Roma, Italy
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Brehler ACE, Hartmann W, Wiebe S, Kerkhoff A, Schliemann C, Palmes D, Senninger N, Lenze F, Ullerich H, Berdel WE, Kessler T. Perioperative chemotherapy in gastroesophageal cancer. A retrospective monocenter evaluation of 42 cases. PLoS One 2015; 10:e0122974. [PMID: 25855972 PMCID: PMC4391860 DOI: 10.1371/journal.pone.0122974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/12/2015] [Indexed: 11/18/2022] Open
Abstract
Background Perioperative chemotherapy increases the overall and progression-free survival of patients suffering from resectable adenocarcinomas of the lower esophagus, gastroesophageal junction and stomach (GEC). Comparing different chemotherapy regimens platin-based protocols with 5-fluorouracil (5-FU)/calcium folinate (CF) or oral fluoropyrimidines were favorable in terms of efficacy and side-effects. However, there is no consensus which regimen is the most efficacious. Methods 42 consecutive patients with resectable GEC (UICC II and III) were treated with 3 pre- and postoperative chemotherapy cycles each consisting of epirubicin, oxaliplatin and capecitabine (EOX). We analyzed the overall survival, progression-free survival and toxicity retrospectively in comparison to published data. Results The median overall survival in our cohort was 29 months and the progression-free survival was 17 months. The most frequent grade 3 and 4 toxicities during preoperative chemotherapy were diarrhea (16.7%), leukocytopenia (9.5%) and nausea (9.5%); overall 38.1% of our patients suffered from grade 3 or 4 toxicity. Surgery was carried out in 83% of our patients, 69% of those achieved R0 resection. Conclusion Comparing our data with the results of previously published randomized trials EOX is at least non-inferior with regard to overall survival, progression-free survival and toxicity. In conclusion, EOX is an appropriate perioperative therapy for patients with resectable GEC.
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Affiliation(s)
| | - Wolfgang Hartmann
- Gerhard Domagk Institute of Pathology, University of Muenster, Muenster, Germany
| | - Stefanie Wiebe
- Department of Medicine, Hematology and Oncology, University of Muenster, Muenster, Germany
| | - Andrea Kerkhoff
- Department of Medicine, Hematology and Oncology, University of Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine, Hematology and Oncology, University of Muenster, Muenster, Germany
| | - Daniel Palmes
- Department of General and Visceral Surgery, University of Muenster, Muenster, Germany
| | - Norbert Senninger
- Department of General and Visceral Surgery, University of Muenster, Muenster, Germany
| | - Frank Lenze
- Department of Medicine, Gastroenterology, University of Muenster, Muenster, Germany
| | - Hansjoerg Ullerich
- Department of Medicine, Gastroenterology, University of Muenster, Muenster, Germany
| | - Wolfgang E. Berdel
- Department of Medicine, Hematology and Oncology, University of Muenster, Muenster, Germany
| | - Torsten Kessler
- Department of Medicine, Hematology and Oncology, University of Muenster, Muenster, Germany
- * E-mail:
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Pasello G, Carli P, Canova F, Bonanno L, Polo V, Zago G, Urso L, Conte P, Favaretto A. Epirubicin plus paclitaxel regimen as second-line treatment of patients with small-cell lung cancer. Anticancer Res 2015; 35:2183-2189. [PMID: 25862876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM Most patients with small cell lung cancer (SCLC) experience relapse within one year after first-line treatment. The aim of this study was to describe activity and safety of second-line with epirubicin at 70 mg/m(2) followed by paclitaxel at 135 mg/m(2) on day 1 every three weeks for a maximum of six cycles. PATIENTS AND METHODS This is a retrospective review of all patients with SCLC evaluated for second-line treatment between 2003 and 2013 at our Institution. RESULTS Sixty-eight patients received the study regimen of epirubicin with paclitaxel. We observed partial response in 19 (30%), stable disease in 22 (34%) and total early failure rate in 23 (36%) patients. Median progression free and overall survival were 21.8 and 26.5 weeks, respectively. Haematological toxicities were as follows: grade 3-4 leukopenia and neutropenia in 18 (31%) and 30 (22%) of patients, respectively; grade 3 anaemia and grade 4 thrombocytopenia were reported in 2 (3%) and 5 (9%) of patients, respectively. CONCLUSION Epirubicin with paclitaxel is an active and tolerable second-line regimen in patients with SCLC.
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Affiliation(s)
- Giulia Pasello
- Medical Oncology 2, Venetian Oncological Institute, Padova, Italy
| | - Paolo Carli
- Medical Oncology Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Fabio Canova
- Medical Oncology 2, Venetian Oncological Institute, Padova, Italy
| | - Laura Bonanno
- Medical Oncology 2, Venetian Oncological Institute, Padova, Italy
| | - Valentina Polo
- Medical Oncology 2, Venetian Oncological Institute, Padova, Italy
| | - Giulia Zago
- Medical Oncology 2, Venetian Oncological Institute, Padova, Italy
| | - Loredana Urso
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Pierfranco Conte
- Medical Oncology 2, Venetian Oncological Institute, Padova, Italy Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Adolfo Favaretto
- Medical Oncology 2, Venetian Oncological Institute, Padova, Italy
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Miguel I, Winckler P, Sousa M, Cardoso C, Moreira A, Brito M. Febrile neutropenia in FEC-D regimen for early stage breast cancer: is there a place for G-CSF primary prophylaxis? Breast Dis 2015; 35:167-171. [PMID: 26406541 DOI: 10.3233/bd-150411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Breast cancer clinical trials prove better outcomes for anthracycline-taxane regimes albeit of a higher hematologic toxicity. Original trials may under-estimate febrile neutropenia (FN) event rates. OBJECTIVE To describe the occurrence of FN events related to FEC-D for breast cancer treatment in the real-life setting. METHODS Retrospective analysis of 189 patients with non-metastatic breast cancer consecutively treated with FEC-D (3 cycles of 5-FU, Epirubicin and Cyclophosphamide followed by 3 cycles of Docetaxel) at our Center during 33 months. FN and related dose delay and reduction, regimen change, G-CSF prophylaxis and hospitalization were analyzed. RESULTS Fifty-one patients (27%) developed at least one episode of FN during FEC-D, 21% during Docetaxel cycles. There were 61 (5.6%) FN episodes in 1100 cycles of FEC-D administered, 77% occurred during Docetaxel cycles (46% on the first D cycle). G-CSF was used in 5.8% of cycles. Hospital admission needed in 54.1% of FN events, 16.4% prompted dose reduction and 23% next cycle delay. There were no FN related deaths. CONCLUSIONS G-CSF prophylaxis is recommended for chemotherapy regimens associated with a FN rate higher than 20%. Based on our FN rates, we now recommend primary G-CSF prophylaxis during the administration of cycles 4 to 6 in FEC-D.
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Tawada A, Chiba T, Ooka Y, Kanogawa N, Saito T, Motoyama T, Ogasawara S, Suzuki E, Kanai F, Yoshikawa M, Yokosuka O. Transarterial chemoembolization with miriplatin plus epirubicin in patients with hepatocellular carcinoma. Anticancer Res 2015; 35:549-554. [PMID: 25550601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM We aimed to evaluate the therapeutic efficacy of transcatheter arterial chemoembolization (TACE) using miriplatin plus epirubicin in unresectable hepatocellular carcinoma (HCC). PATIENTS AND METHODS The efficacy of TACE was evaluated by dynamic computed tomography (CT) or magnetic resonance imaging (MRI) three months after the procedure according to the Response Evaluation Criteria in Cancer Study Group of Japan. Adverse events (AEs), including clinical symptoms, hematological toxicities and blood chemistry toxicities, were assessed using Common Terminology Criteria Version 4.0. RESULTS Thirty patients with HCC received TACE with miriplatin (miriplatin group) and 29 patients received TACE with miriplatin plus epirubicin (miriplatin-plus-epirubicin group). AEs, such as anorexia and neutropenia, were observed more frequently in the miriplatin-plus-epirubicin group than in the miriplatin group (p=0.028 and 0.014, respectively). However, there was no significant difference in the incidence of these AEs (grade 3/4) between groups. The objective response rate (ORR), including the complete response (CR) and partial response (PR), was 76.7% in the miriplatin group and 58.6% in the miriplatin-plus-epirubicin group (p=0.224). The median time to progression (TTP) in the miriplatin group and the miriplatin-plus-epirubicin group was 8.2 and 6.1 months, respectively (p=0.123). CONCLUSION Although TACE with miriplatin plus epirubicin was safe and tolerable, no additional anti-tumor effects were observed compared to TACE with miriplatin. Further analysis is required to refine the efficacy of TACE using miriplatin plus epirubicin.
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Affiliation(s)
- Akinobu Tawada
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoko Saito
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tenyu Motoyama
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiichiro Suzuki
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Fumihiko Kanai
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaharu Yoshikawa
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Carcinoma in Situ/drug therapy
- Carcinoma in Situ/genetics
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/genetics
- Cyclophosphamide/adverse effects
- Docetaxel
- Epirubicin/adverse effects
- Female
- Fluorouracil/adverse effects
- Genes, BRCA2
- Humans
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/genetics
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/genetics
- Taxoids/adverse effects
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Affiliation(s)
- Armin Rashidi
- Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8056, St. Louis, MO, 63110, USA,
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Enami A, Masuda N, Yamamura J, Mizutani M, Yasojima H, Shikata A, Masaoka M, Takada S, Bamba N, Yamamoto M, Abe M, Makihara K. [Therapeutic effect of rebamipide for oral mucositis associated with FEC therapy for breast cancer]. Gan To Kagaku Ryoho 2014; 41:1407-1412. [PMID: 25434444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
No guidelines for supportive drug therapy have been established for oral mucositis occurring during cancer chemotherapy. We retrospectively examined the progression of oral mucositis in 91 patients with breast cancer who received the 5-fluorouracil, epirubicin, and cyclophosphamide (FEC)-100 regimen between September 2007 and August 2008. Daily rebamipide was administered to patients with oral mucositis as per hospital protocol to evaluate the hypothesized preventive and mucosal protective effects of rebamipide(Mucosta®). Oral mucositis was observed in 43 patients (47%)during 4 courses of FEC. The median age of the patients was 55 years(range, 32-76 years). Of the 91 patients, 49 patients who did not receive rebamipide during the 4 FEC courses were classified as group A, 14 patients who received rebamipide before the start of FEC were classified as group B, and 28 patients who received rebamipide after developing oral mucositis were classified as group C. The incidence of oral mucositis at the start of FEC with or without rebamipide administration was observed in 5 patients in group B (36%) and 38 patients in groups A and C (49%) (p=0.3472). The mucositis grade was G1 in 4 patients and G2 in 1 patient in group B, and G1 in 20 patients and G2 plus G3 in 18 patients in groups A and C (p=0.2467). In group C, the grade decreased in 25 patients (89%) and did not occur (G0) in 17 patients (61%) during the next course, and 15 patients (54%) continued to the final course without any occurrence of mucositis. These results suggest that rebamipide is effective for the treatment of oral mucositis. Although significant differences were not observed in the groups, rebamipide has the potential to prevent development of oral mucositis and alleviate its symptoms, and seems promising as a new supportive drug therapy. We hope to verify the preventive and protective effects of rebamipide by conducting a prospective, randomized trial while treating oral mucositis with basic oral care and appropriate interventions provided by a multidisciplinary team.
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Affiliation(s)
- Akiko Enami
- Dept. of Nursing,National Hospital Organization Osaka National Hospital
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72
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Kameda K, Kiba T, Ogawa Y, Kimoto S, Kajiume S, Okada Y, Morii N, Takahashi H, Ichiba Y, Yamashiro H. [Effect of dexamethasone on vascular pain caused by the administration of fosaprepitant dimeglumine and epirubicin hydrochloride in patients with primary breast cancer]. Gan To Kagaku Ryoho 2014; 41:1255-1257. [PMID: 25335710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Epirubicin hydrochloride injection is indicated as a therapy for patients with primary breast cancer. This drug has been reclassified as a drug with high emetic potential according to the American Society of Clinical Oncology Guidelines for Antiemetics in Oncology. Therefore, patients who receive this agent should also receive fosaprepitant dimeglumine, an anti-emetic agent. However, it has been reported that fosaprepitant induces vascular pain when used in anthracycline-based regimens administered via the peripheral veins. In order to relieve the fosaprepitant and epirubicin-induced vascular pain associated with vasculitis, dexamethasone was administered at the onset of vascular pain. There is a possibility that the fosaprepitant and epirubicin-induced pain may improve owing to the administration of dexamethasone; however, further trials are required to confirm the effect of this method.
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Affiliation(s)
- Keita Kameda
- Dept. of Pharmacy, National Hospital Organization Kure Medical Center and Chugoku Cancer Center
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73
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Hall E, Cameron D, Waters R, Barrett-Lee P, Ellis P, Russell S, Bliss JM, Hopwood P. Comparison of patient reported quality of life and impact of treatment side effects experienced with a taxane-containing regimen and standard anthracycline based chemotherapy for early breast cancer: 6 year results from the UK TACT trial (CRUK/01/001). Eur J Cancer 2014; 50:2375-89. [PMID: 25065293 PMCID: PMC4166460 DOI: 10.1016/j.ejca.2014.06.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/08/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The TACT trial (CRUK/01/001) compared adjuvant sequential FEC-docetaxel (FEC-D) chemotherapy with standard anthracycline-based chemotherapy of similar duration in women with early breast cancer. Results at a median of 5 years suggested no improvement in disease-free survival with FEC-D. Given differing toxicity profiles of the regimens, the impact on quality of life (QL) was explored. METHODS Patients from 44 centres completed standardised QL questionnaires before chemotherapy, after cycles 4 and 8, at 9, 12, 18 and 24 months and at 6 years follow-up. Patient diaries assessed frequency, associated distress and impact on daily activity of 15 treatment related side effects. FINDINGS 830 patients (415 FEC-D; 415 controls) contributed assessments during 0-24 months; 362 of whom participated again at 6 years. During chemotherapy, FEC-D impaired global health/QL and depression rates and significantly more QL domains than standard regimens. Novel diary card ratings highlighted significantly more distress and interference with daily activities due to FEC-D side effects compared with standard treatment. In both groups, most QL parameters returned to baseline levels by 2 years and were unchanged at 6 years. INTERPRETATION Within expected negative effects of chemotherapy on wide ranging QL domains FEC-D patients reported greater toxicity, disruption and distress during treatment with no improvement in disease outcome at 5 years than patients receiving standard anthracycline-based chemotherapy. Findings should inform future patients of relative costs and benefits of adjuvant chemotherapy.
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Affiliation(s)
- E Hall
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK.
| | - D Cameron
- Edinburgh Cancer Research Centre, Western General Hospital, University of Edinburgh, UK
| | - R Waters
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - P Barrett-Lee
- Academic Breast Unit, Velindre Cancer Centre, Velindre NHS Trust, Cardiff, UK
| | - P Ellis
- Department of Medical Oncology, Guy's & St Thomas' Foundation Trust, London, UK
| | - S Russell
- Cancer Clinical Trials Team, Information Services Division, Edinburgh, UK
| | - J M Bliss
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - P Hopwood
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
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Selle F, Wittnebel S, Biron P, Gravis G, Roubaud G, Bui BN, Delva R, Bay JO, Fléchon A, Geoffrois L, Caty A, Soares DG, de Revel T, Fizazi K, Gligorov J, Micléa JM, Dubot C, Provent S, Temby I, Gaulet M, Horn E, Brindel I, Lotz JP. A phase II trial of high-dose chemotherapy (HDCT) supported by hematopoietic stem-cell transplantation (HSCT) in germ-cell tumors (GCTs) patients failing cisplatin-based chemotherapy: the Multicentric TAXIF II study. Ann Oncol 2014; 25:1775-1782. [PMID: 24894084 DOI: 10.1093/annonc/mdu198] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-dose chemotherapy (HDCT) is an effective salvage treatment of germ-cell tumors (GCTs) patients. In the first salvage setting, 30%-70% of patients may achieve durable remissions. Even when HDCT is administered as subsequent salvage treatment, up to 20% of patients may still be definitively cured. However, patients with refractory/relapsed disease still have a very poor long-term prognosis, requiring earlier intervention of HDCT. PATIENTS AND METHODS This phase II trial was addressed to nonrefractory patients failing Cisplatin-based chemotherapy. Inclusion criteria included seminomatous GCT in relapse after two lines of chemotherapy, nonseminomatous GCT in relapse after first or second lines, partial remission after first line, primary mediastinal GCT in first relapse. Patients received two cycles combining Epirubicin and Paclitaxel (Epi-Tax), followed by three consecutive HDCT, one using a Paclitaxel/Thiotepa (Thio-Tax) association and two using the 5-day Ifosfamide-Carboplatin-Etoposide regimen. The main objective was to determine the complete response rate. RESULTS Forty-five patients were included between September 2004 and December 2007: 44 received the first HDCT cycle, 39 two HDCT cycles, 29 could receive the whole protocol. Sixteen patients did not receive the entire protocol, including eight (17.7%) for toxic side-effects. Two patients (4.4%) died of toxicities, and 17 (37.7%) of disease progression. With a median follow-up time of 26 months (range, 4-51), the final overall response rate was 48.8% (including a complete response rate of 15.5% and a partial response/negative serum markers rate of 26.6%) in an intent-to-treat analysis. The median progression-free survival (PFS) and overall survival (OS) times were 22 months [95% confidence interval (CI) 2-not reached] and 32 months (95% CI 4-49), respectively. The 2-year PFS was a plateau setup at 50% (95% CI 32-67) and the 2-year OS was 66% (95% CI 44-81). CONCLUSION The TAXIF II protocol was effective in nonrefractory GCT patients failing Cisplatin-based chemotherapy. The toxic death rate remained acceptable in the field of HDCT regimens. TRIAL REGISTRATION NUMBER NCT00231582.
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Affiliation(s)
- F Selle
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris; Sorbonne Universités, Université Pierre et Marie Curie (UPMC Univ Paris 06), Paris.
| | - S Wittnebel
- Department of Medicine, Institut Gustave Roussy, Villejuif
| | - P Biron
- Department of Medical Oncology, Centre Léon Bérard, Lyon
| | - G Gravis
- Department of Medical Oncology, Institut Paoli Calmette, Marseille
| | - G Roubaud
- Department of Medicine, Institut Bergonié, Bordeaux
| | - B N Bui
- Department of Medicine, Institut Bergonié, Bordeaux
| | - R Delva
- Department of Chemotherapy, Centre Paul Papin, Angers
| | - J O Bay
- Department of Medicine, Centre Hospitalier Universitaire, Clermont-Ferrand
| | - A Fléchon
- Department of Medical Oncology, Centre Léon Bérard, Lyon
| | - L Geoffrois
- Department of Medicine, Centre Alexis Vautrin, Nancy
| | - A Caty
- Department of Medicine, Centre Oscar Lambret, Lille
| | - D G Soares
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris
| | - T de Revel
- Department of Hematology, Hôpital D'Instruction des Armées Percy, Clamart
| | - K Fizazi
- Department of Medicine, Institut Gustave Roussy, Villejuif
| | - J Gligorov
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris; Sorbonne Universités, Université Pierre et Marie Curie (UPMC Univ Paris 06), Paris
| | - J M Micléa
- Cytapheresis and Cell Therapy Unit, Hôpital St Louis (AP-HP), Paris
| | - C Dubot
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris
| | - S Provent
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris
| | - I Temby
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris
| | - M Gaulet
- Statistic, 3ES-Cegedim Strategic Data, Boulogne, France
| | - E Horn
- Department of Internal Medicine, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - I Brindel
- Department of Clinical Research, Hôpital St Louis (AP-HP), Paris, France
| | - J P Lotz
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris; Sorbonne Universités, Université Pierre et Marie Curie (UPMC Univ Paris 06), Paris
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Tirmazy SH, Barthakur U, El-Modir A, Anwar S, Fernando I. Chemotherapy for advanced endometrial cancer with carboplatin and epirubicin. Anticancer Res 2014; 34:3793-3798. [PMID: 24982404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Endometrial cancer is the most common gynecological cancer in the Western world. In early-stage disease, surgery remains the mainstay of treatment. Adjuvant pelvic radiotherapy reduces the risk of pelvic recurrence, however, without improvement in overall survival. The aim of the present study was to assess the efficacy and toxicity of carboplatin and epirubicin combination chemotherapy for patients with advanced and high-risk endometrial cancer. PATIENTS AND METHODS Between 1999 and 2007, 43 patients with endometrial cancer were treated with carboplatin and epirubicin. Two groups were identified: Group 1 (n=34) included patients with stage III endometrial cancer receiving adjuvant chemotherapy; and group 2 included those with metastatic endometrial cancer (n=9). RESULTS After a median follow-up of 37 months, disease in 19 patients had progressed/relapsed (12 patients from group 1; 7 from group 2) and 23 patients had died (15 from group 1; 8 from group 2). The median time-to-progression was 62 months and median overall survival was 64 months. The median survival for patients in group 1 was 69 months and for those in group 2 was 22 months. Ten patients (27.9%) experienced grade 3 or 4 toxicities. There were no cases of treatment-related cardiac failure or neuropathy. CONCLUSION Cisplatin, carboplatin, anthracyclines and taxanes are the most active agents in endometrial cancer. Combination chemotherapy leads to better progression-free survival and overall survival, however, this is at the expense of increased toxicity. RESULTS from our study show that the combination of carboplatin and epirubicin is an effective alternative regimen for patients with advanced endometrial cancer. In addition, treatment-related toxicity is minimal when compared to anthracyclines and platinum agents. There is a particular advantage of this regimen over taxane-based regimens, including minimal neuropathy, less use of steroids and low risk of allergic reaction and alopecia.
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Affiliation(s)
- Syed Hammad Tirmazy
- The Cancer Center, University Hospitals of Birmingham NHS Trust, Birmingham, U.K.
| | - Urmila Barthakur
- The Cancer Center, University Hospitals of Birmingham NHS Trust, Birmingham, U.K
| | - Ahmed El-Modir
- The Cancer Center, University Hospitals of Birmingham NHS Trust, Birmingham, U.K
| | - Suhail Anwar
- The Cancer Center, University Hospitals of Birmingham NHS Trust, Birmingham, U.K
| | - Indrajit Fernando
- The Cancer Center, University Hospitals of Birmingham NHS Trust, Birmingham, U.K
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Shibata K, Suzuki A, Suzuki T, Sato T, Yamagishi T, Kimura S, Kimura W. [A patient with advanced breast cancer who developed bacterial meningitis after chemotherapy]. Gan To Kagaku Ryoho 2014; 41:769-771. [PMID: 25129092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 76-year-old woman was admitted to our hospital because of a right breast tumor and a skin ulcer. The patient was diagnosed as having advanced breast cancer T4bN2M1(lung), Stage IV. A regimen of 5-fluorouracil(500mg/m2)with epirubicin(100mg/m / 2)and cyclophosphamide(500mg/m2)(FEC100)was administered. However, the patient was hospitalized 12 days later because of febrile neutropenia. The patient experienced a stiff neck the next day, and bacterial meningitis was diagnosed on the basis of cerebrospinal fluid examination. Antibacterial agents were administered according to the clinical practice guidelines of bacterial meningitis. The patient recovered and was discharged from our hospital 24 days after admission. Bacterial meningitis after chemotherapy is rare, but this could be progress to a serious condition. Early diagnosis and treatment are paramount in such cases.
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Affiliation(s)
- Kenichi Shibata
- Dept. of Gastroenterological, General, Breast and Thyroid Surgery, Yamagata University Faculty of Medicine
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Schenone AD, Luo J, Montgomery L, Morgensztern D, Adkins DR, Van Tine BA. Risk-stratified patients with resectable soft tissue sarcoma benefit from epirubicin-based adjuvant chemotherapy. Cancer Med 2014; 3:603-12. [PMID: 24574357 PMCID: PMC4101751 DOI: 10.1002/cam4.209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 01/18/2014] [Accepted: 01/20/2014] [Indexed: 01/21/2023] Open
Abstract
As adjuvant chemotherapy (AC) for soft tissue sarcomas is controversial, we performed a retrospective analysis of patients seen at Washington University in St. Louis to evaluate whether it benefited our patient population. Patients were risk-assessed using the Memorial Sloan Kettering Predictive Nomogram (MSKPN). We defined high-risk patients by a MSKPN 4-year postoperative probability of sarcoma-specific death of ≥0.3 and investigated if they benefited from AC. Retrospective review was performed on patients seen between 15 February 1996 and 6 February 2010. A propensity score method in the logistic regression framework was used to model the likelihood of receiving AC. To make causal inference on the effect of AC on survival outcomes, a propensity score inverse probability of treatment weighting approach was applied to survival analysis. Overall, 135 high-grade patients were assessed, 33 were treated with Ifosfamide/Epirubicin (I/Epi) and 102 were non AC patients. The stratified MSKPN risk was not significantly associated with any survival endpoint in the whole cohort, but trended for overall survival (OS) when evaluated against non AC patients. After adjustment for MSKPN risk and other variables, patients not receiving chemotherapy had significantly worse OS, recurrent free survival, and disease-specific survival (DSS) with adjusted hazard ratios of 4.18 (95% CI: 2.22-7.90), 8.96 (95% CI: 3.85-20.83), and 5.42 (95% CI: 2.09-14.06), respectively. In retrospective analyses, risk-stratified patients with soft tissue sarcoma benefited from I/Epi-based AC. Randomized I/Epi versus I/Doxorubicin clinical trials may determine the optimal adjuvant treatment.
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Affiliation(s)
- Aaron D Schenone
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, 63110, Missouri; College of Medicine, Des Moines University, Des Moines, 50312, Iowa
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Jary M, Ghiringhelli F, Jacquin M, Fein F, Nguyen T, Cleau D, Nerich V, El Gani M, Mathieu P, Valmary-Degano S, Arnould L, Lassabe C, Lamfichekh N, Fratté S, Paget-Bailly S, Bonnetain F, Borg C, Kim S. Phase II multicentre study of efficacy and feasibility of dose-intensified preoperative weekly cisplatin, epirubicin, and paclitaxel (PET) in resectable gastroesophageal cancer. Cancer Chemother Pharmacol 2014; 74:141-50. [PMID: 24824852 DOI: 10.1007/s00280-014-2482-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/06/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Perioperative chemotherapy improves the overall survival of resectable gastroesophageal adenocarcinoma (GEA) patients. However, more than 40 % of the patients are not healthy enough to complete their post-operative chemotherapy, and the progression-free survival rate is lower than 35 % at 5 years. In order to optimise neoadjuvant chemotherapy regimen, a pilot study of weekly dose-intensified cisplatin, epirubicin, and paclitaxel (PET) was conducted. The primary objective was a complete resection (R0) rate. Then, a R0 rate ≤80 % was considered as uninteresting, with an expected R0 rate of 92 %. Secondary objectives were the feasibility, safety, histological response rate (Becker score), and survival (Trial registration: NCT01830270). METHODS Patients with >T1N0M0 GEA were included. Treatment consisted of eight preoperative cycles of weekly PET regimen at 30/50/80 mg/m² of cisplatin, epirubicin, and paclitaxel, respectively. Primary prophylaxis by granulocyte colony-stimulating factor was administered. Surgery was performed 4-6 weeks following the last cycle of chemotherapy. Using Fleming two-step design with a unilateral alpha type one error of 5 % and a statistical power of 80 %, it would be required to include 68 patients. At planned interim analysis for futility, it was required to observe at least 25 of 29 patients with R0 resection to pursue inclusion. At the second step, it was required to observe at least 61 of 68 patients with R0 resection to conclude for promising activity of the dose-intensified chemotherapy. RESULTS Between May 2011 and January 2013, 29 patients were enrolled. Median age was 62 years (range 39-83 years), and seven (24 %) patients presented signet-ring cell histology. Twenty-seven (93 %) patients underwent surgery. Pathological complete responses (Becker score 1a) were observed in four patients, and nearly complete responses (Becker score 1b) for additional three patients. A R0 rate was achieved for 24 of 29 (82.7 %; 95 % CI 64-94 %) patients. No Becker score 1a/1b response was observed among patients with signet-ring cell GEA. Twenty-one (72 %) patients completed all eight cycles, and 86 % received seven or more cycles. Sixteen (56 %) patients experienced grade 3-4 neutropenia, and five patients had febrile neutropenia. Among non-haematological toxicities, mucositis and fatigue were the most frequent ones. The median-delivered relative dose intensity (DI) was 80 % for cisplatin, 75 % for epirubicin, and 79 % for paclitaxel. However, only 45 % of the patients received at least 80 % of the planned median DI for all three drugs. CONCLUSIONS Despite high R0 and pathological response rates, neoadjuvant PET chemotherapy did not meet the primary end-point and failed to show an acceptable relative DI. PET chemotherapy is not recommended in resectable GEA patients.
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Affiliation(s)
- Marine Jary
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
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Song Y, Yang L, Zhou A, Chi Y, Wang J. [Treatment and prognosis of 117 patients with advanced urothelial carcinoma of the bladder]. Zhonghua Zhong Liu Za Zhi 2014; 36:212-216. [PMID: 24785283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the clinical characteristics, treatment and prognosis of advanced urothelial carcinoma of the bladder (AUCB). METHODS The clinicopathological data of 117 patients with AUCB admitted in our hospital from 1998 to 2009 were reviewed. All patients received first-line chemotherapy. The survival rate was calculated by Kaplan-Meier analysis and log-rank test. RESULTS The median age of all patients was 56 years and the male-to-female ratio was 3.33:1. Their 6-, 12-, 24-, 36- and 60-month survival rates were 90.3%, 61.3%, 32.3%, 24.2% and 8.1%, respectively. In the first-line chemotherapy regimen, the effectiveness rate of gemcitabine + platinum drugs was 49.3% (37/75), the median progression-free survival(PFS) was 7.9 months and overall survival (OS) was 18.7 months. The effectiveness of cyclophosphamide + epirubicin + platinum drug regimen was 45.5% (10/22), Median PFS was 7.1 months and OS was 15.3 months. The effectiveness of paclitaxel + platinum drug regimen was 47.1% (8/17), median PFS was 6.5 months and OS was 13.7 months. Among them, the effectiveness rate of the gemcitabine + cisplatin regimen in 67 patients was 47.8%, the median PFS was 7.0 months and OS was 15.3 months. In the 13 patients who received paclitaxel + carboplatin regimen, the effectiveness rate was 53.8%, median PFS was 7.7 months and OS was 16.0 months. The major side effects were leucopenia and thrombocytopenia, mostly were tolerable, of grade I to II. CONCLUSIONS In advanced unresectable and metastatic urothelial carcinoma of the bladder, GC regimen is recognized as a standard first-line chemotherapy, with a higher effectiveness and tolerable side effects. Taxane and molecular targeted drugs may further improve the therapeutic effect of the treatment of advanced urothelial carcinomas of the bladder in the future.
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Affiliation(s)
- Yan Song
- Department of Medical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Lin Yang
- Department of Medical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Aiping Zhou
- Department of Medical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yihebali Chi
- Department of Medical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jinwan Wang
- Department of Medical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Takanen S, Bangrazi C, Caiazzo R, Raffetto N, Tombolini V. Multiple bone metastases from glioblastoma multiforme without local brain relapse: a case report and review of the literature. Tumori 2014. [PMID: 24362877 DOI: 10.1700/1377.15323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Extracranial metastases from glioblastoma multiforme (GBM) are a very rare event, even if an increasing incidence has been documented. We report the case of a young woman with primary GBM who developed bone metastases without local brain relapse. Because of persistent headache and visual disturbances, in March 2011 the patient underwent magnetic resonance imaging (MRI) evidencing a temporoparietal mass, which was surgically resected. Histology revealed GBM. She was given concomitant chemoradiotherapy according to the Stupp regimen. After a 4-week break, the patient received 6 cycles of adjuvant temozolomide according to the standard 5-day schedule every 28 days. In December 2011 she complained of progressive low back pain, and MRI showed multiple bone metastases from primary GBM, confirmed by histology. Cases of metastatic GBM in concurrence with a primary brain tumor or local relapse are more common in the literature; only a few cases have been reported where extracranial metastases from GBM occurred without any relapse in the brain. Here we report our experience.
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Joensuu H, Kellokumpu-Lehtinen PL, Huovinen R, Jukkola-Vuorinen A, Tanner M, Kokko R, Ahlgren J, Auvinen P, Saarni O, Helle L, Villman K, Nyandoto P, Nilsson G, Leinonen M, Kataja V, Bono P, Lindman H. Outcome of patients with HER2-positive breast cancer treated with or without adjuvant trastuzumab in the Finland Capecitabine Trial (FinXX). Acta Oncol 2014; 53:186-94. [PMID: 23957715 PMCID: PMC3894716 DOI: 10.3109/0284186x.2013.820840] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background. Little information is available about survival outcomes of patients with HER2-positive early breast cancer treated with adjuvant capecitabine-containing chemotherapy with or without trastuzumab. Patients and methods. One thousand and five hundred patients with early breast cancer were entered to the Finland Capecitabine trial (FinXX) between January 2004 and May 2007, and were randomly assigned to receive either three cycles of adjuvant TX (docetaxel, capecitabine) followed by three cycles of CEX (cyclophosphamide, epirubicin, capecitabine; TX-CEX) or three cycles of docetaxel followed by three cycles of CEF (cyclophosphamide, epirubicin, fluorouracil; T-CEF). The primary endpoint was recurrence-free survival (RFS). The study protocol was amended in May 2005 while study accrual was ongoing to allow adjuvant trastuzumab for patients with HER2-positive cancer. Of the 284 patients with HER2-positive cancer accrued to FinXX, 176 (62.0%) received trastuzumab after amending the study protocol, 131 for 12 months and 45 for nine weeks. The median follow-up time was 6.7 years. Results. Patients with HER2-positive cancer who received trastuzumab had better RFS than those who did not (five-year RFS 89.2% vs. 75.9%; HR 0.41, 95% CI 0.23–0.72; p = 0.001). Patients treated with trastuzumab for 12 months or nine weeks had similar RFS. There was no significant interaction between trastuzumab administration and the type of chemotherapy. Four (2.3%) patients treated with trastuzumab had heart failure or left ventricular dysfunction, three of these received capecitabine. Conclusion. Adjuvant trastuzumab improves RFS of patients treated with TX-CEX or T-CEF. Few patients had cardiac failure.
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Affiliation(s)
- Heikki Joensuu
- Department of Oncology, Helsinki University Central Hospital , Helsinki , Finland
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McCarthy N, Boyle F, Zdenkowski N, Bull J, Leong E, Simpson A, Kannourakis G, Francis PA, Chirgwin J, Abdi E, Gebski V, Veillard AS, Zannino D, Wilcken N, Reaby L, Lindsay DF, Badger HD, Forbes JF. Neoadjuvant chemotherapy with sequential anthracycline-docetaxel with gemcitabine for large operable or locally advanced breast cancer: ANZ 0502 (NeoGem). Breast 2014; 23:142-51. [PMID: 24393617 DOI: 10.1016/j.breast.2013.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/04/2013] [Accepted: 12/04/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy has a sound rationale for use in women with large operable breast cancer, and achievement of pathological complete response (pCR) is prognostic. Epirubicin and cyclophosphamide followed by docetaxel is a standard chemotherapy regimen for early breast cancer. In metastatic breast cancer the combination of gemcitabine and a taxane has shown promising results. This phase II study investigated the efficacy and safety of incorporating gemcitabine into neoadjuvant therapy. METHODS Female patients with operable breast cancer that was clinically T2 (≥3 cm) or T3-4, N0-1, M0 were enrolled to receive 24 weeks of neoadjuvant chemotherapy using epirubicin and cyclophosphamide followed by docetaxel and gemcitabine, plus trastuzumab if HER2-positive. The primary endpoint was the pathological complete response (pCR) rate in the breast in separate HER2-negative and HER2-positive cohorts. Secondary endpoints included pCR in both the breast and axillary lymph nodes, clinical and radiological response rates, disease free survival and safety. RESULTS 81 patients were enrolled: 63 HER2-negative and 18 HER2-positive. 67 (84%) completed all cycles of chemotherapy, and 78 (96%) proceeded to surgery. pCR was achieved by 12 (20%) patients with HER2-negative, and 9 (53%) with HER2-positive disease. At the first interim analysis, addition of prophylactic G-CSF was recommended due to excess neutropenia. The HER2-negative cohort was closed to accrual because it did not meet the pre-specified target for pCR, and the HER2-positive cohort was closed due to slow accrual. At a median follow-up of 24 months, 12 of 81 (15%) patients had experienced a relapse of their breast cancer. CONCLUSION Neoadjuvant gemcitabine, when added to docetaxel, after epirubicin and cyclophosphamide, did not reach the pre-specified expectations for pCR rate in HER2-negative tumours. Excess neutropenia was observed, requiring growth factor support. Addition of gemcitabine to docetaxel in this schedule cannot be recommended. Australia and New Zealand Clinical Trials Registry (www.anzctr.org.au) registration number ACTRN12606000191594.
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Affiliation(s)
- N McCarthy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD 4029, Australia; University of Queensland, Brisbane, QLD, Australia.
| | - F Boyle
- The Mater Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - N Zdenkowski
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia
| | - J Bull
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - E Leong
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - A Simpson
- Wellington Cancer Centre, Wellington Hospital, Wellington, New Zealand
| | - G Kannourakis
- Ballarat Oncology and Haematology Service, Ballarat, VIC, Australia
| | - P A Francis
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Medicine, St. Vincent's Hospital, University of Melbourne, VIC, Australia
| | - J Chirgwin
- University of Newcastle, Newcastle, NSW, Australia; Box Hill Hospital, Box Hill, VIC, Australia; Maroondah Breast Clinic, Maroondah Hospital, Ringwood East, VIC, Australia; Monash University, VIC, Australia
| | - E Abdi
- Tweed Hospital, Tweed Heads, NSW, Australia; Griffith University- Gold Coast, Southport, QLD, Australia
| | - V Gebski
- National Health and Medical Research Council Clinical Trials Centre, Sydney, NSW, Australia
| | - A S Veillard
- National Health and Medical Research Council Clinical Trials Centre, Sydney, NSW, Australia
| | - D Zannino
- National Health and Medical Research Council Clinical Trials Centre, Sydney, NSW, Australia
| | - N Wilcken
- Westmead Cancer Care Centre, Westmead Hospital, University of Sydney, NSW, Australia
| | - L Reaby
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - D F Lindsay
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - H D Badger
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - J F Forbes
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia; Department of Surgical Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
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Özgül N, Köse MF, Keskin HL, Turan AT, Karalök MA, Üreyen I, Borani N, Tulunay HG. Addition of epirubicin to conventional chemotherapy in patients with advanced ovarian cancer: sequential therapy -a retrospective evaluation. Turk J Med Sci 2014; 44:212-219. [PMID: 25536727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
AIM To evaluate the effectiveness of the addition of epirubicin to conventional chemotherapy as a first-line therapy for stage III-IV epithelial ovarian cancer. MATERIALS AND METHODS A total of 132 patients who had undergone primary cytoreductive surgery between January 1998 and March 2003 were enrolled in the study. Twenty-four cases were excluded. Out of the remaining 108 subjects, 35 received epirubicin/paclitaxel/ carboplatin (Group EPC) and 73 were treated with paclitaxel/platinum (cisplatin.or carboplatin) (Group PC). RESULTS The median follow-up period was 66.5 months. The clinical complete response was 94% in the EPC group and 97% in the PC group. The recurrence rate in the first 6 months after treatment was significantly higher in the PC than the EPC group (47% vs. 23%, P = 0.018). Triplet chemotherapy was not found to improve 2- and 5-year disease-free survival (DFS) statistically. No significant difference in overall survival was observed between the 2 groups (80% vs. 83% at 2 years and 56% vs. 57% at 5 years for the PC and the EPC group, respectively). The main toxicity in both groups was hematological, and it was particularly severe in the EPC group. CONCLUSION The addition of epirubicin to the standard treatment protocol yielded an improvement in the DFS rate that was not statistically significant and caused a tolerable increase in toxicity.
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Liu L, Liu ZZ, Liu YY, Zheng ZD, Liang XF, Han YL, Xie XD. [Preventive effect of low-dose carvedilol combined with candesartan on the cardiotoxicity of anthracycline drugs in the adjuvant chemotherapy of breast cancer]. Zhonghua Zhong Liu Za Zhi 2013; 35:936-940. [PMID: 24506965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the effect of low-dose carvedilol combined with candesartan in the prevention of acute and chronic cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer. METHODS Forty patients were randomly divided into two groups: the experimental group with chemotherapy plus low-dose carvedilol combined with candesartan (20 cases) and control group with chemotherapy alone (20 cases). The same chemotherapy was given to the two groups. All the 40 patients had no contraindication for carvedilol and candesartan. Patients of the experimental group received low-dose carvedilol from 2.5 mg orally twice a day at first cycle to 5 mg twice a day gradually if no side reactions, and candesartan 2.5 mg orally once a day. Electrocardiogram, ultrasonic cardiogram, arrhythmia, troponin and non-hematologic toxicity were recorded and compared after the second, forth and sixth cycle of chemotherapy. Each cycle included 21 days. RESULTS LVEF was decreased along with the prolongation of chemotherapy in the experimental group and control group. LVEDD and LVESD showed no significant changes in the experimental group, but gradually increased in the control group. After four and six cycles of chemotherapy, LVEF were (57.00 ± 5.13)% and (45.95 ± 3.68)%, respectively, in the control group, significantly lower than that of (67.00 ± 5.13)% and (57.50 ± 2.57)%, respectively, in the experimental group (P < 0.05). After six cycles of chemotherapy, LVEDD and LVESD were (50.00 ± 10.48) mm and (35.01 ± 2.99) mm, respectively, in the control group, significantly higher than those before chemotherapy (P < 0.05) and experimental group (P < 0.001). The rate of ST segment and T wave abnormalities was 80.0% in the control group after six cycles of chemotherapy, significantly higher than that of 25.0% after four cycles of chemotherapy (P = 0.001) and 10.0% after two cycles of chemotherapy (P < 0.001). The reduction of QRS voltage, arrhythmia and abnormal troponin were 55.0%, 45.0% and 45.0%, respectively, in the control group, significantly higher than those in the experimental group (20.0%, P < 0.05), (10.0%, P = 0.010) and (10.0%, P < 0.05), respectively. The rate of abnormal expression of troponin was 45.0% in the control group, significantly higher than the 10.0% in the experimental group (P < 0.05). CONCLUSIONS The use of low-dose carvedilol combined with candesartan can reduce the acute and chronic cardiotoxicity of anthracycline drugs, and with tolerable toxicities. This may provide a new approach to prevent cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer.
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Affiliation(s)
- Liang Liu
- Department of Oncology, Cancer Center of General Hospital of Shenyang Military Command, Shenyang 110840, China
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Riezzo G, Clemente C, Linsalata M, D'Attoma B, Orlando A, Campanella G, Giotta F, Russo F. Gut peptide profile and chemotherapy-associated dyspepsia syndrome in patients with breast cancer undergoing FEC60 chemotherapy. Anticancer Res 2013; 33:4951-4957. [PMID: 24222135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The association of motilin, ghrelin, leptin, gastrin, pepsinogen (PG) I and II with cancer chemotherapy-associated dyspepsia syndrome (CADS) was investigated in 35 patients with breast cancer receiving first cycle of 5-fluorouracil, cyclophosphamide, epirubicin (FEC60) chemotherapy. PATIENTS AND METHODS The onset of dyspeptic symptoms on days 3 and 10 after chemotherapy identified patients with and without CADS. Gastrointestinal symptoms were scored with the Gastrointestinal Symptom Scoring Rate (GSRS) questionnaire. Gastrointestinal peptides were evaluated by enzyme-linked immunosorbent assay. RESULTS Twenty-one patients (60%) had CADS. The area under the curve (AUC) of ghrelin was higher, whereas that of PGI, PGII and motilin were lower in patients with CADS compared to those without. In patients with CADS, the AUC of PGI and PGII negatively correlated with the GSRS indigestion cluster. CONCLUSION Impairment of gastrointestinal motility suggested by low motilin concentrations and mucosal damage mirrored by an increase of ghrelin seem to be involved in the onset of CADS in patients during chemotherapy for breast cancer.
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Affiliation(s)
- Giuseppe Riezzo
- Laboratorio di Fisiopatologia della Nutrizione, I.R.C.C.S. Saverio De Bellis, via Turi 27, 70013 Castellana Grotte, Bari, Italy.
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Radulescu D, Buzdugan E, Ciuleanu TE, Todor N, Stoicescu L. Can the epirubicin cardiotoxicity in cancer patients be prevented by angiotensin converting enzyme inhibitors? J BUON 2013; 18:1052-1057. [PMID: 24344038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The aim of this study was to assess whether treatment with angiotensin converting enzyme inhibitors (ACEI) can prevent the alteration of left ventricular systolic and diastolic performance in cancer patients treated with different chemotherapy regimens containing epirubicin. METHODS In this prospective study , 68 patients with different malignant tumors treated with epirubicin and perindopril in different chemotherapy protocols (study group), and a gender- and age-matched group of 68 patients with different malignant tumors treated with epirubicin without perindopril in different chemotherapy protocols (control group), were assessed by Doppler echocardiography. Left ventricular systolic function was assessed by measuring left ventricular ejection fraction (EF). Left ventricular diastolic function was assessed by Doppler ultrasound by evaluating the transmitral flow. We also assessed the QTc on the 12 lead electrocardiograms. RESULTS At the end of chemotherapy the left ventricular systolic function was less altered in the study group compared to the control group and was superior in the study group (epirubicin+ACEI) compared to the control group (epirubicin alone). We documented a significantly deteriorated left ventricular diastolic function in both groups at the completion of chemotherapy. QTc time in both arms was also significantly prolonged. CONCLUSION In the present echo-Doppler study we documented a preserved left ventricular systolic performance in patients with various malignancies treated with epirubicin plus perindopril. Although co-treatment with ACEI prevented the alteration of systolic performance, it failed to prevent the deterioration of the left ventricular diastolic performance impairment due to poor left ventricular compliance.
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Affiliation(s)
- D Radulescu
- University of Medicine and Pharmacy "Iuliu Hatieganu", 5th Medical Hospital, Department of Cardiology, Cluj-Napoca, Romania
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Ilhan-Mutlu A, Preusser M, Schoppmann SF, Asari R, Ba-Ssalamah A, Schwameis K, Pluschnig U, Birner P, Püspök A, Zacherl J, Hejna M. Comparison between DCF (Docetaxel, Cisplatin and 5-Fluorouracil) and modified EOX (Epirubicin, Oxaliplatin and Capecitabine) as palliative first-line chemotherapy for adenocarcinoma of the upper gastrointestinal tract. Anticancer Res 2013; 33:3455-3459. [PMID: 23898119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The efficacy of triple-drug combination regimens such as docetaxel, cisplatin and 5-fluorouracil (DCF), and epirubicin, oxaliplatin and capecitabine (EOX), is superior to standard cisplatin/5-fluorouracil in patients with upper gastrointestinal adenocarcinoma. In this analysis, we compare DCF and EOX regarding toxicity and efficacy. PATIENTS AND METHODS Patients received either intravenous docetaxel at 75 mg/m(2), cisplatin at 75 mg/m(2), both given on day 1, and 5-fluorouracil at 750 mg/m(2), on days 1 to 5, or epirubicin at 50 mg/m(2) i.v. on day 1, oxaliplatin at 130 mg/m(2) i.v. on day 1 and capecitabine at a twice-daily dose of 1000 mg/m(2) p.o. for two weeks; both regimens were repeated every three weeks. RESULTS Response rates for DCF and EOX were 28% and 10%, time-to-progression was 26 and 20 weeks, and overall survival were 54 and 52 weeks, respectively. CONCLUSION We conclude that further investigations within comparative prospective clinical trials of these regimens are warranted.
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Affiliation(s)
- Aysegül Ilhan-Mutlu
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Lotrionte M, Palazzoni G, Abbate A, De Marco E, Mezzaroma E, Di Persio S, Frati G, Loperfido F, Biondi-Zoccai G. Cardiotoxicity of a non-pegylated liposomal doxorubicin-based regimen versus an epirubicin-based regimen for breast cancer: The LITE (Liposomal doxorubicin–Investigational chemotherapy–Tissue doppler imaging Evaluation) randomized pilot study. Int J Cardiol 2013; 167:1055-7. [PMID: 23174173 DOI: 10.1016/j.ijcard.2012.10.079] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/28/2012] [Indexed: 02/05/2023]
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Pieri M, Quagliuolo L, La Porta R, Silvestre A, Miraglia N, Pedata P, Acampora A, Castiglia L, Sannolo N, Boccellino M. Epirubicin permeation of personal protective equipment can induce apoptosis in keratinocytes. J Expo Sci Environ Epidemiol 2013; 23:428-434. [PMID: 22569206 DOI: 10.1038/jes.2012.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 03/15/2012] [Indexed: 05/31/2023]
Abstract
The present study investigated the epirubicin (EPI) permeability of various commercially available glove types, as well as toxicity mechanisms and effects on human keratinocyte cell line (HaCaT). Permeability experiments were carried out on various commercially available gloves, differing as regards material and thickness. Permeability was evaluated after different "contact times" and the influence of EPI solution's pH (acid and neutral) on permeability was also examined. Toxicity of EPI toward skin was tested by evaluating the effects of the drug on cell growth and apoptosis, by using an in vitro model based on cultured immortalized human keratinocytes. No permeation was detected in the case of EPI neutral solutions; in contrast, acid solutions were found to penetrate low thickness nitrile gloves. Obtained results also showed the induction of apoptosis in epithelial cells through the activation of intrinsic pathway p53-independent occurring even when cells are exposed at low drug concentration. EPI solution's pH influences the glove's permeability; once penetrated, EPI at concentrations lower than those able to penetrate the nitrile glove during the 8-h work-shift can cause apoptosis in epithelial cells. The findings reported here highly support the choice of either natural rubbers gloves or high thickness nitrile ones for preventing the occupational exposure to EPI.
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Affiliation(s)
- Maria Pieri
- Department of Public Medicine and Social Safety, University of Naples "Federico II", Naples, Italy
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Pacetti U, Veltri E, Fattoruso SIS, Cardillo FD, Evangelista S, Cognetti F, Fabi A. Single-dose palonosetron and dose-reduced regimen of dexamethasone in preventing nausea and vomiting by anthracycline-including chemotherapy in patients with early breast cancer. Anticancer Res 2013; 33:1721-1724. [PMID: 23564822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM To evaluate the efficacy of reduction of dexamethasone with a single-dose of palonosetron in preventing acute and delayed nausea and vomiting in patients receiving highly emetogenic chemotherapy (HEC) for early breast cancer. PATIENTS AND METHODS Chemotherapy-naive patients with breast cancer were given HEC in an adjuvant or neoadjuvant setting. Palonosetron and dexamethasone 4 mg i.v. were given on day 1 and another two administrations of dexamethasone 4 mg i.m. were given on days 2 and 3. The end-point was complete response (CR) and complete control (CC) during the acute and delayed phases. RESULTS Twenty-six patients were observed. Complete response was achieved in 19 out of 26 patients (72.4%); the same result was shown in 72.4% out of 76 courses given. CONCLUSION This alternative schedule suggests efficacy for the control of acute and delayed emesis in moderately emetogenic chemotherapy. Further investigations are required to confirm these results.
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Affiliation(s)
- Umberto Pacetti
- Operative Unit of Oncology, A. Fiorini Hospital, Terracina, Italy
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91
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Jiang Y, Zhou Q, Tang Z, Peng Q. [Velocity vector imaging assessment of early epirubicin-induced myocardial damage]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2013; 38:376-382. [PMID: 23645237 DOI: 10.3969/j.issn.1672-7347.2013.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess the left ventricular (LV) longitudinal systolic and diastolic function in patients treated by epirubicin by velocity vector imaging (VVI) and to discuss the important clinical value of VVI in quantitatively evaluating the regional longitudinal function. METHODS Thirty patients with breast cancer treated with epirubicin chemotherapy and 30 normal controls were included in the study. Dynamic images of apical long axis, four-chamber and two chamber view were obtained in all subjects, and the longitudinal systolic and diatolic parameters were measured in all subjects, including systolic maximum velocity (Vs), systolic maximum strain (SS), systolic maximum strain rate (SSR), diastolic maximum velocity (Vd), and diastolic maximum strain rate (DSR). The parameters were compared between the 2 groups. The conventional echcardiographic parameters were also obtained. RESULTS There was no significant change in all baseline parameters before the chemotherapy in 30 breast cancer patients compared with the normal controls (P>0.05). After the second chemotherapy cycle, DSR was lower in every segment, Vd was lower in the free wall, mainly the lateral, anterior and inferior wall (P<0.05), while Vd didn't change significantly in the septum wall (P>0.05). After the third chemotherapy cycle, Vd, DSR and SSR decreased significantly in all segments (P<0.05). Vs and SS didn't change significantly (P>0.05). CONCLUSION VVI can monitor the epirubicin cardiotoxicity early and is more sensitive than echocardiograph.
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Affiliation(s)
- Yingfeng Jiang
- Department of Ultrasonography, Central South University, Haikou,China.
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92
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Pluschnig U, Schoppmann SF, Preusser M, Datler P, Asari R, Ba-Ssalamah A, Schwameis K, Birner P, Zacherl J, Hejna M. Modified EOX (Epirubicin, Oxaliplatin and Capecitabine) as palliative first-line chemotherapy for gastroesophageal adenocarcinoma. Anticancer Res 2013; 33:1035-1039. [PMID: 23482778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The efficacy of triple-drug combination regimens such as epirubicin, oxaliplatin and capecitabine (EOX) is superior to standard cisplatin/5-fluorouracil, but considerable toxicity needs to be taken into account in patients with upper gastrointestinal adenocarcinoma. Therefore, we aimed to establish a modified version of the EOX regimen with improved tolerability for these patients. PATIENTS AND METHODS Patients received palliative first-line chemotherapy with a modified EOX regimen repeated every three weeks (epirubicin 50 mg/m(2) i.v., day 1; oxaliplatin 130 mg/m(2) i.v., day 1; capecitabine at a twice-daily dose of 1000 mg/m(2) p.o. for two weeks). RESULTS Out of 51 patients, partial remission was observed in five (10.2%) and stable disease in 31 (60.8%). Progression-free survival was four months, and overall survival twelve months. CONCLUSION Modified EOX was generally well-tolerated and, therefore, further investigation within prospective clinical trials is warranted.
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Affiliation(s)
- Ursula Pluschnig
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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93
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Ikeda M, Motoshima T, Kurosawa K, Fujii Y, Miyakawa J, Kamigaito T, Hosoda C, Komatsu H, Okaneya T. [Efficacy and safety of maintenance intravesical instillation therapy with bacillus Calmette-Guerin and epirubicin for non-muscle invasive bladder cancer]. Hinyokika Kiyo 2013; 59:153-157. [PMID: 23633629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objectives of this study were to evaluate the efficacy and toxicity of maintenance intravesical instillation therapy with bacillus Calmette-Guerin (BCG) and epirubicin for non-muscle invasive bladder cancer. From April 1999 to March 2010, 27 eligible patients were enrolled in this study. After receiving one cycle of epirubicin (100 mg/100 ml) by intravesical instillation, all patients received 6 weekly alternate intravesical instillation of BCG (80 mg/50 ml) and epirubicin (50 mg/50 ml), followed by 10 monthly instillations. Among the 27 patients, 19 were men and 8 were women, with a median age of 62.4 years (range, 37-78 years). Tumor pathologic stage was pTa in 25 patients, pT1 in 2 and there were no concomitant carcinoma in situ cases. Median follow-up was 37.1 months (range, 11-82 months). The 3- year recurrence-free and progression-free survival rates were 75.3% and 96.1%, respectively. Furthermore, a high completion rate of 81.5% was achieved in this study. Adverse events of grade 3 or higher occurred in 3 patients (11.1%), 1 patient had anaphylaxis. There were no treatment-related deaths. Maintenance intravesical instillation therapy with BCG and epirubicin is a favorable therapeutic option for non-muscle invasive bladder cancer. Given the safety and benefit profile found in this study, appropriate patient selection is warranted in the future.
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94
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Badalamenti G, Incorvaia L, Provenzano S, Bronte G, Leto G, Fulfaro F, Maltese G. Lenograstim in preventing chemotherapy-induced febrile neutropenia in patients with soft tissue sarcoma. Anticancer Res 2013; 33:679-684. [PMID: 23393367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Neutropenia and its complications represent one of the principal dose-limiting toxicity issues in chemotherapeutic regimens for soft tissue sarcoma. Prophylactic granulocyte colony-stimulating factor (G-CSF) reduces the risk of febrile neutropenia (FN). The correct timing of G-CSF administration should be considered in order to optimize the prophylactic treatment. PATIENTS AND METHODS Patients (≥18 years old) affected by soft tissue sarcoma and treated with epirubicin and ifosfamide, underwent prophylactic treatment with G-CSF (lenograstim at 263 μg) from day 5 to day 9. The proportion of patients experiencing FN and G4 neutropenia was considered. RESULTS A total of 36 patients receiving three cycles of chemotherapy with epirubicin plus ifosfamide were treated. None developed FN; G4 neutropenia was reported in 17% of patients. No treatment delay or dose reduction was required, no antibiotic therapy was administered and no hospitalization occurred. CONCLUSION Five-day lenograstim treatment is efficient as prophylaxis of FN for soft tissue sarcoma chemotherapy regimens and allows maintenance of chemotherapy dose intensity.
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Affiliation(s)
- Giuseppe Badalamenti
- Department of Surgical and Oncological Sciences, Via del Vespro 129, 90127 Palermo, Italy.
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95
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Alba E, Calvo L, Albanell J, De la Haba JR, Arcusa Lanza A, Chacon JI, Sanchez-Rovira P, Plazaola A, Lopez Garcia-Asenjo JA, Bermejo B, Carrasco E, Lluch A. Chemotherapy (CT) and hormonotherapy (HT) as neoadjuvant treatment in luminal breast cancer patients: results from the GEICAM/2006-03, a multicenter, randomized, phase-II study. Ann Oncol 2012; 23:3069-3074. [PMID: 22674146 DOI: 10.1093/annonc/mds132] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Luminal breast cancer is a highly endocrine responsive disease. However, the therapeutic benefit of chemotherapy (CT) in this population is not fully characterized. This study investigates the value of CT and hormone therapy (HT) in luminal breast cancer patients in the neoadjuvant setting. PATIENTS AND METHODS Patients with operable breast cancer and immunophenotypically defined luminal disease (ER+/PR+/HER2-/cytokeratin 8/18+) were recruited. Patients were randomized to CT (epirubicin 90 mg/m(2) plus cyclophosphamide 600 mg/m(2) 4 cycles followed by docetaxel 100 mg/m(2 )4 cycles [EC-T]) or HT (exemestane 25 mg daily 24 weeks [combined with goserelin in premenopausal patients]). The primary end point was the clinical response measured by magnetic resonance imaging. RESULTS Ninety-five patients were randomized (47 CT, 48 HT). The clinical response rate was 66% for CT and 48% for HT (P = 0.075). We performed an unplanned analysis based on Ki67 levels (cut-off of 10%). Similar clinical response was seen between arms in patients with low Ki67 (CT: 63%, HT: 58%; P = 0.74); patients with high Ki67 had a better response with CT (67 versus 42%; P = 0.075). Grade 3/4 toxicity was more frequent with CT. CONCLUSIONS Luminal immunophenotype is not enough to identify patients who do not benefit from neoadjuvant CT. Luminal patients with low proliferation index could potentially avoid CT.
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Affiliation(s)
- E Alba
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga.
| | - L Calvo
- Department of Medical Oncology, C H U Juan Canalejo, A Coruna
| | - J Albanell
- Department of Medical Oncology, H del Mar, Barcelona
| | - J R De la Haba
- Department of Medical Oncology, Hospital Reina Sofia, Cordoba
| | - A Arcusa Lanza
- Department of Medical Oncology, Consorci Sanitari de Terrassa, Barcelona
| | - J I Chacon
- Department of Medical Oncology, H Virgen de la Salud, Toledo
| | | | - A Plazaola
- Department of Medical Oncology, Onkologikoa, Donostia
| | | | - B Bermejo
- Department of Medical Oncology, Hospital Clinico Universitario, Valencia
| | | | - A Lluch
- Department of Medical Oncology, Hospital Clinico Universitario, Valencia
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96
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Iwazawa J, Hashimoto N, Ohue S, Mitani T. Initial safety and outcomes of miriplatin plus low-dose epirubicin for transarterial chemoembolisation of hepatocellular carcinoma. Anticancer Res 2012; 32:5039-5044. [PMID: 23155276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To evaluate the initial safety and efficacy of combination therapy using miriplatin plus low-dose epirubicin for transarterial chemoembolisation (TACE) of unresectable hepatocellular carcinoma (HCC). PATIENTS AND METHODS Patients who underwent TACE using miriplatin plus epirubicin (n=48) and control patients who underwent TACE using miriplatin-alone (n=51) were included in this study. RESULTS The objective response rate in the miriplatin plus epirubicin group (91%) was significantly higher than that in the miriplatin group (74%, p=0.024). Concomitant use of miriplatin and epirubicin was an independent factor associated with higher objective response rate (hazard ratio=0.18; p=0.012). Overall incidence adverse events was not significantly different between the miriplatin plus epirubicin group (50%) and the miriplatin group (49%, p=0.575). CONCLUSION TACE using miriplatin plus low-dose epirubicin was associated with an increased objective response rate and comparable adverse effects compared to TACE using miriplatin-alone.
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Affiliation(s)
- Jin Iwazawa
- Department of Radiology, Nissay Hospital, 6-3-8 Itachibori, Nishiku, Osaka 550-0012, Japan.
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97
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Kluger N, Jacot W, Frouin E, Rigau V, Poujol S, Dereure O, Guillot B, Romieu G, Bessis D. Permanent scalp alopecia related to breast cancer chemotherapy by sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel: a prospective study of 20 patients. Ann Oncol 2012; 23:2879-2884. [PMID: 22571858 DOI: 10.1093/annonc/mds095] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND To analyze the clinical and histological features of permanent alopecia following a sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel regimen for adjuvant breast cancer treatment. PATIENTS AND METHODS Women treated for breast cancer by a sequential adjuvant FEC and docetaxel regimen who developed permanent alopecia diagnosed between 2007 and 2011 were identified from the Department of Dermatology (Saint-Eloi Hospital, Montpellier, France) and the Department of Medical Oncology (CRLC Val d'Aurelle, Montpellier, France). Data were collected regarding demographics, type of cancer, delay of onset after chemotherapy, Dermatology Life Quality Index (DLQI), clinical description of the lesions, scalp biopsies, laboratory explorations investigating steroid hormonal, iron, zinc and thyroid status, therapy and outcome. RESULTS Twenty white Caucasian females were included. Hair loss presented with a moderate or intense androgenetic-like pattern of scalp alopecia. Biopsy specimen examinations were normal or displayed the androgenetic-like pattern. Laboratory explorations ruled out iron or zinc deficiency and thyroid disorders and confirmed hormonal menopause without hyperandrogenism. The overall mean DLQI score reflected the distressing psychological consequences in the patients' lives. No spontaneous regrowth of the scalp hair was noted. Treatment including vitamins, minoxidil, psoralen and ultraviolet A therapy and spironolactone proved to be ineffective. CONCLUSION Permanent and severe alopecia is a newly reported complication of the FEC 100-docetaxel breast cancer regimen.
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Affiliation(s)
- N Kluger
- University of Montpellier 1, Montpellier; Department of Dermatology, Saint-Eloi Hospital, Montpellier
| | - W Jacot
- University of Montpellier 1, Montpellier; Department of Medical Oncology, CRLC Val d'Aurelle, Montpellier
| | - E Frouin
- University of Montpellier 1, Montpellier; Department of Pathology, Hôpital Gui-de-Chauliac, Montpellier
| | - V Rigau
- University of Montpellier 1, Montpellier; Department of Pathology, Hôpital Gui-de-Chauliac, Montpellier
| | - S Poujol
- University of Montpellier 1, Montpellier; Oncopharmacology Department, CRLC Val d'Aurelle, Montpellier, France
| | - O Dereure
- University of Montpellier 1, Montpellier; Department of Dermatology, Saint-Eloi Hospital, Montpellier
| | - B Guillot
- University of Montpellier 1, Montpellier; Department of Dermatology, Saint-Eloi Hospital, Montpellier
| | - G Romieu
- University of Montpellier 1, Montpellier; Department of Medical Oncology, CRLC Val d'Aurelle, Montpellier
| | - D Bessis
- University of Montpellier 1, Montpellier; Department of Dermatology, Saint-Eloi Hospital, Montpellier.
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98
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Appel JM, Zerahn B, Møller S, Christensen HM, Søgaard P, Ejlertsen B, Fogh-Andersen N, Jensen BV, Nielsen DL. Long-term heart function after adjuvant epirubicin chemotherapy for breast cancer. Acta Oncol 2012; 51:1054-61. [PMID: 22909389 DOI: 10.3109/0284186x.2012.702920] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Newer studies raise concern that adjuvant anthracycline treatment for breast cancer (BC) causes long-term heart damage. We aimed to examine whether heart failure or impairment could be demonstrated several years after low-dose epirubicin-based adjuvant treatment. MATERIAL AND METHODS The study-population was a historical cohort comprising 980 women who were randomized to receive one of two adjuvant regimens for treatment for BC: 7-9 cycles of cyclophosphamide-epirubicin-5-fluorouracil [CEF (600 + 60 + 600 mg/m(2))] or cyclophosphamide-methotrexate-5- fluorouracil [CMF (600 + 40 + 600 mg/m(2))]. We collected information in national registries of death and diagnoses and a sample of 77 survivors was examined with tissue-Doppler imaging (TDI), echocardiography, radionuclide ventriculography and N-terminal-pro-B-type-natriuretic peptide (NT-proBNP), an established marker for heart failure. RESULTS AND CONCLUSION Median follow-up was 12 years (39 days-20 years). Fifty-one percent had died. Incidence of CHF was 2.6/1000/year and equal in the treatment groups. In the sample, individuals who had received CEF showed no cardiac impairment when compared to individuals who received CMF. NT-proBNP-levels were within normal limits but higher in the CEF-group than in the CMF-group (confidence limits 105-226%, p = 0.03). Results of our study seem reassuring regarding the long-term risk of cardiotoxicity following low-dose adjuvant epirubicin treatment. However, larger, longitudinal studies are needed to establish the clinical implications.
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Affiliation(s)
- Jon M Appel
- Department of Cardiology, Herlev Hospital, Copenhagen, Denmark.
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99
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Andersen KG, Jensen MB, Kehlet H, Gärtner R, Eckhoff L, Kroman N. Persistent pain, sensory disturbances and functional impairment after adjuvant chemotherapy for breast cancer: cyclophosphamide, epirubicin and fluorouracil compared with docetaxel + epirubicin and cyclophosphamide. Acta Oncol 2012; 51:1036-44. [PMID: 22676048 DOI: 10.3109/0284186x.2012.692884] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Taxanes used in adjuvant therapy for breast cancer are neurotoxic, and thereby being a potential risk factor for persistent pain after breast cancer treatment (PPBCT) and sensory disturbances. The purpose was to compare patients treated with cyclophosphamide, epirubicin and fluorouracil (CEF) and cyclophosphamide and epirubicin + docetaxel (CE + T) in relation to PPBCT, sensory disturbances, peripheral sensory disturbances and functional impairment. MATERIAL AND METHODS A comparative nationwide cross-sectional questionnaire study on two cohorts treated with CEF respectively CE + T, based on the Danish Breast Cancer Cooperative Groups database. INCLUSION CRITERIA women treated with chemotherapy as adjuvant treatment for primary breast cancer, age 18-69 years, without recurrence. RESULTS One thousand two hundred and forty-one patients allocated to CEF in 2005-2006 and 1652 patients allocated to CE + T in 2007-2008 were included. Six hundred and sixty-four (53%) with CEF and 861 (53%) patients with CE + T reported pain. In the multivariate analysis including available risk factors, CE + T did not confer an increased risk of PPBCT, OR 0.95 (95% CI 0.81-1.11), p = 0.52, compared to CEF. Patients treated with CE + T had a lower risk of sensory disturbances in the area of surgery compared with CEF, OR 0.75 (95% CI 0.62-0.90), p = 0.002. More CE + T patients reported peripheral sensory disturbances in the hands, OR 1.56 (95%CI 1.27-1.92), p < 0.0001, and in the feet, OR 2.0 (95% CI 1.66-2.42) p < 0.0001, compared to CEF. There was no difference in functional impairment (p = 0.62). CONCLUSION Docetaxcel as adjuvant treatment for breast cancer does not increase the risk of PPBCT, sensory disturbances in the surgical area or functional impairment, but increase risk for peripheral sensory disturbances.
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Affiliation(s)
- Kenneth Geving Andersen
- Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
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100
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Saimura M, Anan K, Mitsuyama S, Toyoshima S, Ikejiri K, Ohchi T, Rai Y, Oikawa T, Kudaka M, Nishimura R, Kuroki S, Namba K, Nakafusa Y, Tamura K. [A multicenter study of epirubicin-docetaxel(ET)as primary chemotherapy for patients with inflammatory breast cancer(IBC)]. Gan To Kagaku Ryoho 2012; 39:1075-1079. [PMID: 22790042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We evaluated the efficacy and safety of the epirubicin plus docetaxel(ET)regimen, which is a combination of active agents given to patients with inflammatory breast cancer(IBC)as a primary therapy. Nineteen patients received ET(60, 60mg/m2) every 3 weeks for 4 courses, and appropriate surgery was offered unless disease progression occurred. Seventeen patients completed the ET regimen and 1 patient was excluded because of no diffuse erythema, leaving 18 patients evaluable for the response and safety profile of this regimen. Grade 3/4 hematological toxicities were neutropenia in 15 patients(79%), febrile neutropenia in 8 patients(42%)and anemia in 3 patients(16%). Six patients(63%)received granulocyte colony-stimulating factor for febrile neutropenia. Febrile neutropenia was observed only for 1 course in all 6 patients and progression to apparent infection was not observed. Grade 3/4 non-hematological toxicities were constipation in 3, nausea in 2, anorexia in 2, fatigue in 1, vomiting in 1, diarrhea in 1, and stomatitis in 1 patient. The ET regimen was given to 16 patients(89%)as planned. The median number of courses was 4(range: 2-4). The clinical response rate was 44%. The median time to progression was 9 months, and median overall survival was 26 months. It is concluded that the ET regimen was well tolerated and effective as a primary chemotherapy for IBC.
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