Survival times of women with metastatic breast cancer starting first-line chemotherapy in routine clinical practice versus contemporary randomised trials.

BACKGROUND: Survival times of women starting first-line chemotherapy for metastatic breast cancer (MBC) in routine clinical practice were determined and compared with those from a systematic review of randomised clinical trials. METHODS: We identified women with MBC starting first-line chemotherapy from June 2003 to February 2011 and recorded their demographics, tumour and treatment characteristics, and survival times from the start of chemotherapy. Their survival distribution was summarised by the following percentiles (represented scenarios for survival): 90th (worst-case), 75th (lower-typical), 25th (upper-typical) and 10th (best-case), which were compared with the same percentiles from our systematic review of first-line chemotherapy trials. RESULTS: The 273 women had a median age of 56 years, and a median time from diagnosis of MBC of 3 months. Eastern Cooperative Oncology Group performance status was 0-1 in 80%. Tumours were hormone receptor positive in 69%, human epidermal growth factor receptor 2 (HER2)-positive in 27% and triple negative in 13%. Survival times in months in routine clinical practice (vs the systematic review) were: 90th percentile 4 (6); 75th percentile 9 (12); median 20 (22); 25th percentile 36 (36) and 10th percentile 61 (56). Independent predictors of overall survival included HER2-positive disease (hazard ratio (HR) 0.49, P = 0.0002), hormone receptor positive disease (HR 0.51, P = 0.0004), Eastern Cooperative Oncology Group performance status 0-1 (HR 0.36, P < 0.0001) and adjuvant chemotherapy (HR 1.86, P = 0.0002). CONCLUSION: Median and better survival times in routine practice were similar to those from randomised clinical trials; however, survival times worse than the median were shorter, likely reflecting patient selection in trials. Oncologists should adjust trial-based survival estimates for patients not meeting typical trial eligibility criteria.

The efficacy of oral ondansetron and dexamethasone for the prevention of acute chemotherapy-induced nausea and vomiting associated with moderately emetogenic chemotherapy - a retrospective audit.

The optimal dose of oral ondansetron for the prevention of acute chemotherapy-induced nausea and vomiting (CINV) resulting from moderately emetogenic chemotherapy (MEC) is unknown. This retrospective audit was conducted to determine the efficacy of 8 mg oral ondansetron plus 8 mg oral dexamethasone as pre-chemotherapy anti-emetic regimen for patients receiving MEC. The efficacy outcomes analysed were the proportion of patients with no acute vomiting, proportion of patients with no acute nausea and the incidence of grade 3 or 4 CINV. A total of 81 patients were identified. The most frequent chemotherapy regimens received in the study population were anthracycline- (48%) and carboplatin-based (28%). No acute vomiting and nausea rates in the study population were 75% and 44% respectively. The incidence of grade 3 CINV was 1%. Patients who received anthracycline-based regimens had a significantly higher incidence of acute emesis (P= 0.001) and nausea (P < 0.0001) when compared with patients who received non-anthracycline-based regimens. In this study, the use of 8 mg oral ondansetron plus 8 mg oral dexamethasone achieved control of acute emesis in 75% of all patients receiving MEC which is comparable to previously reported rates of 70-80%. The benefits of using oral pre-chemotherapy anti-emetics include reduction in the costs of drugs and nursing administration time.

A short outpatient hydration schedule for cisplatin administration.

BACKGROUND: Cisplatin remains a principal chemotherapy agent in the treatment of many solid tumours. However because of its nephrotoxicity, inpatient hydration schedules have been utilized to ensure safe administration. In May 1995, due to significant load on in-patient bed availability, the Medical Oncology Department of the Cancer Therapy Centre, Liverpool Hospital, developed a short, intravenous fluid hydration protocol to be used on an out-patient setting. METHODS: Following an initial pilot program of the abbreviated hydration regimen, a retrospective study of all adult in-patients and out-patients who received cisplatin (60-100 mg/m2) from May 1995 to August 1998 was conducted. Biochemistry was performed prior to the start of chemotherapy, and a repeat serum creatinine level was taken immediately prior to each subsequent cycle of chemotherapy, unless clinically indicated at an earlier time. The in-patient hydration protocol was 6000 ml of normal saline with 60 mmol/L KCL, and 30 mmol/L MgSO4 over 24 to 28 hours, and the out-patient hydration was 4000 ml of normal saline over 6 hours. RESULTS: A total of 145 patients were included, 57 in-patient (39%) and 88 out-patients (61%), 95 males, and 50 females. The mean age was 56 years. The maximum mean percentage change in creatinine from baseline for all cycles of chemotherapy for in-patients was 32.5% ranging from -7% to 288% (95% CI=19.9-45.11), and for outpatients 19.9% ranging from -20% to 154% (95% CI=13.47-26.39). Although the mean increase was higher in the in-patient group by 12.6%, it was not statistically significant (p=0.079). CONCLUSION: In patient's eligible for cis-platinum therapy on the basis of good performance status and normal renal function, this agent can be safely administered in the out-patient setting with an abbreviated duration, moderate volume intravenous hydration regimen.

Primary peritoneal carcinoma: a treatable subset of patients with adenocarcinoma of unknown primary.

The syndrome of adenocarcinoma of unknown primary (ACUP) is a frequent problem in both medical and surgical practice. The prognosis is poor, the median lifespan being 4 months. In general, multiple invasive procedures aimed at determining the primary tumour are not warranted due to the low frequency of detecting a tumour for which adequate treatment exists. In this paper we wish to highlight a subset of female patients presenting with malignant ascites and no evidence of a pelvic mass, who on laparotomy were found to have primary peritoneal papillary serous adenocarcinoma. These tumours must be regarded as a potentially treatable subset of patients with ACUP in view of their frequent response to chemotherapy and relatively good prognosis.