Does triplet chemotherapy [gemcitabine, oxaliplatin and etoposide] have an impact on treatment outcome in advanced/metastatic non-small cell lung cancer?

Non-small-cell lung cancer [NSCLC] is the leading cause of cancer-related death. The combination of Vinca alkaloid and cisplatin represents a standard option for the initial therapy of patients with advanced NSCLC. A number of new anticancer agents have been tested and approved for the treatment of advanced NSCLC. Triplet agent chemotherapy has entered clinical practice in treatment of advanced cases of NSCLC. 28 evaluable patients of NSCLC with stage III-B or IV were enrolled in this study. One group received doublet regimen of cisplatin [120mg/m 2 D1, 22] and etoposide [120mg/m 2 D1-3 and recycle every 21 days]. Other group received triplet regimen of gemcitabine [800mg/ m 2 D1, 8] then oxaliplatin [80mg/ m 2 D1] and VP16 [120mg/ m 2 D1-3] with recycling every 21 days. Evaluation of response, toxicity and survival was performed. Age ranged from 36-75 years with a median age of 61 years. The main side effects were nephrotoxicity, neurotoxicity and gastrointestinal tract toxicity in doublet regimen, while hematological toxicity, orthostatic hypotension and neurotoxicity in triplet regimen group. Febrile neutropenia occurred in 37.5% in triplet regimen compared to 8.3% in doublet regime. Partial response was higher in triplet agent chemotherapy group. It occurred in 25% and 50% of cases

Role of gemcitabine, oxaliplatin and prednisolone combination as first-line chemotherapy in non-Hodgkin's Lymphoma

Non-Hodgkin's lymphomas [NHL] are commonly treated with cyclophosphamide, doxorubicin, vincristine and prednisolone [CHOP]. The objective of the current study was to evaluate the efficacy and safety of gemcitabine, oxaliplatin and corticosteroids [GEMOX-P] as first-line treatment for patients with intermediate-high grade non-Hodgkin's lymphoma [NHL]. Thirty-three patients with intermediate/high grade NHL were randomized into two groups. First group received standard [CHOP] with prednisolone tablets 40 mg/m2/day for five days. The second group received gemcitabine 1000 mg/m2 D1, 8, then oxaliplatin 80 mg/m2 D1 and prednisolone tablets 40 mg/m2/day for five days with recycling every 21 days. The primary end point was response rate. The secondary end points were disease-free survival and overall survival. From the results of this study, it was concluded that the regimen of [GEMOX-P] had beneficial effects over [CHOP] regimen, that included higher complete response rate in high-risk cases and lower cardiac and hepatic toxicity, but there was no difference after 18 months in disease free or overall survival between both treatment arms. Selection of cases that may benefit from chemotherapy treatment either [CHOP] or [GEMOX-P] is needed balance between anticipated toxicities, treatment outcome and cost benefit aspect

Does Intermittent low weekly doses of docetaxel-estramustine have an impact on treatment outcome in hormone refractory prostate cancer?

Although the majority of men with metastatic prostate cancer respond initially to and rogen ablation, most of them will eventually develop hormone-refractory progressive disease; with generally median survival less than one year from that point. The management of hormone refractory prostate cancer [HRPC] is challenging, as there is no uniformly accepted strategy. Combinations of estramustine and taxanes produced objective responses in soft tissue, reductions in serum PSA levels, and relief from bone pains. Different dosing and frequency of palliative chemo-hormonal therapy [docetaxel-estramustine] was evaluated in HRPC in relation to overall response, toxicity and survival. 21 patients with progressive, metastatic HRPC were r and omized to receive either [I] estramustine 280 mg PO tid, [Dl-5] with docetaxel as 70 mg/m[2] [1 hour infusion- D2] and recycling 3 weeks or [II] docetaxel 35 mg/m[2] [1 hour infusion] weekly for 3 consecutive weeks and estramustine 140 mg PO tid on days [Dl-3], [D8-10] and [D15-17] with recycling every 4 weeks. Primary endpoint was time to progression. However secondary endpoints were response rate, toxicity and survival. Twenty one patients were presented with a median age of 69 years [range, 49-78 years], median Gleason score of 8 [range, 6-10]. Metastases to bones and lymph nodes were present in 85.7% and 38.1% of total cases respectively. PSA response was statistically higher in weekly regimen than conventional schedule [75% vs. 44.4%], while partial response and pain relief was [22.2% vs. 33.3%] in conventional schedule compared to [44.4% vs. 50%] in weekly regimen respectively [p>0.05]. Median time to progression was [6.1 months vs. 5.6 months]; median survival [18.2 months vs. 16.5 months] and overall 1 year survival [77.8% vs. 66.7%] in conventional schedule vs. weekly regimen respectively. Grade III/IV of neutropenia occurred in 44.4% vs. 25% in conventional schedule treatment and weekly regimen respectively [p<0.05]. Neutropenic fever occurred only in one patient [11.1%] in conventional schedule group. Docetaxel-estramustine is a good effective combination of chemo-hormonal treatment used for hormonerefractory prostate cancer. Even though administration of lower weekly doses of doctaxel-estramustine does not seem to have statistically significant effect on time to disease progression and survival, but criteria of objective response rate with increase PSA response and measurable disease response and subjective improvement of pain are promising. Hematological toxicity, fatigue, fluid retention, attacks of thrombosis and neurotoxicities were lower in weekly regimen compared to conventional schedule. Nevertheless, the data presented here suggest that additional larger r and omized studies of [docetaxel plus estramustine] in lower doses and intermittent schedule are needed to better evaluate the efficacy and survival outcome of this regimen in men with HRPC

Oral capecitabine in combination with gemcitabine in management of advanced pancreatic carcinoma

Preclinical studies indicate positive biochemical and synergistic effects between capecitabine, an oral fluorouracil, and gemcitabine, the standard treatment for advanced pancreatic cancer [APC]. The goals of this study were to investigate the efficacy and safety of such combination for patients with APC. Twenty-two eligible patients with APC were treated with oral capecitabine and gemcitabine [CapGem regimen]. Capecitabine was given in a dose of 750 mg/m2 BID daily from day 1 to day 14 followed by one-week rest. Gemcitabine was given on day 1 and day 8 in a dose of 1000 mg/m2/dose given as i.v. infusion in 250 ml normal saline for 30 minutes of each 3-week cycle. Tumor lesions were assessed for objective response by physical examination and abdominal CT every two cycles of chemotherapy. Adverse events were monitored continuously during treatment and for one month after the last dose of the study. Estimation of survival was done every two months alter completion of chemotherapy cycles. The results revealed that among the 22 studied patients, two patients achieved complete clinical response [9.1%] and five patients [22.7%] achieved partial response with overall objective response rate 31.8% [95% CI, 0.21 to 0.39]. The median response duration of all responders was 31 weeks [95% CI, 18 to 39 weeks]. CA-19-9 was dropped >50% in eight patients and dropped >90% in five patients. The median time to disease progression in all 22 patients was 32 weeks [95% CI, 21 to 40 weeks]. The median survival for the whole studied group was 36 weeks [95% CI, 27 to 48 weeks]. Treatment was generally well tolerated in the outpatient settings. In conclusion, capecitabine in combination with gemcitabine was well tolerated regimen with apparent efficacy in patients with APC. Therefore, the supra-additive antitumor effect of such combination regimen of CapGem plus the advantage of oral administration of capecitabine merits this protocol promising

Intravesical sequential chemo - immunotherapy in superficial transitional cell bladder cancer

Thirty-five patients of [Ta/Tl] bladder tumors that initially treated with transurethral resection were randomized into three groups. Group A included patients received intravesical 2 g of gemcitabine in 100 ml saline once weekly for six consecutive weeks. Group B received 150 mg of BCG diluted in 50 ml saline once weekly for six consecutive weeks. Group C received sequential combination of weekly intravesical 2 g of gemcitabine in 100 ml saline for six consecutive weeks, then six weekly intravesical 75 mg of BCG diluted in 50 ml saline. After median follow up of 17 months, recurrence of progression was assessed as terminal events of the study. High risk cases that may have either multiple bladder lesions or more than grade I or associated with CIS were present in 72.7% and 66.7% in arm A, B and C, respectively. The most common local side effects were dysuria, hematuria, frequency and cystitis either bacterial or chemical. Systemic toxicities included neutropenia, thrombocytopenia, fever and malaise. Patients treated with intravesical chemo-immunotherapy had higher incidence of systemic toxicities. 36.4%, 66.7% and 75% were disease-free cases; however recurrence was present in 45.5%, 25% and 16.7% of cases in groups A, B and C, respectively