Prophylactic use of carvedilol to prevent ventricular dysfunction in patients with cancer treated with doxorubicin.

OBJECTIVE: Deterioration in ventricular function is often observed in patients treated with anthracyclines for cancer. There is a paucity of evidence on interventions that might provide cardio-protection. We investigated whether prophylactic use of carvedilol can prevent doxorubicin-induced cardiotoxicity and whether any observed effect is dose related. METHODS: A prospective, randomized, double-blind study in patients treated with doxorubicin, comparing placebo (n = 38) with different doses of carvedilol [6.25 mg/day (n = 41), 12.5 mg/day (n = 38) or 25 mg/day (n = 37)]. The primary endpoint was the measured change in left ventricular ejection fraction (LVEF) from baseline to 6 months. RESULTS: LVEF decreased from 62 ±â€¯5% at baseline to 58 ±â€¯7% at 6-months (p = 0.002) in patients assigned to placebo but no statistically significant changes were observed in any of the 3 carvedilol groups. At 6 months, only one of 116 patients (1%) assigned to carvedilol had an LVEF < 50% compared to four of the 38 assigned to placebo (11%), (p = 0.013). No significant differences were noted between carvedilol and placebo in terms of the development of diastolic dysfunction, clinically overt heart failure or death. CONCLUSIONS: Carvedilol might prevent deterioration in LVEF in cancer patients treated with doxorubicin. This effect may not be dose related within the studied range.

Age distribution of nasopharyngeal cancer in Saudi Arabia.

OBJECTIVE: The age standardized rate of head and neck cancer in the Kingdom of Saudi Arabia (KSA) is 5.7% with nasopharyngeal cancer (NPC) accounting for >40% of all head and neck cancers. This study intends to compare age specific incidence of NPC in KSA and other countries. METHODS: Data from the National Cancer Registry for KSA during the period 1994 through to 1996 was compared with data from the World Health Organization International Agency for Research on Cancer (ARC) in Singapore, China, Kuwait and Canada. RESULTS: There were 373 diagnosed Saudi patients with NPC with high incidence among the young population, with 42/373 (22 males/20 females) patients in the first 20 years of life, showing a sharp increase both in boys and girls until the ages of 12-14 years. From that point the incidence curve for both males and females separates. In females the incidence flattens without an identifiable zenith from the age of 12-14 years and above, compared with their male counterpart where they have another peak in the fifth decade. CONCLUSION: Our study indicates a definite early onset of this malignancy in KSA and a similar pattern to that of China and Singapore. Definite increased incidence, at a young age among both sexes, suggests a possible underlying genetic susceptibility in Saudis.