La Clinica terapeutica
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La Clinica terapeutica · Nov 2008
ReviewDocetaxel in the adjuvant therapy of HER-2 positive breast cancer patients.
Considering the clinical benefit of trastuzumab in advanced breast cancer, fi ve prospective adjuvant randomized trials have recently been completed and early results have been published. Two of them, (NSABP-B31 and NCCTG N9831), employed anthracycline-containing regimens with sequential paclitaxel, with or without trastuzumab. The third study, HERA trial, randomized patients after adjuvant chemotherapy into an observational arm, one or two years of trastuzumab. ⋯ Data from the second interim analysis indicate that, in the subgroup of patients without co-amplification of topoisomerase 2 (TOPO-2), the arm without trastuzumab (ACT) showed a DFS significantly poorer that in the other arms; moreover, if we consider the lower toxicity of TCH regimen in comparison with anthracycline-containing arms, the innovative statements offered by BCIRG 006 trial appear evident, and these findings opened an important question about the consolidated employment of anthracyclines in adjuvant setting. The FinHer trial was a small trial testing a short course of trastuzumab (9 weeks) concomitantly with a chemotherapy including docetaxel, and there was a significant advantage in DFS for the trastuzumab based arms, without relevant toxicity and without any cardiotoxicity. Although data from all trastuzumab adjuvant trials, and without particulary from BCIRG-006 and FinHer trials, appear very intriguing, further follow-up is required.
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La Clinica terapeutica · Nov 2008
ReviewOptimal sequence of anthracyclines and taxanes as adjuvant breast cancer treatment.
Results from randomized trials evaluating taxane versus non-taxane containing regimens in adjuvant breast cancer treatment indicate an advantage in DFS and OS for the taxane-arms, but the best schedule of administration, in combination with anthracyclines or in sequence, is still a debated issue, even if the sequential strategy appears to be less toxic. Up to now, the majority of clinical trials employed the "standard" sequence, with anthracycline-based combinations fi rst, followed by taxanes. ⋯ An important issue to be considered is the hypothesized differences in the ability of the drugs to induce cross-resistance to each other, as suggested by data of a preclinical study, and from clinical study with a cross-over design; results of these trials suggest that the best strategy would be to administer a taxane prior to an anthracycline, also according to the Norton and Simon hypothesis. Moreover, trials evaluating the best sequence of anthracyclines and taxanes in adjuvant breast cancer setting are of small sample size, and an adequately powered randomized phase III trial is needed before definitive conclusions are reached.
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La Clinica terapeutica · Nov 2008
ReviewAntioxidant properties of anesthetics: the biochemist, the surgeon and the anesthetist.
General anesthesia can impair immunological defense mechanisms while inducing an inflammatory reaction. Generalized inflammatory reactions involve leucocytes which in turn release inflammatory mediators and free oxygen radicals. ⋯ Similarly, other anesthetics show antioxidant and protective roles but this mechanism is to be related to their ability to induce antioxidant enzyme (i.e., heme oxygenase-1). The aim of the present review is to evaluate the antioxidant properties of anesthetics in various experimental models and if they may be considered efficient therapeutic tools in counteracting oxidative stress during general anesthesia and sedation in ICU.
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La Clinica terapeutica · Nov 2008
ReviewHelicobacter pylori infection and gastric MALTomas: an up-to-date and therapy highlight.
During the last 20 years Helicobacter pylori (Hp) has been, undoubtly, the star of gastroenterology and microbiology, so much to deserve the "Nobel prize 2005" for biology and medicine to its discoverers. More recently, an increased interest arised on Hp and its linkages with other medical fi elds such as immunology, surgery and dentistry. The outcome of the pathologies due to such bacterium is dependent on many factors, including bacterial genotype, host physiology and genetics, and environmental factors such as diet. ⋯ The development of gastric lymphomas is usually preceded by the acquisition of lymphatic tissue, after inflammatory stimuli and particularly after the infection from Hp, which organizes itself with the characteristics of the MALT. Recently, a number of papers have highlighted the remarkable efficacy of Hp eradicating therapy in patients with low-grade MALT lymphoma of the stomach without other modalities, e.g. surgery and systemic chemotherapy. The aim of this study is to be helpful for a comprehensive understanding the possible connections between Hp and gastric MALT lymphoma, evaluating the best therapy strategies, surgical and non surgical, actually available for its treatment.
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La Clinica terapeutica · Nov 2008
Review Comparative Study[Alexithymic features and emotional distress in patients with chronic tension-type headache (CTTH) and medication-overuse headache (MOH)].
The study examined the role of alexythimia and emotional distress in patients with diagnosis of chronic headaches (tension-type and medication overuse headache). ⋯ Findings supported a link between alexithymia and emotional distress, as an index of psychological maladjustment in chronic headache patients.