Phase I study of capecitabine combined with radioembolization using yttrium-90 resin microspheres (SIR-Spheres) in patients with advanced cancer

BACKGROUND

This was a prospective single-centre, phase I study to document the maximum tolerated dose (MTD), dose-limiting toxicity (DLT), and the recommended phase II dose for future study of capecitabine in combination with radioembolization.

METHODS

Patients with advanced unresectable liver-dominant cancer were enrolled in a 3+3 design with escalating doses of capecitabine (375-1000 mg/m(2) b.i.d.) for 14 days every 21 days. Radioembolization with (90)Y-resin microspheres was administered using a sequential lobar approach with two cycles of capecitabine.

RESULTS

Twenty-four patients (17 colorectal) were enrolled. The MTD was not reached. Haematologic events were generally mild. Common grade 1/2 non-haematologic toxicities included transient transaminitis/alkaline phosphatase elevation (9 (37.5%) patients), nausea (9 (37.5%)), abdominal pain (7 (29.0%)), fatigue (7 (29.0%)), and hand-foot syndrome or rash/desquamation (7 (29.0%)). One patient experienced a partial gastric antral perforation with a capecitabine dose of 750 mg/m(2). The best response was partial response in four (16.7%) patients, stable disease in 17 (70.8%) and progression in three (12.5%). Median time to progression and overall survival of the metastatic colorectal cancer cohort was 6.4 and 8.1 months, respectively.

CONCLUSIONS

This combined modality treatment was generally well tolerated with encouraging clinical activity. Capecitabine 1000 mg/m(2) b.i.d. is recommended for phase II study with sequential lobar radioembolization.

The use of a single case design to investigate the effect of a pre-performance routine on the water polo penalty shot

The pre-performance routine (PPR) is proposed to assist the performance of closed skills by enhancing concentration (Crews and Boutcher, 1987) and the recall of optimal psychological and physiological states (Cohn, 1990). A multiple-baseline-across-individuals design was utilised to assess the effect of PPRs on water polo penalty shot performance. Three experienced male water polo players were assisted in designing a personalised multi-component PPR, which was rehearsed in accordance with a training program, and implemented prior to performing penalty shots in simulated trials. Mean performance scores increased for all players between pre and post intervention phases. A Split Middle analysis (White, 1974) further described performance trends and changes. Players 1 and 2 reversed negative baseline trends of -1.071 and -1.031 to positive post intervention trends of +1.011 and +1.011, producing respective positive changes in slope of +1.08 and +1.042. Player 3's baseline trend of +1.008 was reversed post intervention to -1.004, causing a negative change in slope of -1.012. Respective ratios of 1.38, 1.36 and 1.20, suggest a positive change in trend level immediately following PPR introduction. Binomial tests revealed improvements in all participant performances between stages (p<0.001). Results are reviewed in light of previous research and the utilisation of single-subject designs is discussed.

Tolerance of nicotinamide and carbogen with radiation therapy for glioblastoma

Nineteen patients with glioblastoma were treated with nicotinamide and carbogen and radiotherapy. Eight patients did not complete the protocol because of hepatic toxicity from phenytoin/nicotinamide drug interactions, persistent nausea or vomiting with nicotinamide, intolerance of the carbogen breathing apparatus, or other reason. In addition, early radiation neurotoxicity appeared increased.