An open-label, multicenter study of outpatient capecitabine monotherapy in 631 patients with pretreated advanced breast cancer

BACKGROUND

Phase II/III trials have shown that capecitabine is an active, well-tolerated therapy for metastatic breast cancer (MBC). We report clinical findings from an expanded access program enabling patients ineligible for investigative trials to receive capecitabine before its approval and availability.

METHODS

Patients pretreated with at least two chemotherapy regimens, including a taxane, for MBC received oral capecitabine until disease progression or unacceptable toxicity.

RESULTS

Six hundred and thirty-one patients received capecitabine (mean duration 3.8 months, range 0.1-24.7 months). The most common treatment-related grade 3/4 toxicities were diarrhea (9%) and hand-foot syndrome (8%). Grade 3/4 alopecia was absent and grade 3/4 myelosuppression was rare. Dose was modified in 172 patients (27%). Objective response rate in 349 evaluable patients was 35%. Median time to progression (n = 604) was 6.6 months (95% confidence interval, CI, 5.6-7.6) and median overall survival (n = 569) was 10.0 months (95% CI, 8.5-15.3).

CONCLUSIONS

Our findings in a cohort of patients with pretreated progressive breast cancer confirm the high efficacy and tolerability of outpatient capecitabine.

Combined NT-pro-BNP and CW-Doppler ultrasound cardiac output monitoring (USCOM) in epirubicin and liposomal doxorubicin therapy

BACKGROUND

Chemotherapy with epirubicin is approved in women with breast cancer and is associated with a certain degree of cardiotoxicity.

HYPOTHESIS

Epirubicin changes stroke volume, cardiac output and systemic vascular resistance, while liposomal doxorubicin does not.

METHODS

75 patients with HER-2-positive metastatic breast cancer were continuously measured with CW-Doppler ultrasound for stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR) before, during and after drug infusion in combination with NT-pro-BNP before and 10 min after drug infusion.

RESULTS

Epirubicin infusion increased stroke volume significantly in low-level NT-pro-BNP (62+/-23 ml vs. 74+/-29 ml, p=0.004) and high-level NT-pro-BNP (48+/-5 ml vs. 64+/-20 ml, p=0.131), while liposomal doxorubicin infusion increased stroke volume significantly in low-level NT-pro-BNP (54+/-16 ml vs. 67+/-22 ml, p=0.001) and high-level NT-pro-BNP (65+/-22 ml vs. 82+/-27 ml, p=0.001). Cardiac output was significantly increased in epirubicin (p=0.004) by 20% (NT-pro-BNP<125 pg/ml) and not significantly 38% (NT-pro-BNP>125 pg/ml; p=0.144), while in liposomal doxorubicin cardiac output was significantly increased by 23% (NT-pro-BNP<125 pg/ml; p=0.023) and 33% (NT-pro-BNP>125 pg/ml; p=0.001). In liposomal doxorubicin cardiac index was significantly increased by 26% (NT-pro-BNP<125 pg/ml; p=0.021) and 33% (NT-pro-BNP>125 pg/ml; p=0.0001). SVR was significantly reduced during and after epirubicin therapy.

CONCLUSION

Using the CW-Doppler USCOM a different hemodynamic response to epirubicin vs. liposomal doxorubicin is evident. Epirubicin leads to a significant upregulation of stroke volume and cardiac output, which is even more pronounced in the high-level NT-pro-BNP group, while liposomal doxorubicin does not change immediate hemodynamics. No deterioration of cardiac function using the real-time CW-Doppler ultrasound USCOM or an increase in NT-pro-BNP levels was evident during epirubicin or liposomal doxorubicin therapy.

[Rhabdomyolysis after administration of diclofenac]

Rhabdomyolysis may develop after various traumatic and nontraumatic circumstances. The use of lipid-lowering statins as well as the abuse of stimulants such as methylendioxymethamphetamine (ecstasy) can lead to fatal rhabdomyolysis with acute renal failure. We describe a case of diclofenac-induced rhabdomyolysis after a cumulative dose of 200 mg per os with consecutive critical increase of the creatine kinase and myoglobin. Prescription of diclofenac should therefore be done with caution. In cases of emergent myalgias, immediate testing of creatine kinase and myoglobin is mandatory to exclude fatal rhabdomyolysis with acute renal failure.

[Prevention of school sport injuries--an analysis of ballsports with 2234 injuries]

PURPOSE

Ball sport school injuries account for a significant morbidity among children and adolescents.

MATERIALS AND METHODS

During a school year 2234 school sport injuries have been reported to the Gemeinde Unfall Versicherung (GUV) Niedersachsen, Germany.

RESULTS

Regarding the non-gender-specific distribution of the ball sport disciplines, basketball leads with 32 % (n = 431), followed by soccer (24 %, n = 316), volleyball (17 %, n = 232), handball (8.3 %, n = 110) and hockey (4.9 %, n = 65). Sprains (27 %) dominate in basketball, followed by ligament distorsions and ruptures (23 %) and fractures (21 %), with frequent finger injuries (61 %) without contact of an opponent, and injuries of the lower extremity (28 %). Soccer leads to contusions (29 %), in 52 % of the lower extremity frequently after collision with an opponent (22 %) or the ball (20 %). In volleyball upper extremity injuries (71 %) dominate with 53 % finger sprains in individual volleyball play.

CONCLUSION

Ball school sport injuries account for a significant morbidity with frequent finger injuries. Proprioceptive deficits may play a role in those finger injuries in basketball, volleyball and handball. During hockey, severe dental and facial injuries were apparent. A prospective proprioceptive training program aiming on fingers and the ankle region may therefore be a preventive measure such as helmets with facial protection in hockey school sport.

Neuroprotection with amifostine in the first-line treatment of advanced ovarian cancer with carboplatin/paclitaxel-based chemotherapy--a double-blind, placebo-controlled, randomized phase II study from the Arbeitsgemeinschaft Gynäkologische Onkologoie (AGO) Ovarian Cancer Study Group

GOALS OF WORK

Neurotoxicity is a common side effect of platinum/taxane-based therapy of ovarian cancer. We performed a double-blind randomized placebo-controlled trial to evaluate the influence of the cytoprotectant amifostine on the neurotoxicity of first-line therapy of ovarian cancer with paclitaxel/carboplatin with or without epirubicin.

PATIENTS AND METHODS

Of 72 patients randomized, 71 were treated with paclitaxel 175 mg/m2 and carboplatin AUC5 with or without epirubicin 60 mg/m2 (q21 x 6) and randomized for i.v. premedication with amifostine 740 mg/m2 or placebo. Assessment included a questionnaire, NCI-CTC, tendon reflex activity (TRA), two-point discrimination (2-PD), measurement of vibration perception threshold (VPT) and vibration disappearance threshold (VDT), and quality of life.

RESULTS

The majority of neurotoxicity criteria showed a significant impairment during therapy in both treatment arms. A significant protective effect of amifostine was observed for 2-PD, TRA, VPT and VDT. Amifostine failed to improve the 'global health status quality of life' score significantly. Toxicities according to NCI-CTC showed improved sensory neuropathy (P = 0.0046) but a worsening in terms of nausea (P = 0.0005) and vomiting (P = 0.0083). No significant differences were observed for single sensory and motor symptoms, except for a better skilfulness in the amifostine group (P = 0.0404).

CONCLUSION

Amifostine improved sensory neuropathy according to NCI-CTC and with regard to objective neurological assessment, but there were almost no differences in self-estimated specific sensory or motor symptoms. Disadvantages with regard to non-neurological toxicities and inconsistent results for quality of life demand further evaluation of neuroprotection with amifostine as well as alternative approaches to prevent platinum-taxane induced neurotoxicity.

Volleyballverletzungen im Schulsport

INTRODUCTION

Ball sport school injuries account for a significant morbidity among children and adolescents. Volleyball is popular in school sport and leads frequent injuries in youth besides basketball and soccer.

METHODS

During a school year 2234 school sport injuries have been reported to the Gemeinde Unfall Versicherung (GUV) from all schools in Niedersachsen, Germany. The major disciplines were ball sport injuries, accounting for 59.5 % (1330 accidents), Gymnastic sport injuries follow at second position accounting for 18 % (403 accidents), followed by athletics with 8.1 %.

RESULTS

Regarding the non-gender-specific distribution of the ball sport disciplines, basketball leads with 32.4 % (431 injuries), followed by soccer (23.8 %, 316 injuries), volleyball (17.4 %, 232 injuries), small ball games (11.2 %, 149 injuries), handball (8.3 %, 110 injuries), and hockey (4.9 %, 65 injuries). In boys, volleyball accounts third among the ball sport injuries (10 %, 63 injuries), after soccer (38 %, 245 injuries), and basketball (28.5 %, 185 injuries). In girls, volleyball was the second major ball sport injury discipline (24.8 %, 169 injuries) after basketball (36.1 %, 246 injuries), followed by small ball games (12.9 %, 88 injuries), and soccer at 4 (th) position (10.4 %, 71 injuries). The analysis of the distribution of injury during volleyball accidents dominate upper extremity injuries (71.3 %), with special emphasis on finger injuries in 53 %, followed by lower extremity injuries (21.5 %) and head injuries (4.3 %). Spine injuries were rare (0.9 %). The type of injury during volleyball school sport injuries were predominantly sprains (21 %), ligament distorsions and ruptures (20 %), fractures (17 %), and bruise (16 %). Analyzing the circumstances of the injuries, most injuries during volleyball school sport occurred without a opponent contact during ball contact (59 %), followed during movements (9 %), the landing phase (9 %), and after a strike of the ball (7 %).

CONCLUSION

Volleyball injuries account for a significant number of all school sport related injuries. Upper extremity injuries account for the vast majority of all injuries especially during individual game play. Blunt trauma and fractures are most prevalent among school sport injuries in soccer. Preventive measures such as preservation of a high level of attention when scheduling a sport lesson, safety measures, and awareness of the possible severe injuries and knowledge in basic life support are mandatory to implement in school sports, since ball sport is proven to be very valuable for the physical and psychological development of the children. The role of preventive finger taping in volleyball school sport has to be evaluated in prospective clininal trials.

[Prerequisites for effective therapy of chronic recurrent vaginal candidiasis]

67 women with chronic recurrent or persistent vaginal candidosis between 5-79 years of age were seen in our outdoor department. In 34 cases, yeasts could be isolated in a vaginal swab taken at the first consultation. On average the patients reported 5 episodes per year during the last years. Typical symptoms consisted of pruritus vulvae, local inflammation and a curdy vaginal discharge. Nearly all of the women had received local or systemic antimycotic treatment for several times. In 53% (18 patients), C. albicans had been isolated, in 29% (10 patients) C. glabrata and in 9% (3 patients) C. krusei. While candidosis due to C. albicans and C. krusei was frequently associated with distressing complaints, infections with C. glabrata caused only very few symptoms. Independent of the species, severe and persistent infections were characterized by long term persisting specific IgM-antibody-titers and remarkable lack of IgG-antibodies. The laboratory parameters of WBC, CRP and immunelectrophoresis were normal. The minimum inhibitory concentrations (MIC) of 60 Candida strains against fluconacole were determined by microdilution assay. The MIC for C. albicans (n = 35) were between 0.78 and 3.125 micrograms/ml, for C. glabrata (n = 20) between 8 and 32 micrograms/ml and for C. krusei (n = 5) between 25 and 128 micrograms/ml. In 7 cases, local antimycotic treatment was sufficient. Correlating to the sensitivity, 18 women were treated with 100-800 mg fluconacole/d for 10-20 days. In 13 of them, clearance of symptoms and yeasts was achieved. The treatment of fluconacole-resistant strains with itraconazole (100-200 ml/d for 10-20 days) together with local application of nystatin (2 x 1 Mio. IE for 10 days) was without any effect. Three women with C. albicans, C. glabrata and C. krusei infection received a candidin-vaccination (0.005 BE/ml-500 BE/ml). In all of these cases, production of IgM-antibodies was induced. However, the clinical symptoms could not be influenced. Only in two cases it was not possible to reach a clearance of symptoms and yeasts. The results show the benefit of a precise differentiation before therapy. Serologic controls of antibody titers seem to be useful tools to control the efficacy of treatment.