Preferred treatment for advanced ovarian cancer announced
The National Cancer Institute (NCI), part of the National Institutes of Health, has issued an announcement encouraging after-surgery treatment with anticancer drugs through intravenous (IV) and intraperitoneal (IP) administration for women with advanced ovarian cancer. The combined methods extend overall survival for women with advanced ovarian cancer by about a year.
Standard treatment for women with Stage III ovarian cancer has been surgical removal of the tumor (debulking), followed by six to eight courses of IV chemotherapy given every three weeks with a platinum drug, such as cisplatin or carboplatin, and a taxane drug, such as paclitaxel.
The new NCI clinical announcement recommends that women with advanced ovarian cancer who undergo effective surgical debulking receive a combination of IV and IP chemotherapy. IP chemotherapy allows higher doses and more frequent administration of drugs, and it appears to be more effective in killing cancer cells in the peritoneal cavity, where ovarian cancer is likely to spread or recur first.
The clinical announcement to surgeons and other medical professionals who treat women with ovarian cancer was made with the support of six professional societies and advocacy groups. The announcement also coincides with publication in the New England Journal of Medicine of the eighth clinical trial evaluating the use of chemotherapy delivered into the abdomen for ovarian cancer. Together, these trials show a significant improvement in survival for women with advanced ovarian cancer.
CDC updates child/adolescent immunization schedule
The Centers for Disease Control and Prevention (CDC) in Atlanta has announced an updated schedule for recommended childhood and adolescent immunizations. The immunization schedule and catch-up schedule for January-December 2006 were approved by The Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP).
The "Recommended Childhood and Adolescent Immunization Schedule — United States 2006" was published in the Jan. 6 issue of the Morbidity and Mortality Weekly Report. Here is a list of the changes from the 2005 schedule:
- Vaccination of infants born to hepatitis B surface antigen (HBsAg)-negative mothers can be delayed in rare circumstances, but only if a physician’s order to withhold the vaccine and a copy of the mother’s original HBsAg-negative laboratory report are documented in the infant’s medical record. Administering four doses of HepB is permissible; however, if monovalent HepB is used, a dose at age 4 months is not needed.
For infants born to HBsAg-positive mothers, testing for HBsAg and antibody to HBsAg after completion of the vaccine series should be conducted at ages 9-18 months (generally at the next well-child visit after completion of the vaccine series). - The new tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap adolescent preparation), approved last year by the FDA, is recommended for adolescents ages 11-12 years who have completed the recommended childhood diphtheria and tetanus toxoids and pertussis/diphtheria and tetanus toxoids and acellular pertussis (DTP/DTaP) vaccination series and have not received a tetanus and diphtheria toxoids (Td) booster dose. Adolescents ages 13-18 years who missed the age 11-12-year Td/Tdap booster dose also should receive a single dose of Tdap if they have completed the recommended childhood DTP/DTaP vaccination series. Subsequent Td boosters are recommended every 10 years.
- Meningococcal conjugate vaccine (MCV4), also approved by FDA in 2005, should be administered to all children at ages 11-12 years as well as to unvaccinated adolescents at high school entry (age 15 years). Other adolescents who wish to decrease their risk for meningococcal disease also may be vaccinated. All college freshmen living in dormitories also should be vaccinated with MCV4 or meningococcal polysaccharide vaccine (MPSV4). For prevention of invasive meningococcal disease, vaccination with MPSV4 for children ages 2-10 years and with MCV4 for older children in certain high-risk groups is recommended.
- Influenza vaccine now is recommended for children younger than 6 months of age with certain risk factors, which now specifically include conditions that can compromise respiratory function or handling of respiratory secretions or that can increase the risk for aspiration.
- Hepatitis A vaccine now is universally recommended for all children at age 1 year (12-23 months). The two doses in the series should be administered at least six months apart.
- The catch-up schedule for people aged 7-18 years has been changed for Td; Tdap may be substituted for any dose in a primary catch-up series or as a booster if age-appropriate for Tdap. A five-year interval from the last Td dose is encouraged when Tdap is used as a booster dose.
CDC: Millions of people carry drug-resistant bacteria
New research estimates that about 2 million people carry a strain of drug-resistant bacteria in their noses. The research, conducted by the CDC, estimates colonization with Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA). The research was published in the Jan. 15 issue of The Journal of Infectious Diseases.
Those colonized with normal strains of "staph" are at higher risk of infection with the bacterium, which can lead to conditions ranging from mild skin infections to fatal toxic shock syndrome. MRSA causes more difficult to treat and, sometimes, more virulent illnesses. MRSA once was primarily a problem in hospitals, but now is a growing problem in communities around the country.
Researchers collected samples from nearly 10,000 participants in the 2001-2002 National Health and Nutritional Examination Survey, a representative sample of the U.S. population. Nearly one-third were found to be colonized with staph. Prevalence was highest among males and children between 6 and 11 years of age. MRSA prevalence was 0.8%. MRSA was highest among women and those older than 60, but those colonized with strains commonly associated with community-associated MRSA were more likely to be younger and African American.
Overall, strains and toxins previously found to be associated with community-associated MRSA were unusual. The genetic diversity of strains was remarkable, the researchers say. About half of isolates, including MRSA strains, had unique molecular fingerprinting patterns, and some fell outside recognized groups.
Study: Many patients with NSTE ACS given wrong dose
Researchers conducting an observational study found that more than 40% of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) were given the wrong dose of unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), and glycoprotein IIb/IIIa inhibitors.
The researchers conducted the analysis in 387 U.S. academic and nonacademic hospitals of 30,136 patients from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative Registry. Results showed that 3,354 patients (42%) with NSTE ACS who were administered antithrombotic agents received at least one initial dose outside the recommended range. The results of the study were published in the Dec. 28 issue of the Journal of the American Medical Association.
An excess dose was administered to 2,934 patients (32.8%) treated with UFH, 1,378 (13.8%) treated with LMWH, and 2,784 (26.8%) treated with glycoprotein IIb/IIIa inhibitors. Factors associated with excess dosing included older age, as well as female sex, renal insufficiency, low body weight, diabetes mellitus, and congestive heart failure.
Relative to those patients not administered excess dosages, patients with excess dosages of UFH, LMWH, and glycoprotein IIb/IIIa inhibitors either tended toward or had higher risks for major bleeding. Bleeding increased relative to the degree of excess dose and to the number of agents administered in excess. Mortality and length of stay also were higher among those patients administered excess dosing. The researchers estimate that 15% of major bleeding in this population may be attributable to excess dosing.
FDA: Post-marketing rosiglitazone maleate (Avandia) warning
GlaxoSmithKline and the FDA have notified health care professionals about post-marketing reports of new onset and worsening diabetic macular edema for patients receiving rosiglitazone. In the majority of these cases, the patients also reported concurrent peripheral edema. In some cases, the macular edema resolved or improved following discontinuation of therapy and in one case, macular edema resolved after dose reduction. For more information, see www.fda.gov/medwatch/safety/2006/safety06.htm#Avandia.
Preferred treatment for advanced ovarian cancer announced; CDC updates child/adolescent immunization schedule; CDC: Millions of people carry drug-resistant bacteria; Study: Many patients with NSTE ACS given wrong dose; FDA: Post-marketing rosiglitazone maleate (Avandia) warningYou have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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