Raltitrexed plus gemcitabine (TOMGEM) in advanced pancreatic cancer. Results of a Belgian multicentre phase II study.

OBJECTIVES: This multicenter phase II study was designed to determine the activity and tolerance of gemcitabine and raltitrexed in advanced pancreatic adenocarcinoma. PATIENTS AND METHODS: Thirty-three chemonaive patients with measurable disease received the TOMGEM regimen consisting of Raltitrexed 3 mg/m(2) in 15 min followed by Gemcitabine 1,000 mg/m(2) in 30 min on day 1, Gemcitabine alone 1,000 mg/m(2) on day 8 and repeated on day 21. RESULTS: Thirty-three patients (median age: 62; locally advanced/metastatic disease: 5/28) were enrolled; the total number of cycles administered was 173 (median: 4). There were 10 partial response (confirmed), 2 stable disease (SD) >/=24 weeks, 7 SD <24 weeks, and 14 progressive disease for a response rate of 30.3% (95% CI: 14-46%); a clinical benefit was observed in 8/30 patients assessed (30%); median duration of response was 9.1 months. National Cancer Institute Common Toxicity Criteria grade III or IV neutropenia/thrombocytopenia were observed in 42 and 12% of the patients, respectively. Relevant nonhematological toxicities (grade III-IV) were rare although one toxic death was observed. Median time to progression was 2.8 months; one-year survival was 21%; median survival was 4.7 months. CONCLUSION: Our data suggest that the combination of raltitrexed/gemcitabine is a very convenient regimen with an acceptable toxicity, and is active in advanced pancreatic cancer.

[Hypokalemic thyrotoxic periodic paralysis: a case report]. / Paralysie périodique hypokaliémique thyrotoxique: à propos d'un cas.

A 25-year-old Caucasian man is admitted to hospital because of severe hyperthyroidism. Soon after his admission, he develops a lower limbs proximal muscles paresis with tendinous hyporeflexia. He has presented similar episodes in the previous months. Serum potassium level is 2.9 meq/l whereas it was 4.1 meq/l a few hours before. The patient receives intravenous potassium and propranolol. He will not develop a similar episode afterwards. Hypokalemic thyrotoxic periodic paralysis associated with Basedow's disease is diagnosed. Hypokalemic thyrotoxic periodic paralysis is a very rare cause of intermittent muscular weakness in the young Caucasian male. The frequency of this entity is at least ten times higher in Asiatic hyperthyroid people. Its physiopathology involves intracellular potassium shifts in which Na/K ATP-ases of cell membranes, the number and the activity of which increase in hyperthyroid people, seem to play a major role. Treatment consists of correction of hyperthyroidism and administration of potassium during the acute episode Propranolol is efficient in preventing recurrent episodes of paralysis. Points of comparison between hypokalemic thyrotoxic periodic paralysis and hypokalemic familial periodic paralysis are discussed.

Secondary neoplasms following cancer treatment with a special emphasis on lung tumors.

In patients with successfully treated Hodgkin's disease, lung cancers, and particularly small cell lung cancers, are not uncommon (relative risk: +/- 5) and result essentially from radiotherapy. What is usually considered as a late recurrence of small cell lung cancer occurs also frequently in long-term surviving patients after therapy for small cell lung cancer; it is hypothesized that at least some of these tumors might be in fact induced by the therapy used for the initial lung neoplasm.

[Prevention of bacterial infections using ciprofloxacin in granulocytopenic patients with cancer]. / Prophylaxie des infections bactériennes par la ciprofloxacine chez les patients cancéreux granulocytopnéiques.

The optimal approach to reduce bacterial infections in granulocytopenic patients is still controversial. Recently, fluoroquinolones have been developed and real progress has been achieved in the prevention of Gram negative bacilli septicemia. This study reports our experience with ciprofloxacin and shows the excellent tolerance of ciprofloxacin by our patients as well as promising data for the reduction of Gram negative bacilli infection. However, practical modalities to prevent infection caused by Gram positive cocci remain to be defined.

[Prevention using pefloxacin of infections in cancer patients with granulocytopenia]. / Prévention par la péfloxacine des infections chez les malades cancéreux granulocytopéniques.

The practical procedures of digestive tract decontamination and prophylaxis of bacterial infection in granulocytopenic patients are debated. Fluoroquinolones are active against Gram-negative bacilli and have few side-effects. Pefloxacin was administered prophylactically to patients with cancer and granulocytopenia. None of them developed Gram-negative septicaemia, but 2 cases of streptococcal septicaemia were observed. The drug was well tolerated by all patients except one. Studies are currently in progress to try to reduce the incidence of septicaemia caused by Gram-positive cocci, using pefloxacin combined with penicillin.