A randomised phase 2 study combining LY2181308 sodium (survivin antisense oligonucleotide) with first-line docetaxel/prednisone in patients with castration-resistant prostate cancer.

Castration-resistant prostate cancer (CRPC) is partially characterised by overexpression of antiapoptotic proteins, such as survivin. In this phase 2 study, patients with metastatic CRPC (n=154) were randomly assigned (1:2 ratio) to receive standard first-line docetaxel/prednisone (control arm) or the combination of LY2181308 with docetaxel/prednisone (experimental arm). The primary objective was to estimate progression-free survival (PFS) for LY2181308 plus docetaxel. Secondary efficacy measures included overall survival (OS), several predefined prostate-specific antigen (PSA)-derived end points, and Brief Pain Inventory (BPI) and Functional Assessment of Cancer Therapy-Prostate (FACT-P) scores. The median PFS of treated patients for the experimental arm (n=98) was 8.64 mo (90% confidence interval [CI], 7.39-10.45) versus 9.00 mo (90% CI, 7.00-10.09) in the control arm (n=51; p=0.755). The median OS for the experimental arm was 27.04 mo (90% CI, 19.94-33.41) compared with 29.04 mo (90% CI, 20.11-39.26; p=0.838). The PSA responses (≥ 50% PSA reduction), BPI, and FACT-P scores were similar in both arms. In the experimental arm, patients had a numerically higher incidence of grades 3-4 neutropenia, anaemia, thrombocytopenia, and sensory neuropathy. In conclusion, this study failed to detect a difference in efficacy between the two treatment groups.

Current opinion in cervix carcinoma.

We review the current status of the conventional therapeutical approaches of cervix carcinoma. Radical hysterectomy remains as the main stone in early stages and play an important role in relapses. Radiotherapy plays an important role in early and advance disease. New techniques and image expand indications and treatment possibilities. Chemotherapy platinum based with radiation therapy goes on being the standard treatment in advanced tumours or non surgical candidates. New systemic strategies are being explored in clinical trials.

Evaluación del tratamiento del dolor crónico en pacientes oncológicos con buprenorfina transdérmica / Evaluation of transdertnal buprenorphine for the treattnent of chronic pain in cáncer patients

Introducción: El dolor crónico severo en el paciente oncológico no terminal es un problema creciente porque los avances de los tratamientos antineoplásicos están aumentando la supervivencia de los pacientes. Es necesario, pues, el desarrollo de nuevos tratamientos analgésicos eficaces y seguros para estos pacientes. Para ello, la comparación con los resultados terapéuticos en pacientes no oncológicos con dolor crónico resulta de interés. Material y métodos: Se realizó un estudio de post-autorización observacional prospectivo no controlado en el que se siguió durante tres meses a pacientes que comenzaron tratamiento con buprenorfina transdérmica. Se recogió información sistemática sobre el grado de alivio del dolor, la calidad de vida (cuestionario EuroQol-5D), el manejo del parche y los acontecimientos adversos. Los datos ausentes se cubrieron arrastrando valores anteriores válidos. Se presentan comparativamente los resultados obtenidos en un subgrupo de 207 pacientes oncológicos con los de 968 pacientes no oncológicos que participaron en el mismo estudio. Resultados: El 30% de los pacientes oncológicos tenían un tratamiento previo con opioides. El 44’1% precisó de un aumento de dosis, en su mayoría durante el primer mes de tratamiento; proporción significativamente mayor (p<0’001) que entre los no oncológicos (18’8%). Más de dos tercios obtuvieron alivio satisfactorio con independencia del origen del dolor. Se produjo un aumento significativo de la calidad de vida, que fue menor entre los oncológicos (12’2 mm en promedio en una escala analógica visual) que entre los no oncológicos (17’1 mm); y que un análisis ajustado atribuyó principalmente a la mejoría del dolor. La proporción de pacientes que presentaron acontecimientos adversos fue menor entre los oncológicos (42’0%) que entre los no oncológicos (49’1%), p=0’010. Ello mismo ocurrió con los acontecimientos adversos relacionados o los que motivaron el abandono (…) (AU)

Introduction: The concern with chronic severe pain in cáncer patients is growing as antineoplastic therapeutic advances are procuring prolonged survival in many patients. This necessitates the development of new effective and safe analgesic treatments. For this purpose, the comparison of therapeutic outcomes with that obtained in non-cancer patients may be helpful. Methods: A prospective, uncontrolled observational study that included a 3 month follow-up of patients starting transdermal buprenorphine was performed. Information was collected systematically on pain relief, quality of life (EuroQol-5D questionnaire), comfort of patch use and adverse events. Missing data were imputed by carrying forward former observations. This article refers to the comparative results of a subgroup of 207 cáncer patients with that of 968 non-cancer patients that participated in the same study. Results and conclusions: 30% of cáncer patients switched to transdermal buprenorphine from other opioid drug. Dose increases were required by 44% of patients, and most occurred in the first month; this proportion being significantly greater (p<0.001) than among non-cancer patients (18.8%). More than two third achieved satisfactory pain relief, regardless of the origin of pain. There was a significant increase of quality of life score that was, nevertheless, lower among cáncer patients (by an average of 12.2 mm in a visual analogue scale) than among non-cancer patients (17.1 mm); that was mainly attributed to pain improvement. The proportion of patients with adverse events was significantly lower among cancer (42.0%) than non-cancer patients (49.1%), p=0.010. This was true also for related adverse events and withdrawals because of adverse events. Conversely, more cáncer patients had serious adverse events or died during follow-up; although in none case these were related to buprenorphine treatment (...) (AU)

Complete remission in a pancytopenic HIV negative, HHV-8 positive patient with Multicentric Castleman’s Disease induced with anti-CD20

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A 75-year-old woman was diagnosed of MCD plasmacell (PC) variant with B symptoms. Diffuselymph-node enlargement, splenomegaly and pancytopeniawere detected. Induction with Rituximabwas made because pancytopenia was present.Actually patient is free of disease. This is the firstcomplet reponse of MCD published, VIH negative,induced with anti CD20

[5-Fluorouracil-induced small bowel toxicity in a patient with colorectal cancer]. / Toxicidad en el intestino delgado inducida por 5-fluorouracilo en un paciente con carcinoma colorrectal.

5-Fluorouracil-induced gastro-intestinal toxicity predominantly affects the upper and the lower gastro-intestinal tract. Although 5-fluorouracil (5-FU) can cause severe small-bowel toxicity, this has been reported only in 6 patients with colon carcinoma receiving 5-FU-based therapy. The presentation was extensive ulceration and inflammation of the small bowel with no involvement of the colon. We report another case of this toxicity, and discuss the diagnosis and mechanisms by which 5-FU can induce small-bowel toxicity.

Toxicidad en el intestino delgado inducida por 5-fluorouracilo en un paciente con carcinoma colorrectal / 5-Fluorouracil-induced small bowel toxicity in a patient with colorectal cancer

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5-Fluorouracil-induced gastro-intestinal toxicity predominantly affects the upper and the lower gastro-intestinal tract. Although 5-fluorouracil (5-FU) can cause severe small-bowel toxicity, this has been reported only in 6 patients with colon carcinoma receiving 5-FU-based therapy. The presentation was extensive ulceration and inflammation of the small bowel with no involvement of the colon. We report another case of this toxicity, and discuss the diagnosis and mechanisms by which 5-FU can induce small-bowel toxicity

[Paralytic ileus due to vinorelbine]. / Ileo paralítico por vinorelbina.

Intestinal obstruction is very common in cancer patients and occurs in 80% of cases with malignant aetiology. Hence, aggressive treatment is needed in most cases. The occlusion can be caused by luminal obstruction, paralysis of the intestinal muscle or carcinomatosis with mesentery involvement. The clinical case we present is that of a patient diagnosed as having lung cancer and who was admitted with paralytic ileus following treatment with vinorelbine; a vinca alkaloid whose main characteristic toxicities include neutropenia and peripheral neuropathy. Also, on rare occasions, the drug can cause paralysis of the ileum due to autonomic neuropathy. Hence, before administering aggressive treatment to an occlusive syndrome, cases that could benefit from conservative treatment should be ruled out.

Íleo paralítico por vinorelbina / Paralytic ileus due to vinorelbine

No disponible

Intestinal obstruction is very common in cancer patients and occurs in 80% of cases with malignant aetiology. Hence, aggressive treatment is needed in most cases. The occlusion can be caused by luminal obstruction, paralysis of the intestinal muscle or carcinomatosis with mesentery involvement. The clinical case we present is that of a patient diagnosed as having lung cancer and who was admitted with paralytic ileus following treatment with vinorelbine; a vinca alkaloid whose main characteristic toxicities include neutropenia and peripheral neuropathy. Also, on rare occasions, the drug can cause paralysis of the ileum due to autonomic neuropathy. Hence, before administering aggressive treatment to an occlusive syndrome, cases that could benefit from conservative treatment should be ruled out