[Pluriglandular autoimmune syndrome. Systematic review]

There are a lot of autoimmune syndromes with glandular disfunction which are associated to another diseases. Sometimes, these processes are associated to similar cases in the same family. Autoimmune polyglandular syndromes are characterized by the coexistence of two or more endocrine insufficiencies due to an autoimmune mechanism: the activity of autoantibodies or T activated lymphocytes against organs or endocrine glands. In this report, they have been described the main autoimmune syndromes, the diagnostic methods and the mechanisms which take a role in their origin.

An assessment of cancer-related fatigue in patients (pts) with chemotherapy-induced anaemia (CIA) treated with darbepoetin alfa (DA): Comparison of two quality of life (QoL) questionnaires

19654

Background: CIA is often associated with debilitating fatigue and reduced QoL. DA can effectively treat CIA when administered once every 3 weeks (Q3W).This study aims to compare the psychometrics of the Functional Assessment of Cancer Therapy Fatigue Subscale (FACT-F) and The Fatigue Symptom Inventory (FSI) in CIA pts treated with DA Q3W. Methods: Longitudinal single- centre prospective study in adult pts with solid tumours undergoing chemotherapy (CT) and with mild to moderate cancer-related fatigue (CRF) (Visual Analogue Scale (VAS) =30 mm). Pts with haemoglobin (HB) levels <11 g/dL were treated with DA 500 mcg Q3W. Key clinical parameters, FACT-F, and FSI measurements were collected at the beginning and end of the CT treatment period. Psychometric indicators for reliability and validity were calculated. Results: A preliminary analysis was conducted in 58 pts: mean age, 61.3 years (SD 12.3), 51.7% women, 25.9% with breast cancer, 91.4% ECOG 0–1, 69.0% IV stage, 63% had no prior CT. At baseline, the mean CRF score by VAS was 58.8 mm (SD 19.4) and the mean Hb was 10.2 g/dL (SD 0.7). Median CT duration was 15.1 weeks (range, 3.3 - 25.7) and all pts received DA treatment during CT (median duration of CT, 6.6 wks [range, 0 - 19]). The median number of DA doses administered was 3 (range, 1–7). The rate of hematopoietic response (Hb ≥ 12 g/dL or Hb rise from baseline ≥ 2 g/dL) was 69.0%. FACT-F and FIS scores improved by 5.6 and 13.0 points respectively during CT. Consistency (Cronbach alpha coefficient - CA) was high and similar for both questionnaires (FACT-F=0.98; FSI=0.97). Conclusions: Both the FACT-F and FIS QoL questionnaires measured a change in fatigue during the study with high and similar consistency. DA administered at a fixed dose of 500 mcg Q3W seems to be effective in clinical practice.

No significant financial relationships to disclose.

Multidimensional geriatric evaluation in elderly cancer patients and its relationship with age

19651

Background: Age is the major risk factor for the majority of patients with cancer. More than 50% of cancers occurs after the age of 60. Older patients are not simply old, but are geriatric patients because of interacting psychosocial and physical problems. As a consequence, the health status of old persons cannot be evaluated by merely describing the single disease or the group of age. We tested the performance of a new Comprehensive Geriatric Assessment (CGA) and its relationship with groups of age in cancer patients. Methods: Between June 2006 and December 2006, a total of 64 oncologic patients older than 75 years were approached to enrol in our study to analyze their functional, physical, mental, pharmacotherapeutic and socio-economic status and to correlate them to some groups of age: youngest-old (75 to 80 years-old), old-old (80 and 85 years-old) and oldest-old (older than 85 years). They were analysed Activities of Daily Living (ADL) measured by Barthel Scale, Instrumental Activities of Daily Living (IADL) measured by Lawton-Brody Scale, Grade of Fragility measured by Barber Scale, cognitive evaluation measured by Pfeiffer Test, and medication intake. A Chi Squared test was used for statistical analysis; p-value <0,05 was considered significative. Results: Sixty-four oncologic patients age > or = 75 years were recruited. Median age was 80.24 years (range 73.88 to 86.94). 51.6% female. Breast cancer was the most frequent diagnosis (30.2%), followed by lung cancer (19%). 29 patients (45.3%) were aged between 75 and 80 years old; 27 patients (43.5%) were between 80 and 85 years- old. There were statistic significative association between groups of age and Pfeiffer Test (p=0.037), Barber Scale (p=0.031) and medication intake (p=0.021). However, there was not a significative relationship between groups of age and Barthel Scale (p=0.052), Lawton-Brody Scale (p=0.2425), Cruz-Roja Scale (p=0,1485) or number of geriatric syndromes (p=0.129). Conclusions: This abstract reviews the findings regarding the correlation between a comprehensive geriatric assessment (CGA) and groups of age in older patients with cancer. Age per se must not be the only criterion for medical decision as it is not correlated to the health status of older cancer patients.

No significant financial relationships to disclose.

Risk assessment model for first-cycle chemotherapy-induced anaemia (CIA) in patients with solid tumours (ST): DELFOS Study

9122

Background: CIA, a major side effect of systemic cancer chemotherapy, is directly associated with concomitant morbidity, mortality and costs, and therefore has a strong impact on both patient health and healthcare systems. The objective of the present research study is to determine a predictive model for first-cycle CIA in patients with ST in Spain. This will help to establish appropriate protocols in routine patient care, hence improving clinical decision making. Methods: Data were obtained from the DELFOS Study, a multicentre non- interventional prospective-cohort study in Spain. This study has completed enrolment and data were available for this planned analysis. To obtain the predictive logistic regression model (LRM), the hierarchical principle was followed as a way to enable results replication. The model was implemented for CIA defined as anaemia grade = 2 (haemoglobin [Hb]<10 mg/dL). Anaemic patients at baseline according to this criterion were excluded from the studied sample to avoid bias. A receiver operating characteristics (ROC) Curve was used to determine the model's sensitivity and specificity. Results: A total of 1,140 pts (57.3 % female; mean age: 58 yrs [SD: 12]; ECOG = 2) with ST (breast, 38.1%; lung 17.5%; colorectal, 14.3%; other 30.1%) and baseline Hb>10mg/dL were included from 88 Spanish medical oncology health centres. The LRM obtained predicting CIA (pChi-sq < 0.0005) contained the following factors: gender, baseline haemoglobin, platinum-based chemotherapy (PBC) and baseline bilirubin. Risk factors and size effects included: male gender (p=0.003, OR=2.41, 95%CI (1.34, 4.31)), low baseline Hb (p<0.0005, OR=3.32, 95%CI (2.52, 4.39)), PBC as treatment (p=0.017, OR=2.04, 95%CI (1.13, 3.66)) and baseline bilirubin (p=0.029, OR=1.93, 95%CI (1.07, 3.49)). Inherent sensitivity and specificity of the equation were, respectively, 77.6% and 79.2%. Conclusions: A risk predictive model for first-cycle chemotherapy-induced anaemia in patients with ST in Spain was implemented. Four predictive factors were identified. Baseline Hb values were inversely associated with toxicity. Male gender, platinum-based chemotherapy and high bilirubin values showed themselves as risk factors for anaemia.

No significant financial relationships to disclose.

Excision repair cross complementing 6 (ERCC6) single nucleotide polymorphism (SNP) and outcome to gemcitabine (gem)/cisplatin (cis) or docetaxel (doc)/cis in stage IV non-small cell lung cancer (NSCLC) patients (pts)

7605

Background: ERCC6 (alternate name CSB) is involved in both transcription coupled and base excision DNA repair, and the ERCC6 C-6530>G SNP is involved in gene regulation. Different levels of ERCC6 mRNA expression have been observed in cells according to ERCC6–6530 genotype. Methods: We investigated the ERCC6 C-6530>G SNP in 309 stage IV NSCLC pts treated with doc/cis (196 pts) and gem/cis (113 pts). DNA was extracted from peripheral lymphocytes and Taqman assay was used for SNP typing. Results: Distribution of ERCC6 genotypes was: CC 113 pts (36.6%); CG 157 pts (50.8%); GG 39 pts (12.6%). No differences in genotype were observed according to age, gender, performance status (PS), histology, chemotherapy regimen or second-line treatment. Overall time to progression (TTP) was 5.4 months (m) and median survival (MS) 9.9 m. No differences in TTP or MS were observed according to ERCC6 SNP types. However, when pts were broken down by chemotherapy regimen, TTP was 7 m for 31 CC pts treated with gem/cis and 5.4 m for 71 CC pts treated with doc/cis (P=0.04) ( Table ). MS was longer for CC pts treated with gem/cis (11 m) than for CC pts treated with doc/cis (8.9 m) (P=0.46). Differences were also observed in pts with PS 0 and in younger pts. Conclusions: ERCC6 C-6530>G SNP may confer differential sensitivity to gem or doc in combination with cis. We hypothesize that ERCC6 6350 CC is a surrogate of ERCC6 transcript, where lower ERCC6 expression levels may increase the activity of gem/cis in comparison to doc/cis.

No significant financial relationships to disclose.

[Table: see text]

Risk assessment model for first-cycle chemotherapy-induced neutropenia (CIN) among lung cancer (LC) patients: DELFOS study

9132

Background: CIN is common in LC patients (pts) who receive myelosuppressive chemotherapy and contributes to therapy induced morbidity and mortality therefore having strong impact both on health and on health care systems. The objective of the present research study is to determine a predictive model for first-cycle CIN in pts with LC in Spain. This will help to establish appropriate protocols in routine patient care, hence improving clinical decision making. Methods: Data were obtained from the DELFOS Study, a multicentre non-interventional prospective-cohort study in Spain. This study has completed enrolment and data are available for this planned analysis. To obtain the predictive logistic regression model (LRM), the hierarchical principle was followed as a way to enable results replication. The model was implemented for CIN defined as neutropenia grade = 3 (with or without body temperature = 38 C°). A receiver operating characteristics (ROC) Curve was used to determine the model's sensitivity and specificity. Results: A total of 210 pts with LC (86 % male; mean age: 63 yrs (SD: 10); ECOG = 2;) were included in 65 Spanish medical oncology health centres. A selection process of potentially relevant factors was performed among socio-demographic, clinical and biochemical parameters collected. The LRM obtained predicted the CIN at first-cycle (pChi-sq < 0.0005) through the following factors: baseline platelet count (BPC), baseline haemoglobin (Hb) and type of chemotherapy treatment. In that sense, lower BPC was associated with higher risk of CIN (p<0.0005; OR=1.01; 95%CI (1.005, 1.016)) and the same happened with lower baseline Hb (p=0.017; OR=1.4; 95%CI (1.06, 1.8)). Pts in Platinum-based Chemotherapy showed higher risk of CIN compared to those in combination of Platinum and Taxane-based Chemotherapy (p=0.027; OR=5.5; 95%CI (1.2, 24.9). Inherent sensitivity and specificity of the equation were, respectively, 70.4% and 73.2%. Conclusions: A statistically significant risk predictive model for first-cycle CIN in pts with LC in Spain was implemented. Three predictive factors were identified. Baseline platelet count and baseline Hb were inversely associated with toxicity. Toxicity increased for pts with Platinum-based Chemotherapy regimens.

No significant financial relationships to disclose.

Molecular biology of exocrine pancreatic cancer

Exocrine pancreatic cancer is one of the neoplasias with a worse prognosis, with conventional treatments having little impact on disease outcome. Research and genomic high-throughput technology is continuously expanding our knowledge of pancreas cancer biology. Characterization of genetic and epigenetic alterations in pancreatic tumors has allowed a better understanding of the progression model of the disease at the molecular level. The development of new therapeutic approaches with target- oriented agents is been tested in the preclinical and clinical settings. This review updates the current available data on pancreatic cancer molecular biology.

[Fever of unknown origin as first manifestation of two cases of cervix carcinoma]

We present the case of two women with FUO as first manifestation of a cervical carcinoma. In both cases, wide spectrum antibiotic treatment (and tuberculostatic medication in the first woman) were not useful to stop fever. Autoimmune diseases tests were normal. Just image techniques let us detect a suspicious lesion (specially, abdomino-pelvic magnetic resonance) and biopsy gave the definitive diagnosis. A radical surgery caused the fever resolution. These are two cases of cervical cancer as cause of fever of unknown origin and, at the moment, we have not found another cases in the literature. We should consider this kind of tumor as a possible origin of fever.

Folinic acid modulated bolus 5-FU or infusional 5-FU for adjuvant treatment of patients of UICC stage III colon cancer: Preliminary analysis of the PETACC-2-study

3563

Background: Patients with stage III colon cancer have a high risk for recurrence. Infusional 5-FU may be more active than bolus application. Methods: From 01/1997 to 03/2004 a total of 1601 patients with UICC stage III colon cancer were randomized to receive the Mayo-Clinic regimen or infusional 5-FU either the weekly high dose AIO regimen, the bi-weekly LV5FU2 regimen or the Spanish weekly high dose TTD-regime. The major aim of this study was to demonstrate a difference of 7 % in the 5 year survival rate in favour of the infusional arm for which a total of 424 events were required. Results: After a median follow-up of 31 months 478 events have occurred. 804 patients received the standard arm and 797 the experimental arm (AIO N=331, EORTC N=92, FFCD N=211, TTD N=163). The median age was 64 years; patients were well distributed according to TNM-category (T3 73 vs. 75%, T4 17 vs. 16%, N2 31 vs. 34%), vascular and lymphatic invasion and grading. The bolus regimen induced a higher rate of grade 3 or 4 leukopenia (7.1% versus 2.0%), stomatitis grade 3 or 4 (9.8% versus 3.3%) or diarrhea grade 3 or 4 (16% vs. 15%). Hand-Foot-Syndrome was more frequent in the experimental arm (4.4% versus 0.4%). There was no difference in the recurrence free survival at 5 years (57% versus 56%; hazard ratio 1.00, 95% CI, 0.84 to 1.21; P=0.9) or overall survival at 5 years 71% versus 72%; hazard ratio 0.91, 95% CI, 0.71 to 1.16; P=0.44). Conclusions: Infusional 5-FU does not improve RFS or overall survival of stage III colon cancer compared to the Mayo regimen but is less toxic. Supported by Deutsche Krebshilfe

No significant financial relationships to disclose.

Randomized phase III trial of the TTD Group comparing capecitabine and oxaliplatin (XELOX) vs. oxaliplatin and 5-fluorouracil in continuous infusion (FUFOX) as first line treatment in advanced or metastatic colorectal cancer (CRC)

3580

Background: OX plus CI 5-FU is one of the standard chemotherapy regimens for first-line treatment in patients (p) with advanced CRC. Phase II trials have shown XELOX as a convenient combination, with a high activity and a favourable safety profile. This study is a phase III trial comparing both schedules. Methods: Multicenter, randomized and open labeled study was designed to include p withadvanced/metastatic CRC adenocarcinoma, measurable disease, PS ≥70% and adequate bone marrow, renal and hepatic functions. Previous adjuvant chemotherapy was allowed. Primary endpoint is time to progression (TTP). The study was designed to determined non-inferiority when the median time to progression in the XELOX arm was not lower than 5.5 months (hazard ratio no larger than 1.27). A sample size of 348 p (174 per arm) was necessary (0.05 level test; 80% power). Treatment: P were randomly assigned to receive either Arm A: oral XEL 1000 mg/m2 twice daily from day 1 to day 15, plus OX 130 mg/m2, iv, 2h, day 1 (in 3-week treatment cycles) or Arm B: biweekly 85 mg/m2, OX, iv, 2h, plus weekly CI 5-FU 2250 mg/m2, in 48h (TTD schedule). Treatment was continued, until progressive disease, unacceptable toxicity or consent withdrawal. Results: 340 (170/170) p have been included in the interim analysis over 348 enrolled, (M/F, 61%/39%), median age: 65.6 years (32.3–81.6), PS 90–100%: 62%. Primary tumour sites were colon (66.4%), rectum (28.3%) and both (5.3%). Median relative dose intensity was 90% for XEL and 92% for OX in arm A and 78% for OX and 78% for 5-FU in arm B. Efficacy: overall response rate in each arm (A/B) was 37.1/43.0% (p=0.824). With a median follow up of 12.6 months, median TTP was 8.8/9.6 months (p=0.130). Main grade 3–4 toxicity per p in each arm (A/B) was: paresthesia (17.7/15.9%), asthenia (12.4/17.1%), diarrhea (14.1/23.6%), neutropenia (8.3/10.0%) and vomiting (4.1/7.6%). Mature data on TTP and OS will be presented at the meeting. Conclusions: Efficacy and safety results suggest a similar toxicity profile, response rate and TTP for both regimens.

No significant financial relationships to disclose.

Risk assessment model for haematologic toxicity (HT) in patients with solid tumours (ST) during the first chemotherapy (CT) cycle

18516

Background: Bone marrow supression is the main type of CT dose-limiting toxicity. Specific studies on HT impact factors are key to help establish appropriate protocols in routine patient care. Objective: to identify significant factors among demographical and clinical variables for first-cycle CT-induced HT in patients (pts) with ST. Methods: Data was obtained from the Delfos Study, a multicentre prospective-cohort non-interventional study in Spain. To obtain a predictive model of logistic regression (LR), we followed the hierarchical principle as a way to ensure replication of results. This model was implemented for global HT, defined as compliance with at least one of the following criteria: anaemia grade (G) ≥2, thrombocytopenia G ≥2, neutropenia G ≥3, febrile neutropenia (FN, neutropenia G ≥3 and body Tª ≥38 Cº). A ROC curve was used to determine the best value for sensitivity and specificity of the model. Values were chosen so that both sensitivity and specificity resulted ≥70% and among the resulting possibilities, and due to study nature, the one providing higher specificity was taken. Results: A total of 1,194 pts with ST (breast, 37.9%; lung, 17.6%; colorectal, 15%; other, 29.5%) were included in 88 Spanish medical oncology health centres. Most pts were women (56%), mean age (SD) of 58(12) yrs. The LR model obtained predicted the global HT (pChi-sq < 0.0005), and includes the following factors: gender, tumour type, treatment intention, TNM-(T), TNM-(N), baseline haemoglobin (Hb), baseline lymphocyte count (LC), AST and the interaction gender-treatment intention. From those, five were statistically significant at the 0.05 level: baseline Hb (p < 0.0005, OR = 0.555), baseline LC (p = 0.026, OR = 0.8), type of treatment intention -neoadjuvant- (p = 0.013, OR = 0.265), TNM-(N) (p = 0.008, OR = 1.261), and interaction gender-treatment intention (p = 0.014). Inherent sensitivity and specificity of the equation were, respectively, 71.9% and 75.8%. Conclusions: A risk prediction model for global first-cycle CT-induced HT in pts with ST in Spain was implemented. Five prediction factors were identified. Baseline Hb and LC, as well as neoadjuvant intention, were inversely associated with HT. Toxicity increased with the number of affected lymph nodes.

No significant financial relationships to disclose.

Assessment of lifetime exposure to trihalomethanes through different routes

OBJECTIVES

To evaluate lifetime exposure to trihalomethanes (THM) through ingestion, inhalation, and dermal absorption in a hospital based case-control study of bladder cancer conducted between 1998 and 2001 in five areas of Spain. The study base was comprised of subjects living in the catchment areas of the participating hospitals.

METHODS

Individual information on water related habits was obtained from personal interviews of 1219 cases and 1271 controls: residential and occupational history, drinking water source at each residence and job, amount of water consumption, frequency and duration of showering, bathing, and swimming pool attendance. THM levels, water source history, and year when chlorination started in study areas were ascertained through measurements in drinking water samples and questionnaires to water companies and local authorities. Estimates of THM levels covered 79% of the subjects' person-years of exposure.

RESULTS

Current and historical average THM levels in water were correlated. Control subjects reported that drinking water source in the last residence was municipal for 63%, bottled for 22%, private well for 2%, and other sources for 13%. For the time window between age 15 and the time of interview, average residential THM level was 32.2 mug/l. THM exposure through ingestion was 23.7 mug/day on average, and was correlated with the ingestion THM level in the workplace. Overall, 79% usually took showers, 16% usually took baths, and 13% had ever attended a swimming pool. Between 21% and 45% of controls unexposed to THM through ingestion were evaluated as moderately or highly exposed through showering or bathing, and 5-10% were exposed through swimming in pools.

CONCLUSION

The importance of evaluating different routes is underscored by findings from experimental studies showing substantial differences in THM uptake and internal distribution by route.

Randomized phase III study of 3-weekly versus weekly docetaxel in pretreated advanced non-small-cell lung cancer: a Spanish Lung Cancer Group trial

BACKGROUND

Docetaxel is a widely accepted second-line treatment in advanced non-small-cell lung cancer (NSCLC) with a risk of myelotoxicity. This study evaluated the efficacy and toxicity profile of two docetaxel regimens in NSCLC patients who had failed first-line non-docetaxel-based chemotherapy.

PATIENTS AND METHODS

A total of 259 patients from 33 Spanish centers were randomized to receive either docetaxel 75 mg/m(2) administered every 3 weeks (3W arm) or docetaxel 36 mg/m(2) given weekly (1W arm) for 6 weeks followed by 2 weeks of rest. The primary end point was 1-year survival; secondary end points were median survival, time to progression, response and toxicity.

RESULTS

One-year survival was 27% in the 3W and 22% in the 1W arm. Median time to progression was also similar in the two arms. Median survival was 6.6 months in the 3W arm versus 5.4 months in the 1W arm (P = 0.075). Response rates were 9.3% in the 3W arm and 4.8% in the 1W arm. More patients in the 1W arm experienced mucositis [1W, nine patients (7.2%); 3W, two patients (1.6%); P = 0.032], while febrile neutropenia was significantly higher in the 3W arm [3W, 10 patients (7.8%); 1W, one patient (0.8%); P = 0.010].

CONCLUSIONS

Both weekly and 3-weekly docetaxel were effective and well-tolerated, with different toxicity profiles. In general, there was no indication to recommend the weekly schedule. However, the significant lower rate of febrile neutropenia observed in the weekly schedule makes it a good alternative for patients at risk of severe neutropenia.

Guides for adjuvant treatment of colon cancer

The choice of the most suitable chemotherapy schedule for the adjuvant treatment of colon cancer has been reviewed by the TTD group, as well as the principles of risk assessment for patients with stage II disease. In the light of data now available, oxaliplatin- based schedules (FOLFOX4 or FLOX) are recommended. Alternatives in special situations are monotherapy with capecitabine, UFT/LV, or 5- FU/LV in infusion. In patients with stage II disease, the indication of chemotherapy must be individualized and based on the patient's risk of recurrence (perforation, obstruction, peritumoral lymphovascular involvement, poorly differentiated histology, number of lymph nodes examined < or = 11, pre-surgical CEA), and comorbidities that can compromise the safety of treatment or survival of the patient.

Multidrug resistance-associated protein (MRP1) gene is strongly expressed in gastric carcinomas. Analysis by immunohistochemistry and real-time quantitative RT-PCR

AIMS

To assess MRP1 protein and MRP1 mRNA levels in gastric carcinomas and in non-neoplastic mucosa remote from the tumours. MRP1 gene expression may play a role in the complex pattern of chemoresistance present in gastric carcinomas.

METHODS AND RESULTS

A total of 57 carcinomas and respective gastric tissues were included for immunohistochemical assessment with the anti-MRP1 monoclonal antibodies MRPr1 and QCRL-1. Of these, 35 tumour and gastric mucosa tissues were also assessed by real-time quantitative reverse transcriptase-polymerase chain reaction. Medium or high MRP1 protein expression was detected in 89% and 77% of carcinomas and in 96% and 93% of non-neoplastic gastric mucosa by MRPr1and QCRL-1, respectively. No difference in MRP1 mRNA levels was detected between carcinomas and non-neoplastic gastric mucosa tissues in 77% of the patients. A significant correlation was found between MRP1 mRNA level and protein expression detected in carcinomas related to non-neoplastic gastric mucosa, although they were non-concordant in 29% of the patients.

CONCLUSIONS

MRP1 gene is usually expressed in most gastric carcinomas and does not differ substantially from that observed in non-neoplastic gastric mucosa remote from the tumour. However, a decrease in MRP1 gene expression is found in some carcinomas. For accurate assessment of changes in MRP1 expression between tumour and normal tissues both protein and mRNA detection are necessary.

Phase II trial of the novel taxane BMS-184476 as second-line in non-small-cell lung cancer

BACKGROUND

The purpose of this study was to evaluate the tolerability and efficacy of BMS-184476, an analog of paclitaxel, in patients with advanced non-small-cell lung cancer (NSCLC) progressing or relapsing following at least one prior chemotherapy regimen.

PATIENTS AND METHODS

Fifty-six previously treated advanced NSCLC patients received BMS-184476 at a dose of 60 mg/m(2) administered intravenously over 1 h every 21 days.

RESULTS

The median number of cycles delivered per patient was five (range one to 17). Dose reduction was required in only 3.8% of cycles. Grade 4 neutropenia occurred in 19.6% of patients, but no grade 4 thrombocytopenia or anemia was reported. Febrile neutropenia was observed in only two (3.6%) patients and there were no life-threatening events. Grade 3/4 peripheral sensory-motor neuropathy was reported in 9% of patients. Other non-hematological toxicities, such as nausea and vomiting, myalgia and arthralgia, diarrhea, and mucositis, were uncommon. Partial responses were observed in eight (14.3%) patients and stable disease in 33 (58.9%). Median progression-free survival was 3.7 months [95% confidence interval (CI) 2.7-5.4] and median overall survival was 10 months (95% CI 6-13.4).

CONCLUSIONS

BMS-184476 was well tolerated at the dose of 60 mg/m(2) and showed evidence of antitumor activity in previously treated NSCLC.

Phase I/II trial of irinotecan plus high-dose 5-fluorouracil (TTD regimen) as first-line chemotherapy in advanced colorectal cancer

BACKGROUND

We conducted a phase I/II study of weekly irinotecan [30 min intravenous (i.v.) infusion] combined with 5-fluorouracil (5-FU 3 g/m(2) weekly 48 h i.v. infusion, TTD regimen) as first-line chemotherapy for patients with advanced colorectal cancer (CRC).

PATIENTS AND METHODS

The maximum tolerated dose (MTD) and the dose-limiting toxicity (DLT) in the treatment of gastrointestinal solid tumors (in phase I), and the antitumor activity and toxicity of the recommended phase I dose (in phase II) were determined.

RESULTS

Diarrhea was the DLT, and irinotecan 80 mg/m(2) plus 5-FU 3 g/m(2) was the recommended phase I dose. In phase II, the confirmed response rate was 44% [95% confidence interval (CI) 29% to 59%] and the median overall survival was 23.8 months. However, grade 3/4 diarrhea affected 59% of patients and led to withdrawal of three patients. A second cohort of patients studied using the same schedule but with a reduced 5-FU starting dose of 2.25 g/m(2) showed improved tolerance (the incidence of grade 4 diarrhea decreased from 28% to 11% and overall grade 3/4 diarrhea to 56%, with no patient withdrawals) but the confirmed response rate was 28% (95% CI 14% to 45%) and median overall survival was 17.2 months.

CONCLUSIONS

We found weekly irinotecan 80 mg/m(2) plus TTD regimen (5-FU 2.25 g/m(2) given as 48-h i.v. infusion) to be a feasible and active combined chemotherapy for the first-line treatment of advanced colorectal cancer.

Sequential dose-dense paclitaxel followed by topotecan in untreated extensive-stage small-cell lung cancer: a Spanish Lung Cancer Group phase II study

BACKGROUND

Poor survival rates in extensive-stage small-cell lung cancer (SCLC) patients prompted us to evaluate a sequential dose-dense schedule of paclitaxel followed by topotecan.

PATIENTS AND METHODS

Forty-three patients with previously untreated, extensive-stage SCLC received three cycles of paclitaxel 250 mg/m(2) over 3 h every 14 days followed by three cycles of topotecan 2.5 mg/m(2) for 5 days every 21 days. Granulocyte colony-stimulating factor was given after every cycle. Patients progressing at any time and those not achieving complete response (CR) subsequently received four cycles of standard-dose etoposide-cisplatin.

RESULTS

A total of 118 cycles of paclitaxel were administered with minimal hematological toxicity. Grade 2/3 peripheral neuropathy was observed in 21% of patients. Response rate to paclitaxel was 48.8%, and 25.6% had stable disease (SD). Thirty-two patients achieving SD or response to paclitaxel subsequently received a total of 90 topotecan cycles. Topotecan-related toxicities included febrile neutropenia in 15.6% of patients with one toxic death, grade 3/4 anemia in 25% of patients and grade 3/4 thrombocytopenia in 31.3%. Non-hematological toxicities were mild. At completion of sequential paclitaxel-topotecan treatment the overall response rate was 55.8% (22 partial response, two CRs). Median survival for all patients was 10.5 months and median progression-free survival was 8.5 months.

CONCLUSIONS

Sequential treatment with dose-dense paclitaxel followed by topotecan is feasible despite significant hematological toxicity during topotecan treatment. This schedule is an active regimen in extensive-stage SCLC and merits further investigation.