Section of Medical Oncology, Department of Human Pathology and Oncology, University of Siena, Policlinico Le Scotte, Viale Bracci 11, 53100, Siena, Italy, r.petrioli@ao-siena.toscana.it.

PURPOSE: The dose limiting toxicity of oxaliplatin (l-HOP) is neurotoxicity, which is characterized by an acute neuropathy and a clinically distinct chronic neuropathy. This randomized study evaluated if prolonged l-HOP infusion over the conventional l-HOP schedule was useful in reducing acute and possibly chronic l-HOP induced neurotoxicity in colon and gastric cancer patients receiving l-HOP-based regimen as adjuvant chemotherapy. METHODS: Sixty-four patients were randomly assigned to group A (26 colon and 6 gastric cancer) and to group B (23 colon and 9 gastric cancer). Chemotherapy in both groups consisted of l-HOP 85 mg/m(2) i.v. only on day 1, with leucovorin 100 mg/m(2) i.v. as a 2-h infusion followed by bolus 5-fluorouracil (5-FU) 400 mg/m(2)/day and a 22-h infusion of 5-FU 600 mg/m(2)/day, repeated for two consecutive days every 2 weeks for a maximum of 12 cycles. Patients in group A received l-HOP as a continuous 6-h i.v. infusion, and patients in group B received l-HOP as the conventional 2-h i.v. infusion. RESULTS: The percentage of patients presenting with grade >/=2 neurotoxicity was statistically lower in group A than in group B (28.1% vs. 59.3%: P = 0.02). There was a statistically lower percentage of cycles with grade >/=2 neurotoxicity in group A (6.1%) than in group B (18.5%) (P < 0.001). CONCLUSIONS: This study suggests that l-HOP as a continuous 6-h infusion is useful in preventing and reducing acute l-HOP induced neurotoxicity in patients with colon and gastric cancer receiving FOLFOX-4 regimen as adjuvant treatment.

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Research Unit in Medical Senology, European Institute of Oncology, Milan, Italy alessandra.balduzzi@ieo.it.

Breast cancer rarely occurs in young women (<35 years). Several data indicate that diagnosis is associated with a worse prognosis, due to a more aggressive presentation. Although the effect of chemotherapy for premenopausal women is substantial, recent evidence suggested that patients with age <35 years with endocrine responsive tumors had a significant higher risk of recurrence than older premenopausal patients with such biological characteristics. Whereas premenopausal patients with endocrine nonresponsive disease presented similar outcome. Information from different studies of three major researching cooperative groups on breast cancer patients treated with chemotherapy alone, showed a similar interaction between the age and endocrine receptor status. Innovative treatment strategies needed and the combination of ovarian function suppression with endocrine agents (such as tamoxifen) in adjuvant therapy for endocrine receptor positive tumors could be considered. Moreover, more investigation on chemotherapy, its timing, duration, and intensity are required in the adjuvant care for endocrine nonresponsive disease. A strong emotional involvement is required to those patients approaching to adjuvant therapy, which may complicate the phase of treatment decision making. There is an urgent need for tailored clinical trials on young women with breast cancer diagnosis, to allow significant progress on adjuvant treatment of these population.

PMID: 17912178 [PubMed - in process]

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