Angiogenesis and cancer: recent advances

Recent studies have shown the possibility to treat cancer with drugs that affect the formation of new blood vessels instead of attacking directly the malignant cell. This relatively new field in the area of oncology on angiogenesis inhibition has expanded the therapeutic option for malignant diseases. We will discuss several antiangiogenesis drugs in clinical development and their mechanism of action. Some of these drugs include: angiostatin, metalloproteinase inhibitors, thalidomide, tamoxifen, interferons and others. The use of antiangiogenic agents, both in combination with other treatment modalities in the acute setting as well as long-term maintenance or prevention of cancer, is at present one of the better promises in the war against cancer.

Recognition of hemophilia A in an elderly patient

Hemophilia A (classic hemophilia) is an hereditary coagulation disorder characterized by the absence, severe deficiency, or defective functioning of plasma coagulation factor VIII. It is inherited in an X-linked recessive manner and occurs almost exclusively in males. The first manifestations of bleeding are usually first noted as a young child since most of the patients with hemophilia A have a profound deficiency of factor VIII (less than 1% of normal value). However, in mild hemophilia (5-25% of normal level of factor VIII) the condition may escape detection with many of the patients developing bleeding only after trauma or surgery. Hemophilia A is the result of a recent genetic mutation in approximately one third of patients, for whom often there is no family history of a bleeding disorder. Here we present an elderly male patient with spontaneous bleeding in an extremity that has coagulation studies consistent with the diagnosis of hemophilia A. Physicians must be aware that mild hemophilia can present in this unusual manner and should consider this possibility in patients that have unexplained bleeding even if there is no clear personal or family history of an hereditary coagulation disorder

Current role of chemotherapy protectors in cancer treatment

The administration of full doses of chemotherapy according to an established schedule improves the response rate and duration of response in cancer patients. However, frequently there are delays in therapy due to dose-limiting side effects and chemotherapy could affect permanently normal tissues. This has led to the development of chemotherapy protectors and of rescue agents in the past years. We will discuss some of these new agents and their use in cancer treatment. Some of these agents include amifostine (Ethyol), dexrazoxane (Zinecard), mesna (Mesnex), leucovorin, G-CSF, GM CSF, recombinant erythropoietin and thrombopoietin. Oncologists must learn the adequate use of different strategies in reducing chemotherapy toxicity in order to improve both the quality and quantity of life of cancer patients

Recent advances in cancer therapy

The treatment of cancer has developed substantially from its conception in the first years of the 20th century. Since the introduction of alkylating agents during second World War, the oncology specialty has markedly grown. In the recent years, new drugs have been approved for the treatment of cancer. Such examples include the taxanes (Docetaxel and Paclitaxel), Vinorelbine, Irinotecan, Topotecan, Gemcitabine and Gliadel. We will discuss these new chemotherapuetic agents, their pharmacology, indications, toxicity and appropriate dosing. There is no doubt that further clinical research is needed to determine the optimal use of these agents

Non-Hodgkin's lymphoma associated with the acquired immunodeficiency syndrome

Patients with the Acquired Immunodeficiency Syndrome (AIDS) have an increased risk of developing Non-Hodgkin's Lymphomas (NHL). It is estimated that 8-27 of newly diagnosed NHL are associated with AIDS. The majority of these lymphomas are of intermediate or high grade histology. We retrospectively analyzed the clinical manifestations and response to different chemotherapy regimens in patients with AIDS NHL in the San Juan City and San Juan Veterans Administration Hospitals from 1990-1993. Eleven patients (10 M/1F) with an average age of 46 (range 31-68) were analyzed. 64 (7/11) of patients had a prior diagnosis of AIDS before the diagnosis of NHL. Pathology was diffuse large cell in 6, Burkitt's in 4 and immunoblastic in 1.73 of patients presented with Stage III/IV. Sites included gastrointestinal tract (2), skin/soft tissue (2), paranasal sinus (1), kidneys (1). The most common treatment regimen was the modified m-BACOD (64). Complete response (CR) occurred in 46 (5/11) and partial response (PR) in 27 (3/11). 36 of patients developed opportunistic or bacterial infections during treatment. Median survival was 8 months. Two patients are long-time survivors at 24+, 29+ without evidence of NHL at present. This group of patients demonstrate the usual characteristics of NHL in AIDS patients and corroborate that conventional chemotherapy programs are only moderately effective in these patients. It is clear from this data and from other reports that further work will be required to ascertain optimal therapy for the patient with AIDS-related Non-Hodgkin's Lymphoma

Severe autoimmune hemolytic anemia associated with pneumococcal bacteremia

Acquired autoimmune hemolytic anemia frequently occurs in an individual with a deranged immune system. This impaired immune system can also predispose the patient to infections with a wide range of organisms. Also, it is known that certain infectious organisms can induce immune hemolytic anemia in normal hosts by diverse mechanisms. When autoimmune hemolytic anemia presents concomitantly with infection, it is extremely difficult to establish the etiology of the condition. We present a case of severe autoimmune hemolytic anemia of the warm antibody type associated with pneumococcal sepsis in which both the infectious process and the hemolysis are probably secondary to an altered immune system