Chronic Obstructive Pulmonary Disease in Patients with Atherosclerosis

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and affects approximately 10% of the adults of 40 years and older. It is currently the fifth leading cause of death and expected to be the third by 2020. This is mainly driven by the continued use of tobacco, and the population aging. Worldwide, approximately 2.7 million deaths from COPD occurred in the year 2000. COPD is defined by the Global Initiative for Chronic Lung Disease (GOLD) as a preventable and treatable disease characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. This results in a chronic persistent low-grade inflammation in the lungs, and the intensity of the inflammation correlates with the severity of the disease. Importantly, the inflammatory state is not only restricted to the lungs but also extends systemically. This systemic inflammation is associated with the development of atherosclerosis and cardiovascular morbidity and mortality even after taken into account smoking status. Cardiovascular disease is a leading cause of mortality in patients with COPD and accounts for 20-25% of all deaths in COPD. In addition, for every 10% decrease of forced expiratory volume in 1 second (FEV1), the risk of cardiovascular mortality increases with 14% and non-fatal acute coronary events with 20%. Pulmonary complications contribute equally to postoperative morbidity, mortality as cardiac complications and prolong hospital stay by an average of one to two weeks

Systemic treatment of patients with metachronous peritoneal carcinomatosis of colorectal origin

Combining chemotherapy and targeted therapies has resulted in an enhanced survival in metastatic colorectal cancer (mCRC) patients. However, the result of this palliative treatment in patients with metachronous peritoneal carcinomatosis (PC) remains unknown. The current population-based study aims to investigate the use and effect of palliative systemic treatment in patients with metachronous PC of colorectal origin. Data on metachronous PC were collected between 2010 and 2011 for all patients who were diagnosed with M0 colorectal cancer between 2003 and 2008 in the Dutch Eindhoven Cancer Registry. Patient demographics and detailed data on chemotherapeutic treatment were collected and compared. Ninety-two patients with metachronous PC received chemotherapy in a palliative setting compared to 94 patients without treatment. In 36 patients, Bevacizumab was added to the treatment (39%). Overall survival was 3.4, 13, and 20.3 months in the no treatment, systemic treatment and systemic treatment + Bevacizumab respectively (P < 0.001). Male gender was a positive predictor and right sided primary tumor location a negative predictor of receiving bevacizumab. Approximately 40% of patients with metachronous PC received bevacizumab in addition to chemotherapy. Treatment with systemic chemotherapy in combination with bevacizumab may increase survival in a patients with metachronous colorectal PC

Bevacizumab for metachronous metastatic colorectal cancer: A reflection of community based practice

Background: Although the efficacy of bevacizumab has been established in patients with metastatic colorectal cancer (mCRC), population-based studies are needed to gain insight into the actual implementation of bevacizumab in daily practice. Since these studies are lacking for patients with metachronous metastases, the aim of this study is to evaluate the current role of bevacizumab in the treatment of metachronous metastases of CRC. Methods: Data on the use of bevacizumab as palliative treatment of metachronous metastases were collected for patients diagnosed with M0 CRC between 2003 and 2008 in the Eindhoven Cancer Registry (n = 361). Median follow up was 5.3years. Results: One hundred eighty-five patients received bevacizumab in addition to first-line palliative chemotherapy (51%), ranging from 36% to 80% between hospitals of diagnosis (p < 0.0001). Combined cytostatic regimens (CAPOX/FOLFOX in 97%) were prescribed in the majority of patients (63%) and were associated with a higher odds for additional treatment with bevacizumab than single-agent cytostatic regimens (OR 9.9, 95% CI 5.51-18.00). Median overall survival (OS) rates were 21.6 and 13.9months with and without the addition of bevacizumab to palliative systemic treatment respectively (p < 0.0001). The addition of bevacizumab to palliative chemotherapy was associated with a reduced hazard ratio for death (HR 0.6, 95% CI 0.45-0.73) after adjustment for patient- and tumor characteristics and the prescribed chemotherapeutic regimen. Conclusion: Bevacizumab is adopted as a therapeutic option for metachronous metastasized CRC mainly in addition to first-line oxaliplatin-based regimens, and was associated with a reduced risk of death. The presence of inter-hospital differences in the prescription of bevacizumab reflected important differences in attitude and policies in clinical practice. Ongoing efforts should be made to further define the position of targeted agents in the treatment of metastatic colorectal cancer