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Biomedical subjects

E Van Cutsem

Publications and source records attributed to E Van Cutsem.

105 records · Page 6Linked to original sources
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Combination therapy of experimental histoplasmosis and cryptococcosis with amphotericin B and ketoconazole.

Combinations of amphotericin B and ketoconazole had an additive effect in vitro against Histoplasma capsulatum and Cryptococcus neoformans; ketoconazole combined with flucytosine exerted an indifferent effect against C. neoformans. In vivo studies in athymic nude (nu/nu) mice and their heterozygous (nu/+) littermates demonstrated that treatment with the ketoconazole-amphotericin B combination resulted in longer survival of mice with cryptococcosis than did treatment with ketoconazole plus flucytosine. However, mice given ketoconazole plus amphotericin B did not survive significantly longer than those given amphotericin B alone (cryptococcosis) or ketoconazole alone (histoplasmosis). Combination chemotherapy with ketoconazole and amphotericin B may offer a modest therapeutic advantage over therapy with either drug alone.

Amphotericin B↗
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The medical treatment of colorectal cancer: actual status and new developments.

Colorectal cancer is one of the most frequent malignancies and one of the greatest causes of cancer death in the Western world. The prognosis is determined by the stage at diagnosis. Patients with metastatic colon cancer have a bad prognosis. Chemotherapeutic treatment with 5-Fluorouracil (5-FU) and folinic acid is actually considered as the standard treatment in patients with metastatic disease. Although the survival benefit is relatively small, many patients can benefit from this treatment in terms of tumor regression or symptom improvement. Several new drugs are actually in development and create hope for improved tumor or symptom control and longer survival. Thymidylate synthase inhibitors (raltitrexed), topoisomerase I inhibitors (irinotecan), the oral 5-FU prodrugs (capecitabine, UFT), ethynyluracil, and oxaliplatin are promising new drugs. The challenge will be to determine the best combination of these new drugs and the exact sequence in which these drugs will be used. Adjuvant post-operative chemotherapy in colon cancer is one of the most important advances in oncology that has been introduced into the clinic during the last years. For rectal cancer, an adjuvant treatment should consist of a combined chemo-radiotherapy. The search for better prognostic factors for recurrence should help to focus on a better adjuvant treatment for patients with the highest risk for recurrence.

Antineoplastic Agents↗
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Different gastritis features are linked to different gastric neoplasms.

OBJECTIVES: Helicobacter pylori infection induces gastritis, which may evolve to carcinoma or lymphoma. Whether duration of infection and inflammation pattern determine the outcome of the neoplastic process is not known. The aim of this study was to investigate the features of the gastritis associated with neoplasia. METHODS: Gastritis found in association with carcinoma (100 cases) and lymphoma (45 cases) were graded using the Sydney system. RESULTS: In particular in the antrum, gastric carcinomas, in particular of the intestinal type, were associated with a chronic (94%, n = 34/36) atrophic (92%, n = 33/36) gastritis and intestinal metaplasia (81%, n = 29/36). In diffuse type carcinomas inflammation was either absent or mild. An active (64%, n = 16/25), chronic gastritis (100%, n = 25/25) with lymphoid hyperplasia (72%, n = 18/25) was found in marginal zone cell lymphoma. CONCLUSIONS: Our study shows that the (pre)atrophic phases of inflammation are associated with gastric carcinomas. In contrast the active phase of inflammation, characterized by severe activity as well as severe chronicity, is found next to marginal zone cell lymphoma.

Adult↗
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The molecular basis of colorectal cancer.

Colorectal cancers, whether sporadic or hereditary, are caused by a defined set of molecular events. The genes and pathways involved in the earliest steps of tumorigenesis have crucial functions in the regulation of normal crypt homeostasis. Further insight into these pathways can lead to the development of useful prognostic indicators, and target preventive and therapeutic strategies in the management of colorectal cancer. Mutations in the APC/beta-catenin/Tcf-4 pathway lead to important changes in stem cell dynamics, before clinically identifiable lesions appear. Preventive strategies aimed at reversing these changes or therapeutic interventions targeting cell populations with these alterations should be most efficacious.

Adenoma↗
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Compassionate use of Gemzar in advanced pancreatic cancer: a Belgian experience.

Gemzar is a nucleoside analog that has been shown to be superior to 5-fluorouracil for the treatment of advanced pancreatic cancer in terms of both clinical benefit and survival. This open label program enrolled 214 patients. Patients eligible for this program had advanced or metastatic pancreatic cancer, received up to one previous chemotherapy, a baseline Karnofsky performance status (KPS) of at least 50, measurable or evaluable disease, adequate organ function defined as: absolute leucocyte count > 3 x 10(9)/L, platelet count > 100 x 10(9)/L, hemoglobin > 9 gr/dL, total bilirubin < 2 x upper limit of normal (ULN), creatinine < 2 x ULN, ALT and AST levels < 5 x ULN and were at least 18 years. A 1000 mg/m2 of Gemzar was administered weekly up to 7 weeks followed by a week of rest, then once weekly for 3 weeks out of every 4 weeks. The median age at inclusion was 64 years, 52% of the patients were male, 27% were 70 year or older, 66% had stage IV disease, 66% had a KPS of 80 or higher and 34% had received no prior chemotherapy. The overall response rate is 7%. A time-to-first-serious-event analysis was performed since only a limited number of dates of death were available. The first serious event (FSE) was considered as the earliest of the following: increase by at least 2 of the pain score, deterioration of KPS of at least 20, documentation of progressive disease or death. The median time to FSE was 4 months, the free FSE rate at 1 year was 14%. We conclude that the results observed in this program confirm the established efficacy of Gemzar in pancreatic cancer.

Adenocarcinoma↗
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Report on the Belgian consensus meeting on colorectal cancer screening.

Screening and prevention of colorectal cancer must be a public health priority. It is the most frequent malignancy in Europe, the second leading cause of cancer death, including Belgium where more than 6000 new cases occur per year. Various screening modalities, from non invasive to invasive are available and currently in use and they are all cost-effective in comparison with no screening. The decision as to which screening test to use should be made by the patient and clinician. Consensus documents prepared by the Belgian scientific community appear in this issue of Acta Gastroenterologica Belgica, summarizing the scientific evidence in favour as well as the limitations of fecal occult blood tests, flexible sigmoidoscopy, videocolonoscopy and virtual colonoscopy.

Belgium↗
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Computed tomographic colonography.

Computed tomographic colonography, also called virtual colonoscopy, is an evolving technology under evaluation as a new method of screening for colorectal cancer. However, its performance as a test has varied widely across studies, and the reasons for these discrepancies are poorly defined. We provide an overview of some potential causes and discuss the available, often indirect, evidence. In addition, several other obstacles that may influence implementation are discussed. Future investigations should demonstrate the influence of these potential factors on sensitivity of computed tomographic colonography. Despite a growing body of evidence, it remains uncertain to what extent patient acceptance, radiation issues, flat lesions, and extracolonic findings will be a stumbling block to using computed tomographic colonography for colorectal cancer screening.

Aged↗
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Etoposide, leucovorin and 5-fluorouracil in advanced gastric cancer: a phase II study.

It has been suggested that the combination of etoposide, leucovorin and 5-fluorouracil (ELF) is very active in the treatment of advanced gastric cancer in elderly patients. The aim of this study was to confirm the efficacy and to investigate the toxicity of the ELF-regimen in patients of all ages. Thirty patients with advanced gastric adenocarcinoma were treated with leucovorin (300 mg/m2), etoposide (100 mg/m2) and 5-FU (500 mg/m2) for 3 consecutive days every 4 weeks in a phase II study. Reevaluation of measurable disease was done after 3 cycles. A partial response was shown in 8 (27%) patients. An improvement of the Karnofsky Performance Status was observed in 10 (33%) patients. The mean survival amounted to 8 months (range 2-24). Toxicity was mild. No grade 4 toxicity nor chemotherapy-related mortality were observed. It is concluded from this phase II study that the ELF-regimen is an active palliative treatment for advanced gastric cancer, with mild toxicity.

Adenocarcinoma↗
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Repeated hepatic ischemia in combination with chemotherapy for liver carcinoid metastases.

Both hepatic ischemia and chemotherapy are effective in the treatment of carcinoid liver metastases, but their effectiveness is often limited, partial and transient. It has been shown that, during intermittent occlusion of the hepatic artery with a surgically implanted occluder, no revascularisation from collaterals occurs. We studied the feasibility, the side-effects, the response to tumour measurements and hormonal excretions of a combined treatment of repeated hepatic ischemia and 5-Fluorouracil and Streptozotocin-administration in carcinoid liver metastases.

Adult↗
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Georges Brohee Prize. Oestrogen-progesterone, a new therapy of bleeding gastrointestinal vascular malformations.

Gastrointestinal vascular malformations can cause haemorrhage requiring multiple transfusions. Surgical or endoscopic therapy are ineffective when the vascular malformations are spread diffusely over the gastrointestinal tract, when lesions escape identification or are not accessible for treatment. Several reports suggest that oestrogen-progesterone therapy is effective in the treatment of epistaxis in hereditary haemorrhagic telangiectasia. The aim of our studies is to test the hypothesis that oestrogen-progesterone is an effective treatment for bleeding gastrointestinal vascular malformations in patients with a very high transfusion need and in whom surgical or endoscopic treatment failed or could not be performed. The mean transfusion requirement prior to entering the studies amounted to 35.4 units packed per patient. In an uncontrolled trial oestrogen-progesterone therapy diminished significantly transfusion requirements from 3.4 units packed cells per patient per month to 0.1 units packed cells (p = 0.02). Haemorrhage ceased totally in 3 of 7 patients. A double-blind randomized placebo-controlled, cross-over trial shows that therapy with 0.050 mg ethinyloestradiol and 1 mg norethisterone is very effective in reducing transfusion requirements: 2.8 versus 11.2 units packed cells over a 6 month treatment period (p = 0.002). Only 3 of 13 patients treated with ethinyloestradiol and norethisterone required transfusions for persistent bleeding, while 12 of 13 patients in the placebo group had transfusion requirements (p = 0.001). After stopping hormonal therapy, no transfusions were needed for a mean of 10 months. This indicates a long-lasting effect of ethinyloestradiol and norethisterone on bleeding and transfusion requirements.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
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Screening for colorectal cancer.

The authors review the place of faecal occult blood testing, sigmoidoscopy and total colonoscopy in the screening of colorectal cancer. Strategy in high risk patients is also discussed.

Adenomatous Polyposis Coli↗
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Follow-up of colon cancer: detection of liver metastases: benefit and periodicity.

UNLABELLED: The aim a follow-up programme in patients with cancer is to detect relapse or metastases in an early asymptomatic stage. This is only useful if the diagnosis of recurrence has implications for treatment and if early treatment of recurrence leads to an improved prognosis. This is certainly the case for liver metastases of colon cancer. Surgical resection of localised liver metastases has a 25-30% 5-year survival. Early chemotherapy for non-resectable metastatic disease improves the survival and prolongs the symptom-free period in comparison with chemotherapy starting at the onset of symptoms. Follow-up for colorectal cancer should be offered to patients with the highest risk of recurrence and should consist of clinical examination, CEA monitoring, ultrasound of the liver, chest X-ray and periodic colonoscopy. Issues for further research are the determination of a follow-up programme with the highest sensitivity, the determination of the periodicity of follow-up, the search for prognostic factors for recurrence, cost issues and the final proof of a survival benefit in a large follow-up programme. CONCLUSIONS: Indirect evidence supports the need for a good follow-up programme for colorectal cancer focussing on the detection of liver metastases.

Colonic Neoplasms↗