Prescrire international
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Without treatment, patients with inoperable or metastatic colorectal cancer have a median life expectancy of about 8 months. The following article is an update of our 2005 review of chemotherapy regimens used in metastatic colorectal cancer, based on the standard Prescrire methodology. In 2005, the de Gramont protocol, based on fluorouracil (always combined with folinic acid) plus either oxaliplatin (Folfox protocol) or irinotecan (Folfiri protocol), was the standard first-line chemotherapy in this setting. ⋯ When the metastases are inoperable and are unlikely to become operable after chemotherapy, it seems best to begin treatment with single-agent fluorouracil (+ folinic acid) or capecitabine. The use of monoclonal antibodies in first-line treatment of patients with colorectal cancer is not justified. Further trials of these drugs are warranted as second-line treatment for patients with KRAS wild-type tumours.
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Prescrire international · Aug 2010
Secondary leukaemia: after umbilical cord blood stem cell transplantation too.
Since the late 1990s, umbilical cord blood stem cells have been used to treat some severe haematological disorders. In theory, this type of transplant carries a lower risk of immunological incompatibility. ⋯ The patients were severely immunodepressed, and analysis showed that the leukaemias were of donor cell origin. Patients receiving cord blood stem cell grafts, like all transplant recipients, should therefore be monitored for secondary leukaemia.
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5% lidocaine medicated plasters are available for local treatment of neuropathic pain. Treatment is generally poorly effective but has few adverse effects, other than local erythema. Capsaicin is a natural chilli pepper extract that depletes sensory nerve endings of substance P, a pain neurotransmitter. ⋯ Some pharmacological data suggest that repeated application of 8% capsaicin patches might provoke painful nerve damage in the long-term. Patch application and removal by a third party is delicate, due to the strong irritant potential of capsaicin. In practice, when a patient with neuropathic pain requires local treatment, in the absence of a better alternative, it is better to use lidocaine plasters, which are better tolerated and with which we have more experience.
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Prescrire international · Aug 2010
ICH: an exclusive club of drug regulatory agencies and drug companies imposing its rules on the rest of the world.
Under the pretext of harmonising regulatory requirements for marketing authorisation of new drugs, the drug regulatory agencies of the world's wealthiest countries and three pharmaceutical industry trade associations, joined together since 1990 in the ICH, are promoting their own interests by imposing their criteria for evaluating drugs on the whole world. The toxicity standards advocated by ICH sometimes promote faster, cheaper drug development over patient protection. The drug quality standards advocated by ICH sometimes increase manufacturing costs without providing any public health benefit. It would be preferable if the World Health Organization were in charge of setting standards for drug development, focusing on patients' interests.
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Restless legs syndrome can be very troublesome but it has no serious physical complications. The underlying causes are unknown, but it can be triggered or aggravated by a drug. In early 2010, about 60 cases of drug-induced restless legs syndrome had been published in detail. ⋯ Dysfunction of the dopaminergic system has been implicated in some cases. In practice, when a patient presents with restless legs syndrome, the role of a drug, especially a psychotropic, should be considered. Drug withdrawal or a dose reduction may be beneficial.