The effect of YOCAS©® yoga for musculoskeletal symptoms among breast cancer survivors on hormonal therapy.

Up to 50% of breast cancer survivors on aromatase inhibitor therapy report musculoskeletal symptoms such as joint and muscle pain, significantly impacting treatment adherence and discontinuation rates. We conducted a secondary data analysis of a nationwide, multi-site, phase II/III randomized, controlled, clinical trial examining the efficacy of yoga for improving musculoskeletal symptoms among breast cancer survivors currently receiving hormone therapy (aromatase inhibitors [AI] or tamoxifen [TAM]). Breast cancer survivors currently receiving AI (N = 95) or TAM (N = 72) with no participation in yoga during the previous 3 months were randomized into 2 arms: (1) standard care monitoring and (2) standard care plus the 4-week yoga intervention (2x/week; 75 min/session) and included in this analysis. The yoga intervention utilized the UR Yoga for Cancer Survivors (YOCAS©(®)) program consisting of breathing exercises, 18 gentle Hatha and restorative yoga postures, and meditation. Musculoskeletal symptoms were assessed pre- and post-intervention. At baseline, AI users reported higher levels of general pain, muscle aches, and total physical discomfort than TAM users (all P ≤ 0.05). Among all breast cancer survivors on hormonal therapy, participants in the yoga group demonstrated greater reductions in musculoskeletal symptoms such as general pain, muscle aches and total physical discomfort from pre- to post-intervention than the control group (all P ≤ 0.05). The severity of musculoskeletal symptoms was higher for AI users compared to TAM users. Among breast cancer survivors on hormone therapy, the brief community-based YOCAS©® intervention significantly reduced general pain, muscle aches, and physical discomfort.

Selective dose escalation of chemoradiotherapy for esophageal cancer: role of treatment intensification.

This ongoing phase II study is designed to assess the outcomes (survival and failure patterns) of therapy for localized esophageal cancer with conventional dose radiation (50.4 Gy) with concurrent continuous infusion 5-fluorouracil (5-FU) and weekly carboplatin/paclitaxel. Patients with less than complete response or partial response received dose escalation of radiation to 59.4 Gy with the same chemotherapy. This report details the results of the first 18 patients treated. From July 2000 to June 2003, we prospectively enrolled 18 patients with T1-4, N0-1, M0-1a esophageal carcinoma to receive paclitaxel 45 mg/m 2 intravenously over 1 hour and carboplatin AUC 2 intravenously over 30 minutes on days 1, 8, 15, 22, 29, and 36. 5-Fluorouracil 225 mg/m2 was delivered as a continuous infusion on days 1 through 38. Radiation therapy was given 1.8 Gy x 5 days/week x 5.5 weeks (50.4 Gy in 28 fractions). After 6 to 8 weeks, patients underwent repeat staging with computed tomography scan, endoscopic ultrasound, and biopsy. Patients with a positive biopsy, or less than partial response by computed tomography and endoscopic ultrasound, received a boost of 9 Gy with the same concurrent chemotherapy. Patients were followed every 4 months with computed tomography/endoscopic ultrasound the first year and every 6 months thereafter. Median follow-up was 19 months. Eleven of 18 patients (61.1%) attained a complete response/partial response; six of 18 (33.3%) received a boost. Overall survival was 30% at 3 years, with a median of 25 months. Patients with less than 10% pretreatment weight loss had an overall survival of 36% with a median of 26 months. In patients with more than 10% pretreatment weight loss, median survival was 14 months with 0% surviving at 2 years. Local/regional control was 67% (no-boost patients [78%]; boost patients [40%]). Progression-free survival was 31% at 3 years, with a median of 14 months. Distant metastasis-free survival was 40% at 3 years, with a median of 27 months. Seventy-nine percent of patients required at least one dose reduction in chemotherapy because of toxicities. Radiation delays ranged from 0 to 62 days, with a median of 7 days. Grade 2/3 acute esophagitis was experienced by 89% and 39% of patients, respectively; 28% of patients developed esophageal strictures requiring dilatations. The combination of continuous-infusion 5-FU and weekly carboplatin/paclitaxel with selective radiation dose escalation yields promising results without surgery and adjuvant chemotherapy. The toxicities of therapy, while manageable, were significant.

Southwestern oncology group phase II trial (S0526) of pemetrexed in bronchioloalveolar carcinoma subtypes of advanced adenocarcinoma.

BACKGROUND: Pemetrexed, a multitargeted antifolate drug, is an active agent in non-small-cell lung cancer (NSCLC), especially adenocarcinomas. Based on preclinical data supporting the relevance of alpha-folate receptors in adenocarcinoma of the bronchioloalveolar carcinoma (BAC) subtype, this trial was designed to assess pemetrexed in patients with this pathologic subtype of lung adenocarcinoma. PATIENTS AND METHODS: Patients with histologically confirmed stage IIIB (with malignant pleural effusion) or stage IV adenocarcinoma with BAC features or pure BAC were eligible. Treatment consisted of pemetrexed, 500 mg/m(2), administered intravenously every 21 days. RESULTS: Of 27 patients enrolled, 24 were eligible and assessable for adverse events: Toxicity was primarily hematologic, consisting of leukopenia/neutropenia, thrombocytopenia, and anemia. The median follow-up among patients still alive (n = 8) was 35 months (range, 26-47 months). Among 17 patients with measurable disease, the response rate was 23% (all partial responses; 95% confidence interval [CI], 10%-56%). The median progression-free survival (PFS) and overall survival (OS) were 6 and 25 months, respectively. CONCLUSION: Pemetrexed is active and well tolerated and, in patients with adenocarcinoma BAC subtypes, likely related to its underlying mechanism of action as a multitargeted antifolate drug.

Response to paclitaxel and carboplatin in metastatic salivary gland cancer: a case report.

BACKGROUND: Malignant tumors of the salivary gland are rare entities that are treated primarily by surgical resection. For patients with recurrent or unresectable disease, options include radiation therapy or chemotherapy; however, responses are few and of short duration. Patients with metastatic disease have been treated with chemotherapy, but, again, response rates have been low and of short duration. METHODS: A 52-year-old man was seen with a mass on his tongue. A biopsy revealed adenocarcinoma of a minor salivary gland. Ten months after surgical resection, neck dissection, and radiation therapy, the patient was found to have metastatic disease to the lung. Chemotherapy was initiated with carboplatin and paclitaxel. RESULTS: The patient obtained a complete response after six cycles of carboplatin and paclitaxel. CONCLUSIONS: The use of carboplatin and paclitaxel in the setting of metastatic salivary gland cancer is a viable option.