Incidence of chemotherapy-induced neutropenia and current practice of prophylaxis with granulocyte colony-stimulating factors in cancer patients in Spain: a prospective, observational study.

We aimed to describe the incidence of neutropenia in breast cancer and lymphoma patients and granulocyte colony-stimulating factors (G-CSF) use in clinical practice. We conducted a multicentre, prospective, observational study including breast cancer and lymphoma patients initiating chemotherapy (≥ 10% febrile neutropenia risk). We included 734 patients with breast cancer and 291 with lymphoma. Over the first four chemotherapy cycles, patients had an incidence of 11.0% grade 3-4 neutropenia (absolute neutrophil count <1.0 × 10(9) /L) and 4.3% febrile neutropenia (absolute neutrophil count <0.5 × 10(9) /L and fever ≥ 38 °C) in the breast cancer cohort, and 40.5% and 14.8% in the lymphoma cohort. Full dose on schedule (>85% of planned chemotherapy dose and ≤ 3 days delay) was achieved by 85.6% of breast cancer and 68.9% of lymphoma patients. Hospitalisation due to febrile neutropenia was required in 2.0% and 12.0% of breast cancer and lymphoma patients respectively. G-CSF was administered to 70.0% of breast cancer and 83.8% of lymphoma patients, and initiated from the first chemotherapy cycle (primary prophylaxis) in 60.6% and 64.2% of cases. Severe neutropenia affects approximately one in 10 breast cancer patients and one in two lymphoma patients receiving chemotherapy with moderate or greater risk of febrile neutropenia. Most patients received treatment with G-CSF in Spanish clinical practice.

Randomized clinical trial of adjuvant mitomycin plus tegafur in patients with resected stage III gastric cancer.

PURPOSE: The efficacy of adjuvant chemotherapy in gastric cancer is controversial. We conducted a phase III, randomized, multicentric clinical trial with the goal of assessing the efficacy of the combination of mitomycin plus tegafur in prolonging the disease-free survival and overall survival of patients with resected stage III gastric cancer. PATIENTS AND METHODS: Patients with resected stage III gastric adenocarcinoma were randomly assigned, using sealed envelopes, to receive either chemotherapy or no further treatment. Chemotherapy was started within 28 days after surgery according to the following schedule: mitomycin 20 mg/m(2) intravenously (bolus) at day 1 of chemotherapy; 30 days later, oral tegafur at 400 mg bid daily for 3 months. Disease-free survival and overall survival were estimated using the Kaplan-Meier analysis and the Cox proportional hazards model. RESULTS: Between January 1988 and September 1994, 148 patients from 10 hospitals in Catalonia, Spain, were included in the study. The median follow-up period was 37 months. The tolerability of the treatment was excellent. The overall survival and disease-free survival were higher in the group of patients treated with chemotherapy (P =.04 for survival and P =.01 for disease-free survival in the log-rank test). The overall 5-year survival rate and the 5-year disease-free survival rate were, respectively, 56% and 51% in the treatment group and 36% and 31% in the control group. CONCLUSION: Our positive results are consistent with the results of recent studies; which conclude that there is a potential benefit from adjuvant chemotherapy in resected gastric cancer.

Anticachectic efficacy of megestrol acetate at different doses and versus placebo in patients with neoplastic cachexia.

Anorexia and cachexia are present in the majority of patients with advanced-stage cancer. Several agents have been tested for their ability to reverse weight loss in these patients. Megestrol acetate has been demonstrated to improve appetite and weight, independent of tumor response, when used in the treatment of metastatic breast cancer. Several trials have studied the ability of megestrol acetate to stimulate weight gain in patients with non-hormone-sensitive tumors. One hundred fifty patients with a weight lost of more than 5% in the 3 previous months were randomized between double-blind megestrol acetate 160 mg daily (LMA), megestrol acetate 480 mg daily (HMA), or placebo (P). Weight, mid-arm circumference, triceps skinfold thickness (TST), performance status (Karnofsky index), and a quality-of-life status by seven linear analogic self-assessment scales were assessed before the start of treatment and at 4, 8, and 12 weeks thereafter. One hundred seven patients were assessable at 4 weeks, 79 at 8 weeks, and 64 at 12 weeks. Sixty-eight percent of patients treated with HMA increased their weights during their permanence on study, versus 37% and 38% of patients treated with P or LMA (p < 0.03). The mean weight gain after 12 weeks of treatment with HMA was 5.41 kg. A significant increase on TST was observed in the HMA group versus the LMA and P groups. There was no gain in performance status or quality of life in any group of treatment. The toxicity registered was mild. There were no thromboembolic events. This trial supports the efficacy of megestrol acetate at 480 mg/day in the treatment of cancer-related cachexia and anorexia, with mild toxicity. However, performance status and quality of life were not influenced by this treatment.

Addison's disease secondary to prostatic carcinoma. A case report.

Adrenal cortical insufficiency secondary to destruction of the cortex by a metastatic tumor is a rare condition. Addison's disease is usually caused by an autoimmune process or by a tuberculous infection. We report a case of adrenal insufficiency as the first clinical manifestation of a metastatic prostate carcinoma that occurred simultaneously with an active pulmonary infection by M. tuberculosis.

Fatal septic thrombophlebitis due to Salmonella enteritidis.

The case is reported of a patient with gastric adenocarcinoma with metastases who developed a septic focus in a saphenous vein. Salmonella enteritidis was cultured from blood, sputum and stool specimens, and from a thrombus removed from a varicosity of the saphenous vein. Extraintestinal infections caused by non-typhoid salmonella usually afflict debilitated and immunocompromised patients. Metastatic septic foci may appear anywhere in the organism, including the vascular system, but involvement of the venous system has not previously been reported.

Mitomycin-C and vinblastine in advanced breast cancer.

Forty-two patients with metastatic breast cancer refractory to first-line therapies were treated with combination chemotherapy with mitomycin-C and vinblastine. A response to treatment was observed in 11 of 34 evaluable patients (32.3%), with 3 complete remissions (8.8%) and 8 partial remissions (23.5%). The median duration of response was 185+ days. The 12-month survival was 78% for responders, 48% for patients with stable disease and 0% for patients with progressive disease. The toxicity was acceptable with 20 episodes of moderate myelosuppression (58.8%) and 2 cases with congestive heart failure that responded to medical treatment. The MMC-VBL combination is an active regime for advanced breast cancer previously treated with antracyclines. This combination may be regarded as a standard second-line treatment for this type of tumor.

[Alternating chemotherapeutic treatment in patients with localized undifferentiated small-cell carcinoma of the lung]. / Tratamiento quimioterápico alternante en pacientes con carcinoma indiferenciado de célula pequeña de pulmón localizado.

The results obtained from 23 patients suffering small cell lung carcinoma limited to the thorax, treated with 4 cycles of cyclophosphamide, adriamycin, vincristine alternating with cisplatin and VP/16, followed by mediastinal and holocranial prophylactic radiotherapy in patients with a complete response (CR) are here presented. An 87% of global responses were obtained with a 64% rate of RC. The average survival rate was 12 months with an 18% of patients alive two years after treatment. The main toxicity was hematologic and neurologic. Even if this alternating regime produces a high response rate, the results are not superior to those obtained with conventional chemotherapy.

Epithelioid hemangioendothelioma of the liver with myocardial metastases.

Epithelioid hemangioendothelioma is an unusual type of endothelial-derived vascular tumor located mainly in the soft tissues of the limbs. The present report describes a 48-year-old woman with an epithelioid hemangioendothelioma located in the liver with very unusual metastases to the myocardium. While the disease itself was controlled by adriamycin the patient died as a consequence of portal hypertension due to the abundant fibrotic component distinctive of this type of tumor. An epithelioid appearance can sometimes lead to a mistaken diagnosis of metastatic carcinoma, as happened initially in our case. The endothelial origin of the tumor must be confirmed by electron microscope identification of Weibel-Palade bodies or by immunohistochemical staining of factor VIII-related antigen. To the authors knowledge, this is the first case of myocardial metastases from an epithelioid hemangioendothelioma of the liver to be reported in English in the medical literature.

Capillary microscopy is a potentially useful method for detecting bleomycin vascular toxicity.

Capillary microscopy is an easy, noninvasive procedure to examine in vivo the dermis capillaries of the nailfold. It has demonstrated clinical use in the etiologic study of Raynaud's phenomenon. We consider a "vascular activity pattern" to be present at capillary microscopy when one of the following associations is observed: tortuous capillary vessels plus ramifications with or without loss of a moderate amount of capillaries. Capillary tortuousity alone is not considered pathologic. It is well known that bleomycin (BLEO) can occasionally induce vascular-associated diseases. To examine the vascular damage produced by BLEO, we performed capillary microscopic studies on 40 patients with neoplasia, 21 of whom had received BLEO during the previous year. The maximum accumulated doses ranged from 15 to 379 U. The other 19 patients had advanced neoplasia, and 10 of them had received antitumoral combinations that did not contain BLEO. No one had clinical signs attributable to vascular toxicity. Twenty-six patients had no pathologic patterns (11 received BLEO and 15 did not). In the group of 14 patients with activity patterns, 10 had received BLEO and 4 had not (P = 0.035). Ten of 11 patients treated with BLEO who had normal capillary microscopic studies received total doses of less than 100 U. We conclude that capillary microscopy may demonstrate the vascular damage induced by BLEO even in asymptomatic patients.