Platelet transfusion for patients with cancer: clinical practice guidelines of the American Society of Clinical Oncology.

OBJECTIVE: To determine the most effective, evidence-based approach to the use of platelet transfusions in patients with cancer. OUTCOMES: Outcomes of interest included prevention of morbidity and mortality from hemorrhage, effects on survival, quality of life, toxicity reduction, and cost-effectiveness. EVIDENCE: A complete MedLine search was performed of the past 20 years of the medical literature. Keywords included platelet transfusion, alloimmunization, hemorrhage, threshold and thrombocytopenia. The search was broadened by articles from the bibliographies of selected articles. VALUES: Levels of evidence and guideline grades were rated by a standard process. More weight was given to studies that tested a hypothesis directly related to one of the primary outcomes in a randomized design. BENEFITS/HARMS/COST: The possible consequences of different approaches to the use of platelet transfusion were considered in evaluating a preference for one or another technique producing similar outcomes. Cost alone was not a determining factor. RECOMMENDATIONS: Appendix A summarizes the recommendations concerning the choice of particular platelet preparations, the use of prophylactic platelet transfusions, indications for transfusion in selected clinical situations, and the diagnosis, prevention, and management of refractoriness to platelet transfusion. VALIDATION: Five outside reviewers, the ASCO Health Services Research Committee, and the ASCO Board reviewed this document. SPONSOR: American Society of Clinical Oncology

Successful rechallenge with etoposide phosphate after an acute hypersensitivity reaction to etoposide.

Hypersensitivity reactions to etoposide are reported infrequently and consist of hypotension, hypertension, flushing, diaphoresis, dyspnea, bronchospasm, and loss of consciousness. A 23-year-old woman experienced acute bronchospasm, tachycardia, hypoxia, and moderate hypertension minutes after an infusion of etoposide was begun. Symptoms resolved within an hour after administration of intravenous fluids, methylprednisolone, diphenhydramine, and oxygen. Subsequently, the patient was given etoposide phosphate without incident. To our knowledge, this is the first report of successful rechallenge with etoposide phosphate after an acute hypersensitivity reaction to etoposide.

Aminoglutethimide in the treatment of metastatic breast cancer.

Aminoglutethimide in combination with dexamethasone has been used in 44 patients with metastatic breast cancer who had prior response to hormonal manipulation and/or positive estrogen receptors. Objective tumor response (complete response plus partial response) has been achieved in 19 of 44 patients. Responses were seen in soft tissue, bone, and pleura. Eleven of 44 patients had stable disease, and 14 patients had progressive disease. The median duration of response was 8 months. Side effects were moderate, including lethargy, rash, fever, and Cushingoid facies. This treatment is well tolerated and is an effective hormone manipulation in postmenopausal patients with metastatic breast carcinoma.

Cyclophosphamide, doxorubicin, and cisplatin (CAP) in the treatment of urothelial malignancy: a pilot study of the Southeastern Cancer Study Group.

Thirty-four patients with urothelial malignancy were treated with a chemotherapy regimen of cyclophosphamide, doxorubicin, and cisplatin. The objective response rate was 38% (13 of 34 patients), with three patients achieving a complete remission. Objective responders had a significantly longer median survival time than nonresponders (225 vs 137 days [P less than or equal to 0.04]). The median duration of remission was 177 days. Hematologic toxic effects were initially severe, with three episodes of sepsis and one death, but were acceptable after dose modification. This study demonstrates that the regimen of cyclophosphamide, doxorubicin, and cisplatin is effective in metastatic urothelial malignancy. Although response duration was short (25 weeks), responders clearly lived longer than nonresponders.

Aminoglutethimide in the management of metastatic breast cancer.

Aminoglutethimide (AG) with Dexamethasone has been utilized in 26 patients with metastatic breast cancer who had prior response to hormonal manipulation and/or positive estrogen receptor. Objective tumor response (CR + PR) has been achieved in 13 of 26 patients. Responses were seen in soft tissue, bone, and pleura. Six of 26 patients had stable disease and seven of 26 patients had progressive disease. The median duration of response is 12.8 months. The median survival for the responders has not been reached. Non-responding patients had a median survival of five months. Side effects were minimal, including mild lethargy, rash, fever, and weight gain. This regimen is well tolerated and can be used effectively in metastatic hormone-receptor-positive breast cancer.

Phase II study of mitomycin C and vinblastine in women with advanced breast cancer refractory to standard cytotoxic therapy.

The combination of mitomycin C and vinblastine in the dose and schedule used in this study (6 and 5 mg/m2, respectively, every 14 days) was of little clinical efficacy in the management of metastatic breast cancer already refractory to standard chemotherapy and hormonal therapeutic approaches.