scholarly journals Gender Differences in Patients with Metastatic Pancreatic Cancer Who Received FOLFIRINOX

2021 ◽  
Vol 11 (2) ◽  
pp. 83
Author(s):  
Jinkook Kim ◽  
Eunjeong Ji ◽  
Kwangrok Jung ◽  
In Ho Jung ◽  
Jaewoo Park ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Gender Differences ◽  
Dose Reduction ◽  
Metastatic Pancreatic Cancer ◽  
P Value ◽  
Chemotherapeutic Regimen ◽  
Female Patients ◽  
Dose Modification ◽  
Significant Difference ◽  
Initial Cycle

Background: The combination of 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) is a very effective chemotherapeutic regimen for unresectable pancreatic cancer. Previous studies have reported that female gender may be a predictor of a better response to FOLFIRINOX. This study was aimed at investigating the clinical outcomes and dose modification patterns of FOLFIRINOX by gender. Methods: Patients with metastatic pancreatic cancer (MPC) who began FOLFIRINOX as the first-line therapy at Seoul National University Bundang Hospital between 2013 and 2018 were enrolled. The patients received at least four chemotherapy cycles. Local regression and a linear mixed model were used to analyze dose modification patterns by gender. Results: Ninety-seven patients with MPC (54 men; 43 women) were enrolled. In the first FOLFIRINOX cycle, there were significant differences in age and body surface area between the genders (58.8 (men) and 64.9 years (women), p = 0.005; 1.7 (men) and 1.6 m2 (women), p < 0.001, respectively). The median progression-free survival (PFS) and overall survival (OS) were 10.8 and 18.0 months, respectively. There was a trend of longer PFS (10.3 (men) and 11.9 months (women), p = 0.153) and a significantly longer OS (17.9 (men) and 25.9 months (women), p = 0.019) in female patients. During the first year of FOLFIRINOX treatment, there was a significant difference of the age-corrected dose reduction pattern by gender (a mean of 95.6% dose at the initial cycle and −0.35% of dose reduction per week in men versus a mean of 90.7% dose at the initial cycle and −0.53% of dose reduction per week in women, p-value of the slope: <0.001). There was no difference in the adverse event rates between the genders. Conclusions: Female patients showed longer OS despite a more rapid dose reduction during each cycle. Gender differences should be considered during FOLFIRINOX treatment.

scholarly journals Sex Differences in Patients with Metastatic Pancreatic Cancer Who Received FOLFIRINOX

2020 ◽  
Author(s):  
Jinkook Kim ◽  
Eunjeoung Ji ◽  
Kwangrok Jung ◽  
In Ho Jung ◽  
Jaewoo Park ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Sex Differences ◽  
Dose Reduction ◽  
Linear Mixed Model ◽  
Metastatic Pancreatic Cancer ◽  
P Value ◽  
Female Patients ◽  
Dose Modification ◽  
Significant Difference ◽  
Initial Cycle

Abstract Background:The combination of 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) is a very effectivechemotherapeutic regimen forunresectable pancreatic cancer.Previous studies have reported that female sex may be a predictor of a better response to FOLFIRINOX. This study was aimed at investigating the clinical outcomes and dose modification patterns of FOLFIRINOX by sex.Methods:Patients with metastatic pancreatic cancer(MPC) who began FOLFIRINOX as the first-line therapy at Seoul National University Bundang Hospital between 2013 and 2018 were enrolled. The patients received at least four chemotherapy cycles. Local regression and a linear mixed model were used to analyze dose modification patterns by sex.Results:Ninety-seven patients with MPC (54 men;43 women) were enrolled. In the first FOLFIRINOX cycle,there was a significant difference in age and body surface area between the sexes (58.8 [men] and 64.9 years [women], p =0.005 and 1.7 [men]and 1.6 m2[women], p < 0.001, respectively). The median progression-free survival (PFS) and overall survival (OS) were 10.8 and 18.0 months, respectively. There was a trend of longerPFS (10.3 [men] and 11.9 months [women], p = 0.153) and a significantly longer OS(17.9[men] and 25.9 months [women], p=0.019)in female patients. During the first year of FOLFIRINOX treatment, there was a significant difference of the age-corrected dose reduction pattern by sex (a mean of 94.3% dose at the initial cycle and -0.34% of dose reduction per week in menversus a mean of 89.3% dose at the initial cycle and -0.51% of dose reduction per week in women, p-value of the slope:<0.001). There was no difference in the adverse event rates between the sexes.Conclusion: Female patients showed longer OS despite a more rapid dose reduction during each cycle. Sex differences should be considered during FOLFIRINOX treatment.

Comparison of FOLFIRINOX and gemcitabine with nab-paclitaxel in metastatic pancreatic cancer: Using Korean Pancreatic Cancer (K-PaC) Registry.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15762-e15762
Author(s):  
Jong-Chan Lee ◽  
Dong Woo Shin ◽  
Se Yeol Yang ◽  
Min Jae Kim ◽  
Jaihwan Kim ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Sequential Treatment ◽  
Metastatic Pancreatic Cancer ◽  
Ductal Adenocarcinoma ◽  
Comparable Efficacy ◽  
P Value ◽  
Hematologic Toxicity ◽  
Web Based ◽  
Peritoneal Seeding ◽  
Significant Difference

e15762 Background: Although FOLFIRINOX and gemcitabine with nab-paclitaxel (GNP) are widely used in metastatic pancreatic cancer (MPC), the multi-center study comparing two regimens is rare. Recently, a multi-center, web-based registry for pancreatic cancer (K-PaC, Korean pancreatic cancer) was firstly launched in South Korea. We aimed to compare the clinical outcomes for FOLFIRINOX and GNP in MPC patients using K-PaC registry. Methods: In the K-PaC registry, we constructed the web-based database of anonymized 3,748 patients with histologically-proven pancreatic ductal adenocarcinoma. For this study, MPC patients who have received first-line FOLFIRINOX or GNP were enrolled. The baseline characteristics, overall survival (OS), grade III-IV toxicity, and other subgroup characteristics were analyzed. Results: From 2011 to 2017, a total of 413 (FOLFIRINOX 231 vs. GNP 182: with the same order below) patients met the eligible criteria. Median age was 63 year (60 vs. 68) and male were 46% (51% vs. 39%). Origins of tumor were head (41%), body (25%), and tail (34%). Major metastatic sites were liver (62%), peritoneum (32%), lung (18%), and others (34%), including multiple metastases. Median OS was 11.6 month (11.3 vs. 12.4, hazard ratio [HR] 0.91, confidence interval [CI] 0.71–1.16). The major hematologic toxicity was 32% of neutropenia (37% vs. 23% with P-value 0.116) and 12% of febrile neutropenia (16% vs. 10% with P-value 0.172). The major non-hematologic toxicity was 33% of fatigue (29% vs. 37% with P-value 0.455) and 28% of vomiting (27% vs. 29% with P-value 0.516). According to metastatic site, median OS by agents (months, FOLFIRINOX vs. GNP) were as follows: 9.5 vs. 10.2 with HR 0.898, CI 0.66–1.22 in liver; 11.8 vs. 12.5 with HR 0.90, CI 0.61–1.33 in lung; 9.1 vs. 12.6 with HR 0.94, HR 0.70–1.19 in peritoneal seeding. According to the sequential treatment, median OS of 1st-line FOLFIRINOX followed by GNP group (n = 53) was 11.2 month and that of 1st-line GNP followed by FOLFIRINOX group (n = 43) was 12.4 month (HR 0.82, CI 0.68–1.18). Conclusions: In this study using K-PaC registry in Korea, FOLFIRINOX and GNP showed comparable efficacy and toxicity. In the subgroup analysis, sequential treatment did not showed significant difference, but GNP showed a better trend in the group of peritoneal seeding.

Abstract 17356: Gender Differences in Clinical Presentation and Outcomes of Patients With Acute Myocardial Infarction and Spontaneous Coronary Artery Dissection: A Nationwide Inpatient Sample Matched Analysis

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Setri Fugar ◽  
Juliet A Yirerong ◽  
Alfred Solomon ◽  
Ahmed A Kolkailah ◽  
Tauseef Akthar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Gender Differences ◽  
Clinical Presentation ◽  
Artery Dissection ◽  
P Value ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Men And Women ◽  
Significant Difference

Introduction: Spontaneous Coronary Artery Dissection (SCAD) is reported to occur predominantly in young women. Gender differences in the clinical presentation and outcomes of patients with SCAD have not been studied on a population level. We sought to compare the in-hospital outcomes of men and women presenting with acute myocardial infarction (AMI) and SCAD. Methods: We identified patients from the National Inpatient Sample (NIS) between 2005 and 2015 who presented with primary diagnoses of AMI and SCAD. We identified SCAD with ICD-9 code 414.12. A 1:1 propensity-matched cohort was created to examine the outcomes between men and women. Primary endpoint was in-hospital mortality. Secondary endpoints included in-hospital cardiac and non-cardiac complications. Results: Of the 6617 (32017 weighted national estimates) patients with SCAD over the study period, majority were males 3667 (55.4%). Males were younger than females (60.32 yr vs. 61.59 yr) and presented more often with ST-elevation myocardial infarction (STEMI) (53.0% vs. 45.9% P=<0.001). Propensity matching yielded 2366 males and 2366 females. In the matched group, there was no significant difference in in-hospital mortality between males and females (OR 1.20 95% CI -0.93-1.54). With regards to in-hospital complications, ventricular tachycardia (V-Tach) was significantly less frequent in females as compared to males (8.0% vs. 10.1% OR 0.76 p-value 0.003). There was no significant difference between females and males in the frequency of other complications, including intracranial hemorrhage (0.2% vs 0.2% OR 1.45 p-value 0.50), GI bleed (1.8% vs 1.3% OR 1.35 p-value 0.13), cardiogenic shock (9.8% vs 9.7% OR 1.01 p-value 0.86), acute heart failure (3% vs 2.6% OR 1.18 p-value 0.26), ventricular fibrillation(vfib) (5.6% vs 6.0% OR 0.928 p-value 0.48) or stroke ( 1.5% vs 1.0% OR 1.535 p-value 0.06) Conclusion: In our large population-based analysis, compared to females, males were more likely to present with STEMI as compared to females. With the except of V-Tach, which was higher in males, there were no significant gender differences in hospital outcomes namely inpatient mortality, cardiogenic, Vfib or acute heart failure.

Kras mutation as a risk factor for venous thromboembolism in patients with metastatic pancreatic cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16267-e16267
Author(s):  
Elena Serrano ◽  
Elizabeth Inga Saavedra ◽  
Maria Padilla Vico ◽  
Eduardo Perdomo ◽  
Maria Teresa Cano Osuna ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Venous Thromboembolism ◽  
Protective Factor ◽  
Performance Status ◽  
Locally Advanced ◽  
Venous Catheter ◽  
Serum Levels ◽  
Metastatic Pancreatic Cancer ◽  
Study Cohort ◽  
Significant Difference

e16267 Background: Venous thromboembolism (VTE) is a common complication in oncology patients. It has been reported that VTE increases morbidity and mortality in these patients. It’s prevalence in metastatic pancreatic cancer (mPC) ranges around 4-7.5% Preclinic studies suggest that the mutation of the KRAS oncogene (KRASm) is associated with a higher risk of VTE among patients with colorectal cancer. KRASm appears to increase the expression of tissue factor, a physiological trigger of coagulation that is found on the surface of tumor cells. This association has not been studied in mPC, where this mutation can be found in 90% of the cases. Our aim is to determine the prevalence and risk factors associated with VTE taking into consideration the status of KRAS. Methods: We conducted a retrospective study within a cohort of patients with mPC that had a determination of the KRAS status. These patients were treated at Medical Oncology between January 2017 and December 2020. We performed a descriptive and survival analysis of our sample. We also studied the prevalence of VTE among the. Results: Our study cohort was 88 patients (pts), 63 (61, 2%) men and 40 (38, 8%) women. The median age was 63 years (32-84). 19 pts (18, 4%) were KRAS wild type (KRASwt), 69 pts (67%) KRASm. There was no statistically significant difference in gender, age, performance status, comorbidities, primary tumor/metastases location, disease control rate and toxicity between KRASwt and KRASm. Median serum levels of Ca 19.9 were higher in KRASm (39.847 U/ml vs 2026 U/ml). At the time of diagnosis, 78 pts (88, 6%) were metastatic and 10 pts (11, 4%) were localized/locally-advanced. Most of metastatic pts (62/78) were KRASm (p = 0, 015). Most common histology (86, 4%) was adenocarcinoma. This histology was more frequent in KRASm, 61, 8% (p = 0, 02). At time of analysis, 72 pts (69, 9%) were dead, most of them (54, 4%) were KRASm (p = 0, 001). 31 pts developed VTE: 4 were KRASwt and 27 KRASm. The prevalence of VTE was 36, 3%. It was greater in KRASm (39, 1%) than in KRASwt (26, 3%). There were 7 cases of rethrombosis instead of anticoagulant treatment (1 KRASwt and 6 KRASm). KRASwt seems to be a protective factor in the development of VTE (OR 0, 55; CI 95% 0, 18-1, 71). The most common entity were VTE of splenoportomensenteric axis (16 pts), followed by pulmonary embolism, EP, (7 pts), deep venous thrombosis, DVT, (4 pts) EP + DVP (3 pts), thrombosis associated with central venous catheter (3 pts) and other locations (2 pts). There were no differences in VTE location between KRASwt and KRASm. The median overall survival (OS) was 12, 82 months (CI 95%: 7, 87-17, 78). It was higher in KRASwt (26 months; CI 95%: 12, 21-40, 48) than in KRASm (9, 8 months; CI 95%: 6, 07-13, 65). This difference was statistically significant (p = 0, 001). Conclusions: In our cohort, the prevalence of VTE is higher than de prevalence described in the literature and was greater in KRASm population. OS was significantly larger in KRASwt.

scholarly journals Gender differences in estimating I-131 thyroid uptake from Tc-99m thyroid uptake for benign thyroid disease

2020 ◽  
pp. 20200700
Author(s):  
Amna Al-Jabri ◽  
Jennie Cooke ◽  
Seán Cournane ◽  
Marie-Louise Healy
Keyword(s):  
Thyroid Disease ◽  
P Value ◽  
Benign Thyroid Disease ◽  
Female Patients ◽  
Significant Difference ◽  
Thyroid Uptake ◽  
Male Cohort ◽  
Iodine 131 ◽  
Radioactive Iodine 131 ◽  
Benign Thyroid

Objective: For radioactive Iodine-131 (131I) treatments of thyroid diseases, increased efficacy has been reported for personalized dosimetry treatments. The measurement of Iodine-131 thyroid uptake (131IU) is required in these cases. This study aims to investigate whether 99mTc thyroid uptake (99mTcU) may be used in place of 131IU for implementing personalised treatments. Methods: A retrospective study of 152 benign thyroid disease 131I treatments was carried out during 2012–2020; 117 treatments were for female patients while 35 were for male patients diagnosed with either Graves’ disease, multinodular goitre or toxic nodules. Results: A statistically significant correlation was found between 131IU and 99mTcU data, with the data more correlated for male than female patients (r = 0.71 vs 0.38, p-value < 0.001). Patient age and time difference between the two respective uptake measurements significantly influenced the uptake correlation in females but not for the male cohort, although there was no significant difference between the parameters across gender. Thyroid diagnosis and hormone levels showed a significant correlation with uptakes in both genders. Estimating 131IU based on 99mTcU was shown to be predictive for male but not in female patients (R2 = 91% vs 16%). Conclusion: Estimating 131IU based on 99mTcU is not recommended for females at our centre. Males reported good correlation, but a larger sample would be needed for validation. Advances in knowledge: The initial findings showed a significant gender difference in benign thyroid uptake parameters at our centre, highlighting the potential need for gender consideration when planning 131IU patient management and when reporting studies results.

Efficacy of second-line chemotherapy after standard combination chemotherapy in patients with metastatic pancreatic cancer: The results from the NAPOLEON study.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 661-661
Author(s):  
Masaru Fukahori ◽  
Yoshinobu Okabe ◽  
Mototsugu Shimokawa ◽  
Taiga Otsuka ◽  
Futa Koga ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Combination Chemotherapy ◽  
Best Supportive Care ◽  
Metastatic Pancreatic Cancer ◽  
Survival Duration ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Number Of Patients ◽  
Significant Difference

661 Background: Gemcitabine plus nab-paclitaxel (GnP) and FOLFIRINOX (FFX) have been established as standard first-line combination chemotherapy (CTx) for patients with metastatic pancreatic cancer (MPC). However, the efficacy of second-line CTx and the significance of combination CTx in clinical practice are unclear. We therefore investigated the efficacy of second-line CTx in patients with MPC. Methods: Data were collected from CTx-naive MPC patients treated with first-line combination CTx at 14 hospitals in the Kyushu area of Japan from December 2013 to June 2018. The median overall survival (mOS) from second-line treatment was compared between patients who received second-line CTx (CT group) and those who received best supportive care (BSC group). Furthermore, in the CT group, the mOS was compared between the patients who received combination CTx and those who received mono-CTx. To control potential bias in the selection of second-line treatment, we also conducted a propensity score-adjusted analysis. Results: A total of 255 patients received GnP or FFX as first-line CTx. Of these, there were 156 (61%) in the CT group and 77 (30%) in the BSC group. The number of patients who received FFX/GnP as first-line CTx was 79 (51%)/77 (49%) in the CT group and 15 (20%)/62 (80%) in the BSC group, respectively (P < 0.01). The mOS in the CT group was significantly longer than that in the BSC group (5.2 vs. 2.7 months; hazard ratio [HR] 0.42; 95% confidence interval [CI] 0.31-0.57; p < 0.01 and 5.2 vs. 2.6 months; adjusted HR 0.39; 95% CI 0.28-0.55; p < 0.01). In the CT group, 89 (57%) patients received combination CTx, and 67 (43%) received mono-CTx. There was no significant difference in the mOS between the combination CTx and mono-CTx patients (5.5 vs. 4.4 months; HR 0.88; 95% CI 0.62-1.26; p = 0.88 and 5.6 vs. 4.4 months; adjusted HR 0.85; 95% CI 0.56-1.30; p = 0.47). Conclusions: Among patients with MPC receiving second-line treatment, the CT group had a significantly longer mOS than the BSC group, but combination CTx conferred no improvement in the survival duration compared with mono-CTx.

scholarly journals Pharmacoethnicity of FOLFIRINOX versus gemcitabine plus nab-paclitaxel in metastatic pancreatic cancer: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoon Suk Lee ◽  
Jong-chan Lee ◽  
Jae-Hyeong Kim ◽  
Jaihwan Kim ◽  
Jin-Hyeok Hwang
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Survival Benefit ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Metastatic Pancreatic Cancer ◽  
Cochrane Library ◽  
Chemotherapeutic Regimen ◽  
Free Survival ◽  
Ethnic Subgroups

AbstractTreatment outcomes between FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) and GNP (gemcitabine with albumin-bound paclitaxel) as first-line chemotherapy regimens for metastatic pancreatic cancer (PC) were assessed according to ethnic groups categorized as Western or Asian subgroups. PubMed, EMBASE, and Cochrane library were searched. Thirteen studies were eligible in this meta-analysis. Overall survival was not significantly different between FOLFIRINOX and GNP (HR 1.00, 95% CI 0.83–1.20, P = 0.990). However, the Western subgroup showed a higher survival benefit for FOLFIRINOX over GNP (HR 0.84, 95% CI 0.74–0.95, P = 0.006) whereas the Asian subgroup showed the survival benefit for GNP over FOLFIRINOX (HR 1.29, 95% CI 1.03–1.60, P = 0.030). Progression free survival was not significantly different between the two regimens in the Western subgroup (HR 1.01, 95% CI 0.84–1.20, P = 0.950) and the Asian subgroup (HR 1.13, 95% CI 0.97–1.33, P = 0.110). Occurrence of febrile neutropenia was significantly higher in FOLFIRINOX at both ethnic subgroups; however, that of peripheral neuropathy was significantly higher only in GNP of the Asian subgroup. Therefore, pharmacoethnicity might be a factor worth considering when deciding on a frontline chemotherapeutic regimen although the overall survival was not significantly different between FOLFIRINOX and GNP for metastatic PCs.

scholarly journals Characteristics of pulmonary tuberculosis patients in Moses Kotane region North West Province, South Africa

2017 ◽  
Vol 59 (2) ◽  
pp. 32
Author(s):  
Jean Louis Yoko ◽  
John Tumbo ◽  
Benjamin A Mills ◽  
Cila Dominic Kabongo
Keyword(s):  
Pulmonary Tuberculosis ◽  
Health Care Facilities ◽  
P Value ◽  
North West ◽  
Female Patients ◽  
Sputum Microscopy ◽  
Significant Difference ◽  
North West Province ◽  
Directly Observed Treatment ◽  
Male Patients

Aim: To determine the characteristics of patients with pulmonary tuberculosis registered in primary health care facilities in Moses Kotane region North West Province. Method: A retrospective record review of pulmonary TB patients registered in five community health centres (CHCs) in 2010 was conducted. Results: Of the 229 new patients diagnosed using sputum microscopy or culture, 176 were cured and 53 were not cured. The mean age for cured patients was 36.4 years and 34.0 years for not cured patients with standard deviations of 13.5 and 11.4 respectively (p-value 0.195). In total, 97 (55.1%) female patients and 79 (44.9%) male patients were cured while 24 (45.3%) female patients and 29 (54.7%) male patients were not cured (p-value 0.214). Among the 169 unemployed patients, 120 (68.2%) were cured and 40 (75.5%) were not cured. Of the 69 patients with employment, 56 (31.8%) were cured and 13 (24.5%) failed to cure (p-value 0.394). Of 176 cured patients, 130 had directly observed treatment (DOT) support while 31 of 53 not cured patients did not have DOT support (p-value 0.00002). Some 154 (67.2%) patients were HIV positive and among them 119 (67.6%) were cured and 35 (66.0%) were not cured while of the 75 who were HIV negative 57 (32.4%) were cured and 18 (33.9%) were not cured (p-value 0.8680). Conclusion: DOT support was a strong predictive characteristic for the outcomes of these TB patients during their treatment with a statistically significant difference between cured and not cured patients; the majority of not cured patients did not have DOT support. Other characteristics like gender, age, HIV status, employment or other medical conditions did not show any statistically significant difference between cured and not cured patients. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1272249

scholarly journals PALLIDOTOMY IN PARKINSONIAN DISEASE: THE RENAISSANCE

2021 ◽  
Vol 12 (2) ◽  
Author(s):  
Aurangzeb Kalhoro ◽  
Abdul Basit Sattar ◽  
Abdul Sattar M. Hashim ◽  
Abid Saleem
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Contralateral Side ◽  
P Value ◽  
Female Patients ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Difference ◽  
Parkinsonian Disease ◽  
Unilateral Pallidotomy

ABSTRACT: BACKGROUND & OBJECTIVE: To assess the results of pallidotomy in Parkinson’s disease, and its effect on improving the lifestyle of the patients and cost-effectiveness. METHODOLOGY: A descriptive study was conducted at Neuro-Spinal & Cancer Care Institute, Karachi from June 2014 to January 2020. Patients who were known case of Parkinson’s disease refractory to medication and developed side effects to medication were included in the study and patients with previous brain surgery, associated brain disorders like Alzheimer’s disease, basal ganglia lesion, brain trauma were excluded. All patients were treated by pallidotomy on the contralateral side. The significance of the difference between groups to compare between the pre-op or post-op treatments was calculated through non-parametric assessment Kruskal-Wallis tests.   RESULTS: The mean age of the patients was around 57 years. There were 34(81%) male and 8(19%) female patients’ Maximum number of patients who were more than 45 years, were having a left-sided proportion. More male patients were having a left-sided proportion as compared to female patients.  The majority of patients (57.5%) were having dyskinesia as q primary symptom. A significant difference (p-value <0.001) existed in pre & post-operative UPDRS-III scores. A significant difference (p-value <0.001) also existed between on & off medications UPDRS- III (pre-op/post-op) scores. CONCLUSION: The result of pallidotomy is promising especially for unilateral pallidotomy to minimize the risk of cognition and speech disorder and long-term follow-up is needed to prove the statement further. Currently, pallidotomy is associated with minimal complications, more effective, and improving the quality of life of Parkinsonian patients.

scholarly journals Pharmacokinetics and Tolerability of Etoposide in Newly Diagnosed Lymphoma Patients with Hepatic Impairment

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4445-4445
Author(s):  
Catherine Lai ◽  
Diane Cole ◽  
Nicole Lucas ◽  
Seth M. Steinberg ◽  
Brigitte C Widemann ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Dose Reduction ◽  
Hepatic Impairment ◽  
Conflicts Of Interest ◽  
Aggressive Lymphoma ◽  
P Value ◽  
Newly Diagnosed ◽  
Aggressive Lymphomas ◽  
Significant Difference ◽  
Elevated Bilirubin

Abstract Background: The addition of etoposide to chemotherapy regimens (e.g.- CHOEP and EPOCH) may be beneficial for the treatment of aggressive lymphomas. Previous studies have shown decreased clearance of etoposide in hepatic impairment leading to a dose reduction or removal of drug. Total clearance of etoposide does not change significantly in patients with elevated bilirubin. However, free (or unbound) etoposide levels are a more accurate measurement of drug clearance (Stewart el al. Changes in the Clearance of Total and Unbound Etoposide in Patients with Liver Dysfunction. J Clin Oncol. 1990 Nov;8(11):1874-9.). No studies have analyzed etoposide pharmacokinetics and clinical toxicity in lymphoma patients with hepatic impairment. Methods: Patients with newly diagnosed aggressive lymphoma received 1 to 8 cycles of DA-EPOCH +/-R at the NCI. Of 56 pts studied, 48 had normal and 8 had elevated bilirubin (median 3.4mg/dL, range 1.4-22.5mg/dL). All patients received full dose etoposide at 200mg/m2 over 96-hours on cycle 1. Blood samples were collected at 0, 22 and 96 hours after infusion began. Results: There was no significant difference between free etoposide clearance (Cl) and the free etoposide concentration (Css) in patients with elevated versus normal bilirubin (see table below). In all patients, irrespective of bilirubin, there was no significant correlation between free etoposide Cl, free etoposide Css and creatinine clearance (CrCl) or age. Neutropenia and thrombocytopenia was higher in patients with elevated bilirubin. Complete response (CR) was achieved in 75% (6/8) versus 85% (41/48) and PR in 0% (0/8) vs 4% (2/48) of patients with elevated vs normal bilirubin. Conclusions: Etoposide pharmacokinetics were not altered in patients with abnormal versus normal hepatic function. Although there was an increase in hematologic toxicities, there was no difference in Css or Cl of etoposide. Importantly, there were no significant differences in febrile neutropenia or grade 3/4 toxicities. The toxicity difference is likely attributed to other drugs. Response rates were similar between the 2 groups. Our results do not support the empiric dose reduction of etoposide in patients with aggressive lymphomas receiving potentially curative treatment. Table Results Elevated Bilirubin Normal Bilirubin p-value Median age (yrs) 39 (17-59) 54 (20-75) 0.15 IPI (int hi/hi risk) 75% (6/8) 23% (11/48) 0.0070 ANC nadir < 500/mm3 (C1) 100% (8/8) 54% (26/48) 0.017 PLT nadir < 25x103/mm3 (C1) 38% (3/8) 4% (2/48) 0.017 Febrile Neutropenia (C1) 13% (1/8) 13% (6/48) 1.00 G3/4 GI and neuro tox (C1) 38% (3/8) 13% (6/48) 0.11 Median free etoposide clearance on C1 (ml/min/m2) 724 (438-1413) 663 (199-1148) 0.40 Median free etoposide concentration on C1 (μM) 0.082 (0.044-0.135) 0.089 (0.052-0.298) 0.44 Disclosures No relevant conflicts of interest to declare.

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