Real-World Experience with Vismodegib on Advanced and Multiple BCCs: Data from the RELIVIS Study

BACKGROUND

Vismodegib is approved for advanced cases of basal cell carcinomas not amenable to surgery or radiotherapy. Large studies on the use of vismodegib in clinical practice are scarce.

OBJECTIVES

The main objective of the study was to analyse the evolution and therapeutic management of relapses and lack of response in patients who had received vismodegib for locally advanced and/or multiple basal cell carcinomas in a real-life multicentre setting.

METHODS

This nationwide retrospective study collected data on patients treated with vismodegib in 15 specialized centres. We included patients who first received vismodegib until intolerable toxicity, maximum response, or progressive disease. Exploratory research variables referred to patient and tumour characteristics, vismodegib effectiveness and safety, relapse rate and management, and mortality. A multivariable logistic regression model was used to identify predictors of complete clinical response.

RESULTS

133 patients with advanced BCC were included in the registry. The objective response rate (ORR) was 77.5% and nearly half of the patients (45.9%) achieved complete remission. Long-term information and detailed information of subsequent treatments after a regime of vismodegib was available for 115 patients. Only 34% of the patients in this group were subsequently treated with other therapies or vismodegib rechallenge. Sixty-nine percent of the patients who had shown a complete remission with vismodegib remained free of recurrence while 30.7% relapsed. Almost half of the patients who received additional therapies after the first course of vismodegib achieved complete tumour remission. Three and 2 out of 9 patients who were rechallenged with vismodegib achieved complete and partial responses, respectively, with an ORR of 55.5%.

CONCLUSION

Our study confirms efficacy of vismodegib in routine clinical practice. The risk of recurrence after achieving complete response with vismodegib was lower than previous reports. Rechallenge with vismodegib is feasible and most patients responded to re-treatment.

Impact of the parenting style of foster parents on the behaviour problems of foster children

BACKGROUND

Few studies have analysed the effects of the parenting style used by foster carers on children's behaviour problems. This study examines the role played by the quality of the emotional relationship with foster carers and the kind of discipline they use as regard internalizing and externalizing problems among foster children.

METHODS

Participants were 104 foster children (56 boys and 48 girls) and their respective foster families. The Child Behaviour Checklist, the Affect and Communication Scale, and the Rules and Demands Scale were completed by foster parents. A series of linear regression analyses were performed using the stepwise method.

RESULTS

The main findings were as follows: an authoritarian parenting style explained the internalizing problems presented by foster children (11% of the variance); criticism/rejection, authoritarian parenting and permissive parenting explained externalizing problems (37% of the variance); and criticism/rejection and authoritarian parenting explained total problems (29% of the variance). These results indicate that criticism/rejection on the part of foster parents, as well as the use of inappropriate parenting styles (authoritarian and permissive), has an important effect in relation to the behaviour problems of foster children.

CONCLUSIONS

This highlights the key role that foster carers play in terms of tackling the behaviour problems that foster children present. The findings also suggest that preparation for fostering should focus especially on ways of helping foster parents both to acquire positive parenting strategies and to avoid authoritarian and permissive parenting.

Asthma and paracetamol: could we really know what happens between them?

An association between paracetamol use or exposure in different times of life, including gestation and childhood, and asthma has been observed in recent years. Causality cannot be established from observational studies because of the arguable presence of many confounding factors and biases. Randomised trials are needed to disclose the nature of the association, but are difficult to carry out because of ethic, economic and logistical issues as large patient samples should be involved for a long time in such studies. Pragmatic trials may be the best option to shed some light on this issue. Questions regarding the problems and difficulties of conducting such trials and the way to overcome them are discussed.

Allergen sensitization in children with asthma and rhinitis: marked variations related to age and microgeographical factors

BACKGROUND

Each region should know which its predominant allergens are. However, in addition to the differences that exist between different geographical areas, variations within the same area should be determined.

OBJECTIVES

To review the predominant allergens in the paediatric population suffering from asthma or rhinitis in our region and analyse the internal variations and associated factors.

METHODS

A cross-sectional, descriptive study reviewing all the patients having a diagnosis of asthma or rhinitis in the paediatric allergy units of three hospitals in a coastal region in the south-east of Spain between 2001 and 2006.

RESULTS

Data on 3066 patients, 2202 (72 %) of whom were atopic, were collected. Atopy was present in 63 % of asthmatics, 90 % of those with rhinitis and 95 % of those with both asthma and rhinitis. The percentage of atopic patients increased with age. Egg was the main allergen in the first 3 years of life, followed by milk. Aeroallergen sensitization started in the second year of life and increased rapidly in subsequent years. The main aeroallergens in our region, in descending order, were: olive, mites, Salsola, Alternaria, cat, dog and grasses. With the five main aeroallergens, 98 % of atopic patients between 6 and 14 years of age, and 94 % of those between 3 and 5 years of age are detected. In children under the age of three it is necessary to combine food and aeroallergens in order to detect most of the atopic patients. Sensitization to Alternaria occurred at an early age but stabilized before that caused by other aeroallergens. Sensitization to mites was very high along the coastline (83 %) but at only 5-30 km inland it decreased by half. On the other hand, sensitization to pollen and Alternaria increased sharply as we move away from the coast.

CONCLUSIONS

We have described the main allergens in children with asthma and rhinitis in a Mediterranean region in Spain, and have found marked differences depending on age and proximity to the coast. The local importance of Salsola, the early sensitization to Alternaria, and the surprisingly short reach of the influence of the coast in favouring sensitization to mites and protecting from sensitization to pollens and Alternaria are noteworthy.

Anaphylaxis to oral furosemide

Furosemide, one of the most used diuretic drugs, rarely induces type-1 allergic reactions It is included in the non-aromatic sulfonamides but a cross-reactivity mechanism between this group and the sulfonamides antibiotics, has not been clearly demonstrated. A 24-year-old woman, 10 minutes after the intake of one pill of Seguril 40mg experienced oral itching, generalized urticaria, facial angioedema, dyspnea and hypotension. She recovered after the administration of parental adrenaline, methyl-prednisolone and dyphenhydramine. An skin prick test with furosemide (10 mg/ml) was negative. The intradermal skin tests were positive to furosemide (1 %) as well as sulfamethoxazole (0.03 mg/ml), with 10 atopic and non-atopic negative controls. The patient rejected the performance of an oral challenge test with sulfamethoxazole. IgE-mediated reactions to furosemide are infrequent, but it could be the cause of life-threatening reactions. We have reported a case of anaphylaxis after the oral administration of furosemide with a demonstrated hypersensitivity mechanism through the positive intradermal skin test. The previous administration of the drug could probably the mechanism of sensitization, but the positive intradermal test to sulfamethoxazole would open the hypothesis of a cross-reactivity between non-aromatic and antimicrobial sulfonamides. It could be necessary an oral challenge test with furosemide in allergic patients to sulfamides.

Dermatitis to captopril

BACKGROUND

reports on delated cutaneous reactions to captopril have been seldom reported. Captopril is an angiotensin-converting enzyme (ACE) inhibitor and their cutaneous side-effects are documented, but little has been published concerning the usefulness of patch test when they occur. We presented the case of a patient who developed a cutaneous reaction induced by captopril with positive patch test.

METHODS AND RESULTS

patch testing was performed with captopril, other ACE (enalapril, lisinopril ramipril), and European standard series. Following, we performed a double-blind oral challenge test with drugs who results was negative. Positive reaction were obtained to captopril at 4 days and the others test being negative. The same test were negative in five control patients. The patient tolerated enalapril, and lisinopril without problems.

CONCLUSION

the allergological studies confirmed sensitisation to captopril and tolerance to lisinopril, and enalapril. When patch test are performed with several drugs of the same family, results seem to indicate an absence of cross-sensitivity, but in several patients, oral provocation test were needed because patch test gave no conclusive information.

Anaphylaxis after ingestion of sharon fruit

BACKGROUND

The sharon fruit is the edible fruit of the persimmon tree (Diospyros kaki) which belongs to the Ebenaceae family. There are few references of allergic reaction to this fruit. We introduce a case of a 33-years old man with a anaphylactic reaction immediately after ingestion of sharon fruit.

METHODS

Skin prick test (SPT) were performed by prick by prick with sharon fruit, legumes, vegetables, and fresh fruit. The test was considered positive when the average diameter of the wheal was > 3 mm. Serum-specific IgE was identified with use of the EIA, and SDS-PAGE Immunoblotting.

RESULTS

The skin by prick test with sharon fruit was positive in our case, and negative in five controls patients. Specific IgE in patient serum, assayed by EIA was positive for sharon fruit, but the results of immunoblotting were non-specific.

CONCLUSION

We have introduced a cause of anaphylaxis by sharon fruit that suggest an IgE mediated hypersensitivity reaction.

Pathological gambling and depression

A number of previous studies have indicated that pathological gambling is often associated with depression. Equally, a number of theoretical models of pathological gambling have included depression as a key variable. Here we report a study of depression in pathological gamblers identified within a random sample of 1,615 adults living in the major cities of Galicia (northwest Spain). Pathological gamblers were identified on DSM-IV diagnostic criteria. Depression was evaluated with the Beck Depression Inventory, subjects being classified 'depressive' if they obtained a score of 18 or more. Of 19 pathological gamblers who completed the Beck Depression Inventory, 21% were depressive; by contrast, only 9% of the other subjects were depressive. The Beck scores of pathological gamblers were positively correlated with the severity of their addiction as indicated by the number of DSM-IV-specified symptoms reported.