DrugTherapy

Dr Maurie Markman expresses concern over a recent report illustrating the underuse of intraperitoneal chemotherapy for ovarian cancer, despite evidence that this therapy improves survival rates.  

Melanoma rates have been steadily increasing since the 1970s, but cytotoxic chemotherapy generally prolongs survival.  

Breast cancer mortality is declining throughout the Western world.1 2 3 If, as J F Kennedy said, “victory has a thousand fathers,” then progress in breast cancer surely has a lot of parents. In the late 1970s, guidelines recommended screening mammography for women over the age of 40, resulting in implementation of national and regional screening programmes in most developed countries. Soon after, adjuvant endocrine therapy and chemotherapy were found to reduce the risk of breast cancer recurrence and death.4 5 Meanwhile, the combination of early detection and effective radiation therapy enabled breast conserving surgery as an option for most women.6 The implementation of these truly multidisciplinary treatment programmes, combining local and systemic treatments with public health screening initiatives and health awareness campaigns, revolutionised and improved breast cancer care.  

Breast cancer mortality is declining throughout the Western world.1 2 3 If, as J F Kennedy said, “victory has a thousand fathers,” then progress in breast cancer surely has a lot of parents. In the late 1970s, guidelines recommended screening mammography for women over the age of 40, resulting in implementation of national and regional screening programmes in most developed countries. Soon after, adjuvant endocrine therapy and chemotherapy were found to reduce the risk of breast cancer recurrence and death.4 5 Meanwhile, the combination of early detection and effective radiation therapy enabled breast conserving surgery as an option for most women.6 The implementation of these truly multidisciplinary treatment programmes, combining local and systemic treatments with public health screening initiatives and health awareness campaigns, revolutionised and improved breast cancer care.  

Learn more about the immune-mediated effects of chemotherapy and their clinical relevance, the biological and clinical features of immune checkpoint blockers and more.  

Despite the development of new treatment options, the prognosis of high-risk neuroblastoma patients still remains poor; in more than half of patients the disease returns. Stem cell rescue replaces blood-forming stem cells that were destroyed by high-dose chemotherapy in order to recover the bone marrow. It is also known as myeloablative therapy and might improve the survival of these patients. A well-informed decision on the use of myeloablative therapy in the treatment of children with high-risk neuroblastoma should be based on high quality evidence of effectiveness for treating tumours and side effects.  

A phase 2 trial has shown that brentuximab vedotin monotherapy is safe and effective as first-line therapy in elderly lymphoma patients who cannot tolerate standard chemotherapy.  

Senior doctors are calling for a rethink over the use of a chemotherapy drug to treat prostate cancer.  

Team Leuko, an international group collaborating between the Massachusetts Institute of Technology (MIT) and a handful of centers, hospitals, and foundatio  

While this meta-analysis is the most current and comprehensive summary regarding drug treatments for bipolar depression--both approved and off-label--some of the conclusions may be controversial.  

We evaluated the evidence regarding whether giving platelet transfusions to patients with low platelets who are bleeding (therapeutically) is as effective and safe as giving platelet transfusions regularly to prevent bleeding (prophylactically). Our target population was people with blood cancers who were receiving intensive myelosuppressive (causing decreased blood cell production) chemotherapy treatments or stem cell transplantation.  

In 2009 the institutional guidelines changed for perioperative fluid therapy in patients undergoing extrapleural pneumonectomy. This study assesses the consequences of those changes.  

A new oral drug has been approved for use in patients with advanced colorectal cancer who are no longer responding to chemotherapy and biological agents.  

Analyzing the microbiome of patients with acute myelogenous leukemia during chemotherapy could help risk-stratify patients for infection, a new study suggests.  

What was the cause of discolored serum in this multiple myeloma patient undergoing chemotherapy with lenalidomide?  

Evidence based medicine, whose philosophical origins extend back to mid-19th century Paris and earlier, remains a hot topic for clinicians, public health practitioners, purchasers, planners, and the public. There are now frequent workshops in how to practice and teach it (one sponsored by the BMJ will be held in London on 24 April); undergraduate1 and postgraduate2 training programmes are incorporating it3 (or pondering how to do so); British centres for evidence based practice have been established or planned in adult medicine, child health, surgery, pathology, pharmacotherapy, nursing, general practice, and dentistry; the Cochrane Collaboration and Britain's Centre for Review and Dissemination in York are providing systematic reviews of the effects of health care; new evidence based practice journals are being launched; and it has become a common topic in the lay media. But enthusiasm has been mixed with some negative reaction.4 5 6 Criticism has ranged from evidence based medicine being old hat to it being a dangerous innovation, perpetrated by the arrogant to serve cost cutters and suppress clinical freedom. As evidence based medicine continues to evolve and adapt, now is a useful time to refine the discussion of what it is and what it is not.  

The high prevalence of cigarette smoking and tobacco related morbidity and mortality in people with chronic mental illness is well documented. This review summarizes results from studies of smoking cessation treatments in people with schizophrenia, depression, anxiety disorders, and post-traumatic stress disorder. It also summarizes experimental studies aimed at identifying biopsychosocial mechanisms that underlie the high smoking rates seen in people with these disorders. Research indicates that smokers with chronic mental illness can quit with standard cessation approaches with minimal effects on psychiatric symptoms. Although some studies have noted high relapse rates, longer maintenance on pharmacotherapy reduces rates of relapse without untoward effects on psychiatric symptoms. Similar biopsychosocial mechanisms are thought to be involved in the initiation and persistence of smoking in patients with different disorders. An appreciation of these common factors may aid the development of novel tobacco treatments for people with chronic mental illness. Novel nicotine and tobacco products such as electronic cigarettes and very low nicotine content cigarettes may also be used to improve smoking cessation rates in people with chronic mental illness.  

This report evaluates the use of an electronic tool to reduce non-intercepted admission medication reconciliation errors in a children's hospital.  

A review paper questions the indefinite prescription of the big four cardiac drugs, reminding Dr Mandrola of David Foster Wallace's "This is Water" commencement speech challenging us to choose what to pay attention to.  

Abstract and Introduction: For patients with early-stage nasal-type extranodal NK/T-cell lymphoma, the most effective treatment was risk-adapted therapy of radiotherapy alone for the low-risk group and radiotherapy consolidated by chemotherapy for the high-risk group.