Modified outpatient dexamethazone, cytarabine and cisplatin regimen may lead to high response rates and low toxicity in Lymphoma

Objective: Our purpose was to investigate the efficacy of and establish a toxicity profile for a modified regimen of dexamethasone, cytarabine and cisplatin (DHAP) for lymphoma outpatients. Subjects and Methods: Fifty-one lymphoma patients, 26 with Hodgkin's disease and 25 with non-Hodgkin's lymphoma, were included. The patients' median age was 32 years (range: 17-61). Twenty had progressive/refractory disease and 31 relapsed disease. Twenty-five were in clinical stage I/II and 26 in clinical stage III/IV before the initiation of salvage chemotherapy. DHAP consisted of dexamethasone (40 mg i.v. on days 1-4), cytarabine (2 g/m(2) i.v. as 3-hour infusion on days 2 in the evening and 3 in the morning) and cisplatin (35 mg/m(2) as 2-hour infusion on days 1-3) were administered every 21 days. A total of 154 cycles of modified DHAP were administered, with a median of 3 cycles per patient (range: 2-4). Results: The main toxicity was myelosuppression. WHO grade III-IV neutropenia and grade III-IV thrombocytopenia were observed in 27 (52.9%) and 21 (41%) patients, respectively. The overall response rate (85% for Hodgkin's disease and 95% for non-Hodgkin's lymphoma) was 88.3% (39.2% complete response and 49.1% partial response). Conclusion: The results showed that this outpatient schedule of DHAP was well tolerated and an effective salvage regimen

Safety and efficacy of transdermal fentanyl in patients with cancer pain: phase IV, Turkish oncology group trial

We have performed a prospective evaluation of the efficacy, safety and convenience of the transdermal therapeutic system - fentanyl (TTS-F) in Turkish cancer patients when it was newly available in Turkey. Ninety-nine patients with historically confirmed malignancy and pain entered the study; the mean age was 55.1 (16-58) years. The study duration was 28 days. Transdermal therapeutic system - fentanyl was used in opioid-naive or pre-treated patients. Most patients reported a decrease in pain severity. Use of rescue medication decreased from day 4 to day 28. The majority of patients rated patch convenience of use as excellent. A total of 22.2% of patients experienced adverse events that were either probably related or very likely to be related to the study drug. The majority of the adverse events mentioned were related to the digestive system. Eighteen serious adverse events were reported by 13 patients. Six events were doubtfully related, and 12 events were not related to the study drug. Four patients died during the trial. None of these deaths was attributed to the study drug. In conclusion, the trial showed that TTS-F is easily managed, effective and will help to enable the appropriate opioid administration to patients who are suffering from cancer pain in Turkey

Evaluation of the fatigue symptom in patients with cancer and associated clinical problems Kanser hastalarinda halsizlik semptomunun deǧerlendirilmesi ve birlikte görülen klinik problemler

Fatigue is often overlooked in the assessment although it is one of the most common complaints of the patients with cancer. It is a subjective and nonspecific complaint, which negatively affects the life of the patient. Mechanisms of fatigue are multifactorial. Chronic illnesses, treatment modalities, complications (anemia, metabolic abnormalities, ...) or psychological stress may cause fatigue. Fatigue developing during chemotherapy or radiotherapy may depend on the treatment modalities administered, however, it is not easy to explain the etiology of fatigue persisting after the end of treatment. Fatigue has been found to be as a factor affecting survival negatively in studies where predicted survival is ≥100 days. However, most of the studies performed on patients with a predicted survival of 30 days failed to find fatigue as a major predictor of survival. Fatigue loses its prognostic significance since almost all patients with short-term survival have fatigue. Currently there are many questions remained unanswered about the pathophysiology and treatment of the fatigue in cancer patients. Why do patients continue to experience fatigue months or even years following the diagnosis and treatment of cancer? Which treatment modalities are effective in preventing or reducing fatigue? Will the treatment of fatigue be able to improve survival in patients with cancer? © Gülhane Askeri Tip Akademisi 2008