Docetaxel combined with irinotecan or 5-fluorouracil in patients with advanced oesophago-gastric cancer: a randomised phase II study.

BACKGROUND: Docetaxel and irinotecan chemotherapy have shown good efficacy in the treatment of advanced oesophago-gastric cancer. This randomised phase II study evaluated the efficacy and toxicity profile of two non-platinum docetaxel-based doublet regimens in advanced oesophago-gastric cancer. METHODS: Chemotherapy-naïve patients with advanced oesophago-gastric cancer were randomised to receive either 3-weekly DI (docetaxel 60 mg m(-2) plus irinotecan 250 mg m(-2) (Day 1)) or 3-weekly DF (docetaxel 85 mg m(-2) (Day 1) followed by 5-fluorouracil 750 mg m(-2) per day as a continuous infusion (Days 1-5)). RESULTS: A total of 85 patients received DI (n=42) or DF (n=43). The primary endpoint was overall response rate (ORR). The ORR and time to progression (TTP) in the evaluable population (n=65) were 37.5% (DI) vs 33.3% (DF), and 4.2 months vs 4.4 months, respectively. In the intent-to-treat population, the observed ORR, TTP and median overall survival were similar between the two groups. Grade 3-4 neutropenia, febrile neutropenia and diarrhoea were more frequent in the DI arm as compared with the DF arm (83.3% vs 69.8%, 40.5% vs 18.6%, and 42.9% vs 16.3%, respectively). CONCLUSION: Both docetaxel-based doublet regimens show comparable efficacy; however, the DF regimen was associated with a better toxicity profile and is an alternative treatment option for patients in whom platinum-based regimens are unsuitable.

[Addisonian crisis as first manifestation of adrenal gland insufficiency in patient diagnosed with lung cancer]. / Crisis addisoniana como primera manifestación de insuficiencia suprarrenal en paciente diagnosticado de cáncer de pulmón.

Adrenal insufficiency or Addison's disease is actually a rare illness associated with numerous pathologies. We describe the case of a fifty years old male with lung adenocarcinoma and metastasis in both adrenal glands, who was receiving chemotherapy with mytomicin, ifosfamide and cisplatin (MIC), and was diagnosed of adrenal insufficiency as a result of acute episode addisonian crisis. Many times, the clinic symptoms of adrenal insufficiency can go unnoticed due to its low specifity and to mixing up with other syndromes. Hypoadrenalism has been described in association with many tumours, specially with non-Hodgkin's lymphoma. It seems that there is a discordance between the number of patients with bilateral metastatic adrenal destruction and the documented cases of clinic insufficiency. Once the adrenal failure is suspected, the diagnosis and hormone replacement treatment are really easy. Addison's disease ethiologies are revised putting special emphasis on those related with cancer patients.

Is the routine measurement of ionized calcium worthwhile in patients with cancer?

This study was undertaken to analyse the relationship between total calcium (TCa) and ionized calcium (ICa) in patients with cancer, and to assess the clinical value of routine measurements of ICa in these patients. Serum TCa, ICa, albumin, proteins and creatinine were measured in 188 adult patients with solid malignant tumours. Most of them were out-patients, the Karnofsky score being 80 or above in 67%. The correlation coefficient between ICa and TCa was 0.85 (P less than 0.001) and did not improve after correcting TCa for protein concentration with several published formulae. Although TCa measurements had a global diagnostic accuracy (percent of patients correctly classified) of 90%, they failed to identify a substantial proportion of patients with increased levels of ICa (57% for uncorrected TCa, and 27-57% for protein-corrected TCa). However, the finding of slightly increased ICa levels did not seem to predict the development of frank hypercalcaemia and did not impair the prognosis. According to these results, the routine measurement of ICa in unselected patients with cancer has no clinical usefulness.

Noncorrelation between implantation and growth of tumor cells for their final metastatic efficiency.

We have measured the relative contribution of implantation and focal growth metastatic phenomena on the hepatic colonization process of intrasplenically injected B16 melanoma or Lewis lung carcinoma (LLC) tumor cells. To do this, an experimental variation of the parental tumor cell phenotype (seed factor) was performed by a selection of 10 times passaged hepatic-metastasizing tumor cells and changes in biological features of host tissue (soil) were induced following the treatment of the mice with ciclosporin, Thymostimulin, Bleomycin, silica particles or 17 alpha-ethynylestradiol prior to tumor injection. Implantation efficiency of selected variants was highly increased but, while the focal metastatic growth efficiency did not vary in LLC variants, in selected B16 melanoma cells it was clearly higher. In all the pretreated animals final metastatic volume varied with respect to the controls. In some mice, implantation efficiency was increased but this effect did not always determine later increments in the final metastatic volume. In other mice, focal growth of metastases was reduced with respect to the controls without correlative reductions in the final metastatic volume. In general, changes of final metastatic volume in the liver were mostly dependent upon the ability of tumor cells to successfully implant. Thus, final metastatic volume seems to depend on the sum of two relatively independent colonization phenomena: tumor cell implantation and focal growth of metastases.