Bulletin du cancer
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Anticipating postoperative pain is a routine practice in our institution. As part of a quality assurance program we used our computerized anesthetic record system database to evaluate incidence of patients having very severe postoperative pain (grade 4 on a subjective pain scale ranging from 0 to 4) in the Post Anesthetic Care Unit during a two year period. These patients were compared to a control group matched on age, type and date of surgery. Demographic characteristics, type and duration of the surgery, preoperative and intra-operative medications were compared between groups. ⋯ The incidence of severe postoperative pain scores were less than 1% in our institution. In patients with preoperative opioid treatment, adaptation of analgesic treatment has probably prevented the occurrence of severe pain. Multimodal anticipation of postoperative pain should remain mandatory while efforts should focus to identify such patients before surgery.
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Doxorubicin monotherapy is the standard first-line treatment in patients with advanced soft-tissue sarcomas. Ifosfamide still remains the standard 2nd line treatment after doxorubicin-failure. ⋯ Trabectedine should be used preferentially in myxoid liposarcomas and leiomyosarcomas patients whereas paclitaxel should be considered as a first or second-line treatment of choice in angiosarcoma patients. Further studies are needed in order to identify predictive factors of clinical benefit in advanced soft-tissue sarcoma patients treated with cytotoxic agents in combination or not with targeted therapies.
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We propose here a general review of current questions related to early trials, including the choice of the primary endpoint, role of bayesian designs, role of stratification and randomization for phase 2 trials, patient selection, and new designs for phase 1 and phase 0 trials. We also discuss the difficulties to apply such methodologies to molecular targeted therapies development.
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The recent development of antiangiogenic agents has revolutionized the management of renal cell carcinoma. In less than two-years, the French health authorities have approved the use of four drugs (sorafenib, sunitinib bevacizumab, temsirolimus) for the treatment of locally advanced or metastatic renal cell carcinoma. ⋯ The management of toxic effects is essential to ensure treatment compliance and patient quality of life. The present report describes in detail the adverse events associated with each therapeutic class and the management of side effects.
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Ovarian cancers are the leading cause of death from gynaecological malignancies in Western countries. Despite optimal treatment combining surgery and chemotherapy, relapse is observed in the majority of patients. This review aims to present the results of trials having evaluated new drugs in ovarian cancers. ⋯ PARP and mTOR inhibitors may also represent a significant therapeutic improvement. It remains to confirm the interest of these new approaches by assessing the benefit on overall survival. The goal remains to individualize and to tailor the drugs to the tumour biology, in order to provide personalized treatment to each patient.