Anthrazykline und Herceptin® als neue Therapieoption beim metastasierten Mammakarzinom

Single-agent treatment with the humanized monoclonal antibody trastuzumab (herceptin) has shown remarkable activity in patients with metastatic breast cancer overexpressing the HER-2/neu proto-oncogen. Further significant advances could be achieved with the combined use of herceptin and paclitaxel or doxorubicin/cyclophosphamide. However, cardiotoxicity remains a significant and thus far unresolved problem of the herceptin-doxo-rubicin combination. Thus, several studies have recently been initiated to identify equally effective but less toxic first-line regimens. Epirubicin, the taxanes paclitaxel and docetaxel, Navelbine(R), cisplatin, and Caelyx(R), a liposomal encapsulated formulation of doxorubicin, were selected for combination with herceptin in these studies because the appeared the most promising agents

Retrospektive Analyse zur Dosisintensität von Epirubicin beim Mammakarzinom

Objective: In breast cancer the efficacy of epirubicin-based chemotherapy is possibly related to the actual dose intensity applied. We retrospectively determined the administered dose intensity and the relative toxicity and efficacy of an epirubicin-containing regimen in patients with primary or metastatic breast cancer. Patients and Methods: Fluorouracil, epirubicin, and cyclophosphamide (FEC) were either given at a standard dose of 500/50/500 mg/m(2) (FE50C) or at an intensified dose of 500/75/500 mg/m(2) (FE75C) every 3 weeks. Of the 66 patients treated, 63 were evaluable; 43 had metastatic breast cancer, and 20 patients with an increased risk of relapse received FEC as an adjuvant treatment. Results: Dose intensity and absolute dose of adjuvant treatment were 81 and 70% for FE50C and 96 and 88% for FE75C In metastatic breast cancer, the dose intensity for FE50C was 94% and for FE75C 92%. In a retrospective comparison, the 4-year overall survival following adjuvant FE50C and FE75C was 40 and 48%, respectively (p = 0.47). The dose intensification led to a higher response rate of 34 vs. 44%. There were no significant differences in response duration and survival time. The toxicity profiles were comparable between FE50C and FE75C Conclusions: In genera I, the doses applied were lower than initially planned. Higher doses of epirubicin did not result in a significant increase of toxicity. Despite the limitations of a retrospective analysis, our observations support the importance of adherence to the planned dose intensity as a prerequisite for optimal treatment of patients suffering from breast cancer. As our results could be related to selection bias, dose-intensified anthracycline-containing regimens should be further evaluated in prospective trials. Copyright (C) 2001 S. Karger AG, Basel

Visual outcome measures in pediatric myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)

BACKGROUND: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) comprises various age-dependent clinical phenotypes and may be monophasic, multiphasic, or chronic. Optic neuritis (ON) is a common manifestation and frequently appears in combination with other MOGAD phenotypes, particularly in young children. Despite permanent structural damage to the retinal nerve fiber layer (RNFL), children often experience complete visual recovery. AIMS: To analyze the progression and impact of MOGAD on the visual system of pediatric patients independently of the history of ON. METHODS: This retrospective study included children who met specific criteria: myelin oligodendrocyte glycoprotein (MOG) immunoglobulin G (IgG) seropositivity, acute presentation of MOGAD, and written general consent. Main outcome measures were global peripapillary retinal nerve fiber layer (pRNFL) thickness, and near and distance visual acuity, analyzed using descriptive statistics. RESULTS: We identified 10 patients with median age of 7.7 years at first event: 7 patients manifested with acute disseminated encephalomyelitis (ADEM) (with ON 5/7, ADEM only 1/7, with transverse myelitis (TM) 1/7), 2 with isolated ON, and 1 patient with neuromyelitis optica spectrum disorder (NMOSD)-like phenotype with ON. Among ON patients, 5/8 were affected bilaterally, with 3 initially diagnosed with unilateral ON but experiencing subsequent involvement of the fellow eye. None of the patients without previous ON showed a deterioration of visual acuity and, if evaluated, a reduction of the pRNFL. CONCLUSION: Most pediatric MOGAD-ON patients in our cohort presented with acute vison loss and optic disc edema. All patients achieved complete visual recovery, independent of number of relapses or initial visual loss. The pRNFL thickness decreased for several months and stabilized at reduced levels after 12 months in the absence of further relapses. MOGAD may not have subclinical/'silent' effects on the visual system, as visual acuity and pRNFL were not affected in patients without ON

Outcome of Pediatric Cataract Surgeries in a Tertiary Center in Switzerland

Purpose. To determine and to analyze the outcome of pediatric cataract surgery. Methods. A retrospective chart review of individuals aged up to 10 years who underwent cataract surgery between January 1, 2004, and December 31, 2014, at the UniversityHospital Zurich, Switzerland. Results. 63 children (94 affected eyes) with bilateral (68/94) or unilateral (26/94) cataract were identified. Surgery was performed at a median age of 1.5 months (IQR: 1.3–2.6 months) for the aphakic group (45/94) and of 50.7 months (IQR: 38.0–78.4 months) for the IOL group (49/94). At the last follow-up visit (median 31.1 months, IQR: 18.4–50.2 months), visual acuity was better in bilateral than in unilateral cataract cases. Posterior capsular opacification (PCO) was diagnosed in 30.9% of eyes without a significant difference in the IOL and aphakic groups (p=0.12). Aphakic glaucoma was diagnosed in 12/45 eyes at a median of 6.8 months (IQR 2.1–13.3 months) after surgery. Microcornea (5/12) and anterior segment anomalies (8/12) were associated with glaucoma development (p<0.05). Conclusion. Laterality and timing of surgery influence the outcome of pediatric cataract surgery. PCO was the most frequent postoperative complication. Aphakic glaucoma is often associated with ocular developmental abnormalities and a poor visual outcome