Phase II trial of pegylated liposomal doxorubicin-cyclophosphamide combination as first-line chemotherapy in older metastatic breast cancer patients.

OBJECTIVE: To evaluate the efficacy and toxicity of pegylated liposomal doxorubicin (PLD; Caelyx)-cyclophosphamide combination in older metastatic breast cancer patients. METHODS: A multicenter phase II trial was conducted. Inclusion criteria were age 65-75 years, ECOG 0-1 and left ventricular ejection fraction > or =50%. First-line chemotherapy was given to metastatic breast cancer patients resistant to hormonal therapy. The treatment schedule was PLD 40 mg/m(2) and cyclophosphamide 500 mg/m(2) on day 1 every 4 weeks. Efficacy was the primary endpoint, while response duration and tolerance were the secondary endpoints. RESULTS: Thirty-five patients (median age 71.3 years) were enrolled. No treatment-related death, no congestive heart failure or decrease in left ventricular ejection fraction and no febrile neutropenia were reported. TOXICITY: grade 3 dyspnea was found in 1 patient, neutropenia in 11 patients (7 grade 3, 4 grade 4), grade 3 mucositis in 4 patients, grade 3 hand-foot syndrome in 1 patient and a generalized rash in 1 patient. An objective response (complete and partial response) was achieved in 10 (28.6%) patients and disease control in 24 (69%) with a progression-free survival of 8.8 months and a median overall survival of 20.3 months. CONCLUSION: The PLD-cyclophosphamide combination is moderately active and safe in elderly metastatic breast cancer patients, but cannot be recommended routinely due to myelotoxicity and mucositis hazards.

[Quantification of hepatic arterial and portal venous flow using ultrasound contrast agents for early detection of liver metastases of colorectal cancers]. / Quantification des débits hépatiques artériel et porte à l'aide des produits de contraste ultrasonores: application au diagnostic précoce des métastases hépatiques des cancers colorectaux.

PURPOSE: To quantify liver blood flow using US contrast agents and to evaluate arterial and portal changes in control patients and patients with liver metastases. MATERIALS AND METHODS: Twenty eight patients were included in this study, 8 controls (M0) and 20 patients with liver metastases from colon carcinoma (M+). Hepatic blood flow from hepatic artery and portal vein were determined using quantification of enhancement after contrast injection using Power Doppler US. The ratio of enhancement rise from artery and vein allows calculation of Contrast Enhanced Doppler Perfusion Index (CEDPI) as previously described for Doppler Perfusion Index (DPI). RESULTS: A significant difference was noted for CEDPI between controls (0.49 +/- 0.07) and liver with metastases (0.70 +/- 0.12). CONCLUSION: This functional method of evaluation of liver blood flow was easy to perform, and would be valuable for early detection of overt micro-metastases before anatomical changes observed by conventional imaging. This is helpful for accurate staging of colon carcinoma.

[Initial locoregional chemotherapy in recurrent and locoregional advanced or inoperable stages of pelvic uterine and anorectal cancers]. / Chimiothérapie locorégionale initiale dans les récidives et les formes locorégionales avancées ou inopérables des cancers pelviens utérins et anorectaux.

The authors report their 12 years of experience of intra arterial chemotherapy in pelvic recurrences and inoperable advanced stages of uterine carcinoma, rectal cancer and anal cancer. In squamous cell cancers the drug associations were mitomycin C, bleomycin, fluorouracil and folinic acid and cisplatin. In adenocarcinoma the same protocol contained no bleomycin. Drugs were infused for a 48 hours period in continuous infusion. The dosages were the same than in the intravenous regimens. Twenty patients with pelvic recurrences were included in this retrospective study: six were uterine cancers, fourteen were colo rectal cancers and two had advanced stage uterine cancer. Pain decreased in 10/14 patients with ano-rectal cancer pre sacral recurrence. Partial response was observed in 12 patients. Complete secondary surgical resection was possible in 4/14 rectal cancers and 6/6 uterine cancer recurrences. Chemotherapy induced a pathological complete response in 4/6 uterine cervix carcinoma recurrences. These observations led to perform pelvic intra arterial chemotherapy as first line treatment of locally-advanced inoperable pelvic tumors: 11 uterine cancers and five ano-rectal cancers. The objective were: tumor reduction before radiotherapy or surgery, tumor sterilization, decrease tumor volume for better radiation dosimetry, increase the chance of organ-preservation. The observation of tumor reduction in this small number of patients does not allow to draw definite conclusions. However the introduction of intra arterial pelvic chemotherapy as first line treatment of inoperable pelvic cancer warrants further studies.

[Sleep disorders in patients with personality disorders]. / Troubles du sommeil chez des patients présentant des troubles de la personnalité.

63 patients with personality disorders have been hospitalized in a Sleep Disorder Clinic. Sleep disorders usually started during childhood, disappeared ant the reappeared around the age of 25. The polysomnographic data do not show a specific profile. Most of the patients were of the schizotypal or the borderline type. Therapeutic guidelines are presented.