scholarly journals Bowel Perforation in the Emergency Department Related to Bevacizumab Therapy and Recurrent Ovarian Cancer

2020 ◽  
Vol 4 (2) ◽  
pp. 227-229
Author(s):  
Stuart Ostby ◽  
Michael Olushoga ◽  
Charles Leath ◽  
Samuel Burleson
Keyword(s):  
Ovarian Cancer ◽  
Emergency Department ◽  
Side Effects ◽  
Bowel Perforation ◽  
Recurrent Ovarian Cancer ◽  
Imaging Findings ◽  
Case Presentation ◽  
Portal Venous Gas ◽  
Surgical Evaluation

Case Presentation: We describe the presentation to the emergency department of a patient with recurrent ovarian cancer treated with bevacizumab with the complication of bowel perforation. Discussion: We review the frequency and outcomes of bevacizumab-related bowel perforation. We also report the patient’s imaging findings, including the radiologic presentation of free intraperitoneal air and portal venous gas, both indicative of bowel perforation and the need for emergent surgical evaluation. Our case also illustrates the potentially catastrophic side effects of bevacizumab and other targeted oncologic therapies of which emergecny physicians may not be aware.

The Benefits and Side Effects of Bevacizumab for the Treatment of Recurrent Ovarian Cancer

2017 ◽  
Vol 18 (10) ◽  
Author(s):  
Wenwen Zhang ◽  
Zhaojun Shen ◽  
Hui Luo ◽  
Xiaoli Hu ◽  
Lihong Zheng ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Side Effects ◽  
Recurrent Ovarian Cancer

scholarly journals Maintenance with Trabectedin in the Treatment of Platinum-Sensitive Recurrent Ovarian Cancer

2019 ◽  
Vol 12 (2) ◽  
pp. 447-455 ◽  
Author(s):  
Eva María Guerra Alía ◽  
Cayetano Sempere Ortega ◽  
Alfonso Cortés Salgado ◽  
Concepción Sanchez Martínez ◽  
Julio Galindo Álvarez ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Pegylated Liposomal Doxorubicin ◽  
Abdominal Distension ◽  
Recurrent Ovarian Cancer ◽  
Response To Treatment ◽  
Case Presentation ◽  
Good Tolerance ◽  
Platinum Sensitive ◽  
Platinum Based Chemotherapy ◽  
Selection Of

Ovarian cancer is the seventh most common type of cancer and the fifth leading cause of cancer death among women worldwide. The current usual therapeutic approach in this disease includes optimal cytoreductive therapy followed by platinum-based adjuvant chemotherapy, along with neoadjuvant chemotherapy prior to surgery in selected cases. The platinum-free interval (PFI) continues to be the most useful tool to assist in the selection of the subsequent therapy and to predict response to treatment. The combination of trabectedin and pegylated liposomal doxorubicin (PLD) is useful in patients with partially platinum-sensitive recurrent ovarian cancer, in patients who have previously received two or more platinum-based chemotherapy regimens, in patients who have already experienced a platinum-induced hypersensitivity reaction and in patients who have previously failed to respond to a platinum-based treatment. Case Presentation: A 64-years-old postmenopausal woman with pain, abdominal distension, and an altered intestinal transit and with partially platinum-sensitive recurrent ovarian cancer, was successfully treated with a second line of trabectedin chemotherapy in combination with PLD, followed by trabectedin in monotherapy. This case proves the effectiveness of the combination of trabectedin and PLD and demonstrates how the administration of trabectedin, even in monotherapy, allows to maintain an adequate clinical response with good tolerance to the treatment during more than two years of drug administration.

Should Bevacizumab Be Continued After Progression on Bevacizumab in Recurrent Ovarian Cancer?

2013 ◽  
Vol 23 (5) ◽  
pp. 833-838 ◽  
Author(s):  
Floor J. Backes ◽  
Debra L. Richardson ◽  
Georgia A. McCann ◽  
Blair Smith ◽  
Ritu Salani ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Bowel Perforation ◽  
Objective Response ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Response Rates ◽  
Recurrent Ovarian Cancer ◽  
Median Number ◽  
Cytotoxic Chemotherapy

ObjectiveThe optimal role of bevacizumab (Bev) in the treatment of ovarian cancer has not yet been established. Furthermore, it is unclear whether there is a benefit of Bev after progression on a Bev-containing regimen in ovarian cancer. The objective of this study was to compare response rates, progression-free survival (PFS), and overall survival between patients who were treated with chemotherapy and Bev after progression on Bev (BAB) versus patients who were treated with chemotherapy without Bev (CWOB).MethodsWe conducted a retrospective chart review of all patients who received treatment with Bev (with or without cytotoxic chemotherapy) for recurrent ovarian cancer at a single institution. Patients who received additional therapy after progression while on Bev were included.ResultsForty-six patients were included (16 CWOB group and 30 BAB). The median number of previous chemotherapy regimens was 2.5 for CWOB compared with 4 for BAB (P= 0.11). Fifty-two percent of patients had an objective response to the first Bev regimen before progressing on Bev. Response rates for the regimen after progression on Bev were 19% (3/16) in the CWOB group and 23% (7/30) in the BAB group (P= 1). Twenty-five percent of the patients who responded to the first Bev regimen and 18% of those who did not respond to the first Bev regimen responded to the second Bev regimen (P= 0.72). The median PFS for patients in the CWOB group was 2.6 months (95% confidence interval [CI], 1.3–5 months), compared with 5.0 months (95% CI, 3.5–7.3 months) for patients in the BAB group (P= 0.01). Overall survival was similar, 9.4 months (95% CI, 5.0–12.0 months) for CWOB versus 8.6 months (95% CI, 5.8–15.5 months) for BAB (P= 0.19). One patient in the BAB group died of a bowel perforation.ConclusionsIn patients previously treated with Bev for recurrent ovarian cancer, the subsequent addition of Bev to cytotoxic chemotherapy increased the PFS compared with patients not receiving a second course of Bev, but did so without an impact on overall survival. The response to the first Bev regimen did not predict whether a patient would respond again to the next Bev regimen. Randomized, larger studies will have to be performed to confirm this observation.

scholarly journals Acute Extrapyramidal Side Effects from Smoked Haloperidol

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Angeline Pham ◽  
Joo-Young Lee ◽  
Christopher W. T. Miller
Keyword(s):  
Emergency Department ◽  
Side Effects ◽  
Psychotic Disorders ◽  
Medical Literature ◽  
Extrapyramidal Side Effects ◽  
Case Presentation ◽  
Dopamine Receptor Antagonist ◽  
Second Generation Antipsychotics ◽  
Other Substances ◽  
High Doses

Introduction. Haloperidol is a dopamine receptor antagonist used to treat patients with psychotic disorders. Especially at high doses, haloperidol carries a higher risk of extrapyramidal symptoms (EPS) compared to second-generation antipsychotics. Few cases of haloperidol misuse are found in the medical literature. Case Presentation. We describe a patient with schizophrenia who smoked marijuana mixed with crushed haloperidol tablets. After the smoking of cannabis and haloperidol, the patient presented to the emergency department (ED) with suicidal ideation, psychosis, and acute dystonia. With the administration of intramuscular diphenhydramine at the ED, the dystonia resolved in less than an hour. To our knowledge, this is the first report on haloperidol misuse by smoking. Conclusion. Clinicians should be aware that patients might misuse prescribed antipsychotics via unconventional routes, potentially combined with other substances.

scholarly journals The Impact of Pegylated Liposomal Doxorubicin in Recurrent Ovarian Cancer : An Updated Meta-Analysis of Randomized Clinical Trials

2021 ◽  
Author(s):  
Xin-Ru Li ◽  
Yi Zhu ◽  
Guo-Nan Zhang ◽  
Jian-Ming Huang ◽  
Li-Xia Pei
Keyword(s):  
Ovarian Cancer ◽  
Clinical Trials ◽  
Side Effects ◽  
Confidence Level ◽  
Liposomal Doxorubicin ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Pegylated Liposomal Doxorubicin ◽  
Recurrent Ovarian Cancer ◽  
Cochrane Library

Abstract Background: Pegylated Liposomal Doxorubicin (PLD) could improve the survival rate of patients with recurrent ovarian cancer in previous meta-analysis studies. The aim of the present meta-analysis was to further update the role of PLD in the treatment of recurrent ovarian cancer.Methods: Literature search was performed by using the electronic databases Medicine, EMBASE, Web of Science, and Cochrane library until 27 July 2020. We only restricted the randomized clinical trials. Study specific hazard ratios and 95% confidence level (HR/95% CI), risk ratios and 95% confidence level (RR/95% CI), were pooled using a random effect model. Results: 10 studies (12 trials) were included after screening of 940 articles. We categorized the eligible studies into two groups: the doublet regimens (four trials, 1767 patients) resulted that PLD plus carboplatin(carbo) provided superior progression free survival (PFS) (HR, 0.85; 95% CI, 0.74-0.97) and similar overall survival (OS) (HR, 1.00; 95% CI, 0.88-1.14) compared PAC plus carbo. PLD plus carboplatin was associated with significantly more anemia and Thrombocytopenia, other side effects well-tolerated. In platin resistant patients, the monotherapy regimens (eight trials, 1980 patients) resulted that PLD had similar PFS (HR, 1.02; 95% CI, 0.90–1.16) and OS (HR, 0.88; 95% CI, 0.77–1.01) to other monotherapies. PLD alone was more associated with mucositis/stomatitis and hand-foot syndrome, other side effects well-tolerated.Conclusion: In platinum-sensitive recurrent ovarian cancer, PLD plus carbo is more effective than PAC plus carbo. In platinum-resistant or refractory recurrent ovarian cancer, PLD has similar survival to others monotherapies. For side effects, PLD plus carbo or monotherapy chemotherapy both were well-tolerated.

Does repeat usage of bevacizumab in patients with progressive recurrent ovarian cancer offer a survival advantage?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16510-e16510
Author(s):  
D. L. Richardson ◽  
F. J. Backes ◽  
L. G. Seamon ◽  
L. G. Seamon ◽  
J. D. Hurt ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Treatment Regimen ◽  
Bowel Perforation ◽  
Group Versus ◽  
Progression Free Survival ◽  
Recurrent Ovarian Cancer ◽  
Median Number ◽  
Cytotoxic Chemotherapy ◽  
Group 13 ◽  
Additional Therapy

e16510 Background: Many studies show bevacizumab (BEV) has activity in the treatment of recurrent ovarian cancer, especially when combined with cytotoxic chemotherapy. However, it is uncertain whether BEV should be continued if a patient progressives on treatment which includes BEV. Therefore, our objective is to compare response rates (RR), progression-free survival (PFS), and overall survival (OS) between patients who continued on BEV after progression on BEV (BPB) versus patients who were treated with cytotoxic chemotherapy without BEV (no BPB). Methods: All patients who received treatment with BEV (with or without cytotoxic chemotherapy) for recurrent ovarian cancer at a single institution were identified. Patients who received additional therapy after progression on BEV were included. Patients who were treated on GOG 218 or received first-line BEV or had their first BEV therapy discontinued due to side effects from BEV were excluded. RR were assessed using RECIST criteria, CA125 levels, or progressive disease symptoms. PFS was defined as the period from initiation of the treatment regimen until progression or date of last contact. OS was defined as the period from initiation of the second treatment regimen until death or date of last contact. Results: 35 patients met inclusion criteria. The median number of previous chemotherapy regimens was 4 (range 1–8). About 50% of the patients had a CR or PR prior to progressing on BEV. There were 27 patients in the BPB group, and 8 patients in the no BPB group. 13% (1/7) of patients responded to cytotoxic chemo after BEV, and 15% (4/27) of patients responded to repeat treatment with BEV, p = 1. The median PFS for patients in the no BPB group was 4.6 months (95% CI 1.6–5 mo), compared to 4.8 months (2.7–7.5 mo) for patients in the BPB group, p = 0.11. There was no difference in OS, 9.8 months (95% CI 2.73- ∞) versus 8.4 months (95% CI 5.8–15.6 months) p = 0.43 for patients in the no BPB group versus the BPB group. One patient in the BPB group died of a bowel perforation. Conclusions: We offer the first comparison of PFS and OS in patients treated with cytotoxic chemotherapy ± BEV after progression on BEV. After progressing on a BEV regimen, there was no difference in the PFS, OS or RR in those pts treated with or without BEV with an overall OS < 1 year. [Table: see text]

Expression III: What do primary and recurrent ovarian cancer (OC) patients expect from their doctors and therapy management? Results of a survey in eight European countries with 1,743 patients (NOGGO/ENGOT-OV9 study).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5569-5569 ◽  
Author(s):  
Gülten Oskay-Özcelik ◽  
Maren Keller ◽  
Sandro Pignata ◽  
Domenica Lorusso ◽  
Florence Joly ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Side Effects ◽  
Cancer Patients ◽  
Information Needs ◽  
Treatment Options ◽  
Recurrent Ovarian Cancer ◽  
European Countries ◽  
Second Opinion ◽  
Cancer Therapies ◽  
Therapy Management

5569 Background: The primary aim of this study was to investigate information needs and preferences among patients with ovarian cancer, focusing especially on doctor-patient relationships and therapy management in different European countries. Methods: A questionnaire was developed based on the experiences of expression II, a German survey, and then provided to primary and recurrent ovarian cancer patients via internet (online) or as a print-version in 8 countries in Europe (Austria, Belgium, France, Germany, Italy, Poland, Rumania, Spain). In the first part basic data (age, tumour status, therapy) were requested from the patient. In the second part, most of the questions tried to evaluate the expectations and needs concerning their therapy management and doctor-patient communication. Results: From December 2009 to October 2012, a total of 1743 patients with ovarian cancer from 8 European countries participated in the survey.The median age was 58 years (range 16-89). Nearly all patients (96,3%) had a primary surgery and a first-line chemotherapy (91,5%). About 423 (25,7%) patients were included in another clinical trial.Most of the patients in each country were pleased with the completeness and understandability of the explanations about the therapies from their doctors. About 68% of patients would be interested in having the opportunity to have a second opinion. The three most important aspects, which were proposed by patients to improve therapy against ovarian cancer were: “the therapy should not induce alopecia” (42%), “there must be more done to counter fatigue” (34%), and “the therapy should be more effective” (29%). Conclusions: This study underlines the high need of ovarian cancer patients to discuss all details concerning treatment options and clinical management with only minor difference between the countries. Patients also need more information about side effects of cancer therapies and second opinion opportunities. Besides effectiveness of therapy, alopecia and fatigue are the most important side effects bothering the patients.

scholarly journals The Untimely Popping Phial: Poppers as an Unusual Cause of Skin Corrosion of the Thigh

2020 ◽  
Vol 2020 ◽  
pp. 1-2
Author(s):  
Fabienne Moret ◽  
Gregor Lindner ◽  
Bertram K. Woitok
Keyword(s):  
Emergency Department ◽  
Side Effects ◽  
Muscle Relaxant ◽  
Rare Case ◽  
Alkyl Nitrates ◽  
Potential Harm ◽  
Case Presentation ◽  
Burning Pain ◽  
Alkyl Nitrites ◽  
Skin Contact

Background. Alkyl nitrites or “poppers” are widely used as sex-drugs due to their aphrodisiac and muscle relaxant effects. We describe the rare case of a large-sized dermatitis after direct skin contact with the poppers-fluid in a poppers user. Case Presentation. A 52-year-old patient presented to the emergency department due to burning pain on his proximal right thigh and scrotum. Clinical examination showed an 8 × 5 cm measuring burning wound resembling lesion. During further history the patient mentioned that the day before presentation a “poppers” phial unintentionally opened in his pocket and the fluid leaked. Conclusions. The present case shows severe skin defects after skin-contact with alkyl nitrates in a “poppers” user. Maculopathy and methemoglobinemia are prominent unwanted side effects of “poppers” use. However, our report demonstrates that attention should also be paid to potential harm for the skin.

A multi-institutional evaluation of the safety and efficacy of bevacizumab for recurrent, platinum-resistant ovarian cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5019-5019 ◽  
Author(s):  
J. D. Wright ◽  
A. Alvarezsecord ◽  
T. M. Numnum ◽  
R. P. Rocconi ◽  
M. A. Powell ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Stable Disease ◽  
Bowel Perforation ◽  
Single Agent ◽  
Recurrent Ovarian Cancer ◽  
Significant Activity ◽  
Recent Trial ◽  
Platinum Resistant ◽  
Heavily Pretreated ◽  
Grade 3

5019 Background: Bevacizumab has shown activity in recurrent ovarian cancer with an acceptable adverse event profile. However, the incidence of bowel perforation in a recent trial of heavily pretreated ovarian cancer patients was higher than expected from prior experience with bevacizumab. Whether the difference in the rate of bowel perforation was due to refractory disease, treatment history, disease burden, or location of tumor is uncertain. We sought to review our multi-institutional experience with bevacizumab in patients with recurrent ovarian cancer. Methods: A retrospective review of patients with recurrent ovarian cancer treated with single agent or combination bevacizumab therapy was undertaken. Toxicity was assessed using standard criteria. Response was determined radiographically and through serial CA125 measurements. Statistical analysis to determine factors associated with toxicity and response was performed. Results: Sixty-two eligible patients were identified. All had failed prior platinum-based therapy and had received a median of 5 prior chemotherapy regimens and 2 prior platinum-containing regimens. Single agent bevacizumab was administered to 12 (19%) women, while 50 (81%) received the drug in combination with a cytotoxic agent. The most common toxicities were myelosuppression (60%), proteinuria (19%) and hypertension (16%). Grade 3–5 toxicities occurred in 15 (24%) patients, including grade 3–4 hypertension in 4 (7%). Gastrointestinal perforations were identified in 4 (7%) subjects. Nine (15%) patients discontinued therapy due to toxicity. Fifty-eight patients were assessable for response. The overall response rate was 36% (4 CR, 17 PR) with stable disease in 40%. Clinical benefit (CR, PR, stable disease) was seen in 83% of patients treated with single agent therapy and 74% of those treated with bevacizumab-combination regimens. Conclusions: Bevacizumab demonstrates significant activity for recurrent, platinum-resistant ovarian cancer. Life threatening bowel perforations were noted in 7% of our subjects. The frequency of perforations in our cohort suggests that this complication is more likely to occur in heavily pretreated patients. No significant financial relationships to disclose.

Recurrent Ovarian Cancer: Spectrum of Imaging Findings

2006 ◽  
Vol 187 (1) ◽  
pp. 99-104 ◽  
Author(s):  
Jin Wei Kwek ◽  
Revathy B. Iyer
Keyword(s):  
Ovarian Cancer ◽  
Recurrent Ovarian Cancer ◽  
Imaging Findings
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