Prolonged prevention of squamous cell carcinoma of the skin by regular sunscreen use.

Half of all cancers in the United States are skin cancers. We have previously shown in a 4.5-year randomized controlled trial in an Australian community that squamous cell carcinomas (SCC) but not basal cell carcinomas (BCC) can be prevented by regular sunscreen application to the head, neck, hands, and forearms. Since cessation of the trial, we have followed participants for a further 8 years to evaluate possible latency of preventive effect on BCCs and SCCs. After prolonged follow-up, BCC tumor rates tended to decrease but not significantly in people formerly randomized to daily sunscreen use compared with those not applying sunscreen daily. By contrast, corresponding SCC tumor rates were significantly decreased by almost 40% during the entire follow-up period (rate ratio, 0.62; 95% confidence interval, 0.38-0.99). Regular application of sunscreen has prolonged preventive effects on SCC but with no clear benefit in reducing BCC.     

Sunshine and skin cancer: a school-based skin cancer prevention project

Over 50 percent of the cancers diagnosed in the U.S. are skin cancers. The incidence in Arizona far exceeds the national average for all types of skin cancers, currently having the second highest incidence and prevalence in the world. Results from skin cancer prevention programs elsewhere have suggested that awareness, attitudes, and behavior could be changed by educational efforts with eventual decreases in measurable outcomes such as morbidity and mortality. Sensible sun habits develop early in life. Most health educators agree that the ideal place to begin to teach values regarding health choices is with school-aged children. We have evaluated a primary skin cancer prevention education program in a controlled situation. The target population was chosen in a formal school setting and represented pre-adolescents and early adolescents, who were just beginning to develop "sun-worshipping" tendencies as a part of their increasing preoccupation with appearance. Two unique comprehensive "Sunshine and Skin Cancer" curricula comprised of six units about the sun, its benefits and disadvantages, the skin, cancer and skin cancer, and sun damage prevention were developed. The curricula were very well received by the school system, teachers, children, and the community, and have received local, national, and international attention. This program was shown to significantly change the knowledge and the self-reported behavior (p less than .001) of the children with respect to skin cancer prevention. Steps are being taken to integrate this curriculum into all Arizona middle schools.     

Long term use of thalidomide: safe and effective

PURPOSE: To assess the efficacy and safety of high dose thalidomide therapy for longer duration of time in relapsed or refractory Multiple Myeloma (MM) patients. MATERIALS AND METHODS: Twelve relapsed/refractory MM patients (7 Males, 5 Females), who received thalidomide for more than 2 years were selected from the Out Patient Department of Institute Rotary Cancer Hospital (IRCH), AIIMS, India. Patients received thalidomide beginning at a dose of 200 mg/day with fortnightly increment to a maximum dose of 800 mg/day. Patients were assessed for response on the basis of M proteins (MP), bone marrow biopsy with touch preparation and skeletal X-rays. RESULTS: Nine patients tolerated a maximum dose of 800 mg/day whereas three patients were given 600 mg/day. All patients showed > or = 25-50% decline in serum /urine M proteins. Complete response/ near complete response was seen in 50%, partial response in 17% and minimal response (SD) in 34% patients. Median duration of thalidomide therapy was 47 months (range 29-60 months). Currently 11 patients are alive. TOXICITY: Varying degree of constipation and sedation were seen universally. One patient had DVT, which responded to anti-coagulant therapy. Other toxic effects included infections, skin reactions. There was no toxic death. CONCLUSION: Long-term use of thalidomide is safe, effective and feasible. We feel that this is one of few reports describing safety and efficacy of long-term thalidomide in relapsed and refractory MM.     

Transcecum catheterization ileostomy is safe and effective to prevent anastomotic leakage in post-laparoscopic rectal cancer surgery: a single-center retrospective study

BackgroundPreventive ileostomy (PI) is conventionally performed to prevent anastomotic leakage (AL) after laparoscopic total mesorectal excision (LTME) for low rectal cancer; however, secondary surgery is required to remove the ostomy tube. We designed a new type of ostomy, transcecum catheterization ileostomy (TCI) to prevent AL. Its principle is similar to PI, but no secondary operation is needed. We evaluated the safety and efficacy of TCI in AL prevention.MethodsWe analyzed the data of patients who underwent LTME with low anastomosis in Chongqing University Cancer Hospital from October 2015 to August 2021. Patients were divided into three groups according to their choice: those who underwent TCI (TCI group), those who underwent PI (PI group), and those who undergo none (C group). Intra-operation situation, postoperative efficacy and safety indicators were compared between three groups.ResultsOut of the total 534 patients included, 171 underwent TCI, 156 underwent PI, and 207 underwent none. No statistically difference was noted in baseline characteristics between three groups (all P>0.05). Operation time was longer in TCI group and PI group than in C group (P<0.001). No difference was noted in intraoperative blood loss or the number of lymph nodes dissected (P=0.685 and P=0.153). Moreover, no difference was noted in the serum levels of immune cells on postoperative day 1, 3, and 7 (all P>0.05) or in the levels of serum C-reactive protein (CRP), procalcitonin (PCT), and interleukin 6 (IL-6; all P>0.05). No difference was noted in postoperative incision, pulmonary infection rates and intestinal obstruction incidence (P=0.530, P=0.971, and P=0.938). AL incidence and AL-related reoperation rates were lower in TCI or PI group (P=0.002 and P<0.001). The rate of anastomotic stricture was lower in TCI group than in the other two groups (P<0.001).ConclusionsTCI is effective to prevent AL when performed during LTME. But TCI cannot completely avoid AL. When AL occurs, TCI can reduce the degree of abdominal infection and the secondary surgical rate related AL. TCI presents an alternative option to PI, that does not require secondary operation. Therefore, TCI is safe and worthy of application.     

Statin use is not associated with reduced risk of skin cancer: a meta-analysis

Background:

There is contradictory evidence about the association between statin and skin cancer.

Methods:

Literature search in PubMed and Web of Science was undertaken up to June 2013. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated.

Result:

A total of 21 articles with 29 studies were identified. No association was found between statin and skin cancer among neither melanoma (RR, 0.94; 95% CI, 0.85–1.04) nor non-melanoma skin cancer (RR, 1.03; 95% CI, 0.90–1.19).

Conclusion:

Our meta-analysis does not support a potential role of statin use in the prevention of skin cancer.     

Oxaliplatin use in pressurized intraperitoneal aerosol chemotherapy (PIPAC) is safe and effective: A multicenter study

IntroductionPressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new drug delivery method used in patients with peritoneal cancer (PC) of primary or secondary origin. Intraperitoneal use of oxaliplatin raises concerns about toxicity, especially abdominal pain. The objective of this study was to assess the tolerance of PIPAC with oxaliplatin (PIPAC-Ox) in a large cohort of patients and to identify the risk factors for high grade toxicity, discontinuation of treatment and impaired survival.Material and methodsThis retrospective cohort study included all consecutive patients treated with PIPAC-Ox (92 mg/m²) in five centers specialized in the treatment of PC. The procedure was repeated every 6 weeks. Outcomes of interest were Common Terminology Criteria for Adverse Events (CTCAE), symptoms and survival (Kaplan-Meier). Univariate risk factors were included in a multinominal regression model to control for bias.ResultsOverall, 251 PIPAC-Ox treatments were performed in 101 patients (45 female) having unresectable PC of various origins: 66 colorectal, 15 gastric, 5 ovarian, 3 mesothelioma, 2 pseudomyxoma, 10 other malignancies (biliary, pancreatic, endocrine) respectively. The median PCI was 19 (IQR: 10–28). Postoperative abdominal pain was present in 23 patients. Out of the 9 patients with grade 3 abdominal pain, only 3 needed a change of PIPAC drug. CTCAE 4.0 toxicity grade 4 or higher was encountered in 16(15.9%) patients. The patients had a mean of 2.5 procedures/patient (SD = 1.5). 50 subjects presented with symptom improvement.ConclusionsOxaliplatin-based PIPAC appears to be a safe treatment that offers good symptom control and promising survival for patients with advanced peritoneal disease.     

Homoharringtonine is safe and effective for patients with acute myelogenous leukemia.

Homoharringtonine (HHT) is a cephalotaxine alkaloid with reported efficacy in acute myelogenous leukemia (AML). In a phase II trial, we evaluated HHT 5 mg/m2 by continuous infusion daily for 9 days in patients with relapsed or refractory acute leukemia and blastic phase of chronic myelogenous leukemia (BLCML). Sixty-six patients were entered. There were 40 males and 26 females with a median age of 41 years (range 15-81). Of 43 patients with relapsed AML, seven achieved a complete remission (16%, 95% confidence interval 5%-27%). Although 11 patients with AML primarily resistant to an anthracycline/cytarabine combination did not respond, two of three patients primarily resistant to low-dose cytarabine achieved complete remission. No patients with acute lymphoblastic leukemia, biphenotypic leukemia, or BLCML responded. Hypotension during the administration of HHT was the most difficult toxicity encountered, requiring multiple interruptions of therapy in several patients and the administration of intravenous saline. Fluid retention and weight gain occurred in 29% of patients. Transient asymptomatic hyperglycemia was observed in 63% of patients. Other toxicity was mild and included nausea and vomiting, diarrhea, mucositis, hepatic dysfunction, and cardiac arrhythmias. As expected, severe myelosuppression occurred in all patients. HHT is well tolerated, but with unique problems associated with administration. It has demonstrable efficacy in pre-treated patients with AML, but its role in the treatment of this disease remains to be defined.     

A safe and effective method for converting cancer patients from intravenous to transdermal fentanyl.

BACKGROUND: Therapeutic fentanyl blood levels are reached approximately 12-16 hours after the initial application of transdermal fentanyl patches. For this reason, fentanyl patches should not be used to treat acute exacerbations of cancer pain. Acute cancer-related pain can be treated with fentanyl administered by continuous intravenous infusion (CII) in combination with patient-controlled analgesia (PCA). Patients then can be switched from intravenous (IV) to transdermal fentanyl once stable pain relief has been achieved. The objective of the current case series was to evaluate and describe the safety and effectiveness of a method for converting hospitalized patients with cancer-related pain from IV to transdermal fentanyl. METHODS: The authors prospectively evaluated 15 consecutive cancer patients during the conversion from IV to transdermal fentanyl. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous IV infusion was applied. The CII rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. Demand boluses of IV fentanyl equivalent in dosage to 50-100% of the final CII rate remained available via PCA during the 24 hours after patch application. Pain intensity (on a scale of 0-10), sedation (on a scale of 0-3), and hourly PCA administration (microg/hr) were assessed and recorded immediately prior to application of the fentanyl patch and 6, 12, 18, and 24 hours thereafter. RESULTS: Pain intensity, sedation, and hourly PCA administration appeared to remain stable throughout the transition from IV to transdermal fentanyl. CONCLUSIONS: The results of the current study demonstrate that the conversion from IV to transdermal fentanyl can be accomplished safely and effectively using a 1:1 (IV:transdermal) conversion ratio and a two-step taper of the CII over 12 hours.     

Capecitabine monotherapy: safe and effective treatment for metastatic breast cancer

Optimal management for metastatic breast cancer frequently involves cytotoxic chemotherapy. Over the years, several complex multidrug regimens have been developed that were based upon a rationale of synergistic antitumor activity and nonoverlapping toxicities. However, recently the clinical value of these complex regimens has been called into question as several drugs used alone (monotherapy) or in sequence (serial single agent) have been shown to be both efficacious and better tolerated. Capecitabine (an orally administered fluoropyrimidine carbamate) is one such agent that has been proven to be effective when used alone for metastatic breast cancer, metastatic colorectal cancer, and adjuvant colon cancer. In this review, published (or reported in abstract form) data examining various aspects of clinical response and tolerability with single-agent capecitabine for (primarily) first- and second-line metastatic breast cancer are examined. For the most part, response rates are comparable with those of the more complex regimens. Dose reductions from the labeled dose of 1,250 mg/m(2) twice daily are relatively common. Toxicities (following dose reductions if needed) are generally manageable, even by more frail patients. Elderly patients are more likely to have impaired renal function or be receiving warfarin treatment, and special attention to these factors is warranted. Nonetheless, the drug administered alone is a reasonable choice when single-agent chemotherapy is entertained as a treatment option for metastatic breast cancer, including in the first-line setting.     

Approaches to the prevention and control of skin cancer

Skin cancer is the most common and the most preventable form of cancer. Nonmelanoma skin cancers are associated with cumulative exposure to ultraviolet radiation, while melanoma is associated with intense episodes of ultraviolet exposure resulting in sunburns. Numerous risk factors are associated with the development of skin cancer. These include exposure to ultraviolet radiation; phenotypic factors such as skin type, eye and hair color, tendency to burn and tan, and having freckles and moles; a personal or family history of skin cancer; and occupational sun exposure. Primary prevention behaviors include applying SPF 15+ sunscreen 30 minutes before exposure, reapplying SPF 15+ sunscreen every 1¹/₂ to 2 hours or after swimming or sweating, dressing in protective clothing, using shade, limiting exposure during peak sun hours, and avoiding artificial sources of ultraviolet radiation such as tanning beds. Secondary prevention behaviors include screening and early detection in combination with education on the primary prevention behaviors. Interventions designed to increase sun protective behaviors have resulted in increased knowledge and attitudes, but limited behavior change. And while skin cancer screenings have shown promising results, few studies have a follow-up component. Future studies should focus on developing effective strategies for making sun protective behaviors routine and determining the effectiveness of skin cancer screening. To inform approaches to the prevention and control of skin cancer, this paper will summarize key primary and secondary preventive behaviors, highlight primary and secondary prevention programs, and identify key unanswered questions in the area of skin cancer prevention and control.     

Vinorelbine is an effective and safe drug for AIDS-related Kaposi's sarcoma: results of a phase II study.

PURPOSE: To assess the safety and efficacy of vinorelbine in patients with AIDS-related Kaposi's sarcoma (KS). PATIENTS AND METHODS: From December 1994 to May 1997, within the Italian Cooperative Group on AIDS and Tumors, we enrolled 36 patients with AIDS-related KS who experienced disease progression after one or more regimens of systemic chemotherapy. Patients were treated with vinorelbine 30 mg/m(2) every 2 weeks by intravenous bolus. RESULTS: Of 35 assessable patients, three (9%) had a clinical complete response and 12 (34%) had a partial remission, for an overall objective response rate of 43% (95% confidence interval, 26% to 61%). For the 15 patients with objective responses, the median duration of response from the beginning of therapy until the development of progression was 176 days, whereas the median progression-free survival and the median survival durations for 35 assessable patients were 151 days and 216 days, respectively. Vinorelbine also induced responses in patients who had become resistant to regimens that included other vinca alkaloids. Overall, vinorelbine was well tolerated. Toxicity, including neurologic toxicity, was mild and reversible. Neutropenia was the most frequent dose-limiting toxicity. CONCLUSION: Vinorelbine is safe and effective in the treatment of patients with advanced KS who have been previously treated with one or more chemotherapy regimens.     

Radiofrequency ablation: a safe and effective treatment in nonoperative patients with early-stage lung cancer

Surgical resection remains the treatment of choice for patients with early-stage non-small cell lung cancer. However, some patients are not surgical candidates because of medical problems. Therefore, alternative therapies are considered in these medically inoperable patients. Radiofrequency ablation has been used clinically for more than 12 years, with many studies reporting its safety and efficacy. Because there are no large prospective clinical trials comparing the efficacy and long-term survival of the different treatment modalities, the choice of therapy is often based on a combination of tumor location, available technology and expertise, and patient preference. Here we review the principles, procedure, follow up, and clinical outcomes published to date on radiofrequency ablation in the treatment of early-stage non-small cell lung cancer.     

Toremifene is an effective and safe alternative to tamoxifen in adjuvant endocrine therapy for breast cancer: results of four randomized trials

Compared to tamoxifen, the efficacy and side effects of toremifene in adjuvant endocrine therapy for breast cancer were not very clear. This meta-analysis was conducted to give a more precise estimation of the efficacy and severe side effects of toremifene given in the adjuvant setting in comparison to tamoxifen. The electronic database PubMed was searched for randomized trials comparing toremifene with tamoxifen as adjuvant therapies. Four randomized trials published in three articles were eligible, including 1,890 pooled cases treated with toremifene and 1,857 cases treated with tamoxifen. Compared to patients in tamoxifen group, patients in toremifene group did not have a significantly different overall survival rate (risk ratio (RR): 1.07, 95% confidence interval (CI): 0.97–1.19, P = 0.994 for heterogeneity) or a disease-free survival (DFS) rate (RR: 1.05, 95% CI: 0.95–1.17, P = 0.431 for heterogeneity) at the end of the follow-up time. The rates of thromboembolic events in toremifene group, including deep vein thrombosis (odds ratio (OR): 0.68, 95% CI: 0.40–1.17, P = 0.926 for heterogeneity), cerebrovascular accident (OR: 0.59, 95% CI: 0.32–1.09, P = 0.438 for heterogeneity), and pulmonary embolism (OR: 0.91, 95% CI: 0.42–2.01, P = 0.618 for heterogeneity), were not significantly different from those in tamoxifen group. The rates of endometrial polyps and endometrial cancer between the two groups were almost the same. This meta-analysis suggested that toremifene was as effective as tamoxifen in the adjuvant setting for both perimenopausal and postmenopausal breast cancer patients with similar severe adverse effects to tamoxifen. Toremifene was a convincing and safe change for tamoxifen in adjuvant endocrine therapy.