Thursday, January 27, 2011
Wednesday, January 26, 2011
From OncologyEducation.ca (requires registration - Free)
Part 1 - Hormone Receptor Positive
Part 2 - Adjuvant Bisphosphonates
Part 3 - Adjuvant Chemotherapy
Part 4 - Targeted Therapy
(Dr. Sunil Verma)
Tuesday, January 25, 2011
Thursday, January 20, 2011
Anders Ynnerman: Visualizing the medical data explosion | Video on TED.com
(TED = Ideas worth sharing)
The animations help explain in the link noted below.
Osteoblastic versus osteolytic bone metastases
Bone metastases are often characterized by their radiographic appearance as either osteolytic, osteoblastic, or mixed.
Most patients with breast cancer have predominantly mixed or osteolytic lesions. In contrast, patients with prostate cancer are often found to have predominantly osteoblastic lesions. However, regardless of appearance, there is significant osteolytic activity. In fact, osteolytic activity in these lesions often is comparable with, if not higher than, that typically seen in breast cancer and multiple myeloma. Such activity has been demonstrated by markedly elevated biochemical markers of bone resorption in the serum and urine of such patients. Only in multiple myeloma do purely lytic bone lesions develop.
Learn more at:
Tuesday, January 18, 2011
Most tissues contain a cysteine proteinase capable of hydrolyzing and inactivating bleomycin.
The reduced concentration of bleomycin hydrolase in the skin and lung, as compared with other tissues, may explain the medication's adverse reaction profile.
The patient was counseled that the flagellate hyperpigmentation usually fades over a period of several months after the cessation of the medication.
During the past year, the hyperpigmentation in this patient has faded but not yet resolved.
QT interval prolongation may occur, which may in turn result in torsades de pointes, leading to syncope, seizure, and/or death. Sudden deaths have been reported (0.1-1%); ventricular repolarization abnormalities may have contributed.
Prolongation is concentration-dependent. Significant prolongation may occur if taken inappropriately with food, and/or strong CYP3A4 inhibitors, and/or medicines with a known potential to prolong QT interval. The presence of hypokalemia and hypomagnesemia may further enhance this effect.
Drugs that prolong QT interval should be avoided due to the risk of potentially fatal arrhythmias.
- Pain in tumour-containing tissue (rare) as per BCCA.
- It has been hypothesized that it is caused by a ‘‘two-step’’ pathogenetic mechanism.
- First, surgery, radiotherapy, or the tumor itself causes a neural lesion.
- Vinorelbine administration then induces production of pain modulators at the site of the lesion.
- It could be classified and treated as an incident pain.
- Patients in treatment with opioids could receive one-sixth of the daily dose 15 minutes before vinorelbine administration.
- Opioid-naïve patients could be treated with low doses of morphine. Ketorolac alone does not allow effective control of pain and we do not recommend it to treat, or to prevent, vinorelbine associated pain.
- Finally, PO administration (?compounded) does not seem to induce vinorelbine-related pain and a switch from IV to PO vinorelbine could be proposed as a method for opioid-resistant patients.
Monday, January 17, 2011
On September 10, 2010, the US Food and Drug Administration (FDA) approved the use of fulvestrant (Faslodex®, AstraZeneca) injection at a dose of 500 mg intramuscularly per month for hormone receptor–positive metastatic breast cancer in postmenopausal women with disease progression following anti-estrogen therapy. The previously approved dosing regimen was 250 mg monthly.
(J Clin Oncol. 2010;28(30):4594-4600).
|Sea sponge - Halichondria okadai|
- Halaven is a synthetic form of a chemotherapeutically active compound derived from the sea sponge Halichondria okadai. This injectable therapy is a microtubule inhibitor, believed to work by inhibiting cancer cell growth. Before receiving Halaven, patients should have received prior anthracycline- and taxane-based chemotherapy for early or late-stage breast cancer.
US FDA News Release Nov. 15, 2010
FDA begins process to remove breast cancer indication from Avastin label Drug not shown to be safe and effective in breast cancer patients
the results of four clinical studies of Avastin in women with breast cancer and determining that the data indicate that the drug does not prolong overall survival in breast cancer patients or provide a sufficient benefit in slowing disease progression to outweigh the significant risk to patients. These risks include severe high blood pressure; bleeding and hemorrhage; the development of perforations (or “holes”) in the body, including in the nose, stomach, and intestines; and heart attack or heart failure.
FDA: Bevacizumab (marketed as Avastin) Information http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm193900.htm
Risk Rating D: Consider therapy modification
Summary: CYP2D6 Inhibitors (Moderate) may decrease the metabolism of Tamoxifen. Specifically, CYP2D6 inhibitors may decrease the formation of highly potent active metabolites.
Reliability Rating: Fair
Patient Management Moderate CYP2D6 inhibitors may reduce the clinical effectiveness of tamoxifen; consider alternative therapy with less of an effect on CYP2D6 activity when possible.