SummaryDose–intensity of chemotherapy is important in the treatment of Hodgkin lymphoma (HL) and granulocyte‐colony stimulating factor (G‐CSF) is commonly used to maintain it. We reviewed all newly diagnosed HL patients who were treated at our institution between 1996 and 2005. Fifty‐nine patients received adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy with no dose reductions, treatment delays, and without G‐CSF, regardless of absolute neutrophil count (ANC). The median ANC on all ABVD treatment days (n = 658) was 0·925 × 109/l, and was <0·5 × 109/l on 26% of treatment days. Median normalised ABVD dose–intensity was 99·1% (range, 93–100%) and median cycle duration was 28·2 d. Incidence of bleomycin lung toxicity was 1·6%, 0·44% treatments were complicated by febrile neutropenia, and no secondary malignancies have occurred (median follow‐up 48 months; range, 11–130 months). Five‐year event‐free (EFS) and overall survival (OS) were 92·9% and 97·4% respectively. Furthermore, the 5‐year EFS and OS (87·4% and 94·1% respectively) for advanced stage patients compared favourably with a similar ABVD patient group who received routine prophylactic G‐CSF (n = 23) with EFS 80·0% and OS 91·3% (P = 0·46 and 0·67 respectively). Our experience suggests that ABVD may be safely and effectively administered at >99% dose–intensity without G‐CSF support, regardless of the ANC.
Bevacizumab is a humanised monoclonal antibody that inhibits vascular endothelial growth factor (VEGF), the key mediator of tumour angiogenesis, and has been shown to improve survival when given with chemotherapy to patients with metastatic colorectal cancer. In a pivotal Phase III clinical trial, 813 subjects were treated with irinotecan, 5-fluorouracil (5-FU) and leucovorin and randomised to receive placebo or bevacizumab. Median survival for the group receiving bevacizumab was increased by 30%, from 15.6 to 20.3 months (p < or = 001). Other Phase II and III studies in colorectal cancer have demonstrated a benefit when bevacizumab is added to regimens of 5-FU and leucovorin, and 5-FU, leucovorin and oxaliplatin. The toxicity associated with bevacizumab is generally mild, consisting of manageable hypertension, clinically insignificant proteinuria and mild mucosal bleeding. Infrequent severe toxicities have been reported, consisting of arterial thrombosis and gastrointestinal perforations (1.5%). Bevacizumab represents the first angiogenesis modulator that has a proven benefit in cancer therapy.
Introduction: Common manifestations of multiple myeloma include osteolytic lesions, cytopenias, hypercalcemia, and renal insufficiency. Patients may also exhibit heart failure which is often associated with either past therapy or cardiac amyloidosis. A less recognized mechanism is high-output heart failure. Diuretic therapy in this setting has little efficacy in treating the congested state. Furthermore, effective pharmacotherapy has not been established. We report two patients with multiple myeloma and highoutput heart failure who failed diuretic therapy. The patients were given dexamethasone in conjunction with lenalidomide and thalidomide, respectively. Shortly thereafter, each patient demonstrated a significant improvement in symptoms. This is the first report of successful treatment of multiple myeloma-induced high-output failure via the utilization of these agents.
Colorectal cancer is a common disease with therapy that has a proven effectiveness in the adjuvant and metastatic setting. Bevacizumab, a vascular endothelial growth factor inhibitor, is an antiangiogenesis monoclonal antibody that has benefit in response rate and overall survival when used in combination with existing metastatic colorectal cancer regimens. It is well tolerated with a few important side effects to be cognizant of, including hypertension, arterial thrombosis and bowel perforation. Existing treatment and research strategies are examining its use in the adjuvant setting or in combination with other angiogenesis inhibitors.
Preclinical studies suggest that bortezomib, through inhibition of nuclear factor-κB (NF-κB) activation, may enhance the effects of radioimmunotherapy. This phase I trial was designed to determine the maximum tolerated dose (MTD) of weekly bortezomib induction combined with Y-90-ibritumomab tiuxetan followed at the time of count recovery by weekly bortezomib consolidation in patients with relapsed/refractory follicular or transformed non-Hodgkin lymphoma. Grade 3 or 4 toxicities were observed in eight of nine treated patients, and all but one of these toxicities were hematologic. One patient had grade 3 cardiotoxicity. A dose limiting toxicity (DLT) of grade 4 thrombocytopenia was observed in two of three patients treated with bortezomib at 1.6 mg/m(2), resulting in a MTD of 1.3 mg/m(2). The overall response rate was 89% (two complete response [CR], six partial response [PR], one stable disease [SD]), with a median progression-free survival of 6.5 months (range: 3-22.5+ months). A phase II trial at the MTD is under way to better define the toxicity and effectiveness of this regimen.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.