Anti-cancer drugs
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Review Randomized Controlled Trial Clinical Trial
Bicalutamide: a new antiandrogen for use in combination with castration for patients with advanced prostate cancer.
Maximum androgen blockade, a relatively recent development in the treatment of prostate cancer, combines medical or surgical castration with antiandrogen therapy. A large randomized study comparing the non-steroidal antiandrogen, bicalutamide, with flutamide, each in combination with luteinizing hormone-releasing hormone (LHRH) analogs, showed that after a median follow-up of 49 weeks, the time to treatment failure was significantly longer for the bicalutamide patients compared with the flutamide patients (p = 0.005). After a median follow up to 95 weeks, bicalutamide in combination with LHRH analog therapy produced at least equivalent efficacy with flutamide in combination with LHRH analog therapy in terms of time to treatment failure and equivalent efficacy in terms of survival. The tolerability profile of bicalutamide, as based on reported findings and a literature review, indicates a superior tolerability to that of currently available antiandrogens, particularly with respect to diarrhea with a low incidence of treatment-related withdrawals.
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This review focuses on ways to ameliorate diagnosis and treatment of cancer-related pain with currently available knowledge and methods. The first part indicates how to improve pain assessment and diagnosis in the cancer patient. The second part evaluates current views for adequate pain management based on evidence of double-blind analgesic trials in cancer-related pain and deals with misconceptions in established symptomatic therapy.
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Octreotide has proved an effective agent in the palliation of refractory malignant intestinal obstruction. This may be achieved through a pro-absorptive effect on the small bowel mucosa, an effect on improving gastrointestinal motility, by a reduction in gastrointestinal hormone levels and by a direct anti-neoplastic effect on the obstructing tumour. The simple route of administration of octreotide and the paucity of side effects reported in two recent studies should make the physician consider its use in this particularly distressing complication of advanced cancer.
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Multicenter Study Clinical Trial
Docetaxel: an interesting new drug for the treatment of head and neck cancers and soft tissue sarcomas.
Results are summarized for two phase II studies of docetaxel as first-line therapy for advanced squamous cell carcinoma of the head and neck (SCCHN) and one study of docetaxel as second-line therapy for advanced soft tissue sarcomas. In all three studies, docetaxel was administered at a dose of 100 mg/m2 by intravenous infusion over 1 h every 3 weeks. A total of 62 patients were enrolled in the SCCHN trials, of whom 57 were evaluable for response. ⋯ Median duration of response in these patients with soft tissue sarcomas was 5 months. Again, these results are similar to those seen with the three most active single agents in soft tissue sarcomas when used as second-line therapy. Docetaxel may therefore represent a useful drug in both advanced SCCHN and soft tissue sarcomas.
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Multicenter Study Clinical Trial
Transdermal fentanyl: a new step on the therapeutic ladder.
The high efficacy, low molecular weight and high lipid solubility of fentanyl make it a suitable agent for transdermal administration. Effective plasma concentrations are maintained for up to 48-72 hours after application of a transdermal therapeutic system (TTS) fentanyl patch. In a multicentre study, slow-release morphine was replaced by TTS fentanyl according to a special calculation table (10 mg oral morphine corresponding to approximately 0.1 mg TTS fentanyl). ⋯ Special indications for chronic pain therapy using transdermal opioids include head and neck and gastro-intestinal tract cancer. In these cases, TTS fentanyl may be the final non-invasive form of analgesic therapy which allows the patient to maintain a normal lifestyle. TTS fentanyl thus represents a new alternative for therapy with strong opioids on step III of the World Health Organization analgesic ladder.