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Zheng LY, Xue H, Yuan H, Liu SX, Zhang XY. Efficacy of management for obstruction caused by precipitated medication or lipids in central venous access devices: A systematic review and meta-analysis. J Vasc Access 2019; 20:583-591. [DOI: 10.1177/1129729819836846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
At present, central venous access devices (CVADs) are widely used in clinical practice. The reasons for CVAD obstruction caused by precipitated medication or lipids are increasingly complex. However, there is no clear treatment program for CVAD obstruction caused by precipitated medication or lipids. The target of this study was to analyze data regarding obstruction caused by precipitated medication or lipids in CVADs and to calculate the efficacy of different treatment methods. A systematic review with meta-analysis was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The PubMed, Web of Science, EMBASE, Cochrane Library, CINAHL, and China National Knowledge Internet databases were searched for original research published before 2018. There were 1356 publications initially screened, with one additional study identified through snowballing. Seven studies met the inclusion criteria. The reasons for obstruction, except for clot formation, primarily included the following: mechanical complications; lipid deposition; mineral deposition; or drug precipitation. Meta-analysis showed that sodium hydroxide resulted in the highest recanalization rate in lipid deposition, followed by ethanol, and the difference was significant. The efficacy analysis revealed that hydrochloric acid and l-cysteine have similar effects on mineral deposition and drug precipitation. According to this review, the most effective methodology was shown to be the intravenous perfusion of sodium hydroxide in several treatments when the obstruction is caused by lipid deposition. In contrast, mineral deposition and drug deposition are best treated with l-cysteine to recover the patency of central venous access devices.
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Affiliation(s)
- Li-yuan Zheng
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People’s Republic of China
| | - Hui Xue
- Department of Histology & Embryology, College of Basic Medical Sciences, Jilin University, Changchun, People’s Republic of China
| | - Hua Yuan
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People’s Republic of China
| | - Shu-xiang Liu
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People’s Republic of China
| | - Xiu-ying Zhang
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People’s Republic of China
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2
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Clingan PR, Ackland SP, Brungs D, Souza P, Aghmesheh M, Garg MB, Ranson RD, Parker S, Jokela R, Ranson M. First‐in‐human phase I study of infusional and bolus schedules of Deflexifol, a novel 5‐fluorouracil and leucovorin formulation, after failure of standard treatment. Asia Pac J Clin Oncol 2019; 15:151-157. [DOI: 10.1111/ajco.13144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Philip R. Clingan
- Southern Medical Day Care Centre Wollongong Australia
- Illawarra Health and Medical Research Institute Wollongong Australia
| | | | - Daniel Brungs
- Illawarra Health and Medical Research Institute Wollongong Australia
- School of Chemistry and Molecular BioscienceUniversity of Wollongong Wollongong Australia
| | - Paul Souza
- Western Sydney University School of Medicine Sydney Australia
| | - Morteza Aghmesheh
- Illawarra Health and Medical Research Institute Wollongong Australia
- Illawarra Cancer Care Centre Wollongong Australia
| | | | | | | | | | - Marie Ranson
- Illawarra Health and Medical Research Institute Wollongong Australia
- School of Chemistry and Molecular BioscienceUniversity of Wollongong Wollongong Australia
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Di Paolo A, Orlandi P, Di Desidero T, Danesi R, Bocci G. Simultaneous, But Not Consecutive, Combination With Folinate Salts Potentiates 5-Fluorouracil Antitumor Activity In Vitro and In Vivo. Oncol Res 2017; 25:1129-1140. [PMID: 28109077 PMCID: PMC7841196 DOI: 10.3727/096504017x14841698396900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The combination of folinate salts to 5-fluoruracil (5-FU)-based schedules is an established clinical routine in the landscape of colorectal cancer treatment. The aim of this study was to investigate the pharmacological differences between the sequential administration of folinate salts (1 h before, as in clinical routine) followed by 5-FU and the simultaneous administration of both drugs. Proliferation and apoptotic assays were performed on human colon cancer cells exposed to 5-FU, calcium (CaLV), or disodium (NaLV) levofolinate or their simultaneous and sequential combination for 24 and 72 h. TYMS and SLC19A1 gene expression was performed with real-time PCR. In vivo experiments were performed in xenografted nude mice, which were treated with 5-FU escalating doses and CaLV or NaLV alone or in simultaneous and sequential combination. The simultaneous combination of folinate salts and 5-FU was synergistic (NaLV) or additive (CaLV) in a 24-h treatment in both cell lines. In contrast, the sequential combination of both folinate salts and 5-FU was antagonistic at 24 and 72 h. The simultaneous combination of 5-FU and NaLV or CaLV inhibited TYMS gene expression at 24 h, whereas the sequential combination reduced SLC19A1 gene expression. In vivo experiments confirmed the enhanced antitumor activity of the 5-FU + NaLV simultaneous combination with a good toxicity profile, whereas the sequential combination with CaLV failed to potentiate 5-FU activity. In conclusion, only the simultaneous, but not the consecutive, in vitro and in vivo combination of 5-FU and both folinate salt formulations potentiated the antiproliferative effects of the drugs.
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Krug F, Psathakis D, Hirsch U, Bruch HP. The K-port concept: Proposal for optimising a fully implantable port system. J Oncol Pharm Pract 2016. [DOI: 10.1177/107815529900500202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Typical reasons for the malfunction of implantable central venous catheters involve obstructions caused by blood clots, perforation through the skin, and contamination of the device. The objective of introducing this new port concept is to reduce the incidence of complications by making alterations to the design. Design. The main characteristics of this new port chamber are its drop-shaped interior, which opens into the catheter-connecting piece rather like a funnel, the lateral position of the puncture membrane, and the exchangeable catheter connection device. As a result, the following improvements with regard to conventional port catheters are feasible. Results. The puncture is made laterally next to the port chamber in a large, previously unstressed area of skin. The subcutaneous puncture channel can be used for a greater length of time so as to avoid ascending infections. In the event of an occlusion of the catheter, a wire can be pushed through the cannula to clean it. The puncture cannula lies against the skin and can be attached more readily. Various port chamber sizes can be combined with different catheter thicknesses to best meet the individual requirements of the patient. Current Status. The afore-mentioned port system is still at a conceptional stage of development. There are no data on practical experiences with the K-port, as licensing details have yet to be agreed upon with a manufacturer. We have applied for a patent for this device.
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Affiliation(s)
- Florian Krug
- Department of Surgery, University of Lübeck, Lübeck, Germany
| | | | - Ulrich Hirsch
- Faculty of Industrial Design at Muthesius College, Kiel, Germany
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Wells JW. Avoiding degradation of chemotherapy drugs: is graphene the answer? Nanomedicine (Lond) 2015; 10:3307-10. [PMID: 26582274 DOI: 10.2217/nnm.15.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Justin W Wells
- Department of Physics, Norwegian University of Science & Technology (NTNU), NO-7491 Trondheim, Norway
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Development and assessment of novel all-in-one parenteral formulations with integrated anticoagulant properties for the concomitant delivery of 5-fluorouracil and calcium folinate. Anticancer Drugs 2009; 20:822-31. [DOI: 10.1097/cad.0b013e32832fd78e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ardalan B, Kozyreva O, Tsai KT, Santos E, Franceschi D, Livingstone A, Lima M. A phase II study of irinotecan, high-dose 24-h continuous intravenous infusion of floxuridine and leucovorin (IFLUX) for advanced, previously untreated colorectal cancer. Anticancer Drugs 2007; 18:955-61. [PMID: 17667602 DOI: 10.1097/cad.0b013e3281430f8a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Our objectives were to determine response rate, time to progression, overall survival and tolerability of novel combination chemotherapy, consisting of irinotecan, high-dose 24-h continuous intravenous infusion of floxuridine and leucovorin in advanced previously untreated colorectal cancer. Thirty-eight patients with advanced colorectal cancer were treated at Sylvester Comprehensive Cancer Center, University of Miami, from 2000 to 2004, and received weekly intravenous infusion of irinotecan at 110 mg/m with a combination of 120 mg/kg floxuridine and 500 mg/m leucovorin administered as a 24-h continuous intravenous infusion. The treatment cycle consisted of 4 weeks of consecutive therapy followed by 2 weeks of rest. Five (13%) patients achieved complete response, 10 (26%) patients achieved partial response, 17 (45%) patients attained stable disease and six (16%) patients progressed. The overall response rate was 39% in this study. This chemotherapy regiment was well tolerated; the most common grade 3 toxicities were neutropenia (16%), anemia (16%), vomiting (24%), diarrhea (16%), and hand-and-foot syndrome (26%). The median time to progression was 11.5 months (347.5 days) with 95% confidence intervals of 6.8-12.9 months (206-389 days). The time to progression ranged from 1.8 to 34 months. The median survival of the patients in this trial was 31.28 months (952 days) with a confidence interval of 20.9-38.0 months (629-1141 days). Intravenous infusion of floxuridine and leucovorin is beneficial as first-line therapy in advanced colorectal cancer, demonstrating a prolonged time to progression and overall survival with acceptable tolerability and manageable toxicity profile.
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Affiliation(s)
- Bach Ardalan
- Division of Hematology/Oncology, Miller School of Medicine, University of Miami/Sylvester Comprehensive Cancer Center, Miami, Florida 33136, USA.
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Hildebrandt B, Pech M, Nicolaou A, Langrehr JM, Kurcz J, Bartels B, Miersch A, Felix R, Neuhaus P, Riess H, Dörken B, Ricke J. Interventionally implanted port catheter systems for hepatic arterial infusion of chemotherapy in patients with colorectal liver metastases: a Phase II-study and historical comparison with the surgical approach. BMC Cancer 2007; 7:69. [PMID: 17456240 PMCID: PMC1871598 DOI: 10.1186/1471-2407-7-69] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 04/24/2007] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The high complication rates of surgically implanted port catheter systems (SIPCS) represents a major drawback in the treatment of isolated liver neoplasms by hepatic arterial infusion (HAI) of chemotherapy. Interventionally implanted port catheter systems (IIPCS) have evolved into a promising alternative that enable initiation of HAI without laparatomy, but prospective data on this approach are still sparse. Aim of this study was to evaluate the most important technical endpoints associated with the use of IIPCS for the delivery of 5-fluorouracil-based HAI in patients with colorectal liver metastases in a phase 2-study, and to perform a non-randomised comparison with a historical group of patients in which HAI was administered via SIPCS. METHODS 41 patients with isolated liver metastases of colorectal cancer were enrolled into a phase II-study and provided with IIPCS between 2001 and 2004 (group A). The primary objective of the trial was defined as evaluation of device-related complications and port duration. Results were compared with those observed in a pre-defined historical collective of 40 patients treated with HAI via SIPCS at our institution between 1996 and 2000 (group B). RESULTS Baseline characteristics were balanced between both groups, except for higher proportions of previous palliative pre-treatment and elevated serum alkaline phosphatase in patients of group A. Implantation of port catheters was successful in all patients of group A, whereas two primary failures were observed in group B. The frequency of device-related complications was similar between both groups, but the secondary failure rate was significantly higher with the use of surgical approach (17% vs. 50%, p < 0.01). Mean port duration was significantly longer in the interventional group (19 vs. 14 months, p = 0.01), with 77 vs. 50% of devices functioning at 12 months (p < 0.01). No unexpected complications were observed in both groups. CONCLUSION HAI via interventionally implanted port catheters can be safely provided to a collective of patients with colorectal liver metastases, including a relevant proportion of preatreated individuals. It appears to offer technical advantages over the surgical approach.
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Affiliation(s)
- Bert Hildebrandt
- CharitéCentrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - Maciej Pech
- CharitéCentrum für Tumormedizin, Klinik für Strahlenheilkunde, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, D-30120 Magdeburg, Germany
| | - Annett Nicolaou
- CharitéCentrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - Jan M Langrehr
- CharitéCentrum für Chirurgische Medizin, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - Jacek Kurcz
- Akademia Medyczna Katedra i Zakład Radiologii, Szpital Kliniczny Nr 1, M. Skłodowskiej-Curie St. 68, PL-50369 Wrozlaw, Poland
| | - Birgit Bartels
- CharitéCentrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - Alexandra Miersch
- CharitéCentrum für Tumormedizin, Klinik für Strahlenheilkunde, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - Roland Felix
- CharitéCentrum für Tumormedizin, Klinik für Strahlenheilkunde, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - Peter Neuhaus
- CharitéCentrum für Chirurgische Medizin, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - Hanno Riess
- CharitéCentrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - Bernd Dörken
- CharitéCentrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - Jens Ricke
- CharitéCentrum für Tumormedizin, Klinik für Strahlenheilkunde, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, D-30120 Magdeburg, Germany
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Yeste Sánchez L, Galbis Caravajal JM, Fuster Diana CA, Moledo Eiras E. Protocol for the implantation of a venous access device (Port-A-Cath System). The complications and solutions found in 560 cases. Clin Transl Oncol 2006; 8:735-41. [PMID: 17074672 DOI: 10.1007/s12094-006-0120-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The cannulation of suitable peripheral veins may be a very painful experience. Implantable venous access systems have to some degree relieved this problem and help to provide an improvement in terms of quality of life. MATERIAL AND METHODS We have evaluated 560 patients during a follow up period of two years. A low overall complication percentage of 7.32% was seen when using the venous access device. RESULTS Complications and treatments were: pneumothorax; portal rotation or infection; catheter infection; embolism and migration; extravasation; partial or total obstruction of the device; rupture of the catheter or the membrane. CONCLUSIONS There is no other system that allows repeated venous access on such a long term basis. Placing the devices completely under the skin allows the patient to conduct a normal life style, and its maintenance does not need any special care, with the exception of the monthly heparinised serum infusion. The preferred option is to insert the catheter through the cephalic vein in the delto pectoral groove.
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Affiliation(s)
- Luis Yeste Sánchez
- Servicio de Cirugía Plástica, Reparadora y Estética, Unidad de Quemados, Hospital POVISA, Vigo, Pontevedra, Spain.
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Sharma R, Rivory L, Beale P, Ong S, Horvath L, Clarke SJ. A phase II study of fixed-dose capecitabine and assessment of predictors of toxicity in patients with advanced/metastatic colorectal cancer. Br J Cancer 2006; 94:964-8. [PMID: 16552436 PMCID: PMC2361225 DOI: 10.1038/sj.bjc.6603049] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 02/13/2006] [Accepted: 02/13/2006] [Indexed: 02/04/2023] Open
Abstract
The purpose of this study was to evaluate the safety and activity of fixed-dose capecitabine in patients with advanced colorectal cancer and to correlate pretreatment plasma concentrations of homocysteine and serum and red cell folate with toxicity. Patients received capecitabine 2000 mg (4 x 500 mg tablets) twice daily on days 1-14 every 3 weeks. They were reviewed weekly during the first cycle and then three weekly for safety assessment. Eligibility criteria were advanced/metastatic colorectal cancer, < or = 2 prior chemotherapy regimens, ECOG performance status 0-2 and life expectancy >12 weeks. A total of 60 patients were enrolled and 55 were evaluable for efficacy. The median age was 72 years and 63% of patients had a performance status of 1 or 2. Confirmed tumour responses were reported in 15 patients (28%; 95% confidence interval (CI), 15.7-40.3%). The median time to disease progression was 4.9 months and median overall survival was 11.2 months. The median ratio of fixed dose to body surface area (BSA)-calculated dose was 88% (range 65-108%). Significant myelosuppression was not observed. Grade 2/3 treatment-related adverse events were diarrhoea (34%), fatigue (27%), stomatitis (15%) and hand-foot syndrome (22%). Dose reduction due to adverse events was required in 16 patients (29%) and multiple reductions in five patients (9%). There was no grade 3/4 haematological toxicity, any grade 4 adverse events or treatment-related deaths. Patients with higher pretreatment levels of serum folate experienced significantly greater toxicity (P = 0.02, CI: 1.0-1.2) during cycle 1 and over the entire treatment period (P = 0.04, CI: 1.0-1.3). Pretreatment homocysteine concentrations did not predict for toxicity. In conclusion, fixed-dose capecitabine appears to have similar efficacy and safety compared to the currently recommended dose schedule based on body surface area and simplifies drug administration. A high pretreatment folate may be predictive of increased toxicity from capecitabine.
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Affiliation(s)
- R Sharma
- Sydney Cancer Centre, Sydney, NSW, Australia
| | - L Rivory
- Sydney Cancer Centre, Sydney, NSW, Australia
| | - P Beale
- Sydney Cancer Centre, Sydney, NSW, Australia
| | - S Ong
- Sydney Cancer Centre, Sydney, NSW, Australia
| | - L Horvath
- Sydney Cancer Centre, Sydney, NSW, Australia
| | - S J Clarke
- Sydney Cancer Centre, Sydney, NSW, Australia
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Chao Y, Yeh KH, Chang CJ, Chen LT, Chao TY, Wu MF, Chang CS, Chang JY, Chung CY, Kao WY, Hsieh RK, Cheng AL. Phase II study of weekly oxaliplatin and 24-h infusion of high-dose 5-fluorouracil and folinic acid in the treatment of advanced gastric cancer. Br J Cancer 2004; 91:453-8. [PMID: 15226770 PMCID: PMC2409850 DOI: 10.1038/sj.bjc.6601985] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To investigate the efficacy and safety of combining weekly oxaliplatin with weekly 24-h infusion of high-dose 5-fluorouracil (5-FU) and folinic acid (FA) in treatment of patients with advanced gastric cancer. Patients with histologically confirmed, locally advanced or recurrent/metastatic gastric cancer were studied. Oxaliplatin 65 mg m−2 2-h intravenous infusion, and 5-FU 2600 mg m−2 plus FA 300 mg m−2 24-h intravenous infusion, were given on days 1 and 8, repeated every 3 weeks. Between January 2001 through January 2002, 55 patients were enrolled. The median age was 64 years (range: 22–75). In all, 52 patients (94.5%) had recurrent or metastatic disease and three patients had locally advanced disease. Among 50 patients evaluable for tumour response, 28 patients achieved partial response, with an overall response rate of 56% (95% confidence interval (CI): 41.8–70.3%). All 55 patients were evaluated for survival and toxicities. Median time to progression and overall survival were 5.2 and 10.0 months, respectively, during median follow-up time of 24.0 months. Major grades 3–4 toxicities were neutropenia in 23 cycles (7.1%) and thrombocytopenia in 16 cycles (5.0%). Treatment was discontinued for treatment-related toxicities in nine patients (16.4%), of whom eight were due to oxaliplatin-related neurotoxicity. One patient (1.8%) died of neutropenic sepsis. This oxaliplatin-containing regimen is effective in the treatment of advanced gastric cancer. Except for neurotoxicity that often develops after prolonged use of oxaliplatin, the regimen is well tolerated.
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Affiliation(s)
- Y Chao
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - K H Yeh
- National Taiwan University Hospital, Taipei, Taiwan
- Far Eastern Memorial Hospital, Taipei, Taiwan
| | - C J Chang
- National Taiwan University Hospital, Taipei, Taiwan
| | - L T Chen
- Taipei Veterans General Hospital, Taipei, Taiwan
- National Health Research Institutes, Taipei, Taiwan
| | - T Y Chao
- Tri-Service General Hospital, Taipei, Taiwan
| | - M F Wu
- Chung Shan Medical and Dental College Hospital, Taipei, Taiwan
| | - C S Chang
- Changhua Christian Hospital, Taipei, Taiwan
| | - J Y Chang
- National Taiwan University Hospital, Taipei, Taiwan
- National Health Research Institutes, Taipei, Taiwan
| | - C Y Chung
- Changhua Christian Hospital, Taipei, Taiwan
| | - W Y Kao
- Tri-Service General Hospital, Taipei, Taiwan
| | - R K Hsieh
- Mackay Memorial Hospital, Taipei, Taiwan
| | - A L Cheng
- National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine and Department of Oncology, National Taiwan University Hospital, No 7, Chung-Shan South Road, Taipei, Taiwan. E-mail:
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Sternberg CN, Reichardt P, Holland M. Development of and clinical experience with capecitabine (Xeloda®) in the treatment of solid tumours. Eur J Oncol Nurs 2004; 8 Suppl 1:S4-15. [PMID: 15341878 DOI: 10.1016/j.ejon.2004.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The oral fluoropyrimidine capecitabine (Xeloda) delivers 5-FU to the tumour site, thereby limiting the side effects and other complications associated with intravenous (i.v.) 5-FU. As an oral drug, capecitabine is preferred to 5-FU by many patients as it can be conveniently taken at home. In first-line metastatic colorectal cancer (MCRC), capecitabine results in superior response rates and equivalent progression-free and overall survival compared with i.v. 5-FU/LV. There is also increasing evidence for replacing i.v. 5-FU with capecitabine in combination with other anticancer agents (e.g. oxaliplatin and irinotecan) in MCRC and in the adjuvant treatment of early stage colon cancer. In anthracycline-pretreated metastatic breast cancer (MBC), adding capecitabine to docetaxel improves survival, time to progression (TTP) and response rates beyond docetaxel. Single-agent capecitabine is also effective in pretreated MBC and is a promising first-line therapy. Capecitabine has a favourable safety profile, the most frequent adverse events being hand-foot syndrome, stomatitis and diarrhoea. Because capecitabine is orally administered, it is possible to intervene promptly with dose interruption/reduction to resolve adverse events without impacting on efficacy. The increasing availability of capecitabine in the home-based setting requires careful consideration of the role of the oncology nurse, who is the key link between the patient and clinician for effective and efficient management.
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Affiliation(s)
- Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Pavilion Cesalpino II, Circonvallazione Gianicolense 87, Rome 00152, Italy.
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Molassiotis A. Challenges and opportunities when using oral chemotherapy in the home setting: the example of capecitabine (Xeloda®). Eur J Oncol Nurs 2004. [DOI: 10.1016/j.ejon.2004.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Partridge S, Leslie M, Irvine A. Infusional 5-fluorouracil can be a pain in the neck: A case for repositioning displaced Hickman lines. Clin Oncol (R Coll Radiol) 2000; 11:274-6. [PMID: 10473727 DOI: 10.1053/clon.1999.9063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Increasing numbers of patients receive infusional chemotherapy or total parenteral nutrition via Hickman or Grochong lines. Although the insertion of these indwelling catheters is generally performed under radiological guidance and their positions verified by chest radiography, it is still feasible for them to become displaced at a later date. This possibility should be excluded in patients who develop unusual symptoms during the course of their infusional therapy. We review the reported complications associated with Hickman lines, and present a case history demonstrating that interventional radiology has a valuable role in displaced line repositioning, after the exclusion of thrombosis and infection.
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Rauthe G, Altmann C. Complications in connection with venous port systems: prevention and therapy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1998; 24:192-9. [PMID: 9630859 DOI: 10.1016/s0748-7983(98)92963-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Post-operative difficulties apart, venous thrombosis, extravasation and dislocation, obstruction, catheter leakage and local and systemic infections are the typical complications associated with venous port systems. Such complications considerably reduce the benefits otherwise accruing from a reliable access to the venous system of patients with malignant tumours. The vast majority of such disadvantages are attributable to the inexpert handling of ports and, therefore, should be avoidable. This applies to such areas as selecting the right port system, the proper installation of the port chamber and catheter and also to efficient handling and maintenance by trained staff. In may cases it will be possible, with the help of a specific diagnostic investigation, to identify and correct a fault and this ensure that the system installed continues to function. Typical and frequent complications observed (with specific examples) in connection with port systems are described together with preventative measures, diagnosis and therapy.
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Affiliation(s)
- G Rauthe
- Sclossbergklinik Oberstaufen, Tumorzentrum der Universitäten München, Germany
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Young C, Gould JR. The timing and sequence of multiple device-related complications in patients with indwelling subcutaneous ports. Am J Surg 1997; 174:417-21. [PMID: 9337166 DOI: 10.1016/s0002-9610(97)00145-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Multiple complications associated with venous access ports are a common occurrence. In an effort to define patterns of sequential complications in our community, we undertook a prospective analysis of adult cancer patients in whom a subcutaneous port was inserted. METHODS One hundred nineteen consecutive adult cancer patients in whom a subcutaneous port was inserted were observed prospectively for the development of complications. RESULTS Complications were identified in 70 of the 91 evaluable patients, while sequential complications were identified in 35 patients (38%). In aggregate, 121 complications were identified. The ball-valve effect, the most frequently identified problem, was found to occur disproportionately as a primary complication (52 of 70 versus 26 of 51, P <0.02). In contrast, port-related venous thrombosis was identified most frequently as a subsequent complication (11 of 51 versus 4 of 70, P <0.02). The only identified risk factor for the development of port-related complications was the ball-valve effect, found to be associated with the subsequent development of port-related venous thrombosis (9 of 52 versus 2 of 69, P <0.02). CONCLUSIONS Multiple sequential complications of subcutaneous ports are common and occur in a rather predictable order. The occurrence of port-related venous thrombosis in patients with an earlier, relatively minor vascular complication (ball-valve effect) suggests a cause-effect relationship. Insight into complication sequencing may lead to improved strategies for prevention and therapy.
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Affiliation(s)
- C Young
- Oncology Associates of West Kentucky, Paducah 42001, USA
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Schwarz LR. Elimination of dose limiting toxicities of cisplatin, 5-fluorouracil, and leucovorin using a weekly 24-hour infusion schedule for the treatment of patients with nasopharyngeal carcinoma. Cancer 1996; 78:566-7. [PMID: 8697406 DOI: 10.1002/(sici)1097-0142(19960801)78:3<566::aid-cncr27>3.0.co;2-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Chi KH, Chan WK, Chen KY. Author reply. Cancer 1996. [DOI: 10.1002/(sici)1097-0142(19960801)78:3<567::aid-cncr28>3.0.co;2-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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