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Auro del Giglio

Publications and source records attributed to Auro del Giglio.

18 recordsLinked to original sources
PubMed2006

Skipping day 2 antiemetic medications may improve chemotherapy induced delayed nausea and vomiting control: results of two pilot phase II trials.

BACKGROUND: 5HT-3 antagonists and corticosteroids control less than 50% of delayed chemotherapy induced nausea and vomiting (CINV) episodes. MATERIALS AND METHODS: Two pilot phase II studies were conducted at our institution in which all patients received ondansetron 16 mg and dexamethasone 20 mg before highly and moderately emetogenic chemotherapy on day 1. Patients on study 1 received metoclopramide 10 mg PO q8 h, granisetron 0.5 mg PO QD and dexamethasone 8 mg QD on days 2 and 3, whereas only metoclopramide was continued on the same schedule on day 4. On study 2, patients received the same medications, but no drugs were given on day 2, and the same treatment schedule was given to them but from days 3 to 5 instead. Patients were interviewed on days 1 and 6. RESULTS: Twenty-one patients participated on each study. There were no significant clinical differences between these two studied populations. Complete CINV control occurred from days 2 to 5 in 23.1% (95% CI: 8 to 47%) on study 1 vs 61.9% (95% CI: 38 to 81%) of the patients on study 2. By logistic regression, complete CINV control was correlated significantly with antiemetic treatment group (p=0.011) even when we considered only patients who achieved complete CINV control during the first 24 h (p=0.031). CONCLUSIONS: Skipping day 2 antiemetic medications does not seem to worsen delayed CINV control and may even improve it, perhaps by avoiding tachyphylaxis to these medications. A randomized controlled study is in progress to confirm these results.

Adolescent↗
PubMed2006

[Acceptance of chemotherapy by Brazilian women with breast cancer].

INTRODUCTION: Breast cancer has the second highest incidence and is the first cause of death by cancer among Brazilian women. Under the physician's perspective chemotherapy should be indicated according to the risk benefit ratio in each case. However, from the Brazilian breast cancer patient's perspective this risk benefit ratio requires further classification. OBJECTIVE: In patients with breast cancer who have already received chemotherapy evaluate the minimum benefit considered necessary for a renewed administration and learn which factors may influence this decision. METHODS: we surveyed 53 patients comprising general, clinical and cancer related variables, as well as issues related to the minimal expected benefit which would induce the patient to agree to undergo chemotherapy. RESULTS: 75% would accept to receive chemotherapy again even if it would not change their probability of relapse, 50% would accept chemotherapy again, even though it would not increase survival rates. Similarly, 81.54% would submit once more to chemotherapy even though it would not increase their probability of cure. Acceptance of a new chemotherapy treatment yielding minimal benefits correlated significantly with more age, with a lower educational level and with no previous administration of Adriamycin. CONCLUSION: Even with a minimal benefit, the majority of formerly treated breast cancer patients are willing to submit to another chemotherapy treatment.

Adult↗
PubMed2005

Continuous infusion of amphotericin B: preliminary experience at Faculdade de Medicina da Fundação ABC.

CONTEXT AND OBJECTIVE: Intravenous amphotericin B deoxycholate (AmB-D) infusions, usually given over 4 hours, frequently induce nephrotoxicity and undesirable infusion-related side effects such as rigors and chills. There is evidence in the literature that the use of AmB-D in the form of continuous 24-hour infusion is less toxic than the usual four-hour infusion of this drug. Our objective was to evaluate the efficacy and safety of continuous infusion of AmB-D for the treatment of persistent fever in neutropenic patients with hematological malignancies after chemotherapy. DESIGN AND SETTING: Observational retrospective analysis of our experience with continuous infusion of AmB-D, at Faculdade de Medicina da Fundação ABC and Hospital Estadual Mário Covas in Santo André. METHODS: From October 2003 to May 2004, 12 patients with hematological malignancies and chemotherapy-induced neutropenia received 13 cycles of continuous infusion of AmB-D. RESULTS: The median dose of AmB-D was 0.84 mg/kg/day (0.33 to 2.30 mg/kg/day). Concomitant use of nephrotoxic medications occurred in 92% of the cycles. Nephrotoxicity occurred in 30.76% of the cycles, hypokalemia in 16.67%, hepatotoxicity in 30% and adverse infusion-related events in 23%. All patients survived for at least seven days after starting continuous infusion of AmB-D, and clinical resolution occurred in 76% of the cycles. CONCLUSIONS: Continuous infusion of AmB-D can be used in our Institution as an alternative to the more toxic four-hour infusion of AmB-D and possibly also as an alternative to the more expensive liposomal formulations of the drug.

Adolescent↗
PubMed2005

Low-dose granisetron for prophylaxis of acute chemotherapy-induced nausea and vomiting: a pilot study.

OBJECTIVES: Chemotherapy-induced nausea and vomiting (QTNV) are very uncomfortable symptoms for patients with cancer, which can be circumvented in most of them with drug combinations containing serotonin receptor antagonists (5-HT3 receptor antagonists) such as granisetron. In an attempt to decrease costs of QTNV prophylaxis, we studied a lower dose regimen of granisetron. PATIENTS AND METHODS: Sixty patients with cancer scheduled to receive moderately/highly emetogenic chemotherapy were pretreated 1 h before with 0.5 mg granisetron p.o. combined with dexamethasone 20 mg i.v. RESULTS: We observed complete control for nausea, vomiting, and nausea and vomiting in 78% [95% confidence interval (CI), 67-89%], 61% (95% CI, 47.5-74.5%), and 58% (95% CI, 44.3-71.7%) of the patients, respectively. This regimen was very well tolerated; headache (35%), xerostomia (11%), and constipation (5%) were the most frequent adverse symptoms reported. CONCLUSIONS: The regimen with lower dose granisetron is effective for acute QTNV prophylaxis and offers a cheaper alternative for QTNV control. We feel that these encouraging results should be confirmed in a randomized comparative trial.

Adult↗
PubMed2005

Hepatic plasmacytosis as a manifestation of relapse in multiple myeloma treated with thalidomide.

Thalidomide and its analogs have been extensively studied in patients with multiple myeloma. We present the case of a 58-year-old female patient with immunoglobulin GA-kappa multiple myeloma who was receiving thalidomide after failing an autologous transplant. She presented with profound asthenia and several space-occupying hepatic lesions, one of which was shown by a CT-guided percutaneous biopsy to be plasmacytoma. The patient then received bortezomib and had a transient response. Because thalidomide may also increase the expression of cytoadhesion molecules in myeloma cells and in the bone marrow microenvironment, it is possible that some patients with multiple myeloma who relapse on thalidomide may present with extramedullary plasmacytomas, as seen in this case. Therefore, whenever symptoms arise in patients with multiple myeloma who are receiving thalidomide, extramedullary plasmacytomas should be considered.

Antineoplastic Agents↗
PubMed2004

Systemic chemotherapy induces microsatellite instability in the peripheral blood mononuclear cells of breast cancer patients.

INTRODUCTION: Systemic chemotherapy is an important part of treatment for breast cancer. We conducted the present study to evaluate whether systemic chemotherapy could produce microsatellite instability (MSI) in the peripheral blood mononuclear cell fraction of breast cancer patients. METHODS: We studied 119 sequential blood samples from 30 previously untreated breast cancer patients before, during and after chemotherapy. For comparison, we also evaluated 20 women who had no relevant medical history (control group). RESULTS: In 27 out of 30 patients we observed MSI in at least one sample, and six patients had loss of heterozygosity. We found a significant correlation between the number of MSI events per sample and chemotherapy with alkylating agents (P < 0.0001). We also observed an inverse correlation between the percentage of cells positive for hMSH2 and the number of MSI events per sample (P = 0.00019) and use of alkylating agents (P = 0.019). CONCLUSION: We conclude that systemic chemotherapy may induce MSI and loss of heterozygosity in peripheral blood mononuclear cells from breast cancer patients receiving alkylating agents, possibly mediated by a chemotherapy-induced decrease in the expression of hMSH2. These effects may be related to the generation of secondary leukaemia in some patients, and may also intensify the genetic instability of tumours and increase resistance to treatment.

Adult↗
PubMed2004

Gefitinib (Iressa) in metastatic patients with non-small cell lung cancer: preliminary experience in a Brazilian center.

CONTEXT: Patients with metastatic non-small cell lung cancer are deemed incurable, but they may derive some benefit from systemic palliative chemotherapy. Recently, with the introduction of epidermal growth factor receptor (EGFR) antagonists such as gefitinib (Iressa), an effective and less toxic option is now available for the treatment of such patients. OBJECTIVE: To assess the activity and toxicity of gefitinib in a group of Brazilian patients. TYPE OF STUDY: Prospective, open label, non-randomized and non-controlled. SETTING: Clínica de Oncologia e Hematologia (CLIOH), São Paulo, Brazil. PATIENTS AND METHODS: From June 2002 to April 2003 we treated five patients with metastatic previously-treated non-small cell lung cancer (median of two previous chemotherapy regimens), using gefitinib at a dose of 250 mg orally on a daily basis, within a compassionate protocol sponsored by AstraZeneca. The patients' median age was 65 years and two of them were male. Three had a performance status of 1, one of 2 and one of 3, on the ECOG (Eastern Cooperative Oncology Group) scale. RESULTS: We observed skin rash in two patients, diarrhea in three and arthralgia in two. One patient had a partial response and another had stabilization of her disease, as measured via imaging studies (which have lasted for more than 11 and 4 months, respectively), which were accompanied by significant decrease in tumor markers, whereas three patients worsened during treatment. DISCUSSION: New options of chemotherapy agents with favorable toxicity profiles are urgently needed for the treatment of metastatic non-small lung cancer patients who usually have short life expectancies. In our small series of five patients, we observed stabilization of the disease in two of them and the skin and gastrointestinal reactions often described in the literature in all of them. Two had arthralgia, not reported before. CONCLUSION: We concluded that gefitinib is an important addition to the therapeutic armamentarium for patients with metastatic non-small cell lung cancer.

Aged↗
PubMed2004

Praying correlates with higher quality of life: results from a survey on complementary/alternative medicine use among a group of Brazilian cancer patients.

CONTEXT: The use of complementary/alternative medicine has been little studied in Brazil. OBJECTIVE: The purpose of this study was to determine the prevalence of complementary/alternative medicine use among a group of Brazilian cancer patients and correlate these findings with the patients' quality of life. TYPE OF STUDY: Descriptive. SETTING: Oncology Institute of the Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil. PARTICIPANTS: 100 cancer patients. PROCEDURES: The EORTC QLQ C-30 quality of life questionnaire was applied together with another questionnaire on the use of complementary/alternative medicine. MAIN MEASUREMENTS: Use of complementary/alternative medicine and quality of life. RESULTS: 89% of the patients had already used complementary/alternative medicine, 63% were currently using it and most of them (77.7%) believed in the efficacy of complementary/alternative medicine for their treatment. The type most used was individual prayer (77.5%). We found a significant association between believing in the efficacy of complementary/alternative medicine and praying (individually or in groups), in comparison with better scores on the functional (p = 0.001) and overall health (p = 0.001) quality of life scales. Multivariate analysis confirmed these findings regarding praying and also showed that believing in complementary/alternative medicine correlated significantly with functional and symptom quality of life scores. CONCLUSION: The prevalence of complementary/alternative medicine use in this group of cancer patients was high. Praying and belief in the efficacy of complementary/alternative medicine correlated significantly with an overall better quality of life, and therefore these practices should not be discouraged by physicians. New prospective studies should be conducted in order to better characterize the efficacy of such alternative therapeutic approaches.

Adolescent↗
PubMed2004

Negative results in cancer clinical trials--equivalence or poor accrual?

This study was performed to evaluate randomized cancer trials resulting negative regarding inadequate accrual, unsupported assumptions of equivalence and factors implied in such assumptions. A search in PubMed electronic data base was done for a sample of 800 most recently entered studies by March 2003 indexed with MESH term "neoplasms" and categorized according to design, intervention, outcome and conclusion. Minimal detectable differences with optimized power were calculated in each comparison according to number of patients accrued. Factors related with inadequate claim for equivalence in negative comparisons were also searched. Among the papers located, 194 met requirements and 188 were analyzed leading to 392 valid comparisons addressing survival, anti cancer effect or major toxicity, 235 of which resulted "negative". According to accrual, only 15.2% (ci95%, 9.9% to 20.3%) of negative comparisons would detect a 10% absolute difference between arms with 80% of chance. 53.6% (ci95%, 47.0% to 60.1%) of negative comparisons inadequately claimed equivalence. However, equivalence was supported by data in only 20.5% (ci95%, 12.6% to 28.4%) of negative comparisons that claimed for it. Negative comparisons based on new drugs had higher likelihood to be inadequately presented as supporting equivalence than those based in older drugs (66.7% vs. 43.5%, chi-square p=0.024). We concluded that most cancer clinical comparisons resulting negative are affected by poor accrual. They often inadequately claim for equivalence without supporting data. Comparisons involving new drugs are specially affected by this problem. Authors, editors and readers must be more rigorous regarding adequate assumptions of equivalence.

Humans↗
PubMed2004

Simultaneous occurrence of Hodgkin disease and tuberculosis: report of three cases.

Tuberculosis (TB) has been described in association with malignancies including Hodgkin disease (HD). We report three cases of simultaneous occurrence of TB and HD. In two of these cases clinical symptoms improved after TB treatment was instituted and before HD was diagnosed. Fever recurrence in one case and persistence of mediastinal lymphadenopathy in the other, however, prompted consideration of an additional diagnosis. Interestingly, in one these two patients, both TB and HD diagnosis were obtained from the same lymph node. Since both diseases share many symptoms and signs, physicians faced with initial therapeutic failure when caring for HD and TB patients should be aware of the possibility of the simultaneous occurrence of both diseases.

Adult↗
PubMed2004

Ratio between positive lymph nodes and total dissected axillaries lymph nodes as an independent prognostic factor for disease-free survival in patients with breast cancer.

The number of positive axillary lymph nodes involved by tumor is one of the main prognostic factors for women with locoregional breast cancer (BC) for whom adjuvant chemotherapy is being considered. The prognostic importance of the ratio (P/D) between positive lymph nodes (P) and total dissected lymph nodes (D), previously demonstrated in the high-dose chemotherapy (HDC) setting has not yet been tested, however, in the conventional adjuvant chemotherapy setting. The data of 168 patients who were from 2 institutions and who were treated with adjuvant chemotherapy for BC were retrospectively analyzed, and univariate and multivariate analysis were performed, including the other traditional prognostic factors and P/D ratio as possible predictors of disease free survival (DFS). Disease-free survival for quartile 4 of P/D ratio (ratio >0.30) was statistically different from that for the other quartiles (log-rank test p < 0.001). Mean DFS for this series was not reached as well as for quartiles 1, 2, and 3, while mean DFS for quartile 4 was 44.5 months. In univariate analysis, number of positive lymph nodes (r2 = 0.055; p = 0.023), P/D ratio (r2 = 0.213; p < 0.001), and stage (r2 = 0.105; p = 0.002) were predictive of relapse, while in multivariate analysis, only P/D ratio remained an independent predictor of relapse (r2 = 0.213; p < 0.001). It is concluded that P/D ratio could become a simple, inexpensive, and easily available prognostic factor for patients undergoing conventional chemotherapy for BC.

Adult↗
PubMed2003

Prevalence of factor V Leiden, FII G20210A, FXIII Val34Leu and MTHFR C677T polymorphisms in cancer patients with and without venous thrombosis.

Venous thromboembolism (VTE) is a common complication in patients with malignant disease. In addition to well-established acquired risk factors for VTE, several genetic risk factors, mainly related to the haemostatic system, are known to influence thrombotic risk. However, the contribution of gene abnormalities to thrombotic tendency in cancer patients remains poorly explored. We performed a prospective study to evaluate the prevalence and clinical significance of four gene variations (factor V Leiden [FVL], factor II G20210A, factor XIII Val34Leu and MTHFR C677T) in cancer patients, with and without VTE. Enrolled were 211 unrelated and unselected patients (M/F ratio 0.5, mean age 57 years, range 12-91 years) with a diagnosis of cancer, admitted to two University Oncology Clinics in the city of São Paulo, Southeastern Brazil. After admission, all patients were evaluated for the presence of symptoms and signs of VTE. Sixty-four patients (30.3%) had an episode of deep venous thrombosis (DVT) or pulmonary embolism (PE), which has been objectively verified; 147 patients (69.7%) had no evidence of VTE. FVL was found with a frequency of 1.5% and 2.7% in the VTE and non-VTE group, respectively (odds ratio [OR] for VTE 0.6, 95% CI: 0.06-5.3). FII G20210A was found in 1.5% and 1.3% of thrombotic and nonthrombotic patients, respectively, yielding an OR of 1.2 (95% CI: 0.1-13.1). FXIII Val34Leu was detected in 29.6% of the thrombotic patients and in 28.5% of the non-thrombotic patients (OR 1.1, 95% CI: 0.5-2). MTHFR 677T was present in 53.1% and 60.5% of patients with and without thrombosis, respectively (OR 0.8, 95% CI: 0.4-1.4). The present data do not point to an association between the four polymorphisms here investigated and the risk of VTE in cancer patients.

Adolescent↗
PubMed2002

Weight changes during chemotherapy for breast cancer.

CONTEXT: Patients receiving adjuvant chemotherapy for breast cancer have a tendency to gain weight. This tendency has determining factors not completely defined and an unknown prognostic impact. OBJECTIVE: To evaluate weight change during chemotherapy for breast cancer in a defined population and to identify its predisposing factors and possible prognostic significance. DESIGN: Observational, retrospective cohort study. SETTING: Private clinical oncology service. PARTICIPANTS: 106 consecutive patients with breast cancer treated between June 1994 and April 2000, who received neoadjuvant (n = 8), adjuvant (n = 74) or palliative (n = 24) chemotherapy. INTERVENTION: Review of medical records and gathering of clinical information, including patients' body weights before treatment and at follow-up reviews. MAIN MEASUREMENTS: Body weight change, expressed as percentage of body weight per month in treatment; role of clinical data in weight change; and influence of weight change in overall survival and disease-free survival. RESULTS: There was a mean increase of 0.50 +/- 1.42% (p = 0.21) of body weight per month of treatment. We noted a negative correlation between metastatic disease and weight gain (r = -0.447, p < 0.0001). In the adjuvant and neoadjuvant therapy groups there was a mean weight gain of 0.91 +/- 1.19 % (p < 0.00001) per month, whereas in the metastatic (palliative) group, we observed a mean loss of 0.52 +/- 1.21% (p = 0.11) of body weight per month during the treatment. We did not observe any statistically significant correlation between weight changes and disease-free survival or overall survival. CONCLUSIONS: Women with breast cancer undergoing adjuvant or neoadjuvant chemotherapy gain weight, whereas metastatic cancer patients will probably lose weight during palliative chemotherapy. Further studies are needed in order to evaluate the prognostic significance of weight changes during chemotherapy.

Adult↗
PubMed2002

Peripheral blood c-erbB-2 expression by reverse transcriptase-polymerase chain reaction in breast cancer patients receiving chemotherapy.

Minimal residual disease (MRD) evaluation in breast cancer patients is a promising tool to improve current staging procedures. In a previous work employing a CK-19-based reverse transcriptase-polymerase chain reaction (RT-PCR) technique for MRD detection, we identified a group of women who exhibited persistent negativity for this assay and for whom this technique was considered noninformative. In order to improve the yield of MRD detection in these patients, we evaluated the usefulness of RT-PCR detection of c-erbB-2 expression. We were able to detect up to 1 MCF-7 cell (positive for c-erbB-2 expression) in a mixture of 1,000,000 CCRF-CEM cells (negative for c-erbB-2 expression). We evaluated the specificity of this technique in the peripheral-blood mononuclear cells (PBMCs) of 20 healthy women and found that 2 of these women were positive for c-erbB-2 expression. In the PBMCs of a group of 16 women with breast cancer, 25% of the samples were positive for c-erbB-2 expression before chemotherapy. Except for race (P = 0.017), no other significant correlations were found, including c-erbB-2 expression in the primary tumor by immunoperoxidase. Interestingly, in the subgroup of 6 patients for whom this technique was informative, we found that 80% of the samples obtained while on chemotherapy were negative compared to only 10% obtained off treatment (P = 0.017). Additionally, 2 patients for whom CK-19 expression was noninformative had at least 1 c-erbB-2-positive sample. We conclude that this technique might be useful for MRD detection in breast cancer patients, but further studies are necessary to confirm our findings.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

A phase I study of gemcitabine combined with vinblastine in patients with solid tumors.

AIMS AND BACKGROUND: Gemcitabine and vinblastine are chemotherapeutic drugs with a wide spectrum of antitumor activity. We conducted a phase I trial to define the maximal tolerated dose of this combination. METHODS: Twenty-nine patients with a variety of solid tumors with measurable disease were included. Twenty-seven of these patients had been previously treated with chemotherapy. The use of hematological growth factors was not allowed. The maximal tolerated dose was defined as the level in which WHO grades 3 or 4 non-hematological toxicity would occur in at least a third of the patients. RESULTS: The maximal tolerated dose was reached at level 5, which consisted of gemcitabine (1000 mg/m2) with vinblastine (3 mg/m2) given intravenously on days 1, 8 and 15 every 28 days. At this level, one patient had WHO grade 3 cerebellar toxicity and another WHO grade 4 anorexia. Furthermore, patients were able to receive all 3 weekly doses of chemotherapy in only 2 out of 10 cycles of treatment given at this level. We also observed 5 episodes of WHO grades 1 and 2 neuropathy, most of which (4/5) occurred in patients previously exposed to neurotoxic chemotherapy. We recorded 2 partial responses (one at level 3 and the other at level 4) and 8 instances of stable disease after 3 scheduled cycles of the combination. CONCLUSIONS: We therefore recommend gemcitabine (1100 mg/m2) plus vinblastine (5.5 mg/m2) given on days 1 and 8 every 21 days (level 4) for previously treated patients with solid tumors, with special caution in patients previously exposed to neurotoxic chemotherapy.

Adult↗
PubMedDate not supplied

Cytokeratin 19 expression by reverse transcriptase-polymerase chain reaction in the peripheral blood of prostate cancer patients.

AIMS AND BACKGROUND: Sensitive reverse transcriptase-polymerase chain reaction-based techniques for detection of epithelial antigen expression, such as cytokeratin 19, in the peripheral blood mononuclear fraction of prostate cancer patients may allow the detection of tumor progression at A molecular level. METHODS: We studied cytokeratin 19 expression by reverse transcriptase-polymerase chain reaction in peripheral blood mononuclear cell samples of 10 control men and serially in 44 patients with prostate cancer every three months for 18 months. RESULTS: None of the 10 normal control men expressed cytokeratin 19 in their peripheral blood mononuclear fraction. In the patients, cytokeratin 19 positivity at entry was not associated with age, Gleason score, clinical stage, prostate-specific antigen or alkaline phosphatase. Interestingly, having at least one positive cytokeratin 19 result during follow-up correlated significantly with time to prostate-specific antigen progression (P = 0.049), especially in the subgroup of metastatic patients (P = 0.032). CONCLUSIONS: We conclude that cytokeratin 19 expression by reverse transcriptase-polymerase chain reaction in the peripheral blood mononuclear cell fraction of prostate cancer patients correlates with time to prostate-specific antigen progression. Further studies are needed to confirm these findings.

Aged↗