This study examined the validity of the StepWatch activity monitor and the optimal number of monitoring days in patients with chronic obstructive pulmonary disease (COPD). StepWatch activity data ...were obtained from databases of two studies: one of patients with COPD who participated in a trial of two exercise persistence interventions (n = 17) and a second, cross-sectional study of activity in chronically healthy older adults (n = 60). Independent t tests, Pearson's correlations, and Bland-Altman plots were used to examine the activity data (total steps, activity intensity, and distribution of activity). Results indicated that patients with COPD registered 50% fewer total steps and had lower levels of walking intensity compared with chronically healthy older adults. Activity parameters had moderate-to-high correlations with disease severity, peak cycle workload, and physical functioning. More monitoring days were associated with greater measurement precision. This study provides preliminary evidence to support the validity of the StepWatch device for measuring free-living ambulatory physical activity in COPD.
Objective. The incidence of cervical adenocarcinoma is increasing relative to squamous cell carcinoma and all cervical cancers. Few reports have described the outcome of patients with advanced ...cervical adenocarcinoma. The purpose of this study was to determine the prognostic factors and survival for patients with stage IIB–IVB disease.
Methods. Institutional Review Board approval was obtained to perform a computerized search of all women diagnosed with cervical adenocarcinoma at our three institutions between 1982 and 2000. Medical records were retrospectively reviewed. Clinical follow-up was obtained from the SGO database and tumor registry and via correspondence with health care providers. Statistical analysis was performed using logistic regression for clinical variables and the log-rank test to compare Kaplan–Meier survival estimates.
Results. Eighty-three women with FIGO stage IIB–IVB cervical adenocarcinoma were identified. The median patient age was 53 years (range, 22–88). The median follow-up of 17 (20%) surviving patients was 33 months (range, 6–147); 66 (80%) died during the study interval. Stage IIB disease, young patient age, and grade 1 histology were independent variables having a favorable impact on survival (each P < 0.02). Stage IIB patients (n = 41) were more likely to be alive at 2 (64% vs 8%) and 5 years (30% vs 0%) than women with stage IIIA–IVB disease (n = 42; P < 0.01).
Conclusions. Women diagnosed with advanced stage cervical adenocarcinoma have a poor prognosis. Prospective, multicenter trials of platinum-based chemoradiation or other novel therapies are urgently needed in the treatment of this highly lethal disease.
This is the first in a series of papers describing the epidemiology of malaria in an isolated village in western Thailand. The study site was the village of Kong Mong Tha, located in Sangkhla Buri ...District, Kanchanaburi Province, Thailand. In this paper we present an overview of the study site and results from our adult anopheline mosquito surveillance conducted over 56 consecutive months from June 1999 until January 2004. The collection site, indoor/outdoor location, parity, biting activity and Plasmodiumfalciparum (Pf) and P. vivax (Pv) infection rates were used to calculate seasonal entomological inoculation rates for the predominant four Anopheles species. A total of 21,566 anophelines representing 28 distinct species and 2 groups that were not identified to species were collected using human bait, with almost 95% of the collection consisting of Anopheles minimus, An. maculatus, An. sawadwongporni and An. barbirostris/campestris. Mosquitoes generally peaked during the wet season, were collected throughout the night, and were collected most often outside (ca. 75%) versus inside (ca. 25%) of houses. Approximately 50% of collected mosquitoes were parous. Overall Plasmodium infection rates were 0.27%, with a total of 16 and 42 pools of Pf- and Pv-positive mosquitoes, respectively. Annual EIRs were 2.3 times higher for Pv than for Pf, resulting in approximately 5.5 and 2.6 infective bites per person per year, respectively. The results suggest An. minimus and An. maculatus are the primary and secondary vectors of Pf and Pv transmission in Kong Mong Tha, while An. sawadwongporni and An. barbirostris/campestris also appear to play a role based on the presence of circumsporozoite protein (CSP) in the head/thorax of the specimens tested.
To retrospectively investigate the safety and efficacy of weekly topotecan in heavily pretreated patients with ovarian cancer.
Data were collected by retrospective review of patient records. Eligible ...patients had received ≥2 prior regimens for ovarian cancer before treatment with weekly topotecan. Efficacy was determined by measurable disease or CA 125 levels. Adverse event and growth factor support data were also collected.
Fifty patients (median age, 61 years) were evaluable for safety and received a total of 244 4-week cycles of therapy (median, 3; range, 1–21 cycles). Most patients (84%) had measurable disease, and 30% had performance status of ≥2. Patients had received two to six prior treatments for ovarian cancer. Median weekly dose per patient was topotecan 3.7 mg/m
2. Grade 4 hematologic toxicities (generally manageable) occurred in 4% of patients. One patient had febrile neutropenia. Grade 3/4 nonhematologic toxicities were fatigue in two (4%) patients. Forty-two patients were evaluable for response. Of 35 evaluable patients with measurable disease, 11 (31%) had a partial response (median duration, 3 months), and 15 (43%) patients had stable disease (median duration, 3.5 months). Of 41 evaluable patients with elevated CA 125 (median, 154 U/l; range, 47–7200 U/l), 11 (27%) had ≥50% decreases or normalization of CA 125 levels. Median time to progression in all patients with stable disease has not been reached (follow-up range, 1.5–17.3 months).
Weekly topotecan is active and well tolerated in heavily pretreated patients with relapsed ovarian cancer. Prospective studies of this regimen are warranted.
Compared to other subtypes of epithelial ovarian cancer, clear cell carcinoma of the ovary bears an ominous reputation for chemotherapy resistance, increased relapse rate, and diminished survival. ...Among patients with distinct histopathologic subtypes, molecular analyses have identified a variety of known drivers of the malignant behavior, and depict a striking heterogeneity.
A patient with rapidly metastatic CCCO that was refractory to taxane, platinum, pemetrexed, and bevacizumab-based strategies underwent molecular profiling which disclosed dual MAPK and PI3K/AKT/mTOR pathway mutations.
Combined targeted therapy with trametinib and metformin resulted in a dramatic disease regression without toxicity.
The case highlights the utility of precision medicine combining individual molecular diagnosis with rational therapeutic intervention with targeted agents.
Objective. The aim of this study is to evaluate the effect of oral dexamethasone in attenuating palmar-plantar erythrodysesthesias (PPE) in Doxil®-treated patients for gynecologic malignancies.
...Methods. An IRB-approved prospective case study was conducted in patients with recurrent gynecologic malignancies who were treated with Doxil® (50 mg/m
2) on a 28-day cycle. Patients experiencing grades II–IV PPE were delayed until resolution then retreated without dose reduction and with a tapering oral dexamethasone regimen (8 mg BID days −1 to 4; 4 mg BID day 5; 4 mg day 6). Standard treatment for grades II–IV PPE in those not receiving dexamethasone was weekly dose delay until resolution of symptoms up to 2 weeks. If resolution occurred within 3 weeks of delay, a 25% dose reduction was made. Persistent grades III/IV PPE resulted in withdrawal of Doxil®.
Results. Twenty-three patients (ovarian-16, uterine-7) were treated between January 1998 and December 2000. The median number of cycles administered was 5 (range 1–20). Nine patients (39%) developed grades II–IV PPE. All nine patients received more than five cycles of Doxil®. The median time to PPE was 3 cycles (range 2–5). Six out of nine PPE patients received scheduled dose dexamethasone. All six had complete or near complete resolution of PPE and all continued treatment without subsequent dose modification. All three of the nine PPE patients not receiving dexamethasone required treatment delays and were dose reduced.
Conclusion. Oral dexamethasone is effective in attenuating or eliminating Doxil®-induced PPE. The use of the dexamethasone regimen prevents treatment delay and dose reduction.
The First Cambridge Conference on Advances in Treating Metastatic Bone Cancer, a symposium held in Cambridge, Massachusetts, October 28 to 29, 2005, was convened to discuss recent advances and ...research related to the natural history of bone metastases and skeletal complications, bone cancer biology, treatment of myeloma and other solid tumors, and treatment-induced bone loss. The conference format combined brief presentations with extended periods of discussion. The conclusions reached during the 2-day meeting are summarized in this article and presented in more detail in the individual articles and accompanying discussion sessions that comprise the conference proceedings.
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