Prescrire international
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Rhythm and conduction disorders, heart failure, even at low doses.
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Prescrire international · Jan 2014
Regorafenib. Metastatic colorectal cancer in treatment failure: may prolong survival by a few weeks.
Patients with metastatic colorectal cancer who have exhausted their therapeutic options have a life expectancy of only a few months. Treatment is then based on tailored supportive care, without cytotoxic drugs. Regorafenib, an inhibitor of multiple protein kinases, has been authorised in the European Union for the treatment of patients with metastatic colorectal cancer who have no other therapeutic options. ⋯ Some patients died from these adverse effects, notably liver damage and bleeding. In practice, according to the only available trial, regorafenib appears to prolong overall survival by a few weeks in some cases, but at a cost of serious adverse effects in about 40% of patients, including premature death. Pending further evaluation, it is preferable to recommend best supportive care.
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Prescrire international · Jan 2014
ReviewScreening for lung cancer. Too many uncertainties, even for smokers.
Lung cancer is the leading cause of death from cancer. It is often diagnosed at an advanced stage when curative treatment is no longer possible. Does organised screening reduce overall mortality andlor lung cancer mortality, especially in current smokers or former heavy smokers? To answer this question, we reviewed the literature using the standard Prescrire methodology. ⋯ Low-dose CT screening carries a risk of adverse effects, including false-positive results in about 20% of patients, and about 90% of the nodules discovered are false-positives. This screening method also carries a risk of invasive diagnostic procedures, and repeated irradiation. In 2013, the harm-benefit balance of lung cancer screening with low-dose CT has not been adequately evaluated to justify its use in individuals with no signs or symptoms suggestive of lung cancer.