Subject(s)
Blood Transfusion, Autologous , Intraoperative Care , Preoperative Care , Prostatectomy , Aged , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Thromboembolic complications are common in patients with advanced malignancies. For these patients anticoagulation with warfarin is often complicated by severe bleeding. For this reason we evaluated the safety and efficacy of the Bird's Nest Filter, a new device capable of preventing migration of thromboemboli to the pulmonary arteries through interruption of the inferior vena cava. We report a series of 31 unselected patients with advanced malignancies and thromboembolic disease in whom the filter was used in lieu of chronic full-dose warfarin anticoagulation. No documented cases of pulmonary emboli occurred after insertion of the filter. Placement of the filter was uncomplicated. Eight patients (25.8%) developed lower-extremity edema. Venous thrombosis distal to the filter was documented in six (19.4%) patients but did not require institution of heparin or warfarin. Two patients (6.5%) required treatment with aspirin for painful lower-extremity thrombophlebitis. No filter migration was documented. We conclude that the use of the Bird's Nest Filter is an option for patients with cancer-related lower-extremity thrombosis who are at risk for pulmonary emboli and are poor candidates for full-dose systemic anticoagulation with warfarin. A prospective randomized trial comparing the filter and the new strategy of low-dose anticoagulation with warfarin will be needed to completely validate this approach.
Subject(s)
Neoplasms/complications , Thrombophlebitis/prevention & control , Vena Cava Filters , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasms/mortality , Retrospective Studies , Survival Rate , Thrombophlebitis/etiology , Treatment OutcomeABSTRACT
A total of 48 patients with measurable advanced gastric adenocarcinoma (n = 16) or adenocarcinoma of the exocrine pancreas (n = 32) were prospectively treated with iproplatin at a starting dose of 270 mg/m2 intravenously over 2 hours. The dose was repeated every 28 days, and dose escalations or reductions were made on the basis of toxicity in the preceding course. No patient with gastric carcinoma achieved either a complete or partial response. One partial response and two complete responses were seen with pancreatic adenocarcinoma for an overall response rate of 10%. One patient has remained free of disease for more than 2 years. The major toxicities were granulocytopenia, thrombocytopenia, nausea, vomiting, and diarrhea. All toxicities were reversible upon discontinuation of the drug. On the basis of this trial, we conclude that iproplatin has no substantive activity in advanced gastric or pancreatic carcinomas.
Subject(s)
Adenocarcinoma/drug therapy , Antineoplastic Agents/therapeutic use , Organoplatinum Compounds/therapeutic use , Pancreatic Neoplasms/drug therapy , Stomach Neoplasms/drug therapy , Adenocarcinoma/secondary , Adult , Aged , Antineoplastic Agents/administration & dosage , Female , Humans , Male , Middle Aged , Organoplatinum Compounds/administration & dosage , Organoplatinum Compounds/adverse effects , Prospective StudiesABSTRACT
A total of 15 patients with measurable advanced colorectal adenocarcinoma were prospectively treated with fazarabine (Ara-AC), reconstituted in dimethyl sulfoxide, and administered at a starting dose of 48 mg/m2/day as a continuous intravenous infusion for three days. The dose was repeated every 21 days and dose escalations or reductions were made on the basis of toxicities encountered in the preceding course. No patient achieved either a complete or partial response. Major toxicities encountered were granulocytopenia, thrombocytopenia, nausea, vomiting, anemia, and headache. All toxicities were reversible upon discontinuation of the drug and no life-threatening toxicities occurred. These data indicate that further clinical trials in colorectal carcinoma with this agent and schedule of administration are not warranted.
