Efficacy and safety of combination chemotherapy with docetaxel and cisplatin as a first-line treatment for advanced gastric cancer / 대한내과학회지

BACKGROUDN: To evaluate the activity and safety of docetaxel and cisplatin for advanced gastric cancer as a first-line chemotherapy treatment. METHODS: Between December 2001 and February 2006, forty-two patients with recurrent or metastatic gastric cancer were enrolled. Docetaxel (75 mg/m2) was administered as a 1-hour intravenous infusion on day 1 and cisplatin (60 mg/m2) was also administered as a 30-minute intravenous infusion on day 1 every three weeks until disease progression or severe toxicity was detected. The response was assessed every 2 cycles. The toxicities were evaluated for every course of chemotherapy according to NCI toxicity criteria. RESULTS: The median age of the patients was 66 (range, 33~77) years. Among the forty-two patients, 38 were male. Twenty-seven patients had an Eastern Cooperative Oncology Group performance score of 0 or 1 and fifteen patients had a score of 2. All patients had adenocarcinoma. Thirty-three of the forty-two patients were assessable for response. Partial responses were observed in 14 patients. The overall response rate was 42.4% (95% C.I., 25.259.6%) and the median response duration was 5.7 (range, 1.4~17.2) months. The median overall survival of all patients was 8.1 (range, 1.2~47.0) months. During a total of 170 cycles, granulocytopenia worse than National Cancer Institute toxicity grade 3 occurred in 7.6% of the patients, thrombocytopenia in 0.6% and anemia in 3.5%, respectively. No deaths resulting from toxicity were observed. Non-hematologic toxicities were minor and were easily controlled. CONCLUSION: Combination chemotherapy with docetaxel and cisplatin has a tolerable efficacy with acceptable toxicities in patients with advanced gastric cancer as a first-line treatment.

Pseudobacteremic Outbreak of Leclercia adecarboxylata and Pseudomons aeruginosa Related to Contaminated Saline Cotton / 병원감염관리

BACKGROUND: During a 1-month period in 2005 , a series of 4 Leclercia adecarboxylata and 8 Pseudomonas aeruginosa bacteremias were reported from patients admitted to the emergency room. METHODS: An outbreak of L. adecarboxylata and P. aeruginosa bacteremia that occurred from February to March 2005 was investigated. The infection control nurse reviewed medical records and observed the procedures of blood cultures at the clinical microbiology laboratory. Specimens were obtained for investigational cultures from alcohol sponge, tray, sink, water of sink, saline cotton, microscope, computer, and telephone. RESULTS: L. adecarboxylata was isolated from 4 patients and P. aeruginosa from 8 patients during a 1-month period. Observation of the culture procedure revealed that saline cotton was used to prevent betadin skin discoloration. The culture of the saline solution yielded a heavy growth of P. aeruginosa, which was not isolated from any other specimens. CONCLUSIONS: This was a pseudoepidemic caused by contaminated saline cotton. The use of the saline cotton was stopped, and during the follow-up period of 3 months, no additional L. adecarboxylata or P. aeruginosa bacteremia were reported.

Capecitabine and Oxaliplatin (XELOX) for the Treatment of Patients with Metastatic Gastric Cancer and Severe Liver Dysfunction

Gastric cancer patients with severe liver dysfunction secondary to hepatic metastases have limited treatment options. Most cytotoxic drugs have a narrow therapeutic index. Although both capecitabine and oxaliplatin have been well tolerated as single agents for patients with severe hepatic dysfunction, the combination of these drugs has not been investigated. We report here on a case of successful treatment of a patient suffering with severe liver dysfunction and metastatic gastric cancer; the patient was treated with a combination of capecitabine and oxaliplatin (XELOX). The initial bilirubin level of the patient was 10.9 mg/dL. After two cycles of treatment, his bilirubin level decreased to 2.1 mg/dL. He has experienced an excellent radiological response and he has received six cycles of XELOX chemotherapy. XELOX chemotherapy is feasible and it can be associated with positive outcomes for the patients suffering with metastatic gastric cancer and severe liver dysfunction.