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Biomedical subjects

David Cameron

Publications and source records attributed to David Cameron.

31 records · Page 2Linked to original sources
PubMed2004

Maximizing clinical benefit with trastuzumab.

To optimize patient management in breast cancer a number of factors are considered, including hormone receptor and HER2 status. A feasible approach for women with less aggressive, estrogen receptor/HER2-positive metastatic breast cancer is to consider trastuzumab (Herceptin; F. Hoffmann-La Roche, Basel, Switzerland) combined with endocrine therapy. Randomized clinical trials are ongoing to assess the combination of trastuzumab with aromatase inhibitors. In patients with aggressive HER2-positive metastatic breast cancer, trastuzumab/chemotherapy combination regimens are warranted. When administered first line in combination with a taxane, trastuzumab improves all clinical outcome parameters, including survival, in such patients. Trastuzumab adds little to the toxicity profile of taxanes, and trastuzumab combination therapy is associated with improvements in quality of life when compared with chemotherapy alone. There is encouraging evidence of improved efficacy when trastuzumab is combined with other cytotoxic agents with proven single-agent activity in breast cancer, including capecitabine (Xeloda; F. Hoffmann-La Roche), gemcitabine, and vinorelbine. Trastuzumab is also being investigated as part of triplet drug regimens. Trastuzumab has good single-agent activity in first-line therapy. This is of relevance to women with HER2-positive disease who are not suitable for, or do not wish to receive, cytotoxic chemotherapy. The benefits noted with trastuzumab-containing regimens were documented in clinical trials where trastuzumab was given until disease progression. A further rationale exists to continue trastuzumab beyond progression. Data from retrospective reviews indicate that this strategy is feasible.

Antibodies, Monoclonal↗
PubMed2004

Future options with capecitabine (Xeloda) in (neo)adjuvant treatment of breast cancer.

As an active and well-tolerated agent in the treatment of metastatic breast cancer, capecitabine (Xeloda, F. Hoffmann-La Roche, Basel, Switzerland) has the potential to confer significant clinical benefits in the primary treatment of breast cancer. The minimal myelosuppression and alopecia associated with capecitabine, together with its potential for synergistic activity with a range of other anticancer therapies, lend support to its use in combination regimens with other commonly used cytotoxic agents. Trials to date show that capecitabine combinations incorporating taxanes, vinorelbine, anthracyclines, and cisplatin are active and well tolerated in the metastatic setting. To more fully explore the clinical utility of capecitabine in early breast cancer, an extensive, worldwide phase II/III program is evaluating capecitabine as a component of adjuvant and neoadjuvant therapy. Results presented to date of the large adjuvant and neoadjuvant trials incorporating capecitabine are encouraging and suggest that women with breast cancer might benefit from the activity of capecitabine early in the disease course.

Antimetabolites, Antineoplastic↗
PubMed2004

Patient management issues in metastatic bone disease.

The main goals of bisphosphonate therapy are to prevent and treat skeletal events, minimize disability, and relieve pain without increasing the overall burden that bone metastases (and their treatment) place on patients. The ease and convenience of treatment are important to patients, and there are data suggesting that patients prefer oral therapy over intravenous drugs to help them maintain a normal life. Intravenous therapy with zoledronic acid and pamidronate is currently time-consuming; preparation, renal monitoring, infusion, and follow-up use valuable health care resources. Intravenous ibandronate could help alleviate this burden because of its good renal safety profile. Although efficacious, oral clodronate has compliance problems because of multiple dosing, large tablet size, and gastrointestinal tolerability issues. Recent phase III trials of oral ibandronate have shown efficacy similar to that of intravenous ibandronate, with no compliance or tolerability concerns. Ibandronate appears to have several advantages over current therapies that could improve treatment acceptability and reduce the burden of disease on the health care system. Research continues into the efficacy, safety, and pharmacoeconomics of ibandronate.

Administration, Oral↗
PubMed2004

Time for a change in breast cancer therapy?

Taken together, recent studies make a powerful case for the licensing of aromatase inhibitors in the adjuvant setting, offering an alternative to tamoxifen which has long been the gold standard in breast cancer therapy in the prevention of recurrence.

Antineoplastic Agents, Hormonal↗
PubMed2004

Use of sedation to relieve refractory symptoms in dying patients.

OBJECTIVES: To document the use of sedation for refractory symptoms in patients admitted to an independent palliative care unit. METHOD: A prospective descriptive study. SETTING: The 7-bed inpatient unit at Sungardens Hospice, Pretoria. SUBJECTS: Patients who required sedation for refractory symptoms in addition to normal palliative care treatment between January and June 2002. FINDINGS: Twenty of 100 consecutive patients admitted required sedation. All had advanced cancer. Their mean age was 68 years. Thirty-six per cent were men and 64% women. INDICATIONS: Agitated delirium was the most common reason (45%) for using sedation, followed by intractable vomiting due to inoperable malignant intestinal obstruction in 25% of patients. Three patients with persistent convulsions or myoclonic jerking and 2 patients with severe refractory dyspnoea required some sedation. Intractable pain was the main reason for sedation in only 1 patient. SURVIVAL: Mean survival following the start of sedation was 92 hours/3.8 days (range 6 - 369 hours/0.25 - 19.4 days). The combined mean survival recorded in 9 other studies was 57 hours/2.4 days (range 36 - 93.6 hours/1.5 - 3.9 days). MEDICATION: The main drugs used for sedation were midazolam and haloperidol. The mean dosage for midazolam was 18.5 mg/24 hours (range 7.5 - 40 mg) and for haloperidol 8 mg/24 hours (range 5 - 10 mg). For pain relief the mean daily dose of parenteral morphine was 76 mg (range 15 - 260 mg). CONCLUSION: Use of sedation for the relief of refractory symptoms at Sungardens Hospice is in line with several studies reported in the international literature.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Management of postoperative nausea and vomiting in ambulatory surgery.

The management of PONV has improved significantly over the years but remains a frequent occurrence in postoperative patients. Evaluation of individual patient risk and the consideration for prophylactic antiemetic in high-risk populations should reduce these unpleasant symptoms and help direct appropriate clinical strategies. Treatment following failure of prophylactic antiemetic therapy requires knowledge of previously used antiemetics and the time of their administration.

Ambulatory Surgical Procedures↗
PubMed2003

Proven efficacy of zoledronic acid in the treatment of bone metastases in patients with breast cancer and other malignancies.

Many advanced cancers, particularly breast cancer and prostate cancer, metastasize to the bone, resulting in painful lesions and skeletal complications. Intravenous bisphosphonate therapy is an important component of palliative care for patients with bone metastases, and pamidronate has been the standard of care for patients with breast cancer and multiple myeloma since 1996. However, zoledronic acid is the first bisphosphonate shown to significantly reduce skeletal morbidity in patients with a wide range of primary tumor types. Zoledronic acid has demonstrated efficacy in the management of hypercalcemia and metastatic bone disease. In phase III studies involving more than 3000 patients with multiple myeloma, breast cancer, prostate cancer, lung cancer, and other cancers, 4 mg zoledronic acid demonstrated consistent efficacy across a range of clinical end-points, and was safe and well tolerated when infused over 15 min. Based on these studies, zoledronic acid appears to be active in patients with bone metastases irrespective of tumor type, and should be considered as the standard of care for the treatment of bone metastases.

Bone Neoplasms↗
PubMedDate not supplied

A comparison of high-profile and low-profile dynamic mobilization splint designs.

Despite claims that the high-profile dynamic mobilization splint design requires less frequent adjustments than the low-profile design, the authors are not aware of biomechanical evidence supporting such claims. The purpose of this study was to reexamine this claim and quantitatively analyze each design as well as the differences between designs with respect to the actual deviation from a 90 degrees angle of applied force for 60 degrees, 30 degrees, 20 degrees, and 10 degrees gains in proximal interphalangeal joint (PIP) extension. Additionally, for 10 degrees, 20 degrees, and 30 degrees gains in PIP extension, the authors determined the corrective and shear forces as a function of the deviation from a 90 degrees angle of applied force for each design, as well as the difference between the designs. Results show that in all instances examined, the actual difference between the designs is quite small. Implications of such findings are discussed along with newly identified relationships of potential utility to the hand therapist.

Biomechanical Phenomena↗