Painful gynecomastia following cytotoxic therapy for testis cancer: a potentially favorable prognostic sign?

1983 ◽  
Vol 1 (7) ◽  
pp. 416-420 ◽  
Author(s):  
D L Trump ◽  
S A Anderson
Keyword(s):  
Drug Therapy ◽  
Complete Remission ◽  
Advanced Disease ◽  
Cytotoxic Chemotherapy ◽  
Beta Subunit ◽  
Testis Cancer ◽  
Adult Males ◽  
Cytotoxic Therapy ◽  
Prognostic Sign ◽  
Recurrent Malignancy

Ninety-six patients who received cytotoxic chemotherapy for germ cell neoplasms of the testis were studied. Painful gynecomastia developed in eight patients (8%) between 6 and 24 weeks after the initiation of cytotoxic therapy (mean 18 wk). Serum content of the beta subunit of human chorionic gonadotropin was normal in each patient when gynecomastia developed. Gynecomastia occurred following cytotoxic therapy for advanced disease in seven patients, and one patient was receiving adjunctive drug therapy for stage I disease. Six of the seven patients with advanced disease were in complete remission when gynecomastia developed; survival was superior in patients who developed treatment-related gynecomastia compared to those patients who did not (p less than 0.05). Gynecomastia may occur in adult males after cytotoxic therapy for testis cancer; such gynecomastia does not necessarily indicate recurrent malignancy and may be a favorable prognostic sign.

scholarly journals Infection prevention in patients with cancer: microbiological evaluation of portable laminar air flow isolation, topical chlorhexidine, and oral non-absorbable antibiotics

1980 ◽  
Vol 84 (3) ◽  
pp. 457-465 ◽  
Author(s):  
A. S. D. Spiers ◽  
Sylvia F. Dias ◽  
J. A. Lopez
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Drug Therapy ◽  
Acute Leukaemia ◽  
Infection Prevention ◽  
Cytotoxic Chemotherapy ◽  
Prevention Of Infection ◽  
Patients With Cancer ◽  
Flow Apparatus ◽  
Laminar Air Flow ◽  
Nose And Throat

SUMMARYThe increasing use of intensive cytotoxic chemotherapy for patients with solid tumors enhances the risk of opportunistic infection to levels formerly seen only in patients with acute leukaemia, and prevention of infection is a major concern. A relatively simple regimen of isolation, topical antisepsis, and orally administered non-absorbable antibiltics was stuidied in 18 patients. Sixteen of 21 studies were performed using portable laminar ait flow apparatus and five with isolation only. All patients became severly neutropenic but there were no major infections. Microbiological results showed effective decontamination of the skin, which was maintained without recolonization or acquisition of new organisms. The ears, nose and throat were effectively decontaminated only when the regimen was intensified. Colonization with Pseudomonas aeruginosa, a major pathogen in compromised hosts, did not occur. The propective regimen is less expensive than regimens previously desribed, is acceptable to patients, and requires no modification of existing hospital rooms. It merits further evaluation in patients with common cancers who receive intensive cytotoxic drug therapy.

Safety and Efficacy of Cytotoxic Chemotherapy after Allogeneic Hematopoietic Stem Cell Transplantation for Relapsed Hematologic Malignancy.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5333-5333
Author(s):  
Nancy M. Hardy ◽  
Jeanne Odom ◽  
Kelly Snow ◽  
Robert Dean ◽  
Steven Pavletic ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Hematologic Malignancy ◽  
Cytotoxic Chemotherapy ◽  
Cytotoxic Therapy ◽  
Hematopoietic Stem ◽  
Cmv Reactivation

Abstract Relapse of hematologic malignancy is a major problem after allogeneic hematopoietic stem cell transplantation (alloHSCT), with limited treatment options of proven benefit other than donor lymphocyte infusions (DLI). Additionally, toxicity from treatment with cytotoxic chemotherapy after alloHSCT may differ from conventional treatments, and could include graft-versus-host disease, allograft failure, or increased risk of infection. We retrospectively reviewed treatment outcomes of 25 patients who received cytotoxic chemotherapy as treatment for relapsed hematologic malignancies after reduced-intensity, matched-sibling donor alloHSCT. Combination therapies included: EPOCH+/− rituximab (n=12 patients); “7&3” AML induction (ida/ara-c) (n=2); FLAG (n=2); asparaginase/6-MP/vincristine (n=1); R-ICE (n=1); MIME (n=1); BVP (n=1); and bortezomib/doxorubicin/dexamethasone (n=1). Single-agent therapies included: bortezomib (n=6); gemcitabine (n=4), vinorelbine (n=3); vincristine (n=1); methotrexate (n=1); and intrathecal methotrexate and/or cytarabine (n=5). A total of 133 cycles or doses were administered, of which 20 were supported with donor stem cell boosts, and another 9 were followed by nonmobilized DLI. There were 52 Grade 3 or higher toxicity episodes recorded, most commonly: neutropenia (10 episodes); infection with neutropenia (5 episodes); thrombocytopenia (6 episodes); and anemia (3 episodes). There were 12 episodes of CMV reactivation in 8 of 15 patients at risk, including 2 cases of pneumonitis and 1 case of colitis. GVHD flares were considered definitely chemotherapy-induced (2), possibly chemotherapy-induced (7), and unlikely chemotherapy-induced (2). Unusual events after treatment included culture-negative sepsis-like illness after bortezomib (n=2), secondary (11q23) AML of donor origin after one cycle of EPOCH (n=1) and diffuse alveolar hemorrhage after EPOCH (n=1). Seven patients achieved CR with therapy for post-transplant relapse, including three durable remissions. Four patients achieved PR and seven achieved disease stabilization. Median survival after starting cytotoxic therapy was 263 days. Timing of relapse appeared to be associated with survival, with median overall survival of 95 days for patients requiring therapy before Day 100 vs. 508 days for patients after Day 100 (p=0.0008). Treatment of relapse with cytotoxic chemotherapy after alloSCT is feasible and can result in durable remissions in a minority of patients. However, administration of cytotoxic therapy after alloHSCT requires monitoring and support for hematologic toxicities, GVHD and CMV reactivation; selected patients may benefit from prophylactic stem cell boosts or immune suppression. Survival after Cytotoxic Therapy for Relapse after alloHSCT Survival after Cytotoxic Therapy for Relapse after alloHSCT

Randomized Study of Decitabine Versus Observation or Continued Cytotoxic Chemotherapy in Patients with Intermediate and Poor Risk Acute Myeloid Leukemia in First or Subsequent Complete Remission.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2859-2859 ◽  
Author(s):  
Farhad Ravandi ◽  
Jean-Pierre Issa ◽  
Stefan Faderl ◽  
Guillermo Garcia-Manero ◽  
Mary Hood ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Complete Remission ◽  
Clin Oncol ◽  
Myeloid Leukemia ◽  
Cytotoxic Chemotherapy ◽  
Cytotoxic Agents ◽  
High Dose ◽  
Poor Risk ◽  
Grade 3 ◽  
Acute Myeloid

Abstract The role of maintenance therapy in acute myeloid leukemia (AML) remains unclear. Continued therapy with cytotoxic agents similar to those used for induction and consolidation is associated with toxicity but can improve disease free survival (DFS). (Buchner T, J Clin Oncol. 2006;24:2480 and Lowenberg B, J Clin Oncol. 1998;16:872) Immune modulation in this setting may also be effective in prolonging DFS.(Brune M, Blood2006;108:88). Methylation status of tumor suppressor genes in clinical remission predicts the relapse risk in AML with earlier relapse in patients with increased DNA promotor methylation.(Agrawal S, Cancer Res. 2007;67:1370) Therefore, hypomethylating therapy may be effective in maintaining remission and prolonging survival in these patients. We are conducting a clinical trial comparing decitabine to cytotoxic chemotherapy or observation in patients with AML in their first or subsequent complete remission (CR). Patients with non-favorable risk AML (including intermediate and poor risk) receive induction therapy with idarubicin and high dose cytarabine followed by at least 2 cycles of cytarabine based consolidation. They are then stratified by age (≤ 60 vs. > 60) and cytogenetics (intermediate vs. poor risk) and randomized to receive decitabine 20 mg/m2 IV daily × 5 every 4 to 8 weeks for 12 cycles, or to continue chemotherapy/observation. Patients in > first CR are randomized after completion of salvage therapy. Serial samples for methylation studies and determination of minimal residual disease by flow cytometry are collected. To date, 19 (8 M, 11 F) patients with AML (including 14 in first CR and 5 in subsequent CR) have been enrolled onto the study. Median age of the patients is 56 years (range 31 – 74). Fourteen patients are ≤ 60 years. Cytogenetics at diagnosis was intermediate in 10 patients, poor-risk in 8 patients, and favorable [inv(16)] in one relapsed patient. Eight patients were randomized to decitabine and have received a median of 3 cycles (range 1 – 6). Eleven patients were randomized to observation/continued therapy and all, except 2 patients, have received further cytarabine based therapy after consolidation. With a median duration of follow up for the entire group of 5 months (range 1 – 9), 7/8 patients on the decitabine arm and 9/11 patients on the other arm have remained in remission. Toxicity in the decitabine treated patients was limited to 4 episodes of grade 3 neutropenia, 2 episode of grade 3 thrombocytopenia, and 1 episodes of grade 3 anemia. All of these cytopenias were short in duration and reversed without any associated adverse events. We conclude that administration of decitabine in CR at the above schedule/dose is safe and well tolerated.

Nationwide disparities in testicular cancer care delivery: Racial, ethnic, and economic markers of patient vulnerability.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 421-421 ◽  
Author(s):  
Liam Connor Macleod ◽  
Shannon Cannon ◽  
Oliver Ko ◽  
Jonathan L. Wright ◽  
George Schade ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Care ◽  
Care Delivery ◽  
Testis Cancer ◽  
Insurance Status ◽  
Adult Males ◽  
Case Volume ◽  
Early Presentation ◽  
Poor Outcomes ◽  
Large Primary

421 Background: Testis cancer is often curable, yet early presentation is a key determinant of survival and treatment morbidity. Testis cancer affects the young, who have less consistent primary care access. This may impede timely mobilization of complex healthcare resources needed for cancer care. We analyze the National Cancer Database (NCDB) for disparity in disease-specific outcomes. Methods: The NCDB identified adult males with testicular tumors (2004-2013). Four outcomes were selected as markers of care delays: higher stage presentation (defined as stage III+), large primary lesion at diagnosis, time to orchiectomy and overall mortality. Key exposures included race/ethnicity, socioeconomic factors and insurance status. Outcomes were assessed with multivariable hazards regression (survival) or logistic regression (others). Results: 31,964 men were eligible. Seventeen percent had higher stage presentation, 29% had a large primary, and 9.9% had delayed orchiectomy and 4.8% died during follow up. All outcomes were associated with multiple markers of patient vulnerability at the p < 0.001 level. The most consistent and greatest magnitude association was insurance status (e.g. for mortality Medicaid HR 1.9, 95% CI 1.6-2.3, uninsured HR 1.7, 95% CI 1.5-2.1, for large primary Medicaid OR 1.8, 95% CI 1.7-2.0, uninsured OR 2.1, 95% CI 2.0-2.3 [referent private payer]). In addition to markers of vulnerability, center case volume and travel burden were also associated with poor outcomes (p < 0.001). Conclusions: We find association between severity of disease and markers of patient vulnerability. Insurance had the greatest magnitude and most consistent association with poor outcomes and is therefore a priority for quality improvement. As access to primary care is expanded for the testis cancer population with the Affordable Care Act, it will be important to assess whether gains in coverage translate to improvements in cancer outcomes.

scholarly journals Impact of Salvage Cytotoxic Chemotherapy on Prognosis in Patients with Recurrence After Radical Cystectomy: A Multi-Institutional Retrospective Study

2022 ◽  
Author(s):  
Dai Koguchi ◽  
Kazumasa Matsumoto ◽  
Masaomi Ikeda ◽  
Yoshinori Taoka ◽  
Takahiro Hirayama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Liver Metastasis ◽  
Radical Cystectomy ◽  
Treatment Effect ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Cytotoxic Chemotherapy ◽  
Locally Advanced Disease ◽  
Clinicopathologic Factors

Abstract Background In patients experiencing disease recurrence after radical cystectomy (RC) for bladder cancer, data about the impact of clinicopathologic factors, including salvage treatment using cytotoxic chemotherapy, on the survival are scarce. We investigated the prognostic value of clinicopathologic factors and the treatment effect of salvage cytotoxic chemotherapy (SC) in such patients. Methods In this retrospective study, we evaluated the clinical data for 86 patients who experienced recurrence after RC. Administration of SC or of best supportive care (BSC) was determined in consultation with the urologist in charge and in accordance with each patient’s performance status, wishes for treatment, and renal function. Statistical analyses explored for prognostic factors and evaluated the treatment effect of SC compared with BSC in terms of cancer-specific survival (CSS). Results Multivariate analyses showed that liver metastasis after RC (hazard ratio [HR]: 2.13; 95% confidence interval [CI]: 1.17 to 3.85; P = 0.01) and locally advanced disease at RC (HR: 1.92; 95% CI: 1.06 to 3.46; P = 0.03) are independent risk factors for worse CSS in patients experiencing recurrence after RC. In a risk stratification model, patients were assigned to one of two groups based on liver metastasis and locally advanced stage. In the high-risk group, which included 68 patients with 1–2 risk factors, CSS was significantly better for patients receiving SC than for those receiving BSC (median survival duration: 9.4 months vs. 2.4 months, P = 0.005). The therapeutic effect of SC was not related to a history of adjuvant chemotherapy. Conclusions The present study indicated the potential value of 1st-line SC in patients experiencing recurrence after RC even with advanced features, such as liver metastasis after RC and locally advanced disease at RC.

Determinants for the decision of chemotherapy in advanced cancer patients.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 110-110
Author(s):  
Charles Velter ◽  
Helene de-La-Menardiere ◽  
Francois Goldwasser
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Risk Ratio ◽  
Palliative Medicine ◽  
Advanced Disease ◽  
Cytotoxic Chemotherapy ◽  
Evidence Based ◽  
Multidisciplinary Meetings ◽  
Increased Risk ◽  
Unrealistic Expectations

110 Background: Chemotherapy is often prescribed in order not to despair a patient in an advanced stage of cancer, while the physician identifies an unfavorable benefit/risk ratio. The use of chemotherapy in terminally ill cancer patients in the last months of life is associated with an increased risk of aggressive care (Wright A et al. BMJ; 348:g1219 doi: 10, 2014). We previously showed that multidisciplinary meetings with palliative specialists reduce futility (Colombet I et al. BMJ Support Palliat Care; 2(3):239-47, 2012). We studied the parameters leading to inappropriate palliative chemotherapy in France: How oncologists face to unrealistic expectations and what is the process for the decision-making leading to chemotherapy beyond evidence-based medicine? Methods: The study was conducted in April 2014 in Paris, France. We designed a Multiple Choice Questionnaire. The first part described a clinical situation of a patient with advanced pancreatic cancer with evidence-based factors for not doing chemotherapy. The second part included questions regarding the behavior of the oncologist. Results: We included 62 oncologists. While 58 oncologists (94%) considered beneficial to include palliative medicine specialists, 44 (71%) chose to prescribe cytotoxic chemotherapy. In the decision-making process, 49 oncologists (79%) gave more weight to the demand of the patients than to the benefit/risk ratio. The validated scores for the evaluation of life-expectancy in this setting were not known in 19 cases (31%). In advanced disease, 42 oncologists (68%) acknowledged to decide without multidisciplinary staff meeting. Conclusions: The decision-making in advanced disease tended to be solitary. Cytotoxic chemotherapy appears as a common answer to unrealistic expectations. Multidisciplinary meetings with palliative medicine specialists are recommended to improve end-of-life decisions.

Non-Hodgkin's lymphoma of the stomach: a prospective pilot study of surgery plus chemotherapy in early and advanced disease.

1985 ◽  
Vol 3 (4) ◽  
pp. 495-500 ◽  
Author(s):  
W P Sheridan ◽  
G Medley ◽  
G N Brodie
Keyword(s):  
Pilot Study ◽  
Complete Remission ◽  
Surgical Resection ◽  
Hodgkin’S Lymphoma ◽  
Advanced Disease ◽  
Hodgkin's Lymphoma ◽  
Prospective Pilot Study ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Disease Free

A prospective pilot study of 23 patients with non-Hodgkin's lymphoma involving the stomach was undertaken to assess the efficacy of surgical resection followed by chemotherapy with adjuvant cyclical cyclophosphamide, vincristine, and prednisolone (CVP) in early stage disease, and cyclical cyclophosphamide, vincristine, prednisolone, and doxorubicin (CHOP) in advanced disease. One of 18 evaluable patients died postoperatively; 17 of 18 completed therapy and are alive and disease-free at a median follow-up of 41 months after surgery (range, 5 to 111 months), including four patients with stage IV disease who remain in complete remission 19 to 47 months after surgery. There was one postoperative death, giving an actuarial survival rate of 94% in the study group. Three of five inoperable patients were treated with CHOP, with two achieving complete remission. Two untreated patients died. Overall actuarial disease-free survival was 82.6%. Surgical resection plus chemotherapy is capable of producing long-term remission and cure in both localized and advanced non-Hodgkin's lymphoma of the stomach. Intensive supportive care plus chemotherapy may salvage a proportion of patients with inoperable tumors.

scholarly journals INFLUENCE OF LONG-TERM CYTOTOXIC CHEMOTHERAPY ON THE CONDITION OF PERIPHERAL VENOUS CHANNEL

2017 ◽  
Vol 3 ◽  
pp. 49-55
Author(s):  
Tetiana Tkachuk
Keyword(s):  
Cancer Patients ◽  
Vascular Access ◽  
Venous Access ◽  
Term Treatment ◽  
Cytotoxic Chemotherapy ◽  
Cytotoxic Therapy ◽  
Qualitative And Quantitative ◽  
Long Term Treatment ◽  
Term Administration

The necessity of long-term venous access in cancer patients appears at frequent and long-term courses of cytotoxic therapy. Peripheral veins of forearms are most often used for these aims. The conditions of peripheral venous channel in 32 cancer patients, who underwent the long-term treatment with antitumor preparations were analyzed in the article on own investigatory material. The methods of dopplerography, morphological and immunohystochemical studies were used. The qualitative and quantitative dopplerographic changes in forearm veins in different terms after chemotherapy start were revealed in most patients. The conclusion was made about unsuitability of forearm peripheral veins for the long term administration of cytostatics and the necessity to create the alternative vascular access that would correspond to the criteria of safety, reliability and long-term exploitation.

scholarly journals Tartós SARS-CoV-2-PCR-pozitivitáshoz társuló, lokoregionálisan előrehaladott emlődaganat komplex onkológiai kezelése

2021 ◽  
Vol 162 (16) ◽  
pp. 611-614
Author(s):  
András Drozgyik ◽  
Dániel Kollár ◽  
Márta Knausz ◽  
István Sipőcz ◽  
F. Tamás Molnár ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cytotoxic Chemotherapy ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Cytotoxic Therapy ◽  
Multidisciplinary Cooperation ◽  
Advanced Malignancies ◽  
Antihormonal Therapy ◽  
Aggressive Tumors ◽  
Oncologic Treatment

Összefoglaló. A COVID–19 mortalitását a súlyos társbetegségek, közöttük bizonyos daganatos betegségek is növelik. Immunszuppresszív hatásuk miatt felmerülhet a citotoxikus kezelések rizikónövelő hatása is. Ugyanakkor az onkológiai terápia megszakítása vagy halasztása, különösen az agresszívebb, kiterjedtebb és fiatalkorban jelentkező daganatok esetében ronthatja a kórjóslatot. Egy 39 éves nőbeteg esetét ismertetjük. A járvány során késlekedve felismert, lokoregionálisan kiterjedt emlődaganat miatt primer szisztémás kemoterápiában részesült. A kezelés 5. ciklusa során enyhe légúti tünetek kapcsán, az onkológiai ambulancián SARS-CoV-2-fertőzése igazolódott. Kemoterápiás kezelését felfüggesztettük. A diagnózistól számított 3. napon tünetmentessé vált, ám SARS-CoV-2-PCR-pozitivitása még a 43. napon is fennállt. A 19. napon hormongátló kezelést indítottunk. Az 51. napon mastectomia és axillaris block dissectio történt. A 82. napon a megszakított kemoterápiát a hormongátló kezelés leállítását követően G-CSF-profilaxis mellett újraindítottuk. A kezelés során fertőzéses szövődményt nem észleltünk. Kemoterápia és műtét SARS-CoV-2-fertőzött, tünetmentes daganatos betegnél szövődménymentesen végezhető elhúzódó virológiai pozitivitás esetén, felszabadító vizsgálat nélkül is. A daganatos betegek koronavírus-fertőzése esetén az onkológiai protokolltól történő eltérés egyénre szabott optimalizálásával és a multidiszciplináris team szorosabb együttműködésével az infektológiai és az onkológiai kockázat együttes alacsonyan tartása is megvalósítható. Orv Hetil. 2021; 162(16): 611–614. Summary. Mortality of COVID-19 is increased when certain co-morbidities, among others advanced malignancies are present. Deleterious effect of cytotoxic therapy, related to its immunosuppressive effect, may also be hypothesised. However, postponing or cancelling oncologic treatment, especially in younger patients with advanced and more aggressive tumors may worsen the prognosis. The case of a 39-year-old female patient is presented, who was diagnosed with loco-regionally advanced breast cancer during the pandemic. Primary systemic chemotherapy was started. The patient presented with acute respiratory tract symptoms during the fifth cycle and subsequently SARS-CoV-2 infection was diagnosed. Chemotherapy was cancelled. Symptoms resolved in three days after diagnosis. SARS-CoV-2 PCR remained positive up to day 43. Antihormonal therapy was introduced on day 19 and she underwent mastectomy with axillary lymph node dissection on day 51. Chemotherapy was reset postoperatively on day 82 with prophylactic G-CSF protection. No adverse event was observed throughout the treatment. Cytotoxic chemotherapy and surgery can be successfully delivered in breast cancer patients with prolonged asymptomatic SARS-CoV-2 PCR positivity, even without negative swab result. Individual optimisation of the therapy may require deviations from standard protocols. Closer multidisciplinary cooperation may contribute to the minimisation of both oncologic and infectious risks. Orv Hetil. 2021; 162(16): 611–614.

Sign in / Sign up

Export Citation Format

Share Document