scholarly journals Optimal Supportive Measures during Primary Treatment

2021 ◽  
pp. 221-230
Author(s):  
Paolo Bossi ◽  
Luigi Lorini
Keyword(s):  
Supportive Care ◽  
Dose Intensity ◽  
Primary Treatment ◽  
Therapeutic Interventions ◽  
Key Factors ◽  
Curative Therapy ◽  
Consistent Manner ◽  
Late Adverse Effects ◽  
Therapeutic Measures ◽  
Tailored Approach

AbstractSupportive care during curative treatment of head and neck cancer patients has different scopes: reducing the burden of acute toxicities and limiting the risk of developing late adverse effects; increasing the quality of life of the patients; allowing to perform optimal curative therapy, maintaining treatment dose intensity; preventing higher grade toxicities so to reduce also the costs associated with hospitalization, examinations, visits and use of drugs. At the same time, it is necessary to give uniformity in the supportive care protocols, as these preventive and therapeutic measures may influence the results of oncological treatments and their efficacy should be evaluated in a consistent manner. Several preventive and therapeutic interventions are available, particularly in the context of chemoradiotherapy, where the adverse events are more prominent. An accurate evaluation of the patient and a tailored approach with preventative indications and therapeutic interventions represent key factors. This approach could be easily identified within a “simultaneous care” strategy, as the optimal supportive measures are provided concurrently to the best therapeutic approach since the beginning of the treatment.

scholarly journals A questionnaire survey on evaluation for penetration and compliance of the Japanese Guideline on Febrile Neutropenia among hematology-oncology physicians and surgeons

2021 ◽  
Author(s):  
Nobu Akiyama ◽  
Takuho Okamura ◽  
Minoru Yoshida ◽  
Shun-ichi Kimura ◽  
Shingo Yano ◽  
...  
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Supportive Care ◽  
Questionnaire Survey ◽  
Primary Treatment ◽  
Beta Lactam ◽  
Clinical Practices ◽  
High Risk Patients ◽  
Mascc Score ◽  
Risk Patients

Abstract Purpose The Japanese Society of Medical Oncology published a guideline (GL) on febrile neutropenia (FN) in 2017. The study’s purpose is to reveal how widely GL penetrated among physicians and surgeons providing chemotherapy. Methods A questionnaire survey was conducted with SurveyMonkey™ for members of the Japanese Association of Supportive Care in Cancer and relevant academic organizations. Each question had four options (always do, do in more than half of patients, do in less than half, do not at all) and a free description form. Responses were analyzed with statistical text-analytics. Result A total of 800 responses were retrieved. Major respondents were experts with more than 10-year experience, physicians 54%, and surgeons 46%. Eighty-seven percent of respondents knew and used GL. Forty-eight percent assessed FN with Multinational Association of Supportive Care in Cancer (MASCC) score “always” or “more than half.” Eighty-one percent chose beta-lactam monotherapy as primary treatment in high-risk patients. Seventy-seven percent did oral antibacterial therapy in low-risk patients ambulatorily. Seventy-eight percent administered primary prophylactic G-CSF (ppG-CSF) in FN frequency ≥ 20% regimen. Fifty-nine percent did ppG-CSF for high-risk patients in FN frequency 10–20% regimen. Ninety-seven percent did not use ppG-CSF in FN frequency < 10% regimen. The medians of complete and complete plus partial compliance rates were 46.4% (range 7.0–92.8) and 77.8% (range 35.4–98.7). The complete compliance rates were less than 30% in seven recommendations, including the MASCC score assessment. Conclusion GL is estimated to be widely utilized, but some recommendations were not followed, presumably due to a mismatch with actual clinical practices in Japan.

Systemic Therapy for Osteosarcoma and Ewing Sarcoma

2015 ◽  
pp. e644-e647 ◽  
Author(s):  
Paul A. Meyers
Keyword(s):  
Ewing Sarcoma ◽  
Systemic Therapy ◽  
Dose Intensity ◽  
Initial Response ◽  
Response To Therapy ◽  
High Dose ◽  
Improve Outcome ◽  
Curative Therapy ◽  
Dose Methotrexate ◽  
Multiagent Chemotherapy

Curative therapy for both osteosarcoma and Ewing sarcoma requires the combination of effective systemic therapy and local control of all macroscopic tumors. Systemic therapy for osteosarcoma consists of multiagent chemotherapy. The most common regimen uses cisplatin, doxorubicin, and high-dose methotrexate. Addition of ifosfamide and etoposide to treatment for patients with poor initial response to therapy does not improve outcome. Addition of interferon to treatment for patients with favorable initial response does not improve outcome. Addition of liposomal muramyl tripeptide to chemotherapy may improve overall survival. Systemic therapy for Ewing sarcoma consists of multiagent chemotherapy including doxorubicin, vincristine, etoposide, and cyclophosphamide and/or ifosfamide. Increased dose intensity of therapy, either by shortening the intervals between cycles of chemotherapy or by increasing doses of chemotherapy, improves outcome. Regimens such as irinotecan/temozolomide or cyclophosphamide/topotecan have shown activity in metastatic recurrent Ewing sarcoma. Trials are ongoing to evaluate the addition of these drugs to existing multiagent regimens in order to test their ability to improve outcome. High-dose systemic therapy with autologous stem cell reconstitution is being tested for patients at high risk for recurrence; definitive results await completion of a prospective randomized trial.

EPOCH chemotherapy: toxicity and efficacy in relapsed and refractory non-Hodgkin's lymphoma.

1993 ◽  
Vol 11 (8) ◽  
pp. 1573-1582 ◽  
Author(s):  
W H Wilson ◽  
G Bryant ◽  
S Bates ◽  
A Fojo ◽  
R E Wittes ◽  
...  
Keyword(s):  
Continuous Infusion ◽  
Prolonged Exposure ◽  
Oral Prednisone ◽  
Stage Iv ◽  
Dose Intensity ◽  
Primary Treatment ◽  
Treatment Regimens ◽  
Aggressive Lymphomas ◽  
Stage Iv Disease

PURPOSE Based on in vitro evidence that tumor cells are less resistant to prolonged exposure to low concentrations of the natural product class, compared with brief higher concentration exposure, we developed a chemotherapy regimen (etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone [EPOCH]) in which the natural products are administered as a continuous infusion. PATIENTS AND METHODS This is a phase II study of etoposide, vincristine, and doxorubicin, administered as a 96-hour continuous infusion, with intravenous (IV) bolus cyclophosphamide and oral prednisone (EPOCH) in 74 consecutive patients who relapsed from or failed to respond to most of the same drugs administered on a bolus schedule. Patients with aggressive lymphomas who achieved a good response after EPOCH were eligible to undergo bone marrow transplantation. RESULTS Patients with intermediate- or high-grade lymphoma comprised 76% of this series and 77% had stage IV disease. Seventy-one percent had previously received all of the drugs contained in the EPOCH regimen and 92% had received at least four of the drugs. Seventy patients were assessable for response, of whom 19 (27%) achieved a complete remission (CR) and 42 (60%) a partial remission (PR). Among 21 patients who had no response to prior chemotherapy, 15 (71%) responded, but only one achieved a CR. Patients who relapsed from an initial CR had a 100% response rate, with 76% CRs. With a median potential follow-up duration of 19 months, there was a 28% probability of being event-free at 1 year. Toxicity was primarily hematologic with neutropenia during 51% of cycles, but only a 17% incidence of febrile neutropenia. Gastrointestinal, neurologic, and cardiac toxicity were minimal. CONCLUSION EPOCH chemotherapy was well tolerated and highly effective in patients who were resistant to or relapsed from the same drugs administered on a bolus schedule, suggesting that continuous infusion of the natural drug component of this regimen is capable of partially reversing drug resistance and reducing toxicity. Dose-intensity (DI) was > or = that achieved in primary treatment regimens for aggressive lymphomas.

Rat Model to Investigate the Treatment of Acute Nitrogen Dioxide Intoxication

1992 ◽  
Vol 11 (3) ◽  
pp. 179-187 ◽  
Author(s):  
J. Meulenbelt ◽  
J.A.M.A. Dormans ◽  
M. Marra ◽  
P.J.A. Rombout ◽  
B. Sangster
Keyword(s):  
Lung Injury ◽  
Nitrogen Dioxide ◽  
Lung Tissue ◽  
Rat Model ◽  
Therapeutic Interventions ◽  
Nitrite Concentration ◽  
Therapeutic Measures ◽  
Severe Lung

1 The pulmonary toxic events induced by acute nitrogen dioxide (NO)2 exposure were studied in the rat to develop an inhalation model to investigate therapeutic measures. 2 A good correlation was observed between the lung weights and severity of the atypical pneumonitis. The pulmonary effects observed, became more pronounced with increasing NO 2 concentrations (0, 25, 75, 125, 175 or 200 ppm, 1 ppm NO2=1.88 mg m-3 NO2) and exposure times (5, 10, 20 or 30 min). 3 An adequate NO 2 concentration is 175 ppm, because it can induce a severe lung injury without mortality. This makes it possible to investigate suitable therapeutic interventions for several days. 4 Following acute inhalatory NO2 intoxication, transformation of NO2 to nitrate is presumably more notable than transformation to nitrite. 5 The transformation of NO2 to nitrate in lung tissue causes a slight increase in the serum nitrite concentration, which does not induce measurable formation of methaemoglobin. 6 Presumably, methaemoglobin does not contribute to the toxicity of NO2 intoxication.

scholarly journals Drug resistance, supportive care and dose intensity

1993 ◽  
Vol 4 ◽  
pp. S57-S62 ◽  
Author(s):  
E.G.E. de Vries ◽  
T.C. Hamilton ◽  
M. Lind ◽  
J. Dauplat ◽  
J.P. Neijt ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Supportive Care ◽  
Dose Intensity

scholarly journals Inherited NUDT15 Variant Is a Genetic Determinant of Mercaptopurine Intolerance in Children With Acute Lymphoblastic Leukemia

2015 ◽  
Vol 33 (11) ◽  
pp. 1235-1242 ◽  
Author(s):  
Jun J. Yang ◽  
Wendy Landier ◽  
Wenjian Yang ◽  
Chengcheng Liu ◽  
Lindsey Hageman ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Race And Ethnicity ◽  
Genome Wide Association Study ◽  
Lymphoblastic Leukemia ◽  
Dose Intensity ◽  
Average Dose ◽  
Childhood All ◽  
Curative Therapy ◽  
Genome Wide ◽  
A Genome

Purpose Mercaptopurine (MP) is the mainstay of curative therapy for acute lymphoblastic leukemia (ALL). We performed a genome-wide association study (GWAS) to identify comprehensively the genetic basis of MP intolerance in children with ALL. Patients and Methods The discovery GWAS and replication cohorts included 657 and 371 children from two prospective clinical trials. MP dose intensity was a marker for drug tolerance and toxicities and was defined as prescribed dose divided by the planned protocol dose during maintenance therapy; its association with genotype was evaluated using a linear mixed-effects model. Results MP dose intensity varied by race and ethnicity and was negatively correlated with East Asian genetic ancestry (P < .001). The GWAS revealed two genome-wide significant loci associated with dose intensity: rs1142345 in TPMT (Tyr240Cys, present in *3A and *3C variants; P = 8.6 × 10−9) and rs116855232 in NUDT15 (P = 8.8 × 10−9), with independent replication. Patients with TT genotype at rs116855232 were exquisitely sensitive to MP, with an average dose intensity of 8.3%, compared with those with TC and CC genotypes, who tolerated 63% and 83.5% of the planned dose, respectively. The NUDT15 variant was most common in East Asians and Hispanics, rare in Europeans, and not observed in Africans, contributing to ancestry-related differences in MP tolerance. Of children homozygous for either TPMT or NUDT15 variants or heterozygous for both, 100% required ≥ 50% MP dose reduction, compared with only 7.7% of others. Conclusion We describe a germline variant in NUDT15 strongly associated with MP intolerance in childhood ALL, which may have implications for treatment individualization in this disease.

scholarly journals Coagulopathy in Acute Promyelocytic Leukemia: Can We Go Beyond Supportive Care?

2021 ◽  
Vol 8 ◽  
Author(s):  
Bryan C. Hambley ◽  
Ciprian Tomuleasa ◽  
Gabriel Ghiaur
Keyword(s):  
Supportive Care ◽  
Acute Promyelocytic Leukemia ◽  
Causes Of Death ◽  
Promyelocytic Leukemia ◽  
Therapeutic Interventions ◽  
Term Survival ◽  
Common Causes ◽  
Thrombotic Complications ◽  
Risk Of Hemorrhage

Acute promyelocytic leukemia (APL) is characterized by frequent complications due to a distinct coagulopathy. While advances in treatments have improved long-term survival, hemorrhagic and thrombotic complications remain the most common causes of death and morbidity. Improved understanding of the mechanisms of the coagulopathy associated with APL may lead to therapeutic interventions to mitigate the risk of hemorrhage and thrombosis.

Trauma-Focused Presence

2019 ◽  
pp. 002216781988065
Author(s):  
Anthony Cameron
Keyword(s):  
Meaning Making ◽  
Medical Model ◽  
Therapeutic Interventions ◽  
Theory Of Change ◽  
Integrative Approach ◽  
Key Factors ◽  
Model Framework ◽  
Strict Adherence ◽  
Psychotherapy Outcome Research ◽  
Trauma Therapist

The purpose of this article is to capture and illuminate a trauma-focused presence in psychotherapy treatment. The goal is to highlight an integrative approach that centers on the trauma survivor’s battle with freedom and limitation. Both the expansive and the constrictive tendencies of many traumatized clients are exemplified, focusing on the dichotomous or polarized positions that clients present. Key factors of evidence-based therapeutic relationships that can guide therapist stances and engagement efforts are explored. This approach moves away from an overemphasis on and strict adherence to the medical model framework and toward a contextual standard grounded in a humanistic blanket and characterized by a person-centered and relationally driven therapeutic approach. The trauma therapist chiefly fosters engagement and makes space or pathways for an assortment of therapeutic interventions that are congruent with the client’s theory of change and take shape organically. Developing intrapersonal and interpersonal presence are primary focal points that correlate with the importance of personal and interactive processes in successful psychotherapy outcome research. Meaning making is at the core of a trauma-focused presence and takes place through client and therapist dialogue.

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