Caelyx [CA] and paraplatin [PA] for patients with advanced ovarian cancer in late relapse

Introduction: 0varian cancer is the sixth most common malignancy [4.4% of cases] and also cause of death from cancer [4.5 %] in women worldwide. Epithelial tumors, arising from the swface of the ovary, account for approximately 90% of all ovarian malignancies. The vast majority [approximately 70%] of those patients with ovarian cancer present with advanced [stage III/IV] disease. Platinum-based chemotherapy, as a front-line therapy, is recommended for advanced-stage patients and those with high-risk early-stage disease. Liposomal doxorubicin has been evaluated in phase II trials with a good safety profile and efficacy

Methods: A total of 26 patients were accrued in this study between July 2002 and September 2003, they were clinically diagnosed and pathologically confirmed epithelial ovarian tumors. Liposomal doxorubicin [Caelyx] was given at a dose of 30 mg/m2, 1 hour infusion and, Paraplatine AUC 5, 30 minutes infusion day one every 3 weeks for at least 3 cycles. Univariate and multivariate analysis were conducted and 5% level of significance was adopted

Results: The most common adverse event was Palmar-Plantar erythrodysesthesia [PPE, 42.3 %], with severe grade 3/4 PPE observed in 23% of patients. However, in the majority of patients PPE was managed successfully, There was an overall response rate of 42.3% [11/26 patients], with a median progression-free survival of 4.9 months [ with 1 patient in complete response at 21 months] and a median overall survival 11 months

Conclusion: Based on survival and toxicity advantages, liposomal doxorubicin is the first choice non platinum agent for relapsed ovarian cancer. It may also have clinical application in combination regimens for platinum sensitive ovarian cancer, as consolidation / maintenance therapy for ovarian cancer and as a component of first line therapy. Liposomal doxorubicin is an active, well tolerated agent, when combined with paraplatine as a salvage therapy for recurrent ovarian carcinoma

phase II trial using altered fractionation irradiation with concomitant chemotherapy in the management of patients with muscle invasive bladder cancer [MIBC]

To identify the place of conservative treatment in patients [pts] with MIBC using concomitant cisplatin [C] and gemcitabine [G] with bifractionated split course radiotherapy. Eligible pts with stages T2-T4a, No Mo were entered in this study. Treatment began with transurethral resection [TUR] with complete macroscopic debulking followed by induction chemoradiation. The treatment regimen consisted of C 15 mg/m[2] and G 200 mg/m[2] on days 1-3 and 15-17 [one cycle of 6 days induction chemotherapy] .On days 1, 3, 15, and 17, radiation was given immediately following chemotherapy using twice-daily 2 Gy per fraction to the whole pelvis for a total dose of 16 Gy delivered in 8 fractions over 17 days. Patients with a complete response [CR] via cystoscopy after the induction cycle received another chemoradiation cycle as consolidation. Patients who did not achieve CR underwent cystectomy. Both groups received outpatient adjuvant chemotherapy: G 1g/m[2] on days 1, 8, and 15 plus C 70 mg/m[2] on day 1 every 28 days for 4-6 cycles. From July 2001 to January 2003, 36 pts were enrolled. All pts were evaluable for efficacy and toxicity. Twenty pts [55.5%] achieved CR after induction therapy and received consolidation chemoradiation. Of the pts who still had detectable tumor, 9 pts [25.0%] underwent radical cystectomy and 7 [19.4%] refused cystectomy and received the same chemoradiation. 6/16 died of progressive disease. The median follow-up is 22 months. The 2-year overall survival is 80%, and the 2-year probability of surviving with an intact bladder is 69.4%. Grade 3/4 thrombocytopenia was observed in 8 pts [22.2%], non hematologic toxicities in the form of grade 3 radiation cystitis in 3 pts [8.3%] and proctatitis in 4 pts [11.1%].This trial comprising of local TUR plus concurrent C/G, and hypofractionated radiation has been associated with acceptable hematologic toxicity. Both the complete response rate to induction therapy and the 2-year survival rate with an intact bladder are encouraging. Longer follow-up is needed to assess efficacy

high dose cytarabine with dexamethasone and cisplatin [DHAP] solve the problem of patients with relapsed non-Hodgkin's lymphoma?

Between 2001 and 2002, 56 patients with refractory or relapsing non-Hodgkin lymphoma after prior anthracycline based chemotherapy were treated with DHAP [dexamethasone, high dose cytarabine and cisplatin]. After 6 cycles, 28.8% of patients [16/56] achieved complete response, while 58.9% [33/56] attained partial response. The overall survival at 2 years was 25%. Myelosuppression was the major toxicity; 24 patients [42.85%] had grade IV neutropenia and 39 patients [69.64%] had grade III-IV thrombocytopenia, but there was no treatment-related death. DHAP regimen is an effective salvage therapy for the patients with relapsed and refractory NHL, but the response duration time is short and long-term prognosis remains poor; high dose chemotherapy with autologous bone marrow transplantation is necessary for improvement in long-term survival

Combined modality [chemotherapy and radiotherapy] versus radiotherapy alone in the management of locally advanced head and neck cancer

Generally radiotherapy alone or combined with surgery for locally advanced head and neck epidermoid carcinoma yields poor results. This study was designed to assess the therapeutic efficiency of combined modality treatment [neoadjuvant chemotherapy and radiotherapy] versus radiotherapy alone in the management of locally advanced head and neck cancer and to evaluate its impact on the progression free and overall survival. Three cycles of cisplatin [100 mg/m[2]] day I and 5-fluorouracil [1 gm/m[2]] days 1-3 repeated every 21 days were given for 30 untreated patients followed by radiation therapy. This arm [group I] was compared with radiation therapy alone In another 30 patients [group II]. These patients had stages III and IV disease with performance of 70=70% and with a minimum followed up of 18 months. In group I neoadjuvant chemotherapy induced complete response [CR] in seven patients [23.3%] and partial response [PR] in 19 patients [63.3%]. After the addition of radiation therapy, CR increased to 56.7%. In the radiotherapy alone group. CR and PR were 40% and 43.3% respectively The difference between both arms as regards the overall response was not statistically significant [p=0.704]. The chemotherapy schedule was tolerable but it increased the acute radiation reactions to the extent that eight patients could not tolerate the boost radiation dose. The progression free survival [PFS] of responders in the combined treatment arm was 52% compared with 44% in radiation alone ann. The median time to progression was 8.2 months versus 7.3 months in both arms respectively. The overall survival [OS] was higher in the combined treatment arm but not statistically significant [p>0.05]. Neoadjuvant chemotherapy could improve the response rate and OS with acceptable local and systemic toxicity. Accrual of large number of patients and longer follow up period is needed to emphasis the advantageous effect of neoadjuvant chemotherapy

Experience with interstitial iridium-192 irradiation and electron beam therapy after conservative surgery for locally advanced breast carcinoma

Thirty-one patients with locally advanced breast cancer [stage IIIA and IIIB] received booster irradiation to a dose of 15-20 Gy by electron beam therapy [20 patients] or interstitial iridium-192 [11 patients] after conservative surgery [lumpectomy and axillary dissection] and external irradiation to the breast and nodal regions [45-50 Gy/5 weeks]. All patients were initially treated by 3 cycles of combination chemotherapy [FAC] and all patients had tumor size /

Combined modality approach of locally advanced breast cancer with conservative surgery

One hundred and eleven patients with noninflammatory locally advanced breast cancer [LABC] stage IIIA and B [T3-4b, No-2] were treated. Patients were randomized into two groups: The study group A [61 patients] and the control group B [50 patients]. Patients of group A received three cycles [FAC] neoadjuvant chemotherapy [NCT] [5- fluorouracil 500 mg/m2, adriamycin 50 mg/m2 and cyclophosphamide 500 mg/m2, every three weeks]. Lumpectomy and axillary dissection [LAD] were performed for patients achieving downstaging to /T2 after NCT and El underwent simple mastectomy and axillary dissection [SM + A]. All patients of group A received 5 cycles adjuvant [FAC] and in addition tamoxifen [20 mg/day] was given to postmenopausal. It was concluded that multimodality treatment utilizing NCT, El and conservative surgery [CS] can give results comparable to conventional modalities of treatment