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In a phase I trial for patients with advanced ovarian cancer, irinotecan and carboplatin were administered at 6 different dose levels to determine maximum tolerated dose. The dose-limiting toxicity was hematologic (neutropenia and thrombocytopenia). The recommended dose for the Phase II study was irinotecan 60 mg/m2 on Days 1, 8, and 15 and carboplatin 5 mg/mL (AUC) on day 1, repeated every 4 weeks. Of note, of the ten patients with measurable disease, criteria for treatment response were achieved in 5. This level of response bodes well for this combination.
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Paclitaxel, administered weekly, compared to once-every-3-weeks in a trial of primary systemic (neoadjuvant) treatment for operable breast cancer was shown by Green and colleagues at M.D. Anderson and Brown University to provide comparable clinical responses but superior rates of pathological complete response (pCR) and breast conservation. Both the weekly and q3 week regimens were followed by 4 cycles of fluorouracil/doxorubicin/cyclophosphamide (FAC).
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In this series, all 3 indexes, IPI, ILI, and FLIPI, were useful to classify FL patients into differentiated risk groups, although the FLIPI identified a larger proportion of high-risk patients than the IPI and ILI.
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Summarizing adverse events reported to the FDA, 6 definite cases of intravascular hemolysis (hemoglobinuria/hemoglobinemia and/or DIC) are detailed after administration of anti-D IGIV (WinRho). Several patients developed intravascular hemolysis after previously uncomplicated anti-D IGIV. Five patients were adults and all died. This study not only demonstrates that potentially fatal acute intravascular hemolysis may occur after anti-D IGIV and the importance of post-marketing surveillance.
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Fertility-sparing surgery for ovarian LMP tumors is an option for motivated patients. Preservation of the contralateral adnexa increases the risk of recurrence, but surgical resection is usually curative.
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The prevalence of depression among low-income, ethnic minority women with breast or gynecologic cancer is largely unknown, but limited formal screening programs and restricted access to effective therapies would suggest the number to be high. The trial by Ell and colleagues represents a unique insight into the scope of the problem.
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MDS is a relatively common disorder managed by oncologists; but, until recently, few therapies have been available. In this observation study, patients with MDS who were treated with erythropoietin and G-CSF (EPO/G-CSF) for anemia with prolonged follow-up were assessed and then compared to another large cohort of MDS subjects. The response rate was 46% in the low-risk subjects according the IPSS score. Subjects treated with EPO/G-CSF demonstrated no increased risk of AML progression or death, providing reassurance that such treatment is unlikely to hasten disease progression.
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Advanced age is an adverse prognostic factor in aggressive non-Hodgkins lymphoma (NHL). The analysis of the cumulative case series of aggressive NHL carried out by The International Non-Hodgkins Lymphoma Prognostic Factor Project has shown that patients aged older than 60 years have a worse prognostic outcome than younger patients, although a direct comparison of response and survival of patients aged older than 70 years with younger patients is complicated by the fact that the randomized studies were specifically designed for patients aged < 70 years.
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In a retrospective review of clinical outcomes in non-Hodgkins lymphoma patients who underwent response assessment at the end of treatment, the addition of PET to the standard International Workshop Criteria (IWC) improved staging accuracy and gave a better prediction of overall progression-free survival.
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Although remissions have been more frequent and treatments more aggressive, there are little data in the literature that overall survival for follicular lymphoma has been improved. Examination of the SEER database, however, clearly demonstrates that over the last quarter century, overall survival for follicular lymphoma patients has improved. Explanations could include the sequential application of more effective therapies and/or improvement in supportive care.
