RESUMEN
The use of intrapleural instillation of recombinant tissue plasminogen activator (r-tPA) in the treatment of pleural infection may increase pleural fluid drainage associated with a clinical and imaging improvement, leading to a faster resolution. The use of r-tPA is generally well tolerated. Here we report 2 cases of massive pleural hemorrhage resulting in life-threatening hypovolemia, in 2 patients treated with intrapleural r-tPA for a pleural infection, who were simultaneously receiving systemic anticoagulation (1 therapeutic, the second prophylactic) with low-molecular weight heparin. It appears that the decision of treating pleural infection with r-tPA in patients receiving therapeutic or prophylactic systemic anticoagulation must be well balanced and in case of association of these compounds, close monitoring is necessary.
Asunto(s)
Fibrinolíticos/efectos adversos , Hemotórax/inducido químicamente , Heparina de Bajo-Peso-Molecular/efectos adversos , Hipovolemia/etiología , Activador de Tejido Plasminógeno/efectos adversos , Anciano , Quimioterapia Combinada/efectos adversos , Hemotórax/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Derrame Pleural/tratamiento farmacológicoRESUMEN
The activity of a triplet of chemotherapeutic drugs, namely docetaxel, gemcitabine and liposomal doxorubicin, was investigated in patients with advanced non-small cell lung cancer. The regimen was supported with amifostine cytoprotection (1000mg injected subcutaneously) and hemopoietic growth factors (rhuG-CSF and rhuEPO) in an attempt to minimize the substantial toxicity reported in previous studies investigating docetaxel/gemcitabine chemotherapy. Twenty chemotherapy- naïve patients with advanced non-small cell lung cancer (NSCLC) (18 with stage IV and 2 with stage IIIb) were recruited. None of the patients presented with grade 3-4 hematological or non-hematological toxicity. Palmar-plantar erythrodysesthesia grade 2 was noted in 6/20 (30%), mucositisloesophagitis grade 2 in 3/20 (15%) and mild alopecia in 6/20 (30%) patients. No case of interstitial pneumonia was noted. The overall response rate (complete and partial) in 18 evaluable patients was 33% (6/18), with 1/18 (5%) patients achieving complete response. The median survival was 11 months. The efficacy of the regimen was as high as the one reported in gemcitabine/docetaxel studies, but the toxicity was remarkably lower. Amifostine may have contributed to the better tolerance profile observed.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Desoxicitidina/análogos & derivados , Neoplasias Pulmonares/tratamiento farmacológico , Anciano , Alopecia/inducido químicamente , Amifostina/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Astenia/inducido químicamente , Desoxicitidina/administración & dosificación , Docetaxel , Doxorrubicina/administración & dosificación , Femenino , Factor Estimulante de Colonias de Granulocitos y Macrófagos/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Estomatitis/inducido químicamente , Taxoides/administración & dosificación , GemcitabinaRESUMEN
BACKGROUND: : Lipoplatin is a new liposomal cisplatin that already has been tested in solid tumors, with encouraging results. The purpose of the current study was to determine the maximum tolerated dose (MTD) and the dose-limiting toxicity (DLT) of a 21-day regimen of lipoplatin plus a fixed dose of gemcitabine in patients with refractory or resistant nonsmall cell lung carcinoma (NSCLC) with an Eastern Cooperative Oncology Group (ECOG) performance status of