Impact of the incorporation of tyrosine kinase inhibitor agents on the treatment of patients with a diagnosis of advanced renal cell carcinoma: study based on experience at the Hospital Universitario Central de Asturias

INTRODUCTION: For nearly the past two decades, cytokines (CKs) have been the only systemic treatment option available for advanced renal cell carcinoma (RCC). In recent years, tyrosine kinase inhibitors (TKIs) have demonstrated clinical activity on this tumour. Our purpose is to describe one centre's experience with the use of CKs and TKIs in the treatment of patients with advanced RCC. MATERIALS AND METHODS: This study was designed as a retrospective chart review of RCC patients who were treated with CKs and/or TKIs in our department between July 1996 and June 2008. Efficacy and toxicity were assessed using World Health Organization (WHO) criteria. The Kaplan-Meier method was used to estimate progression-free (PFS) and overall (OS) survival. RESULTS: Ninety-four patients were classified into three groups depending on the modality of treatment administered: 46 were treated with CKs alone and/or chemotherapy (27 with immunotherapy, one with chemotherapy and 18 with both), 28 with TKIs alone (25 with sunitinib and 13 with sorafenib) and 20 with TKIs in second-line treatment following failure with CKs (17 with sunitinib, eight with sorafenib, four with bevacizumab and one with lapatinib). The median age was 60 years in the CK group and 65 and 62, respectively, in TKI in first and second-line treatment groups. Eighty-five percent of patients treated with CKs and 75% in the TKI group in first-line treatment and 80% in second-line treatment were men. Overall, 89% of patients had favourable risk, and 11% had intermediate risk. All patients were considered evaluable for toxicity. The main grade 3-4 (%) toxicity was asthenia for both groups, (ten in TKIs and 15 in CKs). Other grade 1-2 toxicities were mucositis (39), bleeding (8), hypertension (19), skin toxicity (33) and hypothyroidism (12.5) associated with TKIs; and anaemia (33), cough (29), asthenia (39) and emesis (14) associated with CKs. The objective response rate among 80 patients evaluable for activity was 10.6% with CKs and 46.5% and 35%, respectively, with TKIs in first- and second-line treatments. Disease stabilisation with CKs was recorded at 59% of patients and with TKIs 25% and 50% in first- and second-line treatment groups, respectively. The median progression-free survival (PFS) with CKs was 122 days [95% confidence interval (CI) 82-162] and with TKIs 201 days (65-337) in the first and 346 days (256-436) in second-line treatment groups. The median overall survival (OS) was 229 days (142-316) and 2,074 days (1,152-2,996) for patients treated with CKs and TKIs. CONCLUSIONS: Our results are in line with the activity and survival rates previously reported in the literature regarding the use of TKIs for patients with advanced RCC in first- and second-line treatment, which has demonstrated an acceptable toxicity level (AU)

Impact of erythropoietin on the reduction of blood transfusions and on survival of lung cancer patients receiving first-line chemotherapy

INTRODUCTION: Anaemia is a common problem in patients with cancer who receive chemotherapy and is normally associated with a negative impact on patients' quality of life (QOL), poor cancer control and diminished survival. In clinical trials, recombinant human erythropoietin has been shown to correct and prevent anaemia, decrease the need for blood transfusions and improve cancer patients' QOL. METHODS: A retrospective study followed lung cancer patients who received first-line chemotherapy in our hospital in 1998 and in 2005. The incidence of anaemia was analysed, as was the impact of incorporating erythropoietin into the treatment. RESULTS: The incidence of anaemia was 68% (69% of which reported asthenia) in 1998 vs. 54% (60% with asthenia) in 2005. The comparison of anaemia rates (1998 vs. 2005) were grade 1 (16% vs. 32%), grade 2 (36% vs. 16%), grade 3 (16% vs. 5%) and grade 4 (none). Treatment for anaemia included transfusion 52%, intravenous iron 5% and epoetin 4% in 1998. In 2005 anaemia was treated with transfusion 9%, intravenous iron 41%, and epoetin 49%. Median survival (1998 vs. 2005) was 242 days [95% confidence interval (CI) 217-329) vs. 356 days (95% CI 322-382). CONCLUSIONS: Erythropoietin is a valid alternative for cancer patients with anaemia undergoing chemotherapy. It can possibly avoid the need for transfusions without negatively impacting survival (AU)

No disponible

Estudio retrospectivo en pacientes con diagnóstico de carcinoma de pulmón no microcítico estadio avanzado tratados con la combinación gemcitabina y vinorelbina: valoración de la eficacia terapéutica y factores pronósticos / No disponible

Introducción: La Gemcitabina (G), la vinorelbina (V) y su combinación (GV) han demostradosu utilidad en pacientes con Carcinoma de Pulmón no Microcítico (CPNM). El propósito del estudioha sido confirmar la eficacia de GV e identificar factores pronósticos relacionados con los resultadosterapéuticos.Pacientes y Métodos: Se revisó de forma retrospectiva la historia de 144 pacientes conCPNM avanzado tratados entre octubre del 96 y abril del 05 con G (1.000-1.250 mg/m2) + V (25-30mg/m2) administrados el día 1 y 8 cada 21 días.Resultados: El tratamiento fue bien tolerado, desarrollando un 18% de los pacientes leucopeniagrado 3-4 incluyendo un 7% de neutropenia febril como peor toxicidad. La tasa de respuestas objetivasfue del 36,8% (IC al 95: 28,9–44,7) y las medianas de supervivencia libre de progresión y globalfueron de 21 (18–25) y 33 (26–40) semanas respectivamente. En el análisis multivariante sólo la histologíade adenocarcinoma (HR 3; p<,0001), la enfermedad limitada a una o ninguna localización metastática(HR 1,7; p =,02) y el índice Karnofsky (IK) mayor a 70% (HR 1,5; p=,02) tuvieron una asociaciónsignificativa con mayor supervivencia.Conclusiones: La combinación de GV se tolera bien y es eficaz en pacientes con CPNM avanzado.La histología de adenocarcinoma, la enfermedad limitada a una o ninguna localización metastásicay un IK superior a 70% se han identificado como variables independientes relacionadas con unamejor supervivencia

Introduction: Gemcitabine (G), vinorelbine (V) and their combination (GV) have shown to beuseful in patients with non-small cell lung cancer (NSCLC). The purpose of this study is to confirmthe activity of GV administration and to identify prognostic factors related with the clinical outcome.Methods: A retrospective analysis was carried out in relation to 144 patients with NSCL treatedbetween October 1996 and April 2005 with G (1000-1250 mg/m2) + V (25-30 mg/m2) both administeredon days 1 and 8 every three weeks.Results: Treatment was well tolerated, grade 3-4 neutropenia being registered as the worse toxiceffect in 18% cases, including 7% of neutropenic fever. The objective response rate was 36.8% (95%CI: 28.9-44.7) and the median progression free survival and overall survival rates were 21 (18-25) and33 (26-40) weeks respectively. In multivariate analysis only the histology of adenocarcinoma (HR 3;p<0.001), less than two metastatic sites (HR 1.7; p<0.02) and Karnofsky index (KI) above 70% (HR1.5; p<0.02) showed a significant association with longer survival.Conclusion: The GV combination therapy is well tolerated and active in patients with advancedNSCLC. The histology of adenocarcinoma, less than two metastatic sites and KI above 70% were identified as independent variables related with longer survival (AU)