Objective
To evaluate the overall benefits of non‐taxane chemotherapies in a non‐selected population including unfit patients presenting with symptoms and pain.
Patients and Methods
This randomized ...phase II study reports data from 92 patients (52% >70 years old; 40% with a performance score of 2) previously treated with taxane‐based chemotherapy, collected from 15 centres in France.
Patients received i.v. mitoxantrone (MTX), oral vinorelbine, or oral etoposide, together with oral prednisone.
Palliative benefit (pain response without progression of the disease), biological and tumoural responses, and toxicity profile as well as geriatric assessment (in elderly population) were analysed on an intention‐to‐treat basis.
Results
The palliative response rate was 17% for the whole population, and reached 29% when considering the MTX arm.
Pain control was achieved in 40% of the patients. The median overall survival was 10.4 months, and was longer in palliative responders.
Few grade 3–4 toxicities were observed.
The subgroup analysis of elderly patients showed similar results regarding the number and dose intensity of treatments, efficacy and safety.
Conclusion
In a population including frail and/or elderly patients, who are poorly represented in most clinical studies, non‐taxane chemotherapy may remain a relevant option for metastatic prostate cancer having relapsed after a docetaxel‐based regimen.
Although new treatment options are now approved, the decision‐making process should take into account their expected benefit/risk ratio based on the patient status.
Abstract Objective To evaluate the efficacy of pegylated liposomal doxorubicin (PLD) and continuous infusion ifosfamide (IFO) in ovarian cancer patients who relapse within 1 year after first-line ...paclitaxel-platinum-based chemotherapy. Methods Patients were stratified according to treatment-free interval (TFI) (< or ≥ 6 months). PLD (40 mg/m2 , day 1), IFO (1700 mg/m2 , infusion days 1–3), and mesna were given every 28 days for 6–9 cycles. Primary endpoint was objective response rate (ORR). Secondary endpoints were response duration, progression free survival (PFS), overall survival (OS), and toxicity. Results There were 98 evaluable patients (58%, TFI < 6 months). Median number of cycles was 5 (range: 1–9). The frequency of grade 3/4 anemia, thrombocytopenia, and neutropenia was 7%, 3%, and 48%, respectively; febrile neutropenia was 3%. A low rate of grade 3/4 non-hematologic toxicities was reported, including nausea/vomiting (3/4%), hand-foot syndrome (2%), and mucositis (2%). The ORR was 28% (41% and 19% in patients with TFI ≥ 6, or < 6 months, respectively); rate of disease stabilization was 26%; response duration and median OS were 6 (2.4–26) and 14 (1–46) months, respectively. Conclusion The combination of PLD and continuous IFO is a feasible and efficient treatment in patients with relapsed ovarian cancer, especially with TFI between 6 and 12 months. This regimen may represent an alternative to platinum reintroduction and should be evaluated in a randomized trial.
Background
To assess 18-fluorodeoxyglucose (FDG) bowel uptake in patients with differentiated thyroid cancer (DTC) treated with sorafenib.
Findings
Visual (5-point scale) and high maximum standard ...uptake value (SUVmax) semi-quantitative analyses were conducted in 63 positron emission tomography (PET) studies performed in patients on sorafenib (group 1,
n
= 20), in a control group (group 2,
n
= 28) and in patients on sunitinib or vandetanib (group 3,
n
= 15).
Moderate or high and diffuse bowel uptake (grade 4 or 5) was observed in 90% of the PET scans of group 1 versus none in group 2. Only 20% of PET scans in group 3 were scored grade 4. SUVmax values were significantly higher for all colic segments in group 1 than in group 2 (
P
< 0.0001) or 3 (
P
< 0.0004). This uptake pattern appeared rapidly (one month) and disappeared after sorafenib withdrawal.
Conclusions
FDG uptake is increased in the colon of DTC patients treated by sorafenib.
During the past few years, medical treatments of cancer have improved thanks to the discovery of targeted therapies. These therapies are today widely used in cancer treatment. The mechanism of action ...of targeted therapies and the adverse effects they induce are different from the classic chemotherapies, and require a specific management. Most of these drugs are taken at home and orally, and as a consequence, general practitioners should be able to manage these side effects. The most current toxicities in general medicine are fatigue, high blood pressure, dermatologic, gastrointestinal and metabolic side effects. These effects, often moderate are frequent and diverse, and can impact the patient's quality of life and reduce treatment compliance. Management of these toxicities should then be well known by general practitioners in order to optimize care and improve patient wellness.
Abstract
Study Objectives
To explore the effect of sleep regularity on sleep complaints and mental health conditions (i.e. insomnia, fatigue, anxiety, and depressive symptoms) in a population-based ...interventional study using a smartphone-based virtual agent.
Methods
A populational cohort based on the Kanopée application, which provided interactions with a virtual companion to collect data on sleep and make personalized recommendations to improve sleep over 17 days. A pre-intervention sleep diary and interview were used for cross-sectional analysis (n = 2142), and a post-intervention sleep diary and interview were used for longitudinal analysis (n = 732). The intra-individual mean (IIM) and standard deviation (ISD) of total sleep time (TST) were calculated to measure sleep quantity and sleep regularity.
Results
The mean age at baseline was 49 years, 65% were female, 72% reported insomnia, 58% fatigue, 36% anxiety, and 17% depressive symptoms. Before the intervention, irregular and short sleep was associated with a higher likelihood of insomnia (Relative risk RR = 1.26 1.21–1.30 for irregular TST and RR = 1.19 1.15–1.23 for short TST), fatigue, anxiety, and depressive symptoms. After the intervention, the IIM of the TST increased while the ISD of the TST and sleep complaints and mental health conditions decreased. More regular TST was associated with reduced insomnia and depressive symptoms (RR = 1.33 1.10–1.52 and RR = 1.55 1.13–1.98, respectively).
Conclusions
Our results reveal a longitudinal association between sleep regularity and sleep complaints and mental health conditions. Policymakers, health professionals, and the general population should be aware that, beyond its positive effect on sleep health, regular sleep could promote mental health.
Graphical Abstract
Monitoring the use of antimicrobials in hospitalized patients is critical owing to the risk of resistance selection. This study aimed to describe the patterns of antimicrobial prescription for the ...most frequent healthcare-associated infections (HAIs) in France, relating drugs and microbiological data.
We used data from the 2017 point-prevalence survey of HAI and antimicrobial use in France, a large nationally representative sample survey of inpatients. We sought unambiguous correspondence between individual indications of antibiotic regimen and HAI sites to determine which molecules were directed towards which pathogen, considering its resistance profile.
Among 75,698 adult patients from 401 hospitals, 5.1% had an active HAI and 4.3% were being treated for an HAI. The two most frequent antibiotic indications were lower respiratory tract (LRTI, 27.7%) and urinary tract infections (UTI, 18.4%). For LRTI, the most prescribed antibiotic was amoxicillin-clavulanic acid (27.6%) and most frequently isolated pathogens (each accounting for around 17% of isolates) were Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. Meticillin-resistant S. aureus LRTI was more likely to be treated with linezolid. For UTI, ofloxacin, ceftriaxone, amoxicillin/co-amoxiclav were most-prescribed (∼13% each) and E. coli predominantly isolated (52.0%). Extended-spectrum beta-lactamase-producing E. coli UTI were more likely treated by fosfomycin, pivmecillinam or ertapenem.
This study provides a baseline of antimicrobial use in relation to microbiological information in patients with the most common HAIs. These results can serve to direct future efforts in antimicrobial stewardship. Our work could be extended to a broader population, notably in Europe where similar surveys have been conducted.
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