Annals of Oncology 2007 18(4):613; doi:10.1093/annonc/mdm118
© 2007 European Society for Medical Oncology
in this issue
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Venlafaxine versus clonidine for hot flashes in breast cancer patients
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Aproximately two thirds of postmenopausal breast cancer patients
report hot flashes, which can significantly impair quality of
life, especially when estrogens are contraindicated or rejected.
Clonidine is widely used as a non-estrogenic treatment for hot
flashes in breast cancer patients and does decrease hot flashes
to a moderate degree but it is associated with several toxicities.
Venlafaxine is an antidepressant selective serotonin-norepinephrine
reuptake inhibitor (SNRI), and it has been demonstrated in several
trials that venlafaxine and other SNRI or selective serotonin-reuptake
inhibitors, such as fluoxetine or paroxetine, are effective
in reducing hot flashes in cancer patients by at least 50%.
In this issue,
Loibl et al. present the results of a double-blind,
randomized phase III study that aimed to compare venlafaxine
and clonidine in the treatment of hot flashes in breast cancer
patients. These authors report that venlafaxine is significantly
more effective in reducing the frequency of hot flashes in breast
cancer patients than clonidine.
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Gefitinib and irinotecan for fluoropyrimidine-refractory, irinotecan-naive advanced colorectal cancer
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While randomized trials have established irinotecan as standard
therapy in patients with fluoropyrimidine-refractory colorectal
cancer (CRC) median survival of only 9-11 months was reported
in phase III studies for irinotecan monotherapy. Targeting the
epidermal growth factor receptor (EGFR) pathway using a monoclonal
antibody, such as cetuximab, has been shown to be effective
in the treatment of advanced CRC. In this issue
Chau et al. report the results of a phase II study that aimed to establish
the recommended dose level (RDL) and to evaluate the efficacy
and safety of gefitinib plus irinotecan in patients with advanced
fluoropyrimidine-refractory CRC. These authors report that the
RDL was established at irinotecan 225mg/m2 q3 weeks and gefitinib
250mg daily. They conclude, however, that while this dose schedule
was tolerable gefitinib did not appear to add substantial efficacy
to irinotecan.
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Response assessment in lymphoma patients using FDG-PET/CT
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Because of its superior diagnostic performance FDG-PET/CT has
replaced CT alone in many institutions for primary staging in
patients with newly diagnosed lymphoma. Several studies have
also shown FDG-PET to be the best non-invasive imaging tool
for early response assessment. The use of PET/CT in staging
and therapy response assessment remains controversial. However,
only a few studies deal with the topic of cost-effective use
of PET/CT in oncology. In this issue
Strobel et al. report the
results of study that aimed to evaluate the necessity of FDG-PET/CT
after end of treatment in lymphoma patients who had already
received an interim FDG-PET/CT. These authors report that end
treatment PET/CT is unnecessary where interim PET/CT shows a
complete response and the clinical course is uncomplicated.
They calculate that an imaging cost reduction of 27% in theirr
study population could have been achieved by omitting end-of-treatment
FDG-PET/CT in interim complete responders.
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Chinese herbal medicine as complimentary therapy for reduction of chemotherapy-induced toxicity
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Complementary and alternative medicine (CAM) is used by an increasing
number of cancer patients with Chinese herbal medicine (CHM)
a popular form of CAM in China and elsewhere. The belief that
CHM may reduce cancer therapy–induced toxicity is prevalent
in China and throughout Asia, but scientific information on
this is limited. In this issue
Mok et al. report the results
of a study that aimed to examine the role of CHM as complementary
therapy for patients receiving adjuvant chemotherapy. While
the study followed the principles of Good Clinical Practice
the intervention was designed in accordance with a true CHM
practice that provides variable combinations of herbs according
to the body condition of the individual patient. The authors
report slow accrual attributed to patients' lack of interest
in participating in a placebo-controlled study and their preference
for receiving true CHM. An interim analysis showed no significant
difference in severe toxicity (CTC-V2 grade 3 or above) between
the two groups, CHM versus placebo. However, incidence of grade
2 nausea was significantly reduced in the CHM group (14.6% versus
35.7%;
P = 0.04). The trial was terminated early on the recommendation
of the Data Safety Monitoring Committee.
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Quote
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"The aim of science is not to open the door to infinite wisdom,
but to set a limit to infinite error."
From The Life of Gallileo by Bertolt Brecht.
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Venlafaxine versus clonidine for...
Gefitinib and irinotecan for...