Gonadotropin?releasing hormone agonists in prostate cancer: A comparative review of efficacy and safety

Androgen deprivation therapy (ADT) using gonadotropin?releasing hormone agonist (s) (GnRH?A) remains the backbone of advanced prostate cancer treatment. In this review, we assessed the efficacy, safety, and convenience of administration of various GnRH?A. All GnRH?A (goserelin, triptorelin, buserelin, histrelin, and leuprorelin) have comparable potential to suppress testosterone (T) levels (?50 ng/dL in a month and ?20 ng/dL in 3 months). However, goserelin has shown better efficacy in maintaining T levels ?50 ng/dL compared with leuprolide. The incidences of T escape are lower with goserelin and leuprolide than buserelin. Goserelin also has maximum benefit in prostate?specific antigen suppression. In neoadjuvant setting, when only goserelin was used, the 10?year overall survival (OS) rate was 42.6% to 86%. When either goserelin or leuprolide was used, the 10?year OS rate was 62%. As an adjuvant to radical prostatectomy, goserelin had a 10?year survival rate of 87%, and triptorelin had an 8?year survival rate of 84.6%. Goserelin further showed an absolute survival rate of 49% when used as an adjuvant to radiotherapy. The survival rates further improved when GnRH?A are used as combined androgen blockade compared with monotherapy. The frequency and severity of adverse events (hot flushes, fatigue, sexual dysfunction) are comparable among the GnRH?A. Goserelin appears to be the most convenient of all the GnRH?A for administration. Lack of conclusive comparative evidence makes it imperative to have a holistic approach of considering the patient profile and the disease characteristics to select the appropriate GnRH?A for ADT in prostate cancer.

Evaluation of thyroid hormone dysfunction in type – 2 diabetes patients on metformin therapy A cross sectional study

Diabetes and thyroid diseases are two familiar endocrinopathies seen in the general population. Abnormal thyroid hormone levels can also be found in individuals with diabetes. Metformin may lower thyroid stimulating hormone levels both in hypothyroid as well as euthyroid individuals. To this purpose,we studied analys is of serum TSH levels in patients with type-2 DM who were receiving metformin and compared them with serum TSH levels of those individuals with T2DM that were not on metformin. Study participants were selected from the people residing in neighbouring vill ages in and adjoining Kadapa district of Andhra Pradesh. Study duration was 6 months between June-November 2008. Sample size was 80 subjects with T2DM on Metformin and 80 subjects with T2DM receiving non Metformin based therapy were included in the study.Data were entered in Microsoft Excel 2007 and data was expressed as mean and standard deviation (Mean±SD). Serum TSH values, metformin dose and metformin duration were not normally distributed. Comparison of difference in means between the two groups for normally distributed continuous variables namely age HbA1c, R.V. Rama Narayana Reddy, T.A.R.Raja,.Senthil,Priyadharshini. Evaluation of thyroid hormone dysfunction in type -2 diabetes patients on metformin therapy –A cross sectional study. IAIM,2016; 3(1):24-28.Page 25 serum T3 and T4 was done by unpaired student’s t test. P <0.05 was treated as significant.Metformin utilize was not associated with changes in serum thyroid stimulating hormone levels in euthyroid type-2 DM patients. The presence of acomparative group of type 2 diabetes individuals not receiving Metformin add to the analytical value of the study design.

Optimizing second-line therapy for chronic myeloid leukemia.

Treatment of chronic myeloid leukemia has evolved from symptom control to long-term disease-free survival with cure potentially round the corner. This required faster, deeper, and longer response. Optimizing treatment decisions therefore requires clear understanding of and strict implementation of guidelines for shift from imatinib. In patients who are resistant to or intolerant of imatinib, second-line TKIs have to be selected carefully. Currently available data show comparable efficacy between nilotinib and dasatinib. With a better safety profile (especially with respect to grade 3 or 4 hematologic toxicity and clinically relevant non-hematologic toxicities), nilotinib becomes the preferred choice in most instances.

Management of primary and metastatic triple negative breast cancer: Perceptions of oncologists from India.

Background: In order to document the understanding of current evidence for the management of triple negative breast cancer and application of this knowledge in daily practice, we conducted an interactive survey of practicing Indian oncologists. Materials and Methods: A core group of academic oncologists devised two hypothetical triple negative cases (metastatic and early breast cancer, respectively) and multiple choice options under different clinical circumstances. The respondents were practicing oncologists in different Indian cities who participated in either an online survey or a meeting. The participants electronically chose their preferred option based on their everyday practice. Results: A total of 152 oncologists participated. Just over half (53.8%) preferred taxane based chemotherapy as first-line chemotherapy in the metastatic setting. In the adjuvant setting, a taxane regimen was chosen by 61%. Over half of respondents (52.6%) underestimated the baseline survival of a patient with node positive triple-negative tumor and 18.9% overestimated this survival compared to the estimate of the Adjuvant! program. Discussion: This data offers insight into the perceptions and practice of a diverse cross-section of practicing oncologists in India with respect to their therapeutic choices in metastatic and adjuvant settings in triple negative breast cancer.

Profile of viral hepatitis A in Chennai.

This retrospective study compares the clinical features, laboratory profile and complications of anti HAV IgM positive acute viral hepatitis A in 138 children between 1-15 year (1-5 year: n=31; 5-10 year: n=85; and 10-15year: n=22). We found that older children presented with HAV (hepatitis A virus) infection with more atypical manifestations (ascites and splenomegaly) and complications.