ABSTRACT
The purpose of this phase II trial was to compare the efficacy, safety and pharmacokinetics of four irinotecan schedules for the treatment of metastatic colorectal cancer. In total, 174 5-fluorouracil pretreated patients were randomised to: arm A (n=41), 350 mg m(-2) irinotecan as a 90-min i.v. infusion q3 weeks; arm B (n=38), 125 mg m(-2) irinotecan as a 90-min i.v. infusion weekly x 4 weeks q6 weeks; arm C (n=46), 250 mg m(-2) irinotecan as a 90-min i.v. infusion q2 weeks; or arm D (n=49), 10 mg m(-2) day(-1) irinotecan as a 14-day continuous infusion q3 weeks. No significant differences in efficacy across the four arms were observed, although a shorter time to treatment failure was noted for arm D (1.7 months; P=0.02). Overall response rates were in the range 5-11%. Secondary end points included median survival (6.4-9.4 months), and time to progression (2.7-3.8 months) and treatment failure (1.7-3.2 months). Similarly, there were no significant differences in the incidence of grade 3-4 toxicities, although the toxicity profile between arms A, B, and C and D did differ. Generally, significantly less haematologic toxicity, alopecia and cholinergic syndrome were observed in arm D; however, there was a trend for increased gastrointestinal toxicity. Irinotecan is an effective and safe second-line treatment for colorectal cancer. The schedules examined yielded equivalent results, indicating that there is no advantage of the prolonged vs short infusion schedules.
Subject(s)
Adenocarcinoma/drug therapy , Antineoplastic Agents, Phytogenic/therapeutic use , Camptothecin/analogs & derivatives , Camptothecin/therapeutic use , Colorectal Neoplasms/drug therapy , Adenocarcinoma/secondary , Adolescent , Adult , Aged , Antineoplastic Agents, Phytogenic/pharmacokinetics , Camptothecin/pharmacokinetics , Colorectal Neoplasms/pathology , Drug Administration Schedule , Female , Humans , Irinotecan , Male , Middle Aged , Survival Rate , Topoisomerase I Inhibitors , Treatment OutcomeABSTRACT
Accumulation of visceral adipose tissue is associated with metabolic complications such as noninsulin-dependent diabetes mellitus. The aim of this study was to evaluate the effect of abdominal adipose tissue on insulin sensitivity in subjects with noninsulin-dependent diabetes mellitus (NIDDM). Areas of abdominal fat were calculated from axial magnetic resonance images obtained at the level of the umbilicus in 21 men with NIDDM [age, 45.6 +/- 8.3 (+/-SD) yr; body mass index, 29.3 +/- 4.5 kg/m(-2); total body fat (skinfold thickness), 26.8 +/- 5.4%; waist to hip ratio, 0.97 +/- 0.07; duration of diabetes, 59 +/- 47 months; hemoglobin A1c, 8.1 +/- 1.5%]. Insulin sensitivity was evaluated by an insulin tolerance test. The areas of deep abdominal fat and sc abdominal fat were, respectively, 135.3 +/- 55.1 and 211.8 +/- 99.1 cm2. The blood glucose disappearance rate was 2.11 +/- 0.87%/min and was negatively related to deep abdominal fat (r = 0.72; P = 0.0025). In contrast, areas of sc abdominal fat, total body fat, body mass index, and waist to hip ratio were not related to the blood glucose disappearance rate. Plasma triglyceride concentrations averaged 1.8 +/- 0.8 mmol/L and were positively related to deep abdominal fat (r = 0.69; P = 0.0018). We conclude that insulin sensitivity is strongly related to visceral adipose tissue accumulation in NIDDM.
Subject(s)
Abdomen/pathology , Adipose Tissue/pathology , Diabetes Mellitus, Type 2/pathology , Insulin Resistance , Adipose Tissue/diagnostic imaging , Adult , Anthropometry , Cardiovascular Physiological Phenomena , Diabetes Mellitus, Type 2/diagnostic imaging , Diabetes Mellitus, Type 2/physiopathology , Evaluation Studies as Topic , Humans , Linear Models , Magnetic Resonance Imaging , Male , Middle Aged , Physical Fitness , Tomography, X-Ray Computed , Viscera/pathologyABSTRACT
OBJECTIVE: To evaluate the effects of an intense physical training program on abdominal fat distribution, glycemic control, and insulin sensitivity in patients with NIDDM and to determine whether branched-chain amino acid (BCAA) supplements influence these effects. RESEARCH DESIGN AND METHODS: Twenty-four patients (ages 45 +/- 2 [mean +/- SE] years, BMI 30.2 +/- 0.9 kg/m2, HbA1c 7.9 +/- 0.3%) were randomly assigned to four groups: training plus BCAA supplement (n = 6), training plus placebo (n = 6), sedentary plus BCAA supplement (n = 6), and sedentary plus placebo (n = 6). Physical training consisted of a supervised 45-min cycling exercise at 75% of their oxygen uptake peak (VO2 peak) two times per week and an intermittent exercise one time per week for 2 months. RESULTS: Patients who exercised increased their VO2 peak by 41% and their insulin sensitivity by 46%. Physical training significantly decreased abdominal fat evaluated by magnetic resonance imaging (umbilicus), with a greater loss of visceral adipose tissue (VAT) (48%) in comparison with the loss of subcutaneous adipose tissue (18%), but did not significantly affect body weight. The change in visceral abdominal fat was associated with the improvement in insulin sensitivity (r = 0.84, P = 0.001). BCAA supplementation had no effect on abdominal fat and glucose metabolism. CONCLUSIONS: Physical training resulted in an improvement in insulin sensitivity with concomitant loss of VAT and should be included in the treatment program for patients with NIDDM.
Subject(s)
Adipose Tissue/metabolism , Amino Acids, Branched-Chain/pharmacology , Diabetes Mellitus, Type 2/metabolism , Exercise/physiology , Insulin/metabolism , Lipid Mobilization/physiology , Adipose Tissue/drug effects , Adult , Analysis of Variance , Blood Glucose/analysis , Blood Glucose/drug effects , Blood Glucose/metabolism , Cohort Studies , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/physiopathology , Energy Metabolism/physiology , Female , Glycated Hemoglobin/analysis , Glycated Hemoglobin/drug effects , Glycated Hemoglobin/metabolism , Humans , Insulin/blood , Insulin Resistance/physiology , Lipid Mobilization/drug effects , Magnetic Resonance Imaging , Male , Middle Aged , Oxygen Consumption/physiology , VisceraABSTRACT
Twenty-five competitive wrestlers restricted their caloric intake (28 kcal.kg-1.day-1) for 19 days, using a hypocaloric control (hC, n = 6), hypocaloric high-protein (hHP, n = 7), hypocaloric high-branched-chain amino acid (hBCAA, n = 6), hypocaloric low-protein (hLP, n = 6) diet to determine the effects of caloric restriction on body composition and performances versus control diet (C, n = 6). Anthropometric parameters (weight, percent body fat) and adipose tissue (AT) distribution measured by magnetic resonance imaging (MRI) obtained before and after diet, were compared. A significant highest body weight loss (-4 kg, p < 0.05) and decrease in the percent of body fat (-17.3%, p < 0.05) were observed for subjects of the hBCAA group. Subjects of the hBCAA group exhibited a significant reduction (-34.4%, p < 0.05) in abdominal visceral adipose tissue (VAT). There was no change in aerobic (VO2max) (p > 0.75) and anaerobic capacities (Wingate test) (p > 0.81), and in muscular strength (p > 0.82). We conclude that under our experimental conditions, the combination of moderate energy restriction and BCAA supplementation induced significant and preferential losses of VAT, and allowed maintainance of a high level of performance.