Capecitabine in the treatment of colorectal cancer.

The fluorinated pyrimidines have been an important part of cancer treatment since the introduction of 5-fluorouracil several decades ago. Capecitabine is an oral fluoropyrimidine which is converted to 5-fluorouracil primarily in tumor tissue, and has the advantages of ease-of-administration, acceptable toxicity and significant antineoplastic activity. It is currently the only oral fluoropyrimidine approved for use in USA, and has an established role as monotherapy in the treatment of metastatic breast and colorectal cancers. Moreover, the addition of capecitabine to docetaxel in anthracycline-pretreated metastatic breast cancer significantly improved overall survival. The toxicity profile of capecitabine includes hand-foot syndrome, stomatitis and diarrhea, with minimal hematologic side effects. The combination of capecitabine with other anticancer agents is currently being investigated. The focus of the present article will be the role of capecitabine in the treatment of colorectal cancer.

Oral cancer treatment: developments in chemotherapy and beyond.

Oncology is one of the few areas of medicine where most patients are treated intravenously rather than receiving oral drugs. Recently, several oral anti-cancer drugs have been approved and there are many more in development. Oral chemotherapy is attractive because of its convenience and ease of administration, particularly in the palliative setting. With an increasing number of oral agents emerging, we can expect to see a rapid rise in the use of oral chemotherapy in years to come. This article reviews recent developments in oral chemotherapy, both of traditional cytotoxics and novel, targeted agents, from the viewpoint of patients, physicians, drug developers and health-care providers.

A dose-finding study of carboplatin-epirubicin-docetaxel in advanced epithelial ovarian cancer.

The docetaxel-carboplatin combination is active and well tolerated in patients with epithelial ovarian cancer. We added epirubicin to this combination to investigate additional benefits of anthracyclines in epithelial ovarian cancer. Twenty-one patients, FIGO Ic-IV, performance status 0-1, were treated in four dose cohorts. Docetaxel was fixed at 75 mg m(-2), carboplatin doses were AUC 4-5 and epirubicin doses were 50-60 mg m(-2). Drugs were given on day 1, every 3 weeks, except in cohort 3, where epirubicin was given on day 8. Dexamethasone was given prophylactically. One dose-limiting toxicity occurred in cohorts 1, 2 and 4, two occurred in cohort 3. Complicated neutropenia occurred in two patients in cohorts 1 and 2 and one patient in cohorts 3 and 4. Two patients experienced grade III diarrhoea or stomatitis in cohort 1 and two in cohort 3. There were no treatment-related deaths. Grade II sensory neuropathy occurred in one patient. No cardiac toxicity or significant oedema was observed. The overall response rate was 36%, and 62% were CA125 responders. The predefined maximum tolerated dose was exceeded in cohort 3. The cohort 4 dose level (epirubicin 50 mg m(-2), carboplatin AUC 4, docetaxel 75 mg m(-2)), warrants further study.

Spontaneous acute tumour lysis syndrome in patients with metastatic germ cell tumours. Report of two cases.

Acute tumour lysis syndrome (TLS), a condition resulting from rapid destruction of tumour cells with massive release of cellular breakdown products, has been described following the treatment of various malignancies. However, spontaneous TLS has been described only rarely. Germ cell tumours (GCT) have a rapid cell turnover and often present with bulky metastatic disease. We report two cases of patients with metastatic GCT presenting with acute renal failure attributable to spontaneous TLS. All clinical and biochemical features of the syndrome were present. Both patients were treated with haemodialysis and intravenous administration of single-agent etoposide between dialysis sessions, resulting in recovery of renal function and marked decrease in tumour bulk within the first week after presentation. These cases are the first reported instances of spontaneous TLS in poor-risk metastatic GCT. Successful treatment with dialysis and chemotherapy is possible, and prophylactic vigorous hydration and allopurinol may be warranted in this setting.

A retrospective analysis of Hickman line-associated complications in patients with solid tumours undergoing infusional chemotherapy.

We present a retrospective analysis of Hickman line use and associated complications in patients with solid tumours undergoing treatment with infusional chemotherapy. One hundred and ten lines were inserted in 94 patients (55 females and 39 males, median age 51), of whom 107 were placed under radiological screening, the remainder by a surgical approach. Catheters were in situ for a total of 9670 days (median 101 days, range 1-278). Fifty-five complications occurred during the lifespan of 39 catheters (35.5%), giving an overall complication rate of 4.03/1000 catheter days. Early complications included pneumothorax (4%), arterial puncture (1%) and failure of placement (1%). Late complications included sepsis (superficial and systemic) (24.5%), venous thrombosis (9%), line displacement (10%) and catheter blockage (1%). Fifteen episodes of systemic sepsis occurred in 12 patients, giving an overall sepsis rate of 1.55/1000 catheter days, while complications requiring catheter removal occurred in 20 cases (18% of insertions, 2.07/1000 catheter days). We conclude that the use of Hickman catheters as a means of long-term venous access in infusional chemotherapy patients is generally safe, but is associated with significant morbidity.

Audit of oxygen therapy.

We audited the use of oxygen in our hospital. Over three days we found 119 patients using oxygen, 21 wearing their mask incorrectly or not at all. The commonest indication was chronic obstructive pulmonary disease. Forty patients had no record of arterial gas analysis. Of those who had, 29 did not require oxygen and the average time from last arterial gas analysis was 5.7 days and only eight patients were being monitored with an oximeter. Taking into account the risk of exacerbating carbon dioxide retention and the problems that arise when discharging a patient who has been receiving oxygen therapy for the duration of their admission, we fee oxygen therapy should only be administered with the knowledge of the arterial gases and with frequent reassessment during therapy.