Ιατρικά Άρθρα

Πέμπτη 17 Μαΐου 2018

Geriatric analysis from PRODIGE 20 randomized phase II trial evaluating bevacizumab + chemotherapy versus chemotherapy alone in older patients with untreated metastatic colorectal cancer

Publication date: July 2018
Source:European Journal of Cancer, Volume 97
Author(s): T. Aparicio, O. Bouché, E. Francois, F. Retornaz, E. Barbier, J. Taieb, S. Kirscher, P.-L. Etienne, R. Faroux, F. Khemissa Akouz, F. El Hajbi, C. Locher, Y. Rinaldi, T. Lecomte, S. Lavau-Denes, M. Baconnier, A. Oden-Gangloff, D. Genet, L. Bedenne, E. Paillaud
BackgroundOlder patients have frailty characteristics that impair the transposition of treatment results found in younger patients. Predictive factors are needed to help with treatment choices for older patients. The PRODIGE 20 study is a randomized phase II study that evaluated chemotherapy associated with bevacizumab (BEV) or not (CT) in patients aged 75 years or older.Patients and methodsPatients underwent a geriatric assessment at randomization and at each evaluation. The predictive value of geriatric and oncologic factors was determined for the primary composite end-point assessing safety and efficacy of treatment (BEV or CT) simultaneously and also progression-free survival (PFS) and overall survival (OS).Results102 patients were randomized (51 BEV and 51 CT; median age 80 years [range 75–91]). On multivariate analysis, baseline normal independent activity of daily living (IADL) score and no previous cardiovascular disease predicted the primary end-point. High (versus low) baseline Köhne score predicted short PFS and baseline Spitzer quality of life (QoL) score <8, albumin level ≤35 g/L, CA19.9 >2 LN levels above normal and high baseline Köhne score predicted short OS. Survival without deteriorated QoL and autonomy was similar with BEV and CT. On subgroup analyses, the benefit of bevacizumab seemed to be maintained in patients with baseline impaired IADL or nutritional status.ConclusionNormal IADL score was associated with a good efficacy and safety of both BEV and CT. Köhne criteria may be relevant prognostic factors in older patients. Adding bevacizumab to chemotherapy does not impair patient autonomy or QoL.

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Impact of neoadjuvant chemotherapy and pathological complete response on eligibility for breast-conserving surgery in patients with early breast cancer: A meta-analysis

Publication date: July 2018
Source:European Journal of Cancer, Volume 97
Author(s): Carmen Criscitiello, Mehra Golshan, William T. Barry, Giulia Viale, Stephanie Wong, Michele Santangelo, Giuseppe Curigliano
PurposeWe conducted a meta-analysis of randomised trials evaluating pathological complete response (pCR) and surgical outcomes after neoadjuvant systemic therapy (NST) in patients with early breast cancer (EBC).Patients and methodsThe primary outcome was breast-conserving surgery (BCT) rate. Secondary outcomes were pCR rate and association to BCT. Meta-analyses were performed using random effects models that use inverse-variance weighting for each treatment arm based on evaluable patients. Point estimates are reported with 95% confidence interval (CI), and p < 0.05 was considered statistically significant.ResultsThirty-six studies were identified (N = 12,311 patients). We selected for the analysis 16 of 36 studies reporting both pCR and BCT for at least one treatment arm. Arms per study ranged from one to six; 42 independent units were available to evaluate the association between pCR and BCT. BCT rate ranged 5–76% across arms with an average BCT of 57% (95% CI 52–62%). Significant heterogeneity was observed among the trials (Cochrane Q = 787, p < 0.001, I² = 97%). In the meta-regression model, BCT rates were not significantly associated with year of first patient-in (p = 0.89), grade (p = 0.93) and hormone-receptor status (p = 0.39). Clinical N-stage (p = 0.01) and human epidermal growth factor receptor (HER2) status (p = 0.03) were significantly associated with BCT. pCR rate ranged 3–60% across studies. The average pCR across all study arms was 24% (95% CI 19–29%). No association was observed between pCR rate in a study arm and the resulting BCT rate in a univariate model (p = 0.34) nor after adjusting for HER2 and clinical nodal status (p = 0.82). In the subset of 14 multi-arm studies, no significant association was seen between the differences in pCR and BCT between treatment arms (p = 0.27).ConclusionspCR does not increase BCT in patients receiving NST for EBC.

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International Organization of Psychophysiology

Publication date: June 2018
Source:International Journal of Psychophysiology, Volume 128

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Editorial Board

Publication date: June 2018
Source:International Journal of Psychophysiology, Volume 128

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Kasuistik: Metamizol-induzierte Agranulozytose

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 388-394
DOI: 10.1055/s-0043-115329

Metamizol hat insgesamt ein günstiges Nebenwirkungsprofil – aber es birgt ein höheres Risiko einer medikamenteninduzierten Agranulozytose als andere Schmerzmittel und darf daher nicht unkritisch eingesetzt werden. Dieser Beitrag berichtet von einem Patienten, der nach prothetischem Hüftersatz eine medikamenteninduzierte Agranulozytose – mutmaßlich durch Metamizol – entwickelt und trotz maximaler Therapie im septischen Schock verstirbt.
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