ABSTRACT
Background: Achieving a high rate of complete pathological response with pre-operative chemoradiotherapy in rectal cancer is an unmet need. We evaluated the efficacy and toxicity of the combination of cetuximab, capecitabine and radiation therapy in the pre-operative setting of localized rectal cancer
Patients and methods: Patients with clinically staged T3, T4 or nodepositive rectal cancer were treated with concurrent capecitabine and radiotherapy with weekly cetuximab starting one week before the start of radiation. This was followed by total mesorectal excision within 6-8 weeks. All patients achieving R0 resection received adjuvant capecitabine for 6 cycles
Results: Fifteen patients were treated and all underwent surgery. Sphincter preservation was achieved in 11 patients [73.3%] and pathological complete response in two. With a median follow up of 48 months [range 8.4-57.5], 12 patients were relapse-free and 14 were alive with 4- year relapse free survival of 80%. Overall survival was 93%. Significant grade 3 and 4 toxicity was mainly cetuximab-induced skin reactions [33%], radiation-induced skin toxicity [13%] and diarrhea [20%]
Conclusions: Adding cetuximab to pre-operative concurrent capecitabine and radiotherapy provides modest efficacy with manageable toxicity
ABSTRACT
The risk associated with arterial thromboembolism [ATE] increases with the presence of anti-vascular endothelial growth factor [VEGF]. We are reporting a case of transient ischemic attack [TIA] due to stenosis of the carotid and brachiocephalic arteries following long-term treatment with sorafenib for renal cell carcinoma [RCC]. The patient is a non-smoker with no known comorbidities and had no history of cardiovascular disease. The patient underwent a right endarterectomy with angioplasty, aortic arch, and brachiocephalic artery angiogram with a stent placed in the brachiocephalic artery.
ABSTRACT
Poor compliance has been a common feature in clinical trials of adjuvant chemotherapy for NSCLC with only 48% to 69% of patients completing all planned cycles. We retrospectively evaluated compliance and toxicity of platinum-based chemotherapy in the 2 years following recent reports of successful adjuvant chemotherapy trials for NSCLC. Patients who received adjuvant chemotherapy after complete resection of NSCLC between May 2003 and May 2005 were analyzed retrospectively. Patient demographics, ECOG status, stage, pathologic subtype and type of surgery were recorded. The number of chemotherapy cycles, delays, dose reducttions and change of chemotherapy were reported. Fifty patients were identified. The median age was 62 years [38% stage I, 18% stage II, 30% stage III and 14% had multiple primary tumors of variable stages]. Twenty percent were ECOG PS2; Only 12% had undergone pnemonectomy. Forty-one patients [82%] started cisplatin/vinorelbine [three switched to carboplatin because of nephrotoxicity, and one switched to carboplatin/paclitaxel because of fatigue and vomiting]. Three patients received other cisplatin-based combinations; six received carboplatin-based treatment [one each beccause of advanced age and cardiac dysfunction and 4 because of preexisting neuropathy]. Eighty percent comppleted all treatment; 40% required a dose reduction and 58% required delays in treatment. Six events of febrile neutropenia were reported in 5 patients and 5 patients required admission for toxicity. There were no toxic deaths. Multivariate analysis showed no effect of age, gender, extent of surgery or ECOG status on compliance, need for treatment modification or toxicity. Compared to historical trials, adjuvant platinum-based chemotherapy for resected NSCLC is now accepted by patients and physicians with a high degree of compliance