Seminars in oncology
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The weekly administration of docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) at doses up to and including 40 mg/m2 induces low levels of hematologic and nonhematologic toxicity. In particular, weekly scheduling appears to markedly reduce the incidence of neutropenia compared with regimens in which an equivalent dose rate (mg/m2/wk) is given once every 3 weeks. Encouraging responses have been reported in patients with a range of tumor types, including breast cancer, treated with weekly docetaxel. Further trials of weekly docetaxel are in progress, and it appears that this schedule may prove particularly valuable in certain elderly patients who are unsuited to more aggressive chemotherapy.
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Seminars in oncology · Dec 1998
Compilation of phase I and II trial data of docetaxel and doxorubicin in the treatment of advanced breast cancer and other malignancies.
Doxorubicin and docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) are the most active cytotoxic agents in the treatment of advanced breast cancer. In the pre-taxane era, randomized trials demonstrated that doxorubicin-containing chemotherapy regimens are associated with higher response rates and improved survival compared with non-doxorubicin-containing regimens. Doxorubicin-containing regimens were therefore considered the standard of care at that time. ⋯ The regimen was highly effective and did not seem to be associated with an increased risk of congestive heart failure. These findings justify further evaluation of the doxorubicin/docetaxel combination in patients with advanced and operable breast cancer. Such trials are currently in progress and will define the role for this combination in the management of patients with breast cancer.
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Seminars in oncology · Oct 1998
ReviewEfficacy and toxicity of irinotecan in patients with colorectal cancer.
In six published phase II trials, irinotecan (CPT-II; Camptosar; Pharmacia & Upjohn Co, Kalamazoo, MI) has demonstrated consistent activity with response rates of approximately 13% to 27% in patients with advanced colorectal cancer (CRC) refractory to 5-fluorouracil (5-FU) therapy. Similar response and median survival rates have been achieved using either the US regimen (once a week for 4 weeks followed by a 2-week rest) or the European regimen (once-every-3-week schedule). The optimal administration schedule for irinotecan is uncertain. ⋯ Irinotecan has been explored as a single agent in patients with newly diagnosed CRC and has generated response rates in the range of 19% to 32% and a median survival time of approximately 12 months, suggesting a level of antitumor activity similar to that observed with 5-FU and leucovorin. Two recently completed phase III studies in 5-FU-refractory patients have shown that treatment with irinotecan confers a survival advantage compared with treatment with infusional 5-FU or best supportive care. Current studies focus on the activity of irinotecan as part of combined chemotherapy in patients with newly diagnosed advanced-stage CRC, as part of combined-modality therapy with radiation therapy, and as adjuvant chemotherapy for patients with locally advanced CRC.
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There has been a gradual evolution in the philosophy of treatment for metastatic breast cancer. It has long been known that endocrine therapy, radiotherapy, and chemotherapy could offer substantial palliative benefits to patients with symptomatic metastases. While these quality of life issues remain crucially important, it is increasingly recognized that the survival of patients with this condition also appears to be improving as a result of therapeutic advances. ⋯ The results of phase II studies suggest that of these agents, used at the recommended doses, docetaxel (Taxotere, Rhône-Poulenc Rorer, Antony, France) may be the most active, achieving an objective response rate of 59% in minimally pretreated patients and 47% when used in second-line treatment. In these studies, docetaxel was given at the standard dose of 100 mg/m2 over 1 hour. Recent results from phase III studies in which individual studies with docetaxel and paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) have been compared with standard therapies indicate that docetaxel is the most active single agent in metastatic breast cancer.
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Seminars in oncology · Oct 1998
ReviewPrevention and treatment of oral mucositis following cancer chemotherapy.
The administration of many chemotherapy regimens may be complicated by toxicities that limit clinicians' abilities to deliver the most effective doses of active agents. Oral mucositis remains the dose-limiting toxicity of a variety of chemotherapeutic regimens and may result in significant morbidity, impaired nutrition, treatment delays, and dose reductions. In this report, the mechanisms of both direct and indirect stomatotoxicity are reviewed and efforts are made to help identify patient-related and treatment-related factors that predispose patients to oral mucositis. Last, various approaches to prevent and treat chemotherapy-induced mucositis are reviewed.