Fosaprepitant-induced phlebitis: a focus on patients receiving doxorubicin/cyclophosphamide therapy.

PURPOSE: The purpose of this study was to investigate the incidence of fosaprepitant-associated infusion site adverse events (ISAEs) among a cohort of breast cancer patients receiving doxorubicin/cyclophosphamide (AC) chemotherapy. METHODS: A retrospective review of electronic medical record (EMR) data was performed for all patients who were initiated on AC from January 2011 to April 2012. Data collected included baseline demographics, antiemetic regimen, documentation of ISAEs, and type of intravenous (IV) access. Descriptive statistics (mean and standard deviation or percentages) were summarized overall, by type of IV access and initial antiemetic given. RESULTS: Among the 148 patients included in this analysis, 98 initially received fosaprepitant and 44 received aprepitant. The incidence of ISAEs associated with fosaprepitant administration was 34.7 % (n=34), while the incidence of aprepitant-associated ISAEs was 2.3 % (n=1). All ISAEs were associated with peripheral IV access. The most commonly reported ISAEs were infusion site pain (n=26), erythema (n=22), swelling (n=12), superficial thrombosis (n=8), infusion site hives (n=5), and phlebitis/thrombophlebitis (n=5). Twenty-six patients experienced more than one type of ISAE. CONCLUSIONS: The incidence and severity of ISAEs associated with fosaprepitant administration among a group of patients receiving AC chemotherapy are significant and appreciably higher than what has been previously reported.

Management of cancer pain. Safe, adequate analgesia to improve quality of life.

Pain is one of the most common problems for cancer patients, and its management is often hindered by barriers created by patients and physicians alike. By avoiding potential barriers and understanding the principles of pain management and drug selection and titration provided here by Dr Hartmann and colleagues, physicians can safely administer adequate pain relief to their patients in need.

Natural leukocyte interferon-alpha therapy in patients with chronic granulocytic leukemia who have antibody-mediated resistance to treatment with recombinant interferon-alpha.

Two patients with chronic-phase chronic granulocytic leukemia initially responded to recombinant interferon alpha-2a (rIFN-alpha-2a) but relapsed as a result of development of hightiter neutralizing antibodies to rIFN-alpha-2a. Both patients were subsequently treated with natural leukocyte IFN-alpha (IFN-alpha-n3), and one of the two patients achieved a durable second hematologic and cytogenetic remission. IFN-alpha-n3 may be considered for patients in whom antibody-mediated resistance to rIFN-alpha-2a develops.