Weekly paclitaxel and paraplatin as first line chemotherapy in patients with advanced NSCLC

Optimal platinum based combination regimen for advanced NSCLC remains to be defined. Weekly Taxol and paraplatin is an effective and generally well tolerated regimen for first line treatment for stage III and IV NSCLC and affords potential for lower toxicity and increases exposure to drugs with alternative cytotoxic/cytostatic mechanisms. Thirty patients with histologically or cytologically proven NSCLC stages IIIb and IV were included during the period between March 2001-March 2003 with the following criteria, median age was 55 years, measurable or evaluable disease, PS

Biweekly administration of irinotecan [CPT11] and 5-fluorouracil/folinic acid [5FU/FA] "De Gramont" as first line treatment in advanced or metastatic colorectal cancer [CRC]

The combination of CPT11, 5 fluorouracil and folinic acid "De Gramont" is now thought to be the 1st line chemotherapy for advanced or metastatic colorectal cancer. The aim of this study was to evaluate the efficacy and safety profile of the biweekly administration of CPT11 and 5FU/FA as 1[st] line treatment in patients with advanced or metastatic colorectal cancer. Patients with histologically confirmed advanced CRC, >1 measurable metastatic lesion. ECOG PS 0-1 and adequate bone marrow, renal and hepatic function were included. CPT11 [180mg/m[2] was administered on day 1 as 90 minutes infusion] and FA [200mg/m[2]] as 2 hour infusion followed by 5FU [400mg/m[2] bolus and 600mg/m[2] as 22 hours infusion] on days 1 and 2. This schedule was repeated every 2 weeks and each cycle consisted of 6 weeks for 6-9 cycles. Between October 2000 and December 2002, thirty patients were enrolled, M/F [20/10] with a median age of 48 years [40-60] and ECOG PS of 0-1. Primary tumor sites were colon [10 patients], rectum [15 patients], and colorectal [5 patients]. Tumor histology was adenocarcinoma, median number of involved sites was 2 [60% with 2 sites or more], liver [80%], lung [10%], lymph nodes [20%] and local recurrence [50%]. Previous treatment included palliative or radical surgery in 100% of cases, adjuvant chemotherapy in 12 patients [40%] and pelvic radiotherapy in 9 patients [30%]. A total of 235 cycles has been delivered with a median of 8 cycles/patient [6-9 cycles]. All patients were evaluable for toxicity, grade III toxicity was; neutropenia in 2 patients [6.6%], febrile neutropenia in one patient [3.3%] and diarrhea in one patient [3.3%]. Of the thirty patients evaluable, 3 patients [10%] achieved CR, 14 PR [46.6%] 7 SD [23.3%] and 6 patients progressed [20%] resulting in an overall response rate [ORR] of 56.6%. Median time to progression and survival was 12.5 and 21 months respectively. Median duration of response was 14.5 months. Biweekly administration of CPT11 and 5 FU/FA is an active and well tolerated regimen as first line treatment in patients with advanced or metastatic CRC with an ORR of 56.6%

Concomitant chemoradiotherapy versus neoadjuvant chemotherapy followed by radiation in locally advanced head and neck cancer

This study was a prospective randomized trial comparing two schedules of intravenous cisplatin plus continuous infusion fluorouracil combined with radiotherapy, either sequential or concomitant, in the treatment of unresectable head and neck cancers. Two treatment arms were applied to a total of 50 patients and the results were analyzed for efficacy and toxicity. The overall response was better in the concomitant group. The percentage of patients who developed distant metastases was low. The overall survival at 1 and 2 years was 68% and 40% for the concomitant group and 64% and 36% for the sequential group and the differences were not statistically significant. The frequency of skin and mucous membrane toxicities was similar for the two groups occurring predominantly during radiation. So, the concomitant treatment offered improved regional disease control over the sequential treatment, while the overall survival was similar in both treatment groups

predictive value of serial bone scan in assessing response to chemotherapy in advanced breast cancer

Changes in osteoblast function assessed by serial bone scans have been studied in 50 patients receiving systemic chemotherapy [FAC or Taxol] for bone metastases from advanced breast cancer. All patients had baseline scans prior to therapy after the 3rd cycle, after the 6th cycle and then every three months during the follow-up period of the study [ranged 14-27 months]. Thirteen patients had a flare response following the 3rd cycle of chemotherapy characterized by increased activity in baseline lesions and the appearance of new foci of tracer uptake changes which are indistinguishable from progressive disease. These changes are attributed to a flare in osteoblastic activity induced by successful systemic therapy. After six months of successful treatment, the bone scan improved with reduced traces uptake and no new lesions since the 3rd month scan. New lesions appearing after the 6th month indicated progressive disease. Flare on bone scintigraphy may be seen shortly after commencing chemotherapy. Bone scans done within the first three months must be interpreted with caution and should be correlated with clinical and radiological findings to avoid inappropriate discontinuation of chemotherapy

Technetuim-99M-sestamibi scintimammography to differentiate breast masses

The aim of this project was to evaluate the feasibility of 99[MTC] methoxy-isobutylisonitrile [MIBI] as a tumour localizing agent in patients with palpable breast masses in comparison with mammography. Forty females with mean age 46.7 years had palpable breast masses were subjected to clinical examination, mammography, radionuclide scanning and biopsy for histopathologic confirmation. Mammography has the advantage of low cost, non invasive, with sensitivity 82%, specificity 33% and accuracy 75%, it can detect small lesions, but on the other h and it has the disadvantage of radiation exposure, and not reliable in dense breast or previously violated breast by infection, augmentation devices or previous surgery. 99[MTc] MIBI scan was performed on all 40 patients, we used a tumour to background ratio of 1.6 as the cut off level between benign and malignant in early uptake ratios. The present study showed a sensitivity of 97%, specificity 67% and accuracy 92.5%, these results indicate that 99[mTc] MIBI scintigraphy may provide additional information in the differentiation of malignant from benign lesions in patients with palpable breast masses