Menopausal symptoms in women undergoing chemotherapy-induced and natural menopause: a prospective controlled study.

BACKGROUND: Women with breast cancer frequently undergo menopause following adjuvant chemotherapy. Here, we investigated whether they have more severe symptoms than women undergoing natural menopause. PATIENTS AND METHODS: Forty-one women who had undergone menopause as a result of chemotherapy and 57 healthy women who had undergone recent natural menopause were evaluated on two occasions 1 year apart. The primary end point was the summed score of the self-report Functional Assessment of Cancer Therapy, endocrine symptoms (FACT-ES) scale. Quality of life was evaluated by the FACT-G questionnaire and fatigue by the FACT-F subscale. RESULTS: There was a strong trend for patients to report worse FACT-ES scores than controls at the first (P = 0.05) and second (P = 0.04) time points. More patients had moderate/severe hot flashes than controls undergoing natural menopause (51% versus 19%, P = 0.003). Patients reported worse fatigue than controls at the first assessment (P = 0.04), with no difference at the second. Menopausal symptoms were associated with fatigue for both groups. There was no difference between patients and controls in the quality-of-life scale, although assessment of patients is likely subject to adaptation and response-shift bias. CONCLUSIONS: Women undergoing chemotherapy-induced menopause may experience worse symptoms than women undergoing natural menopause.

A study from the EORTC new drug development group: open label phase II study of sabarubicin (MEN-10755) in patients with progressive hormone refractory prostate cancer.

Sabarubicin (MEN-10755), a new synthetic anthracycline analogue, was evaluated for safety and efficacy in a multicentre phase II study in patients with advanced hormone refractory prostate cancer (HRPC). Thirty seven patients were included, of which 34 were evaluable for PSA response according to Bubley's criteria. Sabarubicin was administered as a short (30 min) intravenous infusion at a dose of 80 mg/m(2) every 3 weeks. The main toxicity consisted of grade 3/4 neutropenia in 24 patients (64.9%), with grade 3/4 febrile neutropenia occurring in one patient only. Grade 3/4 cardiotoxicity was observed in 4 patients including one ineligible. Other toxicities were mild. Nine patients achieved a PSA response (26.5%), 10 patients had stable disease (29.4%) and 14 patients disease progression (41.2%). One patient (2.9%) had a PSA response that was not confirmed by repeat PSA testing. The objective response rate according to RECIST criteria was 6.7% in 15 patients with measurable disease. The median duration of PSA responses was relatively long 7.1 months (95% CI 4.9-20.7) as was the median time to treatment progression in patients with stable disease. The median overall survival was 18.7 months (95% CI 9.1-N), comparable to results recently observed in taxotere-containing regimens. To confirm and extend these results, further testing of sabarubicin in larger trials is warranted.

Follicular lymphomas--a review of treatment modalities.

Follicular lymphoma is the most common low-grade non Hodgkin's lymphoma and represent an homogeneous entity as defined by pathological, molecular and clinical data. This indolent disease is characterised by a slow growth pattern with possible spontaneous regression, is often disseminated but remains incurable with available treatments when disseminated. For localised stages, involved field radiotherapy remains the standard choice but other approaches remain to be investigated. In advanced disease, chemotherapy has been demonstrated to produce high response rates but recent trials with new treatment strategies including interferon and monoclonal antibodies may improve the current situation. In this article, we will review treatment of follicular lymphomas, specially emphasising published phase III trials.

Current treatment of Hodgkin's disease.

In spite of the fact that Hodgkin's disease (HD) remains still an enigma its management and treatment yield a cure rate of about 80% of all patients. However, this management has two limits: on one side favourable cases which should not be overtreated because of unacceptable side-effects, and on the other side very unfavourable cases which should be treated differently because of a very high rate of failure and/or relapse. Then it becomes necessary to precise as thoroughly as possible these two limits in order to choose the adequate treatment for the patient. Prognostic factors based on patient and disease characteristics allow a relatively exact classification of favourable and unfavourable cases. This distinction in two prognostic groups has therapeutic implications in terms of chemotherapy (regimen, duration) and radiotherapy (extension, doses). Other specific situations have to be considered, e.g. pediatric cases, pregnancy, old age and HIV-infected patients who need an adapted management according to very different situations.

[Interferon alpha in the treatment of non-Hodgkin's lymphomas of low malignancy]. / L'interféron alpha dans le traitement des lymphomes non hodgkiniens de faible malignité.

Incidence of non Hodgkin's lymphomas (NHL) has been increased regularly during the last two decades. Overall survival did not progress at all during this period. According to the results of preliminary studies, alpha interferon is an attractive approach for NHL treatment. The review analyze published randomized controlled trials which tested interferon alpha either in addition with polychemotherapy or as maintenance of chemotherapy-induced response in disseminated low grade NHL. After literature search, nine studies have been included. Interpretation of results was complicated by various patient's selection criteria (age, tumoral burden, histology) and heterogeneous treatment schemes (interferon schedule and dose, chemotherapy combination). Significant overall improvement was observed in two studies while only relapse free survival and time to treatment failure were improved in seven trials, always in interferon group. Significant observed toxicities were hematologic ones and asthenia since they led either to dose adjustment or to interferon interruption. Finally, we cannot recommend interferon use out of prospective trials. Further studies are warranted to confirm overall survival benefit and to define optimal strategy to use this molecule.

[Mediastinal large B-cell lymphoma. A retrospective anatomic-clinical study of 26 cases]. / Lymphomes médiastinaux à grandes cellules B. Etude anatomoclinique rétrospective de 26 cas.

Mediastinal B-cell lymphomas (with or without sclerosis) have been recently recognized as an entity with particular clinical features. We report 26 patients with a mediastinal large B-cell lymphoma. They represent 5% of the patients with aggressive non-Hodgkin's lymphoma and 2% of all non-Hodgkin's lymphoma seen in our centre between 1962 and 1990. They include 19 females (73%) and 7 males (27%). The sex ratio was 2.7 and the median age was 44 years (range: 17-84 years). Compressive symptoms in relation with a bulky mediastinum were present in 21 cases (80%) and with B symptoms in 5 cases. All these patients received 2 to 4 cycles of chemotherapy with a CHOP-like protocol (epirubicin or doxorubicin, cyclophosphamide, vincristine and prednisone) followed in 24 cases by mediastinum irradiation (40 Gy). Two patients progressed during chemotherapy and did not receive radiotherapy. Nineteen patients had a consolidation chemotherapy according to the same protocol. Twenty-one patients achieved a complete remission after chemotherapy or radiotherapy and 5 failed. Two patients relapsed at 10 months and 9 years. Seventeen patients are alive and in first complete remission with a median follow-up of 102 months (range: 60-260 months). Using the Kaplan-Meier method, the overall survival at 5 and 10 years was respectively 77 and 61% and the relapse-free survival was respectively 68 and 57%. These results confirm the previous findings concerning this distinct entity which is characterized by a predilection for young women, compressive symptoms, a slow response to treatment and a rather good prognosis.

Semen analysis and cryoconservation before treatment in Hodgkin's disease.

BACKGROUND: The prophylaxis of the late effects of chemotherapy and radiotherapy has become one of the major concerns in the management of Hodgkin's disease (HD). Unlike other complications, male sterility could be managed by prior semen preservation (SP). PATIENTS AND METHODS: To evaluate the semen quality of patients with HD and the outcome of insemination, we reviewed spermograms of patients who underwent SP before any treatment. The following criteria were necessary: 1) age > 16 and < 50; 2) HD of any stage; 3) informed about male sterility after HD treatment; 4) fully consenting. RESULTS: Such a proposal was made to 316 men, and 94 fulfilled the criteria. All patients underwent an initial chemotherapy. Mean age of the cohort was 27.5 years (range 16-48 years). Pretherapeutic staging of HD revealed 38 stage I (40%), 38 II (38%), 14 III (15%) and 4 IV (4%). Semen analysis before cryoconservation showed an overall 53% of normal or subnormal cases (50 cases). The analysis of semen quality and spermatozoid amount according to various parameters failed to find a correlation with stage, B symptoms, age, or biologic data (LDH, WBC, platelets, ESR). The use of cryopreserved semen was requested by 13 patients; 88 inseminations were performed leading to 9 pregnancies and 2 births. CONCLUSIONS: The low rate of success with cryopreserved semen in these cases suggests the need for a more careful design of non-toxic chemotherapy regimens in combined modality treatment.

Taxane-induced glaucoma.

We report a case of glaucoma induced by doxetaxel therapy for metastatic breast cancer. The disorder recurred during treatment with paclitaxel.

Quality of life and understanding of disease status among cancer patients of different ethnic origin.

Patients managed in European or North American cancer centres have a variety of ethnic backgrounds and primary languages. To gain insight into the impact of ethnic origin, we have investigated understanding of disease status and quality of life (QoL) for 202 patients. Patients completed questionnaires in their first language (52 English, 50 Chinese, 50 Italian, 50 Spanish or Portuguese), including the Functional Assessment of Cancer Therapy - General (FACT-G) QoL instrument, questions about disease status, expectations of cure and the language and/or type of interpretation used at initial consultation. Physicians also evaluated their status of disease and expectation of cure, and performance status was estimated by a trained health professional. The initial consultation was usually provided in English (except for 32% of Chinese-speaking patients); interpretation was provided by a family member for 34% of patients with limited English proficiency (LEP) and by a bilingual member of staff for 21%. Patients underestimated their extent of disease and overestimated their probability of cure (P=0.001 and <0.0001, respectively). Estimates of probability of cure by the English speakers were closer to those of their physicians than the other groups (P=0.02). English-speaking patients reported better and Italian-speaking patients poorer overall QoL (P<0.001 for Italian vs other groups). Performance status was correlated with QoL and most closely related with the extent of disease. Understanding of cultural differences is important for optimal management of patients with cancer.