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

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

Flicker electroretinogram in newborn infants

PURPOSE To develop and validate a flicker electroretinogram (ERG) protocol in term-born neonates as a potential tool for assessing preterm infants at risk of developing retinopathy of prematurity. METHODS A custom flicker ERG protocol was developed for use with the hand-held RETeval® electrophysiology device. Feasibility of measuring flicker ERG through closed eyelids and without mydriasis was established in a pilot study enabling optimisation of the test protocol. Following this, healthy term-born neonates (gestational age 37-42 weeks) were recruited at the Neonatology clinic of the University Hospital Zurich. Flicker ERG recordings were performed using proprietary disposable skin electrodes during the first four days of life when the infants were sleeping. Flicker stimuli were presented at 28.3 Hz for a stimulus series at 3, 6, 12, 30, and 50 cd·s/m$^{2}$, with two measurements at each stimulus level. Results were analysed offline. Flicker ERG peak times and amplitudes were derived from the averaged measurements per stimulus level for each subject. RESULTS 28 term-born neonates were included in the analysis. All infants tolerated the testing procedure well. Flicker ERG recording was achieved in all subjects with reproducible flicker ERG waveforms for 30 and 50 cd·s/m$^{2}$ stimuli. Reproducible ERGs were recorded in the majority of infants for the weaker stimuli (with detectable ERGs in 20/28, 25/28, and 27/28 at 3, 6, and 12 cd·s/m$^{2}$, respectively). Flicker ERG amplitudes increased with increasing stimulus strength, with peak times concurrently decreasing slightly. CONCLUSION Flicker ERG recording is feasible and reliably recorded in sleeping neonates through closed eyelids using skin electrodes and without mydriasis. Flicker ERG amplitude decreases for lower luminance flicker but remains detectable for 3 cd·s/m$^{2}$ flicker in the majority of healthy term-born neonates. These data provide a basis to study retinal function in premature infants using this protocol