Chemotherapy Research Today is a free monthly online journal that collates and summarizes the latest research about Chemotherapy, including details on cancer treatment, side effects, drugs.

A phase II trial of preoperative chemotherapy with epirubicin, cisplatin and capecitabine for patients with localised gastro-oesophageal junctional adenocarcinoma.

Starling N, Okines A, Cunningham D, Allum W, Wotherspoon A, Benson M, Thompson J, Thomas J, Brown G, Riddell A, Stavridi F, Ashley S, Oates J, Chau I

Department of Medicine, Royal Marsden Hospital NHS Foundation Trust, Sutton, Surrey, UK.

Preoperative cisplatin/fluorouracil is used for the treatment of localised oesophageal carcinoma. This phase II study aimed to assess the efficacy and safety of administering preoperative epirubicin/cisplatin/capecitabine (ECX). Patients with stage II or III oesophageal/gastro-oesophageal junctional adenocarcinoma from one institution received 4 cycles of ECX (epirubicin 50 mg m(-2) day 1, cisplatin 60 mg m(-2) day 1, capecitabine 625 mg m(-2) b.i.d. daily) followed by surgery. The primary end point was the pathological complete response (pCR) rate based on a Simon two-stage design. Secondary end points included overall and progression-free survival (OS/PFS). Thirty-four patients were recruited: median age 60 years (range 41-81), 91% male, 97% PS 0/1, 80% T3, 68% N1. Thirty-one patients completed four ECX cycles. Grade 3/4 toxicities >or=5% included neutropenia (62%), hand-foot syndrome (15%) and nausea/vomiting (9%). Thirteen out of 28 (46%) evaluable patients responded to chemotherapy by EUS (>or=30% reduction in maximal tumour thickness). Twenty-six out of 34 (76%) patients underwent resection (R0=73%, R1=27%). Post-operatively, two patients died within 60 days of surgery. The pCR rate was 5.9% (95% CI 0-14%) in the intent-to-treat population. According to the statistical design, this prompted early study termination. However, with a median follow-up of 34 months the median OS and 1- and 2-year survival rates were 17 months, 67 and 39% respectively. Median PFS was 13 months. Of the 14 relapsed patients, 10 presented with distant metastases. Preoperative ECX is feasible and well tolerated. Although associated with a low pCR rate, survival with ECX was comparable with published studies suggesting that pCR may not correlate with satisfactory outcome from preoperative chemotherapy for localised oesophageal adenocarcinoma.

Published 5 June 2009 in Br J Cancer, 100(11): 1725-30.
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Articles on Chemotherapy published 5 June 2009:

A multicenter phase II study of the combination of oxaliplatin, irinotecan and capecitabine in the first-line treatment of metastatic colorectal cancer.   Br J Cancer, 100(11): 1720-4.

The triple drug combination consisting of irinotecan, oxaliplatin and 5-fluorouracil (FOLFOXIRI) has demonstrated higher activity and efficacy compared to the doublet FOLFIRI. 5-Fluorouracil could be substituted in FOLFOXIRI regimen by capecitabine, an oral fluoropyrimidine with similar efficacy. Recently, a dose-finding trial has demonstrated the feasibility of the combination of irinotecan, oxaliplatin and capecitabine (XELOXIRI) and established their recommended doses. The aim of this study ... [Abstract] [Full-text]

Articles on Chemotherapy published 3 June 2009:

Measuring the quality of medication use in older adults.   J Am Geriatr Soc, 57(6): 1096-102.

The quality of health care in the United States continues to fall short of expectations. A contributing factor is the suboptimal use of medications, a problem that is causing significant morbidity and mortality and costing the healthcare industry billions of dollars each year. Older adults are especially vulnerable to suboptimal quality medication use because of their concurrent medical conditions, multiple medications, and the physiological effects of aging on the use of drug therapy. In ... [Abstract] [Full-text]

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Articles on Chemotherapy published 1 June 2009:

Targeting innate immunity protein kinase signalling in inflammation.   Nat Rev Drug Discov, 8(6): 480-99.

Inflammation is an evolutionarily conserved host reaction that is initiated in response to trauma, tissue damage and infection. It leads to changes in tissue homeostasis and blood flow, immune-cell activation and migration, and secretion of cytokines and mediators in a spatio-temporally coordinated manner. Progress in understanding of the mechanisms of the inflammatory response has identified various protein kinases that act as essential signalling components and therefore represent potential ... [Abstract] [Full-text]

Parental misinterpretations of over-the-counter pediatric cough and cold medication labels.   Pediatrics, 123(6): 1464-71.

OBJECTIVE: Concerns about the safety and efficacy of over-the-counter cold medications have led to a recent US Food and Drug Administration public health advisory against their use in children <2 years of age. Our goal was to examine caregiver understanding of the age indication of over-the-counter cold medication labels and identify factors, associated with caregiver understanding. METHODS: Caregivers of infant children (< or =1 year old) were recruited from clinics at 3 institutions. ... [Abstract] [Full-text]

Dose-finding study of weekly docetaxel, epirubicin and capecitabine, as first-line treatment in advanced breast cancer.   Cancer Chemother Pharmacol, 64(2): 407-12.

BACKGROUND: Combinations of anthracycline, taxane and fluoropyrimidine are highly active in advanced breast cancer (ABC). In a phase II study of epirubicin 50 mg/m(2), docetaxel 75 mg/m(2), and infusional 5-FU 200 mg/m(2)/day, we found dose-limiting neutropenia and frequent central venous catheter complications. An alternative approach has been tested using weekly fractionation of docetaxel, and oral capecitabine. METHODS: Initially, six women with ABC were treated with epirubicin 60 mg/m(2) ... [Abstract] [Full-text]

Antibiotic prophylaxis for the prevention of infection after major limb amputation.   Eur J Vasc Endovasc Surg, 37(6): 696-703.

BACKGROUND: Major limb amputation is often required by patients with a limited capacity to tolerate post-operative complications. Amputation stump infection is common and may necessitate re-amputation, potentially exposing a vulnerable patient to further serious complications. Effective antibiotic strategies should be employed to reduce wound infection after major amputation. METHODS: Online databases were searched to identify studies regarding reduction in wound infection following major limb ... [Abstract] [Full-text]

Articles on Chemotherapy published 29 May 2009:

Variations in gene expression and response to neoadjuvant chemotherapy in breast carcinoma.   Cancer Invest, 27(5): 521-8.

In this study, we performed a screening of 266 gene expressions in breast carcinomas and carried out correlations with histological response to either FEC-100 (fluorouracil-epirubicin-cyclophosphamide; n = 16) or Tax-Epi (docetaxel-epirubicin; n = 12) treatment. Gene expression in biopsies obtained before and after one course of chemotherapy was analyzed. Expression of specific genes was significantly changed after one course of chemotherapy, particularly for Tax-Epi treatment. Comparison with ... [Abstract] [Full-text]

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