Survival of patients with metastatic breast cancer: a single-centre experience.

Metastatic breast cancer (MBC) remains an incurable disease, despite major advances in the treatment in the past 10-12 years. Data on real life overall survival in a non-selected group containing all metastatic breast cancer patients are hard to find in the literature, as is the correlation of their survival with prognostic factors and treatment. This article provides overall survival data for all patients treated for MBC in a single-centre non-academic hospital. Survival data have been correlated with frequently used prognostic factors (subtype, age at diagnosis, M-status at diagnosis, metastases-free interval, and grade). It also gives an insight in the treatments given to and response rates in this population of MBC patients without selection bias representing the real life situation. A total of 169 patients were analysed. Mean survival from metastases is 31·8 months. Overall survival is better for the luminal subtypes, for younger age, for patients with a longer metastases-free interval, and for a lower grade. A small difference in survival has been seen in favour of the patients who represent immediately with metastases. With a larger sample size, we expect these factors to be prognostic significant. The luminal subtypes have a clear predisposition to metastasize in the bone, whereas visceral metastases occur more frequently and earlier in the hormone receptor-negative tumours. Brain metastases do occur in about half of the triple negative tumours and Her2/neu-positive tumours. Overall response rate to first-line chemotherapy was 56% in consecutive lines of treatment, a continuous clinical benefit exceeding 50% when selecting fit patients. This article represents a unique and valuable description of medical oncologists' real-life daily practice in MBC patients, with a clinical outcome that certainly compares to the sparse data provided in the literature.

[Management of dyslipidemias diagnosed in general practice in France--The PRAGMA Study]. / Prise en charge des dyslipidémies diagnostiquées en médecine générale en France--etude PRAGMA.

Several studies have reported the penetration and impact of national and international recommendations on the management of dyslipidaemia, a major cardiovascular risk factor. Most of them were carried out on patients participating in clinical trials or on in-hospital cases. The PRAGMA study was developed in order to evaluate management of this condition in general practice, at the heart of the health care system. From September to December 1998, 1,717 general practitioners were chosen randomly and included 6,623 patients considered to have a lipid disorder. In this sample, the prevalence of the main risk factors was as follows: hypertension: 39.6%, diabetes: 11.6%, obesity: 19.6%, past or present smokers: 33.8%. The main lines of management consisted in prescribing lipid lowering drugs (96.6%) with dietary recommendations (95.8%) and a fall lipid profile (59.9%). The main factors spontaneously cited by the general practitioners as being decisional were: the total cholesterol level (47.8%), diet (40.8%), body weight (29.4%) and drug therapy (19.2%). The cardiovascular risk factors were rarely taken into account in their totality. These results suggest that the management of dyslipidaemia patients by general practitioners is far from being optimal. Efforts should be made to change attitudes to take into consideration the global cardiovascular risk factors of patients with lipid disorders.

Preliminary results of a phase I/II study of paclitaxel, cisplatin, and cyclophosphamide in advanced ovarian carcinoma.

The clinical activity and toxicity of the triple combination of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ), cyclophosphamide, and cisplatin was assessed in both previously treated and untreated women with advanced ovarian carcinoma. Paclitaxel 175 mg/m2 was administered over 3 hours following standard premedication (prednisolone, dexchlorpheniramine, and cimetidine). Cisplatin 80 mg/m2 and cyclophosphamide 600 mg/m2 were given 6 to 12 hours after paclitaxel. Treatment was given at 3-week intervals for six cycles. Twenty-seven patients entered the study; 23 were evaluable for toxicity and 17 for response. Paclitaxel appeared to add additional efficacy to the standard cisplatin/cyclophosphamide regimen. Both the overall and complete remission rates were very high (88% and 70%, respectively), and histologically confirmed complete remissions exceeded 60%. Longer follow-up is needed to determine the duration of these responses. The primary toxicities included leukoneutropenia, peripheral neuropathy, asthenia, and alopecia. Only two of 23 patients withdrew because of toxicity, however, and only two treatment cycles were complicated by neutropenic fever requiring intravenous antibiotics. No life-threatening toxicities were encountered, although the peripheral neuropathy was poorly and slowly reversible and may have a significant impact on the patients' quality of life.

Salpêtrière Hospital experience with biochemotherapy in metastatic melanoma.

PURPOSE: This article investigates the safety and efficacy of a simple cisplatin-based biochemotherapy regimen, containing single-agent cisplatin plus recombinant interleukin-2 (rIL-2) and recombinant interferon-alpha (rIFN-alpha), in the treatment of metastatic melanoma. PATIENTS AND METHODS: Between December 1990 and April 1997, 129 patients were treated with cisplatin (100 mg/m2, day 0) plus continuous intravenous infusion rIL-2 (18 MIU/m2/day, days 3-6 and days 17-21) and subcutaneous rIFN-alpha (9 MIU three times per week) plus or minus tamoxifen (160 mg/day) on three different protocols. Tumor response, disease-free survival, and overall survival were evaluated for all evaluable patients (N = 127). RESULTS: The overall response rate was 49%, and 10% of patients achieved a complete response. Responses were observed at all sites of metastases. In one case, a patient with a large cutaneous inguinal mass experienced a dramatic regression of that lesion within 1 month. The median disease-free survival was 5 months, and median overall survival was 11 months. Patients who responded had a significant survival advantage over nonresponders, and patients who achieved a complete response had a significant survival advantage over patients with a partial response. Toxicities were manageable and reversible upon discontinuation of therapy. CONCLUSION: The response rates achieved with this simple biochemotherapy regimen are comparable to those for other cisplatin-based biochemotherapy regimens, which use more complex multiagent chemotherapy regimens. We found no added clinical benefit from the addition of tamoxifen to cisplatin.

Phase I/II study of paclitaxel, cisplatin, and cyclophosphamide in advanced ovarian carcinoma: preliminary results.

In this phase I/II study, we assessed the impact of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) in the treatment of advanced ovarian carcinoma combined with the standard regimen cisplatin/cyclophosphamide given as follows: paclitaxel 175 mg/m2 (over 3 hours perfusion with standard premedication), cisplatin 80 mg/m2 (6 to 12 hours after paclitaxel), and cyclophosphamide 400 mg/m2. From February 1994 to January 1996, 27 patients (median age, 55 years; age range, 35 to 74 years) were entered into the study. Eight patients had distant metastases and 19 had early locoregional disease (stage III, 18 patients; stage IC, one patient). Twenty-two patients had undergone prior surgery (simple biopsy, six patients; optimally debulked, nine patients; suboptimally debulked, seven patients). Twenty-one patients had received no prior chemotherapy and six were previously treated with at least one platinum-based regimen. A maximum of six courses of paclitaxel/cisplatin/cyclophosphamide were given every 21 days. Twenty-three patients were evaluable for toxicity: neutropenia (World Health Organization grade 3/4), 91% of patients; thrombopenia (World Health Organization grade 3/4), 13% of patients; two episodes of neutropenia with fever; and neurotoxicity grade 3, 17% of patients. Alopecia grade 3 was reported in all patients. No hypersensitivity reactions and no cardiac toxicity was observed. Among 17 patients evaluable for response (patients with stage IV disease or stage III suboptimally debulked), 12 (70%) clinical complete responses (CRs) and three (18%) partial responses were observed. Among the 12 patients with CRs, 10 underwent second-look laparotomy and seven of them (70%) achieved a pathologic CR. In the group of 11 chemotherapy-naive patients evaluable for response, eight (72%) achieved a CR and three (28%) achieved a partial response. This combination seems to be safe, with very acceptable toxicity, and also seems to be highly active in the treatment of patients with advanced ovarian carcinoma.