Clinical Oncology Alert 2008-10-01

Second Malignancies in Patients with Skin Cancer

A prospective analysis of an established epidemiological cohort indicated a significant risk of developing subsequent malignancy among those with compared to those without established non-melanoma skin cancers. The increased risk was apparent even after adjustment for confounding variables such as age, sex, smoking history, socioeconomic status, and sun exposure.

Fludarabine, Cyclophosphamide, Rituximab for CLL

Tam et al report long-term data from 300 CLL patients treated with the fludarabine, cyclophosphamide, and rituximab (FCR) regimen. Complete and overall response rates were 72% and 95%, respectively. The median time to progression was 80 months, and six-year overall survival was 77%. Late infection occurred in 10% after the first year of treatment, and almost 19% had persistent cytopenias after treatment. After adjusting for pre-treatment factors, FCR was associated with prolonged survival compared to other fludarabine regimens for initial treatment at the same center. The high activity and prolonged remissions suggest FCR as an excellent front-line regimen for CLL in select patients.

Predicting Aggressive CLL

Three CLL cellular markers have been shown to be of prognostic value in determining those patients likely to have aggressive disease. Of the three, ZAP-70 was shown, in this current report from the CLL Research Consortium, to be the greatest discriminator of need for early treatment. The current value of these markers remains investigational.

Gemcitabine/Capecitabine for Biliary Tract Cancer: Patient-Reported Outcomes

Chemotherapy for advanced biliary tract cancers has been of only marginal value, in terms of objective response rates and improved survival. To assess whether chemotherapy with gemcitabine and capecitabine could effect improved quality of life and diminished symptoms, Koeberle et al performed a phase II trial using patient reported outcomes such as pain relief, physical performance and change in body weight, as outcome measures. The gemcitabine/ capecitabine combination did result in a significant improvement in these measures in about one-third of cases, and stability in those measures in another one-third. In terms of palliation, this combination appears to an effective choice.

Pegylated-Interferon Plus Dacarbazine for Metastatic Melanoma

Hauschild et al present the results of a phase II trial of pegylated interferon and dacarbazine for metastatic melanoma. The combination appeared well tolerated, and 7 of 25 patients either had stable disease, partial or complete remission. This combination is worthy of additional study in larger, randomized clinical trials for the treatment of melanoma.

Pharmacology Watch

Some women with DVT may stop warfarin after six months; Vytorin and cancer; preventing recurrent stroke; and FDA news.

– October 1, 2008

October 1, 2008