Comparison of Antiemetic Effects of Ondansetron Granisetron and Tropisetron For Acute Emesis In Ovarian Cancer Patients Receiving Chemotherapy With Paclitaxel and Carboplatin

OBJECTIVE: Emesis is a critical adverse effect of cancer treatment. In this study, prophylactic activity of ondansetron (OND), tropisetron (TRO) and granisetron (GRA) on acute emesis following carboplatinpaclitaxel chemotherapy was compared. STUDY DESIGN: Charts of 277 patients, who had been treated with first-line carboplatin-paclitaxel combined chemotherapy after being operated with a diagnosis of gynecologic malignancy in between 1993 and 2005, were evaluated retrospectively. After premedication, chemotherapy was initiated with paclitaxel 175 mg/m², infused in three hours. Then, carboplatin was infused in one hour (AUC=6). 90 minutes before the onset of chemotherapy, dexamethasone, 24 mg was infused within an hour. 5 HT3 receptor antagonist (OND=8 mg / TRO=5 mg / GRA=3 mg) were infused for a duration of 30 minutes, one hour before the chemotherapy. Toxicity was evaluated according to WHO criteria. Grade 0 toxicity was accepted as complete response, grade 1 and higher toxicity was accepted unresponsive. RESULTS: The mean age was 55 years. Overall 1582 courses of chemotherapy were given. 241 patients (87%) received six courses. OND was given to 57 (20.6%) patients at 321 (20.3%) courses, TRO to 57 (20.6%) patients at 330 (20.9%) courses and GRA to 163 (58.8%) patients at 931 (58.8%) courses. Grade 3-4 toxicity did not develop in any of the patients. Complete response was achieved in 41.2% of the patients in 77.1% of the cycles. Antiemetic activities of TRO and GRA were stronger than OND. CONCLUSION: Even though this study was retrospective, the treatment and patient groups were homogeneous. Both the discovery of an antiemetic that is much more effective and a protocol that is improved are essential. An emerging need for prospective studies achieved with homogeneous patient groups does exist

Comparison of Antiemetic Effects of Ondansetron, Granisetron and Tropisetron in Treatment of Acute Emesis Caused By Cisplatin/Paclitaxel Chemotherapy

OBJECTIVE: Emesis is significant side effect of chemotherapy. In this study we aimed to compare prophylactic effect of ondansetron (OND), granisetron (GRA) and tropisetron (TRO) on acute emesis induced by cisplatin/paclitaxel combine chemotherapy. STUDY DESIGN: Between years 1993 and 2005, 172 patients have been operated for gynecologic malignancy and who had first-line chemotherapy (cisplatin-paclitaxel) were evaluated retrospectively. Chemotherapy was started with paclitaxel (175 mg/m2, 3 hours infusion) followed by cisplatin (75 mg/m2, 2 hours infusion). Dexamethasone (24 mg) was given 60 min before chemotherapy and infused until chemotherapy. 5 HT3 antagonist (OND=8 mg/TRO = 5 mg/GRA=3 mg) is started 1 hour before chemotherapy and given in 30 minutes. The second dose of OND also was given before cisplatin (8 mg, 30 min infusion). Chemotherapy toxicity was assessed according to WHO criteria. According to this, grade 0 was accepted as a complete response while grade 1 and more toxicity were accepted as nonresponse. RESULTS: 172 patients received 968 chemotherapy courses. OND, TRO, GRA were given 23.8% of patients and 23.3% of courses, 16.7% of patients and 15.7% of courses, 60.5% of patients and 59.9% of courses, respectively. Grade 3 toxicity was developed in 3.5% of patients and 0.8% of courses. None of the patients developed grade 4 toxicity. Complete response occurred in 28.5% of patients and 63% of courses. If it has been evaluated only for courses GRA is more effectiv e than TRO. Other than there was no significant difference in antiemetic potency between the drugs for courses and patients. CONCLUSION: Although this study is not prospective, it is homogenous for treatment modalities and patient selection. Complete response was observed in 63% of courses; however this antiemetic affect is not found to be satisfactory. In order to develope better protocols there is need for prospective studies on homogenous group. Antiemetic efficiency has to associate for chemotherapy protocols

Paclitaxel/Platinum combination regimen and alopecia

Introduction: Alopecia in paclitaxel and platinum combination treatment that is widely used in gynecological oncology was evaluated. Materials and Method: The study evaluated retrospectively and the data of toxicity belonging to 470 patients who underwent surgery in the period from 1993 to 2006 because of epithelial ovarian cancer, fallopian tube cancer, primary peritoneal papillary serous tumor or advanced stage endometrial cancer and were given 6 cycles of paclitaxel and platinum chemotherapy as first line treatment and did not receive neo-adjuvant chemotherapy. The chemotherapy was started with 175 mg/m2 dose of paclitaxel. Then, carboplatin calculated from AUC=6 was infused in one hour or 75 mg/m2 dose of cisplatin was given with two-hour infusion. The treatment was administered with 21-day intervals. Toxicity was assessed according to the criteria established by the World Health Organization. Results: Results: Paclitaxel and cisplatin combination was given to 186 patients and paclitaxel and carboplatin combination was administered to 284 patients. Grade 4 alopecia was not observed. Alopecia did not develop in one patient. Grade 3 alopecia was found in 431 patients (91.7%). Both chemotherapy combinations were similar in terms of the severity and frequency of alopecia (p=0.722). Alopecia became remarkable as the cycles of chemotherapy advanced. Discussion: Alopecia with relation to paclitaxel and platinum chemotherapy combination observe in more than 90% of the patients at the end of the treatment. However, alopecia is reversible and improves after chemotherapy

Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000–14 (CONCORD-3): analysis of individual data from 258 cancer registries in 61 countries

Background: Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed data for children (aged 0–14 years) and adults (aged 15–99 years) diagnosed with a haematological malignancy during 2000–14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and morphology, in young patients (aged 0–24 years). Methods: We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3 that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0–14 years), adolescents (15–19 years), and young adults (20–24 years). We categorised leukaemia subtypes according to the International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs, using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age survival estimates were standardised to the marginal distribution of young people with leukaemia included in the analysis. Findings: 164 563 young people were included in this analysis: 121 328 (73·7%) children, 22 963 (14·0%) adolescents, and 20 272 (12·3%) young adults. In 2010–14, the most common subtypes were lymphoid leukaemia (28 205 [68·2%] patients) and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and young adults for all leukaemias combined during 2010–14 varied widely, ranging from 46% in Mexico to more than 85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better age-standardised survival (from 43% in Ecuador to ≥80% in parts of Europe, North America, Oceania, and Asia) than those with acute myeloid leukaemia (from 32% in Peru to ≥70% in most high-income countries in Europe, North America, and Oceania). Throughout 2000–14, survival from all leukaemias combined remained consistently higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young adults in most countries. Interpretation: This study offers the first worldwide picture of population-based survival from leukaemia in children, adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators of the quality of cancer management in this age group