Treatment of advanced renal cell carcinoma with the combination bevacizumab/erlotinib/imatinib: a phase I/II trial.

PURPOSE: The aim of this study was to evaluate the efficacy and toxicity of imatinib, a platelet-derived growth factor-beta receptor antagonist, when added to the combination bevacizumab/erlotinib in the treatment of patients with advanced clear cell renal carcinoma. PATIENTS AND METHODS: Ninety-four patients with metastatic clear cell renal carcinoma were treated with bevacizumab 10 mg/kg intravenously every 2 weeks, erlotinib 150 mg orally daily, and imatinib 400 mg orally daily. Patients were reevaluated after 8 weeks of treatment; patients with objective response or stable disease (SD) continued to receive treatment until they experienced tumor progression. RESULTS: Fifteen of 88 evaluable patients (17%; 95% confidence interval, 10%-26%) had partial responses, whereas an additional 54 patients (61%) had SD. The median progression-free and overall survival for all patients was 8.9 months and 17.2 months, respectively. The addition of imatinib markedly increased toxicity compared with the bevacizumab/erlotinib regimen; the most common grade 3/4 toxicities were diarrhea, rash, and fatigue. CONCLUSION: Bevacizumab/erlotinib/imatinib was unacceptably toxic in this group of patients. Inhibition of the PDGF receptor (PDGFR) with imatinib did not appear to improve efficacy compared retrospectively with the results of treatment with bevacizumab/erlotinib. The importance of PDGFR inhibition in the treatment of advanced clear cell renal carcinoma remains unclear. Further development of this particular combination is not planned or recommended.

Paclitaxel, carboplatin, and oral etoposide as initial treatment for advanced ovarian carcinoma: a Minnie Pearl Cancer Research Network phase II trial.

PURPOSE: To evaluate the feasibility and toxicity of the combination of paclitaxel, carboplatin, and etoposide in the first-line treatment of patients with stage III or IV adenocarcinoma of the ovary. PATIENTS AND METHODS: Patients entering this trial received paclitaxel 200 mg/m(2), 1 h IV infusion, day 1; carboplatin AUC 6.0 IV, day 1; etoposide 50 mg alternating with 100 mg orally, days 1-10. Patients received 6 courses of treatment, administered at 21-day intervals. All patients were assigned a response category using clinical restaging criteria. The primary endpoints for this trial were progression-free and overall survival. RESULTS: Between October 1996 and April 2001, 52 patients were treated. The overall objective response rate for the 48 evaluable patients was 75%, with 46% complete responses. Amongst the 36 patients with suboptimal disease, median progression-free and overall survivals were 12 and 24 months, respectively. After a median follow-up of 64 months, the median progression-free and overall survival has not been reached for the optimal patients; 5-year progression-free survival is 57% for this group. Treatment-related myelosuppression was common, but myelosuppression-related complications were uncommon, as was grade 3/4 non-hematologic toxicity. No episodes of acute myelogenous leukemia have developed. CONCLUSIONS: The combination of paclitaxel, carboplatin, and oral etoposide was feasible and effective in this patient population. Unlike previous reports, no episodes of acute leukemia were seen following this treatment. Definitive conclusions regarding the benefit of adding etoposide to a taxane/platinum combination will require a comparative trial.

Pseudomonas aeruginosa infections in a neonatal intensive care unit.

This report describes a cluster of nosocomial infections with Pseudomonas aeruginosa in a neonatal intensive care nursery. All 5 cases of P aeruginosa infection were clustered in September 1999. Aggressive infection control measures were instituted, including installation of a user-friendly handwashing soap and environmental cleaning. On the basis of the finding of persistent dirty equipment, a new full-time position was created that was dedicated to equipment cleaning. These measures were effective in eliminating the cluster. The nursery has remained free of P aeruginosa infection for more than 2 years, attesting to the success of our program.

Control of transmission of Norwegian scabies.

Seven staff members developed scabies after exposure to a patient with acquired immunodeficiency syndrome (AIDS) dementia and hyperkeratotic skin lesions. They were treated and prophylaxis was given to 11 staff members in September 1998. The hospital has had no nosocomial scabies since then despite the admission of 11 patients with AIDS and Norwegian scabies.