Twelve cases of Trichosporon spp. fungemias occurring in a national cancer institution within 10 years are described. The trend of hematogenous trichosporonosis within the last 10 years is ...increasing. While no cases occurred in 1988-1991, after 1991, Trichosporon spp. was the most common species among non-Candida spp. fungemias in 1993-1997. The 12 cases of fungemia included 5 that started while the patients were receiving prophylaxis with oral itraconazole, and 2 appeared despite empiric therapy with amphotericin B. Five of the 12 fungemias were catheter associated. Risk factors for fungemia were: central venous catheter, broad-spectrum antibiotics (third-generation cephalosporins plus aminoglycoside); all but 1 had neutropenia and were receiving antineoplastic chemotherapy. All but 2 of the patients died of systemic fungal infection (83.3% mortality). Amphotericin B was administered to all but 1 patient, who was not treated because he died the day after his culture was found to be positive for T. beigelii, before antifungals were administered. All cases infected with T. pullulans were catheter related, and all these patients died. One of the remaining 9 fungemias was caused by T. capitatum (Blastoschizomyces capitatus), and 8 by T. beigelii. Only 2 patients were cured, 1 with a combination therapy with amphotericin B plus fluconazole, and 1 with amphotericin B monotherapy. Several risk factors (neutropenia, acute leukemia, prior therapy or prophylaxis with antifungals and catheter as source of fungemia, breakthrough fungemia) were significantly associated with Trichosporon spp. fungemia, in comparison to 63 C. albicans candidemia occurring in the same period at the same institution. Attributable mortality of hematogenous trichosporonosis was also significantly higher (83.3% vs. 15.8%, P<0.001) than that of hematogenous candidiasis.
Addition of epirubicin to adjuvant chemotherapy can provide important benefits for patients with early breast cancer, but the optimal dose remains unclear. Further improvements can be achieved with ...dose-dense regimens, but densification of fluorouracil/epirubicin/cyclophosphamide (FEC) has proved difficult, with FEC
60
providing little benefit over standard chemotherapy and FEC
100
associated with toxicity. We investigated the feasibility of two intermediate dose-dense FEC regimens. Patients were randomised to six cycles of FEC
75
or FEC
90
, with all three drugs given on day 1 of each 14-day cycle. Patients also received pegfilgrastim 6 mg as a single subcutaneous injection on day 2 of each cycle. The primary efficacy endpoint was the proportion of subjects receiving ≥85% relative dose intensity and was achieved by 96% and 88% of patients in the FEC
75
and FEC
90
arms, respectively. Of 147 FEC
75
infusions, 4.1% were delayed, while 9.8% of 143 FEC
90
infusions were delayed. The most common reasons for delay were adverse events and personal/logistical reasons. One dose reduction occurred during the study (FEC
90
), related to diarrhoea. Grade 3–4 haematological toxicities were reported in two patients in the FEC
90
arm. There were no incidences of febrile neutropenia during the study. The most common adverse events were increases in liver enzymes and gastrointestinal events; no event resulted in discontinuation. Only one patient (FEC
90
) experienced serious adverse events (vomiting and throat oedema). In conclusion, dose-dense FEC
75
and FEC
90
are feasible with pegfilgrastim support. These regimens are associated with a very low risk of Grade 3–4 toxicity.
Because of controversial data on virulence and mortality, six cases of fungemia caused by Candida glabrata were reviewed in a single cancer institution within 8 years. Risk factors and outcome of C. ...glabrata, Candida albicans, and other non-albicans Candida spp. appearing within the same period under the same antibiotic policy at the same institution were compared. Among other non-albicans Candida spp. in 1990-1997 C. glabrata fungemias showed a decreasing tendency, from 9% to 4.5% in 1997. Analyzing the proportion of C. glabrata among blood cultures, among 170 positive blood cultures 12 were caused by C. glabrata (6.2% among all pathogens and 24% among non-albicans Candida spp.). C. glabrata among all fungemias was diagnosed as the fourth most common pathogen after C. albicans, C. krusei, and C. parapsilosis. Three of six C. glabrata fungemias were breakthrough. Two appeared during prophylaxis with itraconazole and one during fluconazole prophylaxis. Five of six received broadspectrum antibiotic therapy with third-generation cephalosporines, five of six had vascular catheter insertion, four of six were neutropenic, and two of six received amphotericin B therapy. One patient died before his blood cultures were reported to be positive. Overall mortality of C. glabrata fungemia was 16.7%. One patient died of underlying disease with fungemia. There were no significant differences in risk factors between C. glabrata and C. albicans. However, overall and crude mortality was lower in C. glabrata than in C. albicans (25.5% vs. 16.7%; P = 0.03). Attributable mortality was lower in comparison to C. albicans (0 vs. 15.7% in C. albicans; P = 0.001).
Byline: Zsuzsanna Kahan (1), Stanislav Spanik (2), Maria Wagnerova (3), Tomas Skacel (4), Barbara Planko (5), Elisabeth Fitzthum (6), Elisabeth Lindner (6), Victoria Soldatenkova (7), Christoph C. ...Zielinski (8), Thomas Brodowicz (8,9) Keywords: Breast cancer; Chemotherapy; Cyclophosphamide; Dose densification; Epirubicin; Fluorouracil; Granulocyte colony-stimulating factor; Pegfilgrastim Addition of epirubicin to adjuvant chemotherapy can provide important benefits for patients with early breast cancer, but the optimal dose remains unclear. Further improvements can be achieved with dose-dense regimens, but densification of fluorouracil/epirubicin/cyclophosphamide (FEC) has proved difficult, with FEC.sub.60 providing little benefit over standard chemotherapy and FEC.sub.100 associated with toxicity. We investigated the feasibility of two intermediate dose-dense FEC regimens. Patients were randomised to six cycles of FEC.sub.75 or FEC.sub.90, with all three drugs given on day 1 of each 14-day cycle. Patients also received pegfilgrastim 6 mg as a single subcutaneous injection on day 2 of each cycle. The primary efficacy endpoint was the proportion of subjects receiving aY=85% relative dose intensity and was achieved by 96% and 88% of patients in the FEC.sub.75 and FEC.sub.90 arms, respectively. Of 147 FEC.sub.75 infusions, 4.1% were delayed, while 9.8% of 143 FEC.sub.90 infusions were delayed. The most common reasons for delay were adverse events and personal/logistical reasons. One dose reduction occurred during the study (FEC.sub.90), related to diarrhoea. Grade 3--4 haematological toxicities were reported in two patients in the FEC.sub.90 arm. There were no incidences of febrile neutropenia during the study. The most common adverse events were increases in liver enzymes and gastrointestinal events no event resulted in discontinuation. Only one patient (FEC.sub.90) experienced serious adverse events (vomiting and throat oedema). In conclusion, dose-dense FEC.sub.75 and FEC.sub.90 are feasible with pegfilgrastim support. These regimens are associated with a very low risk of Grade 3--4 toxicity. Author Affiliation: (1) University of Szeged, Szeged, Hungary (2) Onkologicky Astav Sv. Alzbety, Bratislava, Slovakia (3) Oncology Institute, Kosice, Slovakia (4) Amgen (Europe) GmbH, Zug, Switzerland (5) CECOG, Vienna, Austria (6) Pharmaceutical Monitoring Agency, Vienna, Austria (7) InnoPharm, Smolensk, Russia (8) Medical University Vienna, Vienna, Austria (9) Clinical Division of Oncology, Department of Medicine I, University Hospital, 18-20 Waehringer Guertel, 1090, Vienna, Austria Article History: Registration Date: 02/01/2008 Received Date: 20/12/2007 Accepted Date: 02/01/2008 Online Date: 13/01/2008
Objectives: The aims of this study were to evaluate risk factors, clinical presentation, outcome and antimicrobial susceptibility in patients with
Escherichia coli bacteremia occurring over seven ...years in a single cancer hospital.
Methods: Sixty five episodes of bacteremia from
E. coli appearing over seven years from 12,301 admissions in a single cancer institution were retrospectively analyzed.
Results: The proportion of bacteremia caused by
E. coli among Gram-negative bacteremia was 20.8% (the second most common organism after
Pseudomonas aeruginosa), and infection-associated mortality was 17%.The incidence in 1989–1995 varied from 14.3 to 24.7%. The most common risk factors were: solid tumors as the underlying disease (70.7%); central venous catheter insertion (32.3%); prior surgery (46.2%), and prior chemotherapy within 48 h (44.4%). Neutropenia and urinary catheters did not place patients at high risk in any of the subgroups. When we compared the two subgroups of 61 cases of bacteremia — monomicrobial and polymicrobial (when
E. coli was isolated from blood culture with another microorganism) — we found that acute leukemia and breakthrough (recurrence while receiving antibiotics) bacteremia were more frequently associated with polymicrobial
E. coli bacteremia. There was also a difference in infection-associated mortality: monomicrobial bacteremia due to
E. coli only had a significantly lower mortality in comparison with polymicrobial
E. coli bacteremia (8.9 vs 35.0%, respectively; P<0.03).
Conclusion: The susceptibility of 115
E. coli strains isolated from 65 episodes of bacteremia was stable. Only two episodes caused by quinolone-resistant strains occurred, both in 1995, after six years of using ofloxacin for prophylaxis in neutropenic patients in our hospital. We found that 85.2–91.3% of all strains were susceptible to aminoglycosides, 97.8% to quinolones, and 90–100% to third generation cephalosporins and imipenems.The patients most commonly infected had solid tumors and the mortality was only 17%.
Approximately one quarter of patients with colorectal carcinoma (CRC) have distant metastases at initial dia-gnosis and almost 50% will develop them during the disease course. Only radical surgical ...resection of metastases improves clinical outcome and offers a chance of longterm survival. Initially unresectable metastases can become resectable after downsizing with systemic therapy.
Retrospective analysis included 21 patients with metastatic colorectal carcinoma (mCRC) who were treated from 2006 to 2012 and underwent resection/ ablation of metastases. Fourteen patients had resection at initial dia-gnosis of metastatic disease and seven patients achieved operability of metastases after systemic treatment. The aim of the analysis was to evaluate surgical treatment of metastases and its impact on prognosis in patients with mCRC in correlation with clinical pathological genetic factors.
The median age of patients was 59 years. Fourteen patients had metastases in the liver, one patient had metastases in the lungs, two patients had combination of hepatic and extrahepatic metastases and four patients had metastases in other regions. During median followup of 47 months, 17 patients experienced disease progression and 13 patients died. Median progression free survival (PFS) after surgical resection/ ablation of metastases was 17 months (95% CI 13.8820.12), and median overall survival (OS) was 48 months (95% CI 38.7757.23). KRAS mutation was detected in 47.6% of patients and BRAF mutation in 9.5% of patients. Patients with BRAF mutation had worse PFS (median = 10 months vs 17 months; p = 0.523) and OS (median = 22 months vs 51 months; p = 0.05) compared to patients with BRAF wildtype. No difference was observed in PFS and OS between the patients with one or more metastatic lesions and between the patients who underwent resection/ ablation of metastases initially or after systemic treatment.
These data suggest that resection/ ablation of metastases significantly improves prognosis of patients with mCRC and support the notion that mutated BRAF has a strong negative prognostic significance also in the group of patients, who undergo surgical resection/ ablation of metastatic lesions.
The aim of this study was to retrospectively compare the incidence, risk factors, and outcome in patients seen over a 7-year period at the National Cancer Institute in the Slovak Republic, with ...vancomycin-sensitive or vancomycin-resistant enterococcal bacteremia. The total incidence of enterococcal bacteremia at the National Cancer Institute increased from 5.1% in 1991 to 11.1% in 1993 and then decreased to 4.3% in 1995. Analysis of the 77 episodes of enterococcal bacteremia from 66 patients showed that 69 episodes from 60 patients were due to vancomycin-sensitive Enterococcus faecalis (group 1) and 8 episodes from 8 patients were due to vancomycin-resistant Enterococcus faecium (group 2). The features most frequently associated with enterococcal bacteremia were the insertion of a central venous catheter, neutropenia lasting more than 10 days, previous therapy with cephalosporins or vancomycin, previous prophylaxis with quinolones, and the incidence of superinfections. There was no difference in the clinical course or outcome between the 2 study groups. Previous therapy with aminoglycosides, cephalosporins, vancomycin or imipenem, neutropenia less than 10 days in length, malignancies other than leukemia or solid tumors, and the incidence of breakthrough bacteremia significantly correlated with patients with vancomycin-resistant E. faecium rather than patients with vancomycin-sensitive E. faecalis. The overall mortality was similar in both groups and averaged 32.5% for all enterococcal bacteremic patients. In this study, the major risk factors associated with cancer patients for developing vancomycin-resistant enterococcal bacteremia were previous therapy with aminoglycosides, cephalosporins or vancomycin, superinfections with other organisms and the incidence of breakthrough bacteremia.
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