Phase II study of irinotecan plus leucovorin and bolus 5-fluorouracil as first- or second-line chemotherapy in patients with advanced gastric or esophageal-gastric junction adenocarcinoma.

The aim of this study was to evaluate the activity and safety of 5-fluorouracil (5-FU)/leucovorin (LV) and irinotecan as first- or second-line treatment in patients with advanced gastric adenocarcinoma. Treatment consisted of irinotecan 80 mg/m(2) intravenously (i.v.), followed by LV 200 mg/m(2) (i.v.) and 5-FU 450 mg/m(2) as an i.v. bolus, administered weekly for 6 weeks, followed by a 2-week rest period. Thirty-one patients (23 chemo-naïve, 8 chemo-exposed) were enrolled. The overall response rate was 22.6% and the disease control rate was 38.7%. Among the patients who received the regimen as first-line treatment, objective response rate was 30.4% and the disease control rate was 52.1%. However, progression of the disease was recorded in all the patients receiving the combination as second-line chemotherapy. The median time to disease progression (TTP) was 4 months and the median duration of survival was 7 months. The median TTP was 6 months for patients treated with first-line chemotherapy and 2.5 for those who received study treatment as second line. Furthermore, the median survival duration was 8 months and 6 months, respectively. The most frequent grade 3 toxicity was febrile neutropenia. Grade 3 non-hematological toxicities were rare. There were no treatment-related deaths. The combination of 5-FU/LV and irinotecan as first-line treatment was found to be well tolerated and effective in patients with advanced gastric cancer. Further investigation would be worthwhile, particularly in elderly or debilitated patients who cannot tolerate aggressive chemotherapy.

Octreotide Acetate in the Treatment of Fluorouracil-Induced Diarrhea.

Cytotoxic chemotherapy, particularly the regimens that contain 5-fluorouracil (5-FU), can produce diarrhea. Octreotide acetate appears to have a major therapeutic effect in the management of 5-FU-induced diarrhea. A prospective study was conducted to investigate the efficacy of two different doses of octreotide acetate, 100 µg and 500 µg three times daily, for the treatment of severe 5-FU-induced diarrhea refractory to loperamide, and also to evaluate whether the higher dose is more effective in the management of this complication. Fifty-nine patients with tissue-documented colorectal and head and neck carcinoma were enrolled in this study, 28 in the 100 µg arm and 31 in the 500 µg arm of octreotide acetate which was administered s.c. three times daily. Patients were required to have National Cancer Institute Common Toxicity Criteria

Use of oral ciprofloxacin in community-acquired pneumonia.

Twenty-five acutely ill patients, 21 men and 4 women aged 20-90 years (mean, 54 years) with acute community-acquired bacterial pneumonia, were treated with ciprofloxacin orally. The diagnosis of pneumonia was based on clinical and roentgenographic evidence of pulmonary infiltrate and a Gram stain of sputum demonstrating neutrophils and bacteria. Initially, 12 patients received 750 mg of ciprofloxacin orally every 12 hours for 3-6 days (mean, 3.8 days) followed by 500 mg of oral medication twice daily for 4-7 days (mean, 4.8 days). The remaining 13 patients received 500 mg of ciprofloxacin orally for 8-15 days (mean, 8.5 days). Treatment was successful in all patients (100%). No superinfections occurred, and there was no development of resistance. The drug was well tolerated and only moderate transient elevation of transaminase levels (serum glutamic-oxaloacetic transaminase and serum glutamine pyruvic transaminase) was noted in one patient.

Aqueous humor penetration of ciprofloxacin in the human eye.

Two doses of ciprofloxacin were administered intravenously, 200 mg every 12 hours, to 25 patients undergoing cataract surgery. Plasma and aqueous humor were obtained at 1, 3, 5, 7, and 9 hours after the administration of the second dose of the drug. Peak intraocular concentrations (mean +/- SD), 0.21 +/- 0.1 mg/L, were detected at one hour following ciprofloxacin administration. A time-dependent decrease of the penetration was observed, and by nine hours after the administration, ciprofloxacin levels were 0.05 mg/L. These results illustrate that ciprofloxacin may be an effective antimicrobial agent for prophylactic use in ophthalmologic surgery and also for the treatment of intraocular infections due to susceptible organisms.

Amiodarone-induced recurrent allergic pneumonitis.

Two patients with history of amiodarone-induced pulmonary reactions were accidentally treated again with amiodarone and the pulmonary complication recurred. The clinical symptoms and radiographic findings disappeared after amiodarone was discontinued and the administration of corticosteroids. Recurrent pulmonary reaction from amiodarone on different occasions is a rarely reported complication and confirms the relationship of pulmonary toxicity to chronic amiodarone administration.

Early echocardiographic detection of acute myocardial infarction.

Early echocardiographic wall motion changes were detected in a patient with subepicardial infarction of the true posterior wall. Left ventricular wall excursion and velocities were found diminished one hour following the onset of symptoms and before any significant electrocardiographic changes. Sublingual nitroglycerin administration reverted the hypokinetic posterior wall to normal but only temporarily. These observations may be of added value in the early detection of the acute myocardial ischaemia.