Nonimaging metaoptics.

So far, metalenses have only been studied in imaging optics, where a point from the object space is mapped to a corresponding point in the image space. Here we explore metalenses and metamirrors for dealing with the optimal transfer of light energy. Owing to its compactness and high design flexibility, metasurface-based flat optics may open new opportunities in the nonimaging field, which deals with light concentration and illumination. The building blocks of metalenses are subwavelength-spaced scatterers. By suitably adjusting their shape, size, position, and orientation, one can control the light spatial distribution, as is desired in nonimaging problems. In this Letter, we introduce nonimaging metaoptics, review its basics, and briefly explore three cases: the compound-metasurface concentrator [analogous to the compound parabolic concentrator (CPC)], the total internal reflection (TIR) metalens (analogous to the TIR lens), and a simple condensing metalens.

A dose-dense schedule of docetaxel followed by doxorubicin and cyclophosphamide as neoadjuvant treatment for breast cancer: results from a phase II study

INTRODUCTION: The objective was to evaluate a dose-dense schedule of docetaxel followed by doxorubicin and cyclophosphamide (AC) as neoadjuvant treatment for patients with locally advanced breast cancer. PATIENTS AND METHODS: Ninety-nine patients were included and received 100 mg/m(2) of docetaxel every two weeks for four cycles followed by 60 mg/m(2) of doxorubicin and 600 mg/m(2) of cyclophosphamide every two weeks for four cycles. Primary prophylaxis with granulocyte colony-stimulating factor (G-CSF) was administered systematically to all patients. RESULTS: Efficacy and toxicity analyses were carried out on an intention-to-treat basis. After treatment, complete pathological response in the breast and lymph nodes was confirmed in 15 patients (15%, 95% confidence interval [CI]: 8.4-22.9). Clinical response rate was 74% (95% CI: 65-82), of which 19% were complete responses. Breast-conserving surgery could be performed in 41% of patients. The dose-dense schedule was generally well tolerated. The most important grade 3/4 toxicities per patient were cutaneous toxicity (12.1%) and hepatic dysfunction (9.1%) during docetaxel administration, and neutropenia (28.1%) and leucopenia (8.3%) with AC. CONCLUSION: A dose-dense schedule of docetaxel followed by AC as neoadjuvant treatment is an effective and safe treatment for locally advanced breast cancer. Primary prophylaxis with G-CSF, and possibly the change in the sequence of drug administration, appears to play a major role in avoiding the excessive toxicity of dose-dense schedule (AU)

Weekly docetaxel as second-line therapy for patients with advanced breast cancer resistant to previous anthracycline treatment.

This phase II trial evaluated the efficacy and toxicity of weekly docetaxel as treatment of advanced metastatic breast cancer patients resistant to prior anthracycline chemotherapy. After the first 18 patients, the initial dose (40 mg/m2, 30-min i.v. infusion for 6 consecutive weeks, followed by 2-week rest) was reduced to 36 mg/m2 in the remaining 17 patients due to the incidence of toxicity (28% grade 3-4 asthenia). Overall response rate was 34% (95% CI, 19-50): two complete (6%) and ten partial responses (28%) were found. The median duration of response was 6.8 months, the median time to disease progression was 8.4 months, and the median overall survival was 13.6 months (median follow-up of 11.4 months). Neutropenia was the only severe hematologic toxicity (17% of patients), whereas asthenia, nail, ocular and skin disorders were the most common nonhematologic toxicities. Only one death during further follow-up was related to toxicity (caused by pulmonary fibrosis). In conclusion, we found weekly docetaxel to be an active and safe chemotherapy regimen for patients with metastatic breast resistant to previous anthracyclines. This weekly regimen caused minimal myelosupression, while retaining significant activity against advanced breast cancer. Both factors provide attractive possibilities for the development of combination therapies incorporating weekly docetaxel. Nevertheless, the number of patients receiving either dose (40 and 36 mg/m2) which we studied is low and our results require confirmation on larger groups of patients.

Carboplatin-based versus cisplatin-based chemotherapy in the treatment of surgically incurable advanced bladder carcinoma.

BACKGROUND: The carboplatin-based chemotherapeutic regimen M-CAVI (methotrexate, carboplatin, and vinblastine) is active against bladder carcinoma and can be administered to patients who are ineligible to receive cisplatin or doxorubicin. The authors designed a randomized study to evaluate whether M-CAVI offers a therapeutic advantage over the cisplatin-based regimen M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) in the treatment of patients with surgically incurable advanced bladder carcinoma. METHODS: Patients with surgically incurable advanced bladder carcinoma were enrolled on a randomized trial comparing M-CAVI, which consists of carboplatin (300 mg/m2 on Day 2, adjusted using Calvert's formula for an area under the curve of 5), methotrexate (30 mg/m2 on Days 1, 15, and 22), and vinblastine (3 mg/m2 on Days 2, 15, and 22) administered every 28 days, versus standard M-VAC. The eligibility criteria included histologically proven bladder carcinoma, surgically incurable disease, and no prior chemotherapy. Patients were treated until disease progression or unacceptable toxicity occurred. RESULTS: From January 1989 to January 1994, 47 assessable patients were included. Seventeen patients had lymph node disease and 30 had distant metastatic disease. Twenty-three patients were randomized to receive M-CAVI and 24 to receive M-VAC. Patient characteristics in the two groups were similar. Overall response rates were 39% (95% confidence interval [CI], 20-62%) for M-CAVI and 52% (95% CI, 30-73%) for M-VAC (P = 0.3), with 3 complete responses observed among patients treated with M-VAC and none among those in the M-CAVI group. M-VAC was associated with more gastrointestinal toxicity, stomatitis, alopecia, and Grade 4 neutropenia than M-CAVI. One toxicity-related death occurred in the M-VAC group. There was a statistically significant difference in median disease-related survival time favoring M-VAC (16 months; range, 6 to 22+) versus M-CAVI (9 months; range, 6 to 14+) (P = 0.03). CONCLUSIONS: M-CAVI is less toxic but less active than M-VAC in the treatment of patients with advanced bladder carcinoma. Carboplatin-based regimens in which carboplatin is administered at the dose range used in the current study should be reserved for patients who cannot tolerate cisplatin treatment. Further research is required to assess the impact of high dose carboplatin in the treatment of this disease.