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Biomedical subjects

Dirk Schrijvers

Publications and source records attributed to Dirk Schrijvers.

12 recordsLinked to original sources
PubMed2006

Independent risk factors for anemia in cancer patients receiving chemotherapy: results from the European Cancer Anaemia Survey.

OBJECTIVES: To develop a hitherto unavailable risk factor model for accurately predicting anemia development in cancer patients before chemotherapy (CT) administration. METHODS: 2,070 nonanemic patients from the European Cancer Anaemia Survey (ECAS) with hemoglobin (Hb) > or =12 g/dl at enrollment who received their first CT during ECAS and underwent at least two CT cycles were divided randomly into split half (SH) 1 and SH2 (n = 1,035 each). The model was developed on SH1 using logistic regression to simultaneously evaluate predictive factors, and was validated using SH2 and an additional similar subpopulation of 5,901 ECAS patients. Anemia risk values were assigned to the predictive factors and the sum of the predictive factors gave the total anemia risk score; lower-, higher-, and highest-risk cutoff points of the total anemia risk score were determined. RESULTS: Variables ultimately identified as significant predictive factors for anemia were: lower initial Hb (< or =12.9 g/dl in females, and < or =13.4 g/dl in males); having lung or gynecologic cancer versus gastrointestinal (GI)/colorectal cancer; cancer at any other site versus GI/colorectal cancer; treatment with platinum CT, and female gender. CONCLUSION: Using this evidence-based risk model, nonanemic patients who are at the highest risk of developing anemia prior to receiving CT can be identified clinically, allowing appropriate anemia management to be planned.

Adult↗
PubMed2005

Metabolic emergencies.

Life-threatening metabolic complications observed in cancer patients are: hypercalcaemia, hyponatremia, hyperurcaemia, tumour lysis syndrome, hypoglycaemia, hyperuremia and hypercreatininemia secondary to renal failure, hyperammoniemia, lactic acidosis and adrenal failure. They may be associated with any kind of neoplastic disease causing dysfunction of vital organs, which can be determined by neoplastic spread, anti-cancer treatment or, more rarely, by paraneoplastic phenomena. The clinical presentation of metabolic complications is typically aspecific. Encephalopathy, raging from mild confusion to coma, is the most common and clinically most severe symptom. The severity of consciousness impairment is related to both the rate of onset and the magnitude of the metabolic disorder. The definitive diagnosis will be established by laboratory examination and radiological work-up. Cancer patients presenting metabolic should be referred to oncologic departments or intensive care units. The treatment of metabolic disorders include: prophylactic measures, emergency measures to preserve vital functions and to restore biological parameters and the treatment of the underlying primary.

Antineoplastic Agents↗
PubMed2005

Epidural spinal cord compression.

Spinal cord compression from epidural metastases (epidural spinal cord compression, ESCC) is the most common neurological complication of cancer after brain metastases. Extradural compression represents 97% of spinal cord metastatic lesions. ESCC usually occurs in patients with disseminated disease. The most common tumours associated with ESCC are lung and breast cancers, followed by lymphoma, myeloma, prostate cancer and sarcoma. ESCC represents a medical emergency because delayed treatment can be responsible for irreversible deficits, such as paralysis and loss of sphincter control. Patients with ESCC require a multidisciplinary diagnostic and therapeutic approach. Clinical suspect is radiologically detected for confirmation. The median expected survival time from diagnosis usually ranges from 3 to 6 months. The nature of the primary tumour and the degree of the neurological deficit are the most important factors affecting survival. The lack of prospective randomized trials makes the optimal treatment of ESCC controversial and the decision is to be tailored to the individual. Treatment options include: bed rest, administration of corticosteroids, surgery followed by radiation therapy, radiotherapy alone and, to a limited extent, chemotherapy and hormonal therapy.

Epidural Neoplasms↗
PubMed2005

Taxanes in the treatment of head and neck cancer.

PURPOSE OF REVIEW: This review presents new data on the role of paclitaxel and docetaxel in the management of squamous cell carcinoma of the head and neck. Recently both agents have been tested in squamous cell carcinoma of the head and neck in combination with other chemotherapeutic agents, targeted drugs, and radiotherapy in in-vitro experiments and in the clinic as first-line treatment of patients with metastatic/recurrent and locally advanced squamous cell carcinoma of the head and neck. RECENT FINDINGS: The combination of taxanes with standard or accelerated radiotherapy is feasible and induction chemotherapy followed by chemoradiation is active and feasible without excessive toxicity in patients with locally advanced squamous cell carcinoma of the head and neck. The use of low-dose fractionated radiotherapy shows promising in-vitro and clinical results and is further explored. SUMMARY: Both docetaxel and paclitaxel can be combined with chemotherapeutic agents and radiotherapy, but phase III studies are needed to prove the superiority of these approaches compared to standard treatment. The final results of the combination study of cisplatin and 5-fluorouracil with or without docetaxel may change the standard chemotherapeutic regimen for induction chemotherapy in patients with locally advanced squamous cell carcinoma of the head and neck.

Antineoplastic Agents, Phytogenic↗
PubMed2005

Cancer-related anemia: pathogenesis, prevalence and treatment.

Cancer-related anemia is a cytokine-mediated disorder resulting from complex interactions between tumor cells and the immune system. Overexpression of certain inflammatory cytokines results in shortened survival of red blood cells, suppression of erythroid progenitor cells, impaired iron utilization, and inadequate erythropoietin production. Numerous other factors may also contribute to the development of anemia in cancer patients. The European Cancer Anaemia Survey (ECAS) has provided the most current, comprehensive, prospectively collected data on the incidence and prevalence of anemia among cancer patients, as well as important perspectives on anemia treatment and relationship of hemoglobin and performance status. ECAS enrolled over 15,000 treated and untreated patients with various malignancies from cancer centers in 24 European countries and followed them for up to 6 months. The initial analysis of the ECAS data revealed that 39% of the total cancer patient population was anemic (hemoglobin <12.0 g/dl) at enrollment, although the rate varied according to tumor type, disease status, and cancer treatment status. Of the patients who were not anemic at enrollment and started cancer treatment during the survey, those undergoing chemotherapy--either alone or in combination with radiotherapy--had the highest incidence of anemia (63 and 42%, respectively). Low hemoglobin levels correlated with poor performance status and only 40% of patients who were anemic at some time during the survey received treatment for their anemia. These findings are noteworthy, since a growing body of clinical evidence indicates that the treatment of anemia can significantly improve patients' quality of life and may also improve the clinical outcome.

Anemia, Hypochromic↗
PubMed2005

Management of cancer-related anemia in patients with breast or gynecologic cancer: new insights based on results from the European Cancer Anemia Survey.

The incidence, prevalence, and treatment of anemia (hemoglobin [Hb] <12 g/dl) in women with breast cancer and gynecologic cancer were evaluated using data from the European Cancer Anemia Survey (ECAS). Adult patients with newly diagnosed treated or untreated disease, persistent/recurrent disease, and disease in remission were enrolled and followed for up to six chemotherapy cycles or six evaluation points within a 6-month period. At enrollment, 30.4% of breast cancer patients and 49.1% of gynecologic cancer patients were anemic. A significant correlation was shown between low Hb level and poor performance status (World Health Organization criteria) at enrollment for both breast cancer and gynecologic cancer patients. In all, 62.4% of breast cancer patients and 81.4% of gynecologic cancer patients were anemic at some time during the survey. The incidence of anemia, determined in a carefully defined population, was 59.8% for breast cancer patients and 74.8% for gynecologic cancer patients. Despite the high prevalence and incidence of anemia, only 26.3% and 42.7% of patients in the respective groups received anemia treatment. In breast cancer patients, the mean Hb trigger was 10 g/dl for epoetin treatment and 8.6 g/dl for transfusion; corresponding values for gynecologic cancer patients were 10.1 g/dl and 9.1 g/dl. Logistic regression analyses in the overall ECAS population identified five factors as significant and suitable predictors of anemia: lower initial Hb, having lung or gynecologic cancer versus gastrointestinal/colorectal cancer, any other cancer versus gastrointestinal/colorectal cancer, treatment with platinum chemotherapy, and being female. The ECAS data highlight the need for greater awareness of the adverse impact of anemia on cancer patients and for optimal anemia management to ensure maximal patient quality of life.

Adult↗
PubMed2005

Taxanes in head and neck cancer.

Paclitaxel and docetaxel are cytotoxic agents that act on the microtubule system and cause cell death. They are active in patients with squamous cell carcinoma of the head and neck region. They can be combined with other cytotoxic agents and radiotherapy with acceptable toxicity. This article reviews of both docetaxel and paclitaxel data in this patient population. Taxanes do not yet have a a license for use in the standard treatment of patients with head and neck cancer in Europe.

Head and Neck Neoplasms↗
PubMed2004

The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients.

The European Cancer Anaemia Survey (ECAS) was conducted to prospectively evaluate the prevalence, incidence and treatment of anaemia (haemoglobin <12.0 g/dL) in European cancer patients, including the relationship of mild, moderate and severe anaemia to performance status. Patients were evaluated for up to 6 months. Data (N=15367) included demographics, tumour type, performance status, haemoglobin levels, cancer treatments and anaemia treatments. Prevalence of anaemia at enrollment was 39.3% (haemoglobin <10.0 g/dL, 10%), and 67.0% during the survey (haemoglobin <10.0 g/dL, 39.3%). Low haemoglobin levels correlated significantly with poor performance status. Incidence of anaemia was 53.7% (haemoglobin <10.0 g/dL, 15.2%). Anaemia was treated in 38.9% of patients (epoetin, 17.4%; transfusion, 14.9%; and iron, 6.5%). Mean haemoglobin to initiate anaemia treatment was 9.7 g/dL. Anaemia prevalence and incidence in cancer patients are high. Anaemia significantly correlates with poor performance status and many anaemic patients are not treated.

Adolescent↗
PubMed2003

Role of red blood cells in pharmacokinetics of chemotherapeutic agents.

After oral or parenteral administration of chemotherapeutic agents, these drugs are transported to the tissues by the blood in different fractions: plasma water, plasma proteins or cells. Erythrocytes may play an important role in the storage, transport and metabolism of chemotherapeutic agents. Anthracyclines, ifosfamide and its metabolites, and topoisomerase I and I/II inhibitors are incorporated in red blood cells. They may be transported to the tumour tissue and mobilised from the erythrocyte by different active or passive transport mechanisms. Erythrocytes may also be used as carriers for drugs such as asparaginase. This leads to a decreased toxicity profile. Finally, it has been shown that red blood cells are important in the transport and metabolism of mercaptopurine. The erythrocyte concentration of mercaptopurine has a prognostic value in the treatment of childhood acute lymphoblastic leukemia. In this review, the role of red blood cells for various anticancer drugs is further discussed.

Alkylating Agents↗
PubMed2002

Phase I studies with bendamustine: an update.

Bendamustine is a novel agent with both alkylating and purine-like moieties that is currently in phase II/III trials for the treatment of hematologic malignancies and breast, lung, and gastrointestinal tumors. Bendamustine was developed in the early 1960s and first used clinically in 1969 in patients with multiple myeloma. Since then, various dose and treatment schedules have been used empirically. Although bendamustine has been in clinical use for over three decades, the early clinical trials do not conform to present-day standards of good clinical practice. Therefore, it was necessary to conduct a full range of clinical trials before application for a European marketing license could be made. To date, bendamustine has been investigated both as a single agent and in combination with other anticancer drugs, in phase I, II, and III clinical trials. This article presents an overview of the recent phase I trials and a summary of ongoing clinical trials.

Antineoplastic Agents↗
PubMed2002

A new method to obtain and present complete information on the compatibility: study of its validity for eight binary mixtures of morphine with drugs frequently used in palliative care.

Parenteral administration of mixtures of morphine with other drugs has become common practice in palliative care. Such mixtures are sometimes found to be incompatible but compatibility data are scarce. An attempt was made to develop a quick and simple investigation strategy to obtain complete information on the compatibility of two drugs. This strategy was then used to study the physical and chemical compatibility of morphine HCl with alizapride HCl, atropine sulphate, dexamethasone sodium phosphate, hyoscine butylbromide, metoclopramide HCl, octreotide lactate, ranitidine HCl and hyoscine hydrobromide. These compatibility data are presented in such a way that they are easy to use in clinical practice. The investigation strategy outlined here allows the collection of complete information on the compatibility of morphine with another drug by studying a limited number of carefully selected mixtures per combination. The mixtures to be studied are selected using a scheme in which all possible mixtures prepared by mixing morphine solutions of varying concentrations with a drug solution in different volume ratios can be visualized. Applying this strategy to the eight combinations revealed, except for ranitidine HCl, no physical (visual) or chemical (HPLC; >90%) incompatibility in any of the mixtures studied for seven days at 22 and 32 degrees C. This indicates that all possible mixtures of these drug solutions with morphine HCl are compatible. For the combination with ranitidine incompatibility was observed only when using morphine HCl solutions containing >40 mg/ml and at certain ratios (drug/morphine HCl [D/M]: 4/42, 10/6 and 8/8, v/v), but all physically compatible mixtures were chemically stable (>90%). Studying extra mixtures in addition to those required to be studied according to the strategy revealed no discrepancies for any of the eight combinations studied. Adaptation of the layout of the scheme and the design of a decision tree resulted in an easy tool to check compatibility in daily practice. The scheme designed in this study is a useful tool for research and for daily practice. It simplifies and thereby encourages investigation of the compatibility of drugs. The availability of data on the physical as well as chemical compatibility in daily practice will contribute to a better quality of the mixtures used in palliative care and help to avoid complications and inadequate symptom control.

Analgesics, Opioid↗