Perspectives in palliative care?

Palliative care is an important issue to both patients and their families. It is a major contributor to the improvement of the quality of life of patients suffering from chronic diseases as well as terminally ill patients. Its importance increases with the aging of our population. Palliative care has met an enormous success in Western countries and particularly in the U.S.A. over the past two decades. In Lebanon we are far behind the international health community in this field. The educational efforts initiated by medical schools are to be applauded but unfortunately very few institutions offer palliative care to their patients in our country. This is mainly due to the lack of support for such an activity from official health organizations and the lack of information among the public concerning the advantages of palliative care. The efforts of medical schools to incorporate palliative care in their teaching programs will be useless if they are not conjugated with an integration of palliative care in every day's clinical practice.

Gemcitabine plus carboplatin combination therapy as second-line treatment in patients with relapsed breast cancer.

This study was designed to determine the safety and efficacy of the combination therapy of gemcitabine plus carboplatin when used as a second-line treatment in patients with metastatic breast cancer (MBC). From February 2002 to May 2003, 30 previously treated patients with adenocarcinoma of the breast received gemcitabine 1000 mg/m2 on days 1 and 8 plus carboplatin to an area under the curve (AUC) of 5 on day 1. The carboplatin dose was changed to an AUC of 4.5 because of toxicity, with cycles repeated every 3 weeks. Among 30 patients enrolled, 25 were assessable for response rate (RR). There was no complete response; 9 patients (30%) had partial response, for an overall RR of 30%. The median time to progression for the study group was 20.47 weeks (range, 8-46 weeks). Treatment-related toxicities included grade 3/4 neutropenia in 50% of patients (20% of whom had febrile neutropenia), grade 3/4 anemia in 26.6% of patients, and grade 3/4 thrombocytopenia in 30%. Eleven patients (36.67%) had grade 1 alopecia, and 1 patient (3.33%) had grade 2 alopecia. Moderate nausea was observed in 8 patients (26.67%), and vomiting occurred in 7 patients. Four patients had asthenia and 3 (10%) experienced stomatitis. Three patients discontinued treatment because of hematologic toxicity (thrombocytopenia) and 2 patients are still receiving treatment. Carboplatin plus gemcitabine is an active combination for patients with MBC despite significant but manageable hematologic toxicity.