104 research outputs found
Non-blood medical care in gynecologic oncology: a review and update of blood conservation management schemes
This review attempts to outline the alternative measures and interventions used in bloodless surgery in the field of gynecologic oncology and demonstrate their effectiveness. Nowadays, as increasingly more patients are expressing their fears concerning the potential risks accompanying allogenic transfusion of blood products, putting the theory of bloodless surgery into practice seems to gaining greater acceptance. An increasing number of institutions appear to be successfully adopting approaches that minimize blood usage for all patients treated for gynecologic malignancies. Preoperative, intraoperative and postoperative measures are required, such as optimization of red blood cell mass, adequate preoperative plan and invasive hemostatic procedures, assisting anesthetic techniques, individualization of anemia tolerance, autologous blood donation, normovolemic hemodilution, intraoperative cell salvage and pharmacologic agents for controlling blood loss. An individualised management plan of experienced personnel adopting a multidisciplinary team approach should be available to establish non-blood management strategies, and not only on demand of the patient, in the field of gynecologic oncology with the use of drugs, devices and surgical-medical techniques
Lenalidomide: an update on evidence from clinical trials
Lenalidomide is a novel immunomodulatory agent with a unique dual
mechanism of action: its tumoricidal effect leads to direct tumor cell
death, and its immunomodulatory effect keeps the tumor in remission.
Phase III clinical trials have demonstrated that in patients with
relapsed/refractory multiple myeloma (MM), lenalidomide in combination
with dexamethasone offers high clinical response rates and improved time
to disease progression, progression-free survival (PFS), and overall
survival (OS) compared with dexamethasone alone. In patients with newly
diagnosed MM, the combination of lenalidomide and low-dose dexamethasone
prolonged survival compared with lenalidomide and standard high-dose
dexamethasone. The benefits of lenalidomide-based treatment regimens can
be optimized by initiating treatment early in the disease course, either
as a frontline treatment or at first relapse. Lenalidomide is generally
well tolerated; the primary adverse events are myelosuppression and
venous thromboembolic complications. These adverse events emerge early
in the course of treatment and can be managed using standard
interventions such as granulocyte colony-stimulating factor, dose
reduction, and thromboprophylaxis. The combination of lenalidomide and
dexamethasone is effective and generally well tolerated in patients with
renal impairment provided that creatinine clearance level and adverse
events are carefully monitored and the starting dose of lenalidomide is
adjusted appropriately. Early results from phase III trials indicate
that in patients with newly diagnosed MM, continuous lenalidomide
therapy is well tolerated and associated with significant improvements
in PFS, offering a new treatment option for patients with MM - although
no OS benefit has yet been seen in this setting. Lenalidomide-based
treatment is effective across the spectrum of MM disease phases,
allowing for the long-term management of myeloma. (C) 2010 Elsevier Ltd.
All rights reserved
Bortezomib in multiple myeloma
Background: Bortezomib is a novel, first-in-class proteasome inhibitor
that has improved outcomes in multiple myeloma, with manageable
toxicities. Objective: To summarise the chemistry, pharmacokinetics and
metabolism of bortezomib, and review its clinical efficacy and toxicity,
including use in elderly patients, use in patients with renal impairment
and/or a poor prognosis, and effects on bone metabolism. Methods:
Literature search of bortezomib studies (within 10 years) and recent
congress abstracts. Results/conclusions: Bortezomib has improved
response rates, overall survival, and time to progression in relapsed or
refractory disease, both as a single agent and as part of combination
regimens. Promising results have also been reported with bortezomib
combinations in frontline induction therapy. Patient subgroups where
conventional approaches are inappropriate may also benefit, thereby
expanding the therapeutic armamentarium against this debilitating
disease
Antibodies to receptor activator of nuclear factor- B ligand (RANKL)
Patent WO02095012A1 claims for the development of antibodies against
receptor activator of nuclear factor-kappa B ligand (RANKL) and
immunologically functional fragments that neutralize RANKL. These
molecules can be used to detect RANKL in biological samples, allowing
the identification of pathological conditions in which RANKL alteration
contributes to their pathophysiology. The use of anti-RANKL antibodies
is of high importance in the treatment of bone disorders characterized
by the stimulation of osteoclast function and subsequent bone loss.
Postmenopausal and steroid-induced osteoporosis, myeloma bone disease,
cancer bone metastases with lytic lesions and bone loss due to
rheumatoid disorders (including rheumatoid arthritis) are candidates for
anti-RANKL therapy, as RANKL is implicated in their pathogenesis
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