Predictive factors of delayed emesis in cisplatin-treated patients and antiemetic activity and tolerability of metoclopramide or dexamethasone. A randomized single-blind study.

To prevent delayed emesis induced by cisplatin (mean dose 90 mg/m2), 120 consecutive patients were randomized to receive, in a 7-day crossover design, oral metoclopramide (20 mg q.i.d.), dexamethasone (1 mg q.i.d.) or placebo (two tablets q.i.d.) starting 24 hours after the end of chemotherapy. Complete protection from nausea, but not from vomiting. was significantly increased by both dexamethasone and metoclopramide with respect to placebo. Important prognostic factors favoring the appearance of delayed emesis were incomplete protection from vomiting during the first 24 hours after cisplatin, female gender, and highest cisplatin doses. Tolerability of both drugs was good. Larger and randomized controlled trials are necessary to identify better preventive treatment of delayed emesis induced by cisplatin.

Neoadjuvant cisplatin and etoposide for stage IIIA (clinical N2) non-small cell lung cancer.

In an attempt to improve the curative potential of surgery, 46 patients with unresectable Stage IIIA (Clinical N2) non-small cell lung cancer received neoadjuvant chemotherapy with cisplatin and etoposide. After 2 or 3 cycles, 45 patients were evaluable for response; the overall response rate was 82% (37/45) with 3 complete and 34 partial responses. Toxicity was primarily hematologic. Surgical exploration was performed on 35 patients, but resection was possible in only 33 (73%). Of these, 28 resections were complete (62%). Four patients (2CR, 2PR; 9%) had no tumor in biopsy specimen. Three deaths were surgery-related. Median survival of the entire 46 patients was 24.5 months with a 2-year survival of 53%. Cisplatin and etoposide is an effective chemotherapeutic regimen for regionally advanced non-small cell lung cancer; the resection and survival rates justify further trials to compare this approach to other treatment modalities.

Community-acquired pneumonia in adults: a multicentric observational AIPO study.

The aim of this study was to obtain reliable data about the current aetiology (i.e. the frequency of the individual pathogens) of community-acquired pneumonia (CAP) while surveying the diagnostic and therapeutic behaviour of Italian chest physicians, compared with existing guidelines, and to test the usefulness of the current severity "criteria" or score as a predictor of disease outcome and guide for appropriate hospitalization. A prospective multicentre observational trial was carried out between October 1994 and February 1996 by the Italian Association of Hospital Pneumologists (AIPO) study group on respiratory infections. A total of 613 consecutive patients suffering from CAP were enrolled in 25 centres throughout Italy. Clinical, radiological and microbiological data were collected and patients were followed-up until complete resolution or death. Aetiological tests were not carried out in 204 patients. In the remaining 409 cases, the aetiology was defined by serological and quantitative microbiological tests in 184 (44.9%) patients. A total of 194 strains of pathogen were detected. The most frequently detected micro-organism was Streptococcus pneumoniae (18.5% of pathogen strains) but, unlike in other series of patients, high percentages of intracellular pathogens (32.5%, all with serological confirmation, mostly due to Chlamydia pneumoniae (13.4%) and of Gram-negative enterobacteria and Pseudomonas aeruginosa (12.5%) were also found. Antibiotic treatment differed from that recommended in American Thoracic Society guidelines, with a greater use of third-generation cephalosporins. Overall, a higher rate of hospitalization and a lower death rate than in other comparable studies was observed.