Subject(s)
Antineoplastic Agents, Alkylating/adverse effects , Central Nervous System/pathology , Cryptococcosis/etiology , Dacarbazine/analogs & derivatives , Radiotherapy/adverse effects , Brain Stem Neoplasms/drug therapy , Brain Stem Neoplasms/radiotherapy , Cryptococcosis/diagnosis , Dacarbazine/adverse effects , Glioblastoma/drug therapy , Glioblastoma/radiotherapy , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Temozolomide , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: This study aimed to examine the efficacy and toxicity of pemetrexed in Singapore. METHODS: We conducted a retrospective review of patients treated with pemetrexed between July 2005 and November 2007. RECIST was used to assess the efficacy independent of the treating physician's assessment, and NCI CTC-AE version 3.0 was used to describe adverse events. RESULTS: 37 patients had non-small-cell lung cancer (NSCLC) and six had malignant pleural mesothelioma. Those with NSCLC had a median age of 60 and an ECOG PS of 0-1, and they were predominantly male, ethnic Chinese and smokers. A median of two cycles were delivered (total 95; range 1-12). Grade 3/4 toxicity was rare. Five (14 percent) patients had an objective response (one complete, four partial) and 13 (35 percent) had stable disease. Median time to treatment failure was 1.86 months (95% confidence interval [CI] 0-6.5). Median overall survival was 18.6 months (95% CI 12.6-27.7). Median age of patients with mesothelioma was 46.5 (range 29-73) years. Five men and one woman received a median of four (total 30, range 1-15) cycles of pemetrexed in combination with cisplatin. Three patients had a partial response, two had stable disease and one had disease progression. Grade 3/4 toxicities were as follows: leucopenia, neutropenia and thrombocytopenia in one patient. CONCLUSION: The results of this retrospective study and literature review show that pemetrexed is safe and efficacious in the treatment of Asian patients with NSCLC and mesothelioma.
Subject(s)
Glutamates/therapeutic use , Guanine/analogs & derivatives , Thoracic Neoplasms/drug therapy , Adult , Aged , Aged, 80 and over , Antimetabolites, Antineoplastic/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Female , Guanine/therapeutic use , Humans , Lung Neoplasms/drug therapy , Male , Mesothelioma/drug therapy , Middle Aged , Pemetrexed , Retrospective Studies , Singapore , Thoracic Neoplasms/ethnology , Treatment OutcomeABSTRACT
BACKGROUND: Trousseau's syndrome is a prothrombotic state associated with malignancy that is poorly understood pathophysiologically. METHODS AND RESULTS: Here we report studies on the blood of a 55-year-old man with giant-cell lung carcinoma who developed a severe form of Trousseau's syndrome. His clinical course was dominated by an extremely hypercoagulable state. Despite receiving potent antithrombotic therapy, he suffered eleven major arterial and venous thrombotic events over a 5 month period. We examined the patient's blood for tissue factor (TF), the major initiator of coagulation, and found its concentration in his plasma to be forty-one-fold higher than the mean concentration derived from testing of 16 normal individuals. CONCLUSION: Almost all of the TF in the patient's plasma was associated with cell-derived microvesicles, likely shed by the cancer cells.