Future oncology
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Breakthrough pain (BTP) is an unmet clinical need that is still poorly diagnosed, evaluated and inadequately treated. The prevalence of BTP has been estimated to affect at least 64% of cancer patients. Two pain-relief strategies were proposed: preventive and active ('rescue'). ⋯ Fentanyl buccal tablet (FBT) is a novel delivery system for fentanyl citrate. FBT utilizes OraVescent technology to improve bioavailability and speed of drug delivery. Recent studies have demonstrated superior pharmacokinetic profiles when compared with other available transmucosal opioids (OTFC), however, pharmacodynamic data are still somewhat limited.
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Alemtuzumab is a humanized monoclonal antibody specific for CD52, a glycosylphosphatidylinositol-anchored, lymphocyte-surface glycoprotein. Administration of alemtuzumab to patients with chronic lymphocytic leukemia depletes normal and neoplastic lymphocytes from the blood, spleen and marrow, but appears to be less effective in resolving lymphadenopathy. Owing to its activity in clearing leukemia cells of patients who are refractory to purine analogs, such as fludarabine, alemtuzumab became the first and only monoclonal antibody approved by the US FDA and other regulatory authorities for the treatment of chronic lymphocytic leukemia. Here we review the results of clinical studies evaluating the activity and safety of alemtuzumab when used alone or in combination with other antileukemia agents for the treatment of this disease.
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Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The emetogenicity of the chemotherapeutic agents, repeated chemotherapy cycles and patient risk factors (female gender, younger age, alcohol consumption, history of motion sickness) are the major risk factors for CINV. The use of 5-hydroxytryptamine (5-HT)3 receptor antagonists plus dexamethasone has significantly improved the control of acute CINV, but delayed nausea and vomiting remains a clinical problem. ⋯ There were no clinically relevant differences seen among palonosetron, ondansetron or dolasetron in laboratory, electrocardiographic or vital-sign changes, and adverse reactions reported in the clinical trials were the most common reactions reported for the 5-HT3 receptor antagonist class. Recent studies using palonosetron-based anti-emetic combinations in moderately and highly emetogenic chemotherapy, as well as in the clinical setting of multiple-day chemotherapy, have been reported. Future studies may consider the use of palonosetron with current and other new agents and in other clinical settings, such as bone marrow transplantation and radiation therapy.
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Review Comparative Study
Epidermal growth factor receptor mutations predict sensitivity to gefitinib in patients with non-small-cell lung cancer.
Despite advances in chemotherapeutics, overall survival for advanced lung cancer patients remains poor. Consequently, efforts have focused on the use of targeted therapies to improve response rates and survival. ⋯ Two recent studies published simultaneously, identified mutations in the ATP-binding cleft of the EGFR that are associated with clinical response to gefitinib. This finding has extraordinary implications and serves as a critical step toward individualized, patient-specific treatment plans based on the molecular constitution of the tumor of each individual.