Clondronate for the treatment of bone metastases in hormone refractory prostate Cancer

To evaluate the clinical efficacy of clondronate for the treatment of symptomatic skeletal metastases due to hormone refractory prostate cancer in terms of decreased pain and an improved Karnofsky index. Between January 2003 and February 2005, a total of 20 patients presented to Clinical Oncology Department, Alexandria University and El-Obour Insurance Hospital, Kafer El-Sheikh, with bone pain due to metastases from hormone refractory prostate adenocarcinoma, were evaluated and treated with clondronate in open prospective non controlled study. A significant pain decrease in terms of a mean pain score 3 [ranged from 0 to 5] was achieved in 15 patients [75%]. Fifteen patients were completely pain free without further need for analgesic medications. The initial mean karnofsky index of 48% [ranged from 35% to 60%] elevated to 65% [range 50-80%]. Side effects consisted mainly of slight gastrointestinal discomfort in three patients [15%] in the form of epigastric and excessive salivation and superficial phlebitis in one patient [5%]. Clondronate is an effective drug for palliative treatment of bone metastases caused by hormone refractory prostate cancer, with prompt effects on pain, improvement of Karnofsky index, decrease consumption of analgesics with few side effects and improvement in the quality of life

Gemcitabine as a single agent in the treatment of relapsed or refractory aggressive non Hodgkin's lymphoma

To evaluate the efficacy and safety of gemcitabine in the treatment of patients with relapsed or refractory aggressive Non-Hodgkin's lymphoma [NHL]. This prospective open-label nonrandomiied study included twenty patients with refractory or relapsed maggressive NHL between February 2001 and April 2004 seen at the department of Clinical Oncology, Alexandria University and El-Obour Insurance Hospital, Kafer El-Sheikh. Toxicities were recorded according to the WHO scoring. Patients were evaluated for complete response [CR], time to tumor progression for responders [TTP], and treatment toxicities. No complete response was observed, but only 25% of the patients achieved partial response [PR], 45% of them had stable disease and 30% had progressive disease. The median time to best response for the five patients [25%] was 2.5 months while the median time to progression for the responders was 6.5 months. At the end of follow up period [18 months] eight out of the 20 patients [40%] had died. Grade 3 anemia, leucopenia and thrombocytopenia developed in 10%, 15% and 35% respectively. Most of the chemotherapy non-hematologic toxicities were mild or moderate and manageable. Gemcitabine is effective salvage chemotherapy for patients with aggressive NHL. Most of the chemotherapy toxicities were mild or moderate and manageable. Thrombocytopenia was the main dose-limiting toxicity

Dexamethasone, ifosfamide, cisolatin and etoposide with involved field radiotherapy in relapsed or refractory non hodgkin s lymphoma

To evaluate the tolerance and efficacy of dexamethasone, ifosfamide, cisplatin, and etoposide [DICE] combination chemotherapy regimen, as salvage the rapy for relapsed or refractory patients with intermediate and high-grade Non-Hodgkin's lymphoma [NHL]. It is a prospective trial that included forty-patients with refractory or relapsed NHL. All patients had a histological confirmation of intermediate or high-grade NHL and received DICE regimen. Toxicities were recorded according to the WHO scoring. Radiotherapy was given as involved-field [36 Gy in 20 fractions, 180 cGy per fraction] and began three weeks after the last cycle of chemotherapy. Patients were evaluated for response rate [RR], time to treatment failure [TTF], overall survival [OS] and prognostic factors that affect these variables. The overall response rate to treatment was 26.7%, and 35.5% achieved partial response. By adding involved field radiotherapy to chemotherapy, CR increased to 37.8%, and the overall response rate was 60%. Significant factors that affect response rate were stage at relapse, p=0.0001, IPI p=0.002], and disease status [p=0.03]. Time to treatment failure was significantly affected by IPI [p=0.04]. The median time to treatment failure was 8 months while the median OS was 12.5 months. Grade 3 and 4 neutropenia were observed in 31%, nausea and vomiting in 15.6%. Most of the chemotherapy toxicities were mild or moderate and manageable. DICE regimen is an effective salvage chemotherapy for patients with intermediate and high grade NHL. Most of the chemotherapy toxicities were mild or moderate and manageable. Neutropenia was the main dose-limiting toxicity

Quality of life and efficacy of vinorelbine and fluorouracil versus fluorouracil, adriamycin and cyclophosphamide chemotherapy in advanced breast cancer

To assess the effect of vinorelbine and 5-fluorouracil [NF] in comparison to 5-fluorouracil, adriamycin and cyclophosphamide [FAC] chemotherapy regimen on the treatment outcome and their impact on the quality of life in patients with advanced breast cancer [ABC]. The prognostic significance of the quality of life on survival was also studied. It is a phase Ill study that included 104 women with ABC who were randomly assigned to receive either FAC [Group I] or NF regimen [Group II]. Patients were evaluated for response rate [RR], time to tumor progression [TTP], overall survival [OS] and toxicities. The quality of life was assessed using Spitzer's quality of life index [QLI]. Patients who received FAC achieved significantly higher overall RR, compared to those who received NF regimen [69.2% versus 50.0%, p=0.04]. A significantly higher median TTP was achieved in patients who received FAC compared to those received NF [11.4 and 6.1 months] respectively with p=0.03. A higher median OS was observed in group I patients compared to group II 19.0 versus 16.4 months, however, the difference in OS was not statistically significant [p=0.4]. The quality of life index [QLI] was proved to be an independent factor affecting TTP in group I [p=0.001] and in group II as well [p=0.01] As regards OS, QLI has no significant prognostic influence in either groups. Since improvement in TTP is a major goal where treatment is mainly palliative, our impression is that FAC is still one of the standard anthracycline-containing regimens in ABC. Vinorelbine, 5-fluorouracil can be used as second-line or as first-line regimen in cases where anthracyclines are not appropriate. Quality of life can be used as a predictor for progression-free survival