A phase II study of feasibility and toxicity of bevacizumab in combination with temozolomide in patients with recurrent glioblastoma

Purpose. The aim of this prospective and multicentric phase II study was to evaluate the efficacy and safety of temozolomide (TMZ) and bevacizumab (BV) in patients (pts) with recurrent glioblastoma (GB), previously treated with chemoradiotherapy and at least three cycles of adjuvant TMZ. Patients and methods. Patients with GB at first relapse received BV 10 mg/kg day every 2 weeks and TMZ 150 mg/m2 days 1–7 and 15–21, every 28 days. Patients underwent brain magnetic resonance imaging every 8 weeks. Results. Thirty-two evaluable pts were recruited in 8 sites. Fourteen pts (44 %) had gross total resection. O6-methylguanine-DNA methyltransferase (MGMT) promoter was methylated in 12 pts, unmethylated in 6 pts, and missing in 14 pts. The estimated 6-month progression free survival (PFS) rate was 21.9 % (95 % CI 9.3–40.0 %). The median PFS and overall survival (OS) were 4.2 months (95 % CI 3.6–5.4 months) and 7.3 months (95 % CI 5.8–8.8 months), respectively. No significant association with MGMT status was found in terms of OS or PFS. Six of 32 pts (19 %; 95 % CI 7.2–36.4) were long-term survivors, with a median PFS and OS (50 % events) of 9.5 months (95 % CI 7.9–23.6) and 15.4 (95 % CI 8.9–NA), respectively: no differences in baseline characteristics were identified in comparison with total population. No unexpected toxicities or treatment-related deaths were observed. Conclusions. This regimen showed to be feasible and well tolerated in pts with recurrent GB pretreated with TMZ. Further investigation is warranted to identify subpopulations that are more likely to benefit from addition of BV to GB therapy (AU)

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Absceso vulvar de origen odontógeno / Odontogenic vulvar abscess

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Trombosis no oclusiva de stent asociada a parada cardiocirculatoria / Non-occlusive stent thrombosis associated to cardiocirculatory arrest

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Utilización de azul de metileno en el tratamiento del síndrome vasopléjico del postoperatorio de cirugía cardíaca / Use of methylene blue in the treatment of vasoplegic syndrome of post-operative heart surgery

La vasoplejía es una complicación frecuente en el postoperatorio de cirugía cardíaca y determina un importante aumento en la morbi-mortalidad. Cuando a pesar de una fluidoterapia optimizada con el uso del catéter Swan-Ganz y una perfusión de noradrenalina persiste la vasoplejía, disponemos de una alternativa segura, eficaz y económica, el azul de metileno. Presentamos el caso de un paciente que en el postoperatorio programado de revascularización miocárdica desarrolló una vasoplejía refractaria al tratamiento y shock. La utilización de una sola dosis de azul de metileno resolvió la inestabilidad hemodinámica y permitió la suspensión total de los fármacos vasoactivos. Por tanto, se expone esta novedosa indicación del azul de metileno, aún no aprobada por los organismos correspondientes, de la que no hemos encontrado publicaciones nacionales, así como su manejo clínico y la ausencia de efectos adversos tras su utilización

Vasoplegia is a frequent complication in post-operative heart surgery and determines a significant increase in morbidity-mortality. When vasoplegia persists in spite of optimized fluid therapy with the use of Swan-Ganz catheter, we have a safe, effective and economical alternative, methylene blue. We present the case of a patient who developed vasoplegia refractory to treatment and shock in the scheduled post-operative period of myocardial revascularization. The use of a single dose of methylene blue resolved the hemodynamic instability and allowed for total discontinuation of vasoactive drugs. Thus, we present this new indication of methylene blue, still not approved by the corresponding bodies, for which no national publications have been found and its clinical management and the absence of adverse effects after its use