ABSTRACT
Utilization of risk-stratification tools in the setting of neutropenic fever is currently limited by inadequate knowledge and lack of awareness. Within this context, the approach to management of low-risk patients with neutropenic fever is inconsistent with the available evidence across many Australian treating centres. These clinical guidelines define and clarify an accepted standard of care for this patient group given the current evidence base. The Multinational Association for Supportive Care in Cancer risk index is presented as the preferred risk assessment tool for determining patient risk. Suitability of ambulatory care within specific patient populations is discussed, with defined eligibility criteria provided to guide clinical decision-making. Detailed recommendations for implementing appropriate ambulatory strategies, such as early discharge and outpatient antibiotic therapy, are also provided. Due consideration is given to infrastructural requirements and other supportive measures at a resourcing and operational level. An analysis of the relevant health economics is also presented.
Subject(s)
Ambulatory Care/methods , Disease Management , Fever/drug therapy , Neoplasms/complications , Neutropenia/complications , Risk Management , Severity of Illness Index , Adult , Ambulatory Care/organization & administration , Anti-Bacterial Agents/therapeutic use , Australia , Cancer Care Facilities/organization & administration , Cancer Care Facilities/standards , Drug Resistance, Multiple, Bacterial , Evidence-Based Medicine , Fever/etiology , Humans , Patient Care Team , Patient Discharge , Practice Patterns, Physicians' , Recurrence , RiskABSTRACT
The aim of this multicentric phase II study was to investigate the efficacy and toxicity of a combination of chemotherapy containing paclitaxel (Taxol) and a novel compound, a liposomal encapsulated doxorubicin (Caelyx), as first line therapy for patients with metastatic breast cancer. Thirty-four patients with advanced breast cancer were treated with a combination of paclitaxel 175 mg/m2 and liposomal doxorubicin 30 mg/m2, every 3 weeks. The combination chemotherapy was effective in 73% of the patients (ITT) (95% CI 55-86%) (7 complete and 18 partial responses). Grade 3/4 toxicities were documented in a small number of patients. Two toxic deaths (6%) were documented, one a hepatorenal failure and another a febrile neutropenia. One patient experienced pulmonary embolism but continued on treatment after appropriate therapy. The combination of paclitaxel and liposomal encapsulated doxorubicin induces a high and durable response rate with a moderate toxicity profile.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Adult , Aged , Bone Neoplasms/drug therapy , Bone Neoplasms/secondary , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Disease-Free Survival , Doxorubicin/administration & dosage , Female , Humans , Liposomes/administration & dosage , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Lung Neoplasms/drug therapy , Lung Neoplasms/secondary , Middle Aged , Neoplasm Metastasis , Paclitaxel/administration & dosage , Soft Tissue Neoplasms/drug therapy , Soft Tissue Neoplasms/secondary , South Africa , Survival Analysis , Treatment OutcomeABSTRACT
Locoregional recurrence is a harbinger of disseminated disease, and historically the estimated 5-year survival when treated with local therapy only varies between 21% and 37%. The role of systemic treatment after local treatment is unclear at present. The authors investigated the results of systemic chemotherapy for these patients after complete local surgical resection. Data on 80 patients were evaluable for toxicity, time to treatment failure (TTF), and survival. Sixty-four patients received doxorubicin-based treatments, four received methotrexate-based combinations, and 12 received tamoxifen only. Among the 68 patients treated with cytostatics, there were two possible treatment-related deaths. Two patients developed grade 3 neutropenia, four developed grade 3 vomiting, and 42 had grade 2 toxicity. The 2- and 5-year disease free survival at a mean follow-up period of 5.5 years were 56% and 38%, respectively. The projected median TTF was 32 months (95% confidence interval, 23-82). Two- and 5-year overall survival were 86% and 62%, respectively, with a projected median survival of 93 months (7.75 years; 95% confidence interval, 64-177). These results show systemic therapy improved TTF and survival for patients with stage IV, no-evidence-of-disease breast cancer. Randomized studies are needed to confirm these findings and define optimal therapy.
Subject(s)
Breast Neoplasms/drug therapy , Neoplasm Recurrence, Local/drug therapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/surgery , Chemotherapy, Adjuvant , Female , Humans , Middle Aged , Neoplasm Recurrence, Local/surgery , Survival AnalysisABSTRACT
Rapid advances in our understanding of the biology and pathology of lymphoproliferative disorders, permitted mainly by new diagnostic tools, constantly change our approach to this heterogenous group of disorders. In this review of the more indolent subgroup of lymphoproliferative disorders, some of the recent advances are highlighted, and treatment options discussed.