Weekly cetuximab and paclitaxel combination in metastatic/recurrent squamous cell cancer carcinoma of the head and neck (SCCHN): Clinical experience of a single institution

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Background: Results of a recent phase III randomized study with cetuximab and platin-5FU chemotherapy support its use in recurrent/metastatic SCCHN. However, many patients (pts) are not able to be treated with platin combinations. Paclitaxel (P) and cetuximab (C) have shown an encouraging activity in a similar patients subset. We review the data of the patients treated with this schedule in our centre. Methods: From our database, we conducted a retrospective study of 20 patients with recurrent SCCHN who did not meet criteria for platin therapy and were treated with weekly P (80 mg/m2) and C (initially 400 mg/m2 followed by 250 mg/m2) until progression or intolerable toxicity. We have collected data regarding previous treatments, response rate (RR), progression free survival (PFS), overall survival (OS) and toxicity. Results: From January 2007 to November 2008, 20 patients were included (18 male, 2 female) with a median age of 63 (50–81). Oral cavity (35%) and oropharynx (25%) were the most frequent locations. Most of the pts (13/20) had been treated with previous chemotherapy combinations (range 1–3 lines). All pts were evaluable for response and toxicity. Overall RR was 45% (1CR, 8 PR) and 35% of the pts (7/10) had SD. Response in radiated areas were 35% (6/17). With a median follow up of 10 months the median PFS and OS were 6.5 and 7 months respectively. Main related toxicities (Gr 2/3) were acne-like rash (30%), asthenia (15%), anemia (10%), and mucositis (10%). Conclusions: Our analysis confirms that weekly paclitaxel-cetuximab is an effective and safety combination in metastatic/recurrent SCCHN. Treatment is very well tolerated and could be a good alternative to platin-based chemotherapy in unfit patients for this therapy.

No significant financial relationships to disclose.

Trastuzumab in the elderly: Is it age or cardiovascular risk profile that really matters?

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Background: Elderly breast cancer (BC) patients (pts) are usually excluded from clinical trials. Nevertheless, with the increased use of trastuzumab (T) there is a need to assess and predict T-related cardiotoxicity in this population. Methods: Data were collected from women ≥70 years with BC and serial cardiac monitoring treated with T at our institution since 2005. Cardiovascular risk factors (CRF) were analysed together with left ventricular systolic function (LVEF) assessed at baseline and during T. Results: Thirty pts with early (10) or advanced (20) BC, median age 75.7 years (range 70–87), were identified. WHO performance status was 0–1 in 90% of pts. Median duration of treatment was 45 weeks (range 2–87). Basal LVEF was 63.8% (range 46.3–76). Five of 30 pts (16.6%) experienced asymptomatic cardiotoxicity defined as an absolute drop ≥10% with a final LVEF < 50% (13.3%, 4/30 pts) or any absolute drop >20% (3.3%, 1/30 pts). Four of 30 patients (13.3%) developed symptomatic cardiac heart failure. Median time to LVEF decline was 9 weeks (range 3–87). LVEF recovered to normal values in a median time of 4 weeks (range 3–48) in all but one patient. CRF are shown in Table 1 . Pts with T-related cardiotoxicity presented more often with history of cardiac disease (22.2% versus 9.5%), diabetes (22.2% versus 5%) and BMI>30 (68% versus 45%) as compared to the rest. No relevant difference was seen in terms of hyperlipemia, tobacco or hypertension. Previous or concomitant exposure to anthracyclines was not found as a risk factor either. Conclusions: Despite the limited numbers, this series shows that elderly BC pts treated with T experience reversible cardiac events similarly to those already described in younger pts. However, particular attention may be paid to cardiac history, diabetic and obese pts who appear more likely to develop T-related cardiotoxicity.

[Table: see text]

No significant financial relationships to disclose.

Reduction of nasal volume after allergen-induced rhinitis in patients treated with rupatadine: a randomized, cross-over, double-blind, placebo-controlled study

OBJECTIVE

To measure the reduction in nasal obstruction using acoustic rhinometry in patients with allergic rhinitis treated with rupatadine.

METHODS

We performed a randomized, double-blind, cross-over, placebo-controlled clinical trial in asymptomatic patients with allergic rhinitis. Patients received rupatadine 10 mg or placebo once daily for 3 days, in 2 subsequent periods separated by a washout interval of 14 days. We performed a nasal allergen challenge during each period, and measured nasal volume using acoustic rhinometry and nasal nitric oxide (nNO) at baseline, and at 2 hours and 24 hours after the challenge. We also evaluated nasal symptoms (rhinorrhea, itching, obstruction, and sneezing), as well as total symptom score (T4SS) at the same time points as for the primary objective.

RESULTS

The study population comprised 30 outpatients with a mean (SD) age of 28 (10) years. Nasal airway blockage was significantly lower in the rupatadine group than in the placebo group (47%, P < .05) at 2 hours postchallenge. nNO in the rupatadine-treated patients remained unaltered, unlike in the placebo-treated group, where levels decreased at 2 hours. After treatment with rupatadine, patients showed a lower decrease in the mean total symptoms score at 2 hours (3.6 [2.6]) compared with placebo (3.9 [2.9]), although these differences did not achieve statistical significance. Overall, rupatadine was well tolerated and no serious or unexpected adverse events were observed.

CONCLUSIONS

Rupatadine 10 mg can reduce nasal obstruction assessed by objective measures and is well tolerated in patients with allergic rhinitis.

Light-driven novel properties of TiO2-modified polypropylene-based nanocomposite films

Nanocomposite films obtained by TiO2 incorporation into a polypropylene (PP) polymer matrix were prepared via a straightforward melting process. The structural characteristics of the nanocomposite materials were examined by a multitechnique approach showing the outstanding morphological uniformity of the films. TiO2 incorporation into the polymer matrix renders self-sterilized and self-degradable materials which showed an impressive performance against gram-positive, gram-negative, coccus and yeast micro-organisms. Optimization of the novel properties of TiO2-PP nanocomposite films is reached with a 2 wt% of oxide content loading. The physico-chemical bases of this optimum are discussed.

Oestrogen-dependent hereditary angio-oedema with normal C1 inhibitor: description of six new cases and review of pathogenic mechanisms and treatment

BACKGROUND

Hereditary angio-oedema (HAE) is a rare condition in which there is a deficiency in the quantity or activity of C1 inhibitor (C1INH). Recently, an additional type of HAE with no alterations in the levels or the function of C1INH has been reported. It is defined as HAE with normal C1INH, and named type III HAE or oestrogen-dependent HAE. The aim of this study is to describe the clinical and laboratory findings of six new cases of type III HAE and to review the literature about this disease.

METHODS

A short description of six women with recurrent angio-oedema is provided. The characteristics of the patients are compared with the previously reported case series in a literature-based review.

RESULTS

The mean age of the patients at onset was 22 years (range 16-30). All of them had angio-oedema attacks during oestrogen-based contraceptive treatment and four reported episodes during pregnancy. Four patients reported a positive past family history. Two of them had experienced episodes of laryngeal oedema. None of the patients responded to corticoids or antihistamines during the attacks. Levels and functional activity of C1INH were within the normal range in all cases.

CONCLUSIONS

Clinical and laboratory findings mirror the observations of previous reports of oestrogen-dependent angio-oedema with normal C1INH. This is the first published series of type III HAE in Spain.

Development and validation of a new Spanish instrument to measure health-related quality of life in patients with allergic rhinitis: the ESPRINT questionnaire

OBJECTIVES

To develop and validate an instrument to measure health-related quality of life (HRQOL) specific to patients with allergic rhinitis (AR) and primarily for use in Spanish and Spanish-speaking populations.

METHODS

An initial item pool was generated from literature review, focus groups with AR patients, and consultations with clinical experts. Item reduction was performed using clinimetric and psychometric approaches after administration of the item pool to 400 AR patients. The resulting instrument's internal consistency, test-retest (2-4 weeks) reliability, known groups and convergent validity, and sensitivity to change were tested in a longitudinal, observational, multicenter study in 210 AR patients who also completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ).

RESULTS

The new questionnaire took a mean (SD) of 7.1 (5.4) minutes to answer. Floor and ceiling effects were less than 15% on all dimensions. Cronbach's alpha values and intraclass correlation coefficient values for six of the sevendimensions and the overall score exceeded 0.70. Statistically significant differences (P < 0.01) were observed on all ESPRINT-28 dimensions and the overall score between patients with mild (mean overall score 1.97, SD 0.99), moderate (mean overall score 2.78, SD 0.88), and severe AR (mean overall score 3.89, SD 0.87). Patients with persistent AR had worse scores (P < 0.05) on all dimensions than patients with intermittent AR. Correlations between the ESPRINT-28 and the RQLQ were generally as expected. Effect sizes for score changes between the two study visits ranged from 0.96 to 1.76 for individual dimensions and the overall score.

CONCLUSIONS

This new, Spanish-developed instrument to measure HRQOL in AR patients has shown good reliability, validity, and sensitivity to change. It has also proved easy to use and administer.

Effects on nasal nitric oxide production of 2 mechanisms of vasoconstriction

BACKGROUND

Vasoconstrictor drugs reduce nitric oxide (NO) production in vitro by inhibiting the enzyme involved in the regulation of inducible and constitutive NO synthases (iNOS and cNOS). Intranasal vasoconstrictors also decrease nasal NO concentration in vivo. It is as yet unclear if this last finding is due to the effects of the drug on the enzyme or on the vessels. Physical exercise also induces nasal vasoconstriction and reduces nasal resistance.

OBJECTIVES

The aim of this study was to clarify the mechanisms involved in xylometazoline-induced reduction of nasal NO concentration.

METHODS

We compared 2 randomized groups of patients with moderate--severe persistent allergic rhinitis. The first group (n = 24) underwent a physiological nasal vasoconstrictor stimulus (exercise) whereas the second group (n = 29) was treated with a nasal vasoconstrictor drug (topical xylometazoline). Nasal volume and NO were determined at baseline and 15 to 20 minutes after the end of each stimulus using acoustic rhinometry and chemiluminescence, respectively.

RESULTS

Baseline values of nasal volume and NO did not differ between the 2 groups. Nasal volume increased by 57% (P = .0001) after exercise and 71% (P = .0001) after xylometazoline. Nasal NO decreased (25%, P = .001) after xylometazoline, but not after exercise.

CONCLUSION

Physical exercise and topical xylometazoline cause vasoconstriction and similar effects on nasal volume. In contrast nasal NO decreased with xylometazoline but not after exercise. These findings suggest that vasoconstrictor drugs reduce nasal NO by mechanisms other than vasoconstriction.

Behavioral flexibility impairment with negative feedback in refractory temporal lobe epileptic patients with unilateral amygdala and hippocampal resection

INTRODUCTION

Patients with amygdala dysfunction generally have behavioral impairment. Temporal lobe surgery might be a model of study of unilateral amygdala resection. The objective of this study was to evaluate behavioral flexibility in epileptic patients who undergo amygdala resection for epilepsy surgery and evaluate its relationship with their neuropsychiatric symptoms.

MATERIAL AND METHODS

Ten epileptic patients who underwent amygdala and hippocampal resection (6 left and 4 right) matched by age and educational level with 10 healthy controls were tested with an extensive neuropsychological and neuropsychiatric battery. Psychiatric symptomatology was measured with the positive and negative syndrome scale (PANSS) and the Beck depression inventory. To assess behavioral flexibility the emotion-related visual reversal-learning task (O'Doherty et al., 2001) and the gambling task (Bechara et al., 1994) were used.

RESULTS

Patient's mean scores were: Beck: 8 +/- 1.5; PANSS positive: 10 +/- 1.3, and negative: 14.4 +/- 2.2; intellectual quotient (IQ): 101.4 +/- 6.3; category number in Wisconsin card sorting test: 4.6 +/- 2.4. The emotion-related visual reversal-learning task showed significance differences in the number of reversion: healthy controls: 9.3; epileptic patients: 4.23 (p < 0.001); in the number of trials to the first reversion: healthy controls: 5; epileptic patients: 23.42 (p < 0.05). There was no correlation between reversion and depression, PANSS and IQ.

CONCLUSIONS

Patients with epilepsy who undergo unilateral hippocampal and amygdala resection appear to have alterations in the reversion capacity with an emotional component that would explain the lack of behavior flexibility that they sometimes have and that are not related with either the isolated presence of executive alterations or low intellectual quotient.

Infección demorada tras el uso de Bio-alcamid®

Bio-alcamid (Polymekon) is a gelatinous endoprothesis constituted of poly-alkyl-imide and water that is used for correction of aesthetic alterations. It presents very good tolerance with few adverse effects. We present a case of localized infection in one of the sites of injection, three months after the implant was placed in the nasolabial furrows and lips. It would be the first case of a delayed infection following injection of this material, although there are few references in this field.