Taxane-induced nail changes: incidence, clinical presentation and outcome

UNLABELLED Docetaxel, a semisynthetic member of the taxoid class of antineoplastic agents, is effective in the treatment of patients with advanced (locally advanced or metastatic) breast cancer. Reported objective response rates for docetaxel 100 mg/m2 ranged from 54 to 69% and 53 to 82% as first-line monotherapy or combination therapy, respectively. Objective response rates of 23 to 65% and 30 to 81% have been reported for docetaxel as second-line monotherapy or combination therapy, respectively. In Japanese studies, second-line docetaxel 60 mg/m2 produced objective response rates of 42 to 55%. At the recommended dose of 100 mg/m2 given as a 1-hour intravenous (i.v.) infusion every 3 weeks, docetaxel had significantly greater efficacy than doxorubicin, mitomycin plus vinblastine and methotrexate plus fluorouracil, and similar efficacy to fluorouracil plus vinorelbine in pretreated patients with advanced breast cancer. In chemotherapy-naive patients, first-line combined therapy with docetaxel and doxorubicin had significantly greater efficacy than doxorubicin plus cyclophosphamide. Promising results have been achieved in phase I/II trials of a weekly regimen of docetaxel (generally 30 to 45 mg/m2). Preliminary data indicate a potential role for docetaxel in the neoadjuvant therapy of early breast cancer. The major dose-limiting adverse event associated with docetaxel is neutropenia. Although other adverse events are common, the tolerability profile of docetaxel is generally acceptable in the majority of patients, particularly in comparison with other antineoplastic regimens. CONCLUSIONS Although no single standard regimen has been identified as optimal for the treatment of advanced breast cancer, phase III trials have shown that docetaxel has improved efficacy over doxorubicin alone (considered one of the current gold standards), methotrexate/fluorouracil and mitomycin/vinblastine in second-line therapy. In combination with doxorubicin, docetaxel has demonstrated better efficacy than doxorubicin/cyclophosphamide in first-line therapy. These results provide a basis for therapy choice in advanced breast cancer. Clinical trials comparing docetaxel monotherapy versus paclitaxel monotherapy and versus docetaxel combination therapy are warranted. The role of docetaxel in the adjuvant and neoadjuvant treatment of early breast cancer is being evaluated.

Docetaxel: an update of its use in advanced breast cancer.

Our aim was to compare the analgesic efficacy of pamidronate (PAM) and synthetic human calcitonin (CT) in intravenous infusion for recent painful benign vertebral compression in a randomised prospective double-blind study. Twenty-seven patients aged 49–85 years with painful benign non-traumatic vertebral compression were included in the study. They received either PAM (1 mg/kg) or synthetic human CT (1.5 mg) as an intravenous infusion. Pain and functional disability were evaluated before infusion, and 4 and 30 days afterwards. The pain score assessed on a visual analogue scale at day 0 was 5.94±2.47 in patients treated with PAM and 6.27±2.50 in patients treated with CT (p=0.74); at day 4, 4.8±2.80 with PAM vs 3.9±2.68 with CT (p=0.37); and at day 30, 3.6±3.13 with PAM vs 3.10±2.76 with CT (p=0.70). Spinal function scores were 18.21±3.17 at day 0 in patients treated with PAM vs 17.23±4.42 in patients treated with CT (p=0.69) and at day 30, 13.7±5.36 with PAM vs 12.33±3.22 with CT (p=0.68). We found no advantage of PAM over CT in a single intravenous infusion for the treatment of painful recent benign vertebral compression. Since CT is ten times less costly, its use should be preferred.

Comparison of the analgesic efficacy of pamidronate and synthetic human calcitonin in osteoporotic vertebral fractures: a double-blind controlled study

Resume Objectif Les chutes sont frequentes chez les personnes de plus de 65 ans et elles sont un motif frequent d’hospitalisation. Certains patients sont incapables de se relever seules malgre l’absence de blessure. Une station prolongee au sol est source de complications. Des exercices d’apprentissage pour se relever du sol existent mais ils n’ont pas ete evalues. Methodes Nous avons mis en place un tel apprentissage dans un service de medecine interne et l’avons evalue a court terme par une etude prospective d’observation menee sur 3 mois chez 29 patients. Chaque semaine, nous avons organise une seance collective d’apprentissage (J0) suivie d’une seance d’evaluation individuelle apres 48 h ou plus (entre le 2 e et le 9 e jour, J2-J9), menees selon un protocole ecrit. Resultats Vingt-quatre des 29 patients (16 % des patients de plus de 65 ans hospitalises dans le service) vus a J0 ont ete revus a J2-J9. Le nombre de malades capables de se relever sans aide etait de 2 sur 29 evaluables a J0 et de 11 sur 24 a J2-J9 (p = 0,003). Les progres significatifs concernaient les 2 premieres etapes, les plus delicates, du redressement : retournement au sol du dos sur le ventre (p = 0,003), et passage en quadrupedie (p = 0,006). Un Mini Mental Status (MMS) Conclusion Apprendre aux personnes âgees hospitalisees en medecine interne a se relever apres une chute semble efficace a court terme. Bien qu’il merite d’etre plus finement evalue, cet apprentissage est denue d’effets indesirables et nous semble pouvoir etre recommande.

Apprentissage de la technique pour se relever du sol chez des patients âgés hospitalisés: Étude prospective en médecine interne

Autoimmune diseases may reveal or occur during the course of a neoplasia or its treatment. Autoimmune cytopenia, especially haemolytic anaemia, is common in lymphoproliferative disorders such as chronic lymphoid leukemia. The link between cancer and myositis is well established. Dermatomyositis is associated with an increased relative risk of cancer of 3.4 to 4.4. A combination of detection of antibodies against p155 and TEP-computed tomography may be the best approach to ascertain the presence of occult malignancy in patients with dermatomyositis. A cutaneous or a systemic vascularitis may reveal a cancer, most often a haematological malignancy such as hairy cell leukemia. Paraneoplastic polyarthritis have been described in particular with adenocardinoma of the lungs. Underlying neoplasia should be considered in male smokers patients with new onset polyarthritis and poor health status. The prevalence of autoimmune conditions in myelodysplastic syndromes is 10 to 30%. Vasculitis and relapsing polychondritis are the most commonly reported manifestations. Immune manifestations can also be related to treatment. The most common treatment complications are autoimmune haemolytic anaemia with fludarabine and thyroiditis related to interferon and cervical radiotherapy.

Maladies auto-immunes et cancers. Deuxième partie : maladies auto-immunes au cours des cancers et de leur traitement

Dermatopolymyosite et cancer: étude rétrospective de 12 cas parmi une cohorte de 50. Évolution et facteurs prédictifs

Effet antalgique d’une perfusion de bisphosphonates à la phase aiguëd’un tassement vertébral ostéoporotiquechez le sujet âgé

Des ongles jaunes

≪ Syndrome de la tortue ≫: chute et rhabdomyolyse chez le sujet âgé

Un syndrome hématopulmonaire bien silencieu...

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