Why not start with thalidomide?
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Angiogenesis Inhibitors↗
Biomedical subjects
Charles Loprinzi
Publications and source records attributed to Charles Loprinzi.
A revisitation of "doc, how much time do I have?".
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Attitude of Health Personnel↗
A phase II study of topical ceramides for cutaneous breast cancer.
PURPOSE: Short chain ceramides induce tumor cell apoptosis in preclinical models. Limited therapeutic options for patients with cutaneous breast cancer prompted the testing of these sphingolipids in patients with this disease. PATIENTS AND METHODS: Twenty-five patients with refractory, cutaneous breast cancer were treated twice a day with a 1% mixture of topical C2 and C6 ceramides administered in a 1:1 ratio. For the first 8 weeks, patients were not allowed to receive other antineoplastic therapy. In addition to tumor status and toxicity assessment throughout the trial, skin biopsies for evidence of apoptosis and quality of life questionnaires (FACT-BR) were completed at baseline and 1 month. RESULTS: Only one patient manifested a partial response with topical ceramides, yielding a response rate of 4% (90% confidence interval 0, 17.6%). Median cutaneous progression-free survival was 2 months. The topical ceramides were also well tolerated, with no grade 3 or 4 toxicity reported. None of the six patients who underwent serial skin biopsies showed increased tumor cell apoptosis morphologically or by the modified TUNEL assay. CONCLUSION: To our knowledge, this trial is one of the first clinical investigations of short chain ceramides. This trial's results are not promising enough to merit further study of ceramides in the manner prescribed.
Administration, Cutaneous↗
Comparison of nicotine patch alone versus nicotine nasal spray alone versus a combination for treating smokers: a minimal intervention, randomized multicenter trial in a nonspecialized setting.
This multicenter, randomized, open-label clinical trial was conducted to determine whether the combined use of nicotine patch therapy and a nicotine nasal spray would improve smoking abstinence rates compared to either treatment alone, without behavioral counseling. Data were collected at 15 regional cancer control oncology centers within the North Central Cancer Treatment Group. Of the 1384 smokers randomized to the study, 20% were abstinent from smoking at 6 weeks and 8% were abstinent at 6 months. At 6 weeks, the 7-day point prevalence smoking abstinence rate for the patch alone (21.1%) was superior to the spray (13.6%) but was significantly lower than the rate for combination therapy (27.1%). At 6 months, the 7-day point prevalence abstinence rates were not significantly different among the three groups. Combination nicotine nasal spray and nicotine patches were delivered safely in a nonspecialized outpatient clinical setting and enhanced short-term smoking abstinence rates, but these rates were not sustained at 6 months.
Administration, Cutaneous↗
Depomedroxyprogesterone acetate for hot flashes.
To evaluate the efficacy of a long-acting preparation of medroxyprogesterone acetate for hot flash management, 3 men receiving androgen ablation therapy for prostate cancer and 15 women with a history of breast cancer were treated as part of clinical practice with three biweekly intramuscular injections of 500 mg depomedroxyprogesterone. A review of hot flash diaries and patient charts were completed to evaluate the effectiveness and tolerability of these injections for managing hot flashes. Treatment was associated with an approximate 90% decrease in hot flashes (95% CI 82-97%). Daily hot flash frequency decreased from a mean of 10.9 on the first day of treatment (95% CI 8.0-13.8 hot flashes per day) to a mean of 1.1 hot flashes 6 weeks later (95% CI 0.5-1.8 hot flashes) and to a mean of 0.7 hot flashes 12 weeks following therapy initiation (95% CI 0.1-1.2). Improvement in the hot flashes remained for months after discontinuing the injections in many patients. Reported side effects were minimal. This experience suggests that treatment with depomedroxyprogesterone may be an effective and well-tolerated option for the treatment of hot flashes.
Adult↗
Novel approaches to preventing chemotherapy-induced cognitive dysfunction in breast cancer: the art of the possible.
Chemotherapy-induced cognitive dysfunction in women with breast cancer has become an increasingly important clinical issue. To date, little is known about its incidence, exact characteristics, and exact pathophysiology. Likewise, no treatments have been shown to prevent or decrease cognitive changes thought to result from chemotherapy. However, ongoing scientific research might help us understand the mechanisms that will help patients maintain maximal cognitive function. Changes in cognition due to chemotherapy might result from indirect chemical toxicity and oxidative damage, direct injury to neurons, inflammation, or a type of autoimmune response. Based on these potential causes, and based on interventions that have been tested in dementia and Alzheimer's disease, there are a number of potential, novel interventions that could be tested in clinical trials as treatments for chemotherapy-induced cognitive dysfunction. Possible anecdotal strategies to consider include hormonal interventions, antioxidants, monoamine oxidase inhibitors, growth factors, dopamine agonists, cholinesterase inhibitors, antiinflammatory agents, and behavioral interventions
Anti-Inflammatory Agents, Non-Steroidal↗
Current management of menopausal symptoms in cancer patients.
Menopause can be experienced prematurely by women with cancer and, as such, is often accompanied by symptoms that are becoming salient management issues. It is common practice to avoid estrogen replacement therapy in women with estrogen-sensitive tumors. Therefore, the effective management of vasomotor symptoms, urogenital problems, and the prevention of osteoporosis and cardiac disease requires knowledge of nonhormonal interventions. This article discusses the changes women experience during menopause and the symptoms to which these changes can contribute. Pharmacologic options without estrogen, as well as nonpharmacologic interventions, are presented for the treatment of hot flashes, vaginal dryness, and urinary incontinence, and the maintenance of skin, bone, and heart health. The issue of cognitive dysfunction is also addressed. For most of the problems associated with menopause, viable, effective options are available for cancer survivors.
Breast Neoplasms↗
Venlafaxine for the control of hot flashes: results of a longitudinal continuation study.
PURPOSE/OBJECTIVES: To evaluate the intermediate term efficacy and toxicity of the use of venlafaxine for the control of hot flashes. DESIGN: An open-label continuation phase study following a double-blind, randomized, placebo-controlled clinical trial that tested three doses of venlafaxine for the control of hot flashes. SETTING: North Central Cancer Treatment Group institutions. SAMPLE: 102 postmenopausal women. METHODS: Women could titrate venlafaxine to optimum efficacy while recording daily hot flash counts and weekly toxicity information. MAIN RESEARCH VARIABLES: Hot flash frequency, hot flash score. FINDINGS: The reduction in hot flashes previously reported in the randomized study phase was maintained during the open-label study. Toxicity did not appear to increase over time. CONCLUSIONS: The data from this study provides evidence that venlafaxine has intermediate term efficacy and good tolerability as a treatment for hot flashes. IMPLICATIONS FOR NURSING PRACTICE: Nurses can inform symptomatic women that an effective nonhormonal alternative exists to control their hot flashes.
Anorexia↗