Publications (110) View all
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Article: Cervical extravasation of bevacizumab.
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ABSTRACT: Monoclonal antibodies such as bevacizumab are widely used in medical oncology, either alone or in combination with chemotherapy. No specific recommendations on the management of monoclonal antibodies extravasation exist. Incidence rates vary considerably. Estimates of 0.5-6% have been reported in the literature. Also, patient-associated and procedure-associated risk factors of extravasation are multiple, such as bolus injections or poorly implanted central venous access. We report on an 86-year-old woman with colon cancer with liver metastasis who was treated with 5-fluorouracil, folinic acid, and bevacizumab. Extravasation occurred during chemotherapy infusion because of a catheter migration of the port outside of the superior vena cava, causing cervical pain without skin modifications. Diagnosis was confirmed with the appearance of clinical right cervical tumefaction and cervicothoracic computed tomography scan indicated a perijugular hypodense collection, corresponding to the extravasation. Conservative management was proposed. The patient recovered within 3 weeks from all symptoms. Physicians should be aware that in cases of bevacizumab extravasation, a nonsurgical approach might be effective.Anti-cancer drugs 12/2012; · 2.23 Impact Factor -
Article: Comparative transplacental transfer of taxanes using the human perfused cotyledon placental model.
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ABSTRACT: OBJECTIVES: The use of taxanes (paclitaxel and docetaxel) in pregnant cancer patients is increasing. We aimed to compare their transplacental transfer using the gold standard human placental perfusion model, to guide drug selection. STUDY DESIGN: Term placentas were perfused with paclitaxel or docetaxel and 2 different albumin concentrations. Main transfer parameters such as fetal transfer rate (FTR), clearance index, and placental uptake of taxanes were assessed. RESULTS: Twelve placentas were perfused, 6 with paclitaxel and 6 with docetaxel. Mean FTR of paclitaxel decreased significantly from 5.67 ± 0.02% in low albumin conditions to 1.72 ± 0.09% in physiological albumin conditions. Similarly, mean clearance index decreased significantly from 0.22 ± 0.02 to 0.09 ± 0.01. Regarding docetaxel, mean FTR were similar in low albumin and physiological conditions (5.03 ± 0.60% and 4.04 ± 0.22%, respectively) while mean clearance index decreased significantly from 0.18 ± 0.02 to 0.13 ± 0.01. Taxanes accumulation in cotyledon was similar for docetaxel and paclitaxel: 4.54 ± 1.84% vs 3.31 ± 1.88%, respectively. CONCLUSION: Transplacental transfer and placental accumulation of paclitaxel and docetaxel were low and similar, especially in physiological conditions of albumin. Further studies are warranted to optimize the selection of a taxane in pregnant cancer patients.American journal of obstetrics and gynecology 12/2012; 207(6):514.e1-514.e7. · 3.28 Impact Factor -
Article: Feasibility of Gemcitabine plus Oxaliplatin in Advanced Hepatocellular Carcinoma Patients with Child-Pugh B Cirrhosis.
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ABSTRACT: Purpose: Sorafenib improves survival in advanced hepatocellular carcinoma (HCC), but the demonstration of its efficacy and safety is limited to Child-Pugh A cirrhotic patients. The biweekly combination of gemcitabine and oxaliplatin (GEMOX) is safe and widely used in patients with advanced malignancies. We aimed to evaluate the feasibility of GEMOX in HCC patients with Child-Pugh B cirrhosis ineligible for sorafenib. Methods: The medical records of cirrhotic patients with advanced HCC receiving the GEMOX regimen between July 2006 and November 2011 were retrospectively reviewed. Treatment was repeated every 2 weeks until disease progression or unacceptable adverse effects occurred. The primary evaluation criterion was safety. Secondary evaluation criteria were the presence of muscle wasting (sarcopenia), response rate, progression-free survival and overall survival (OS). Results: Patients with Child-Pugh A (group A, n = 17) or Child-Pugh B cirrhosis (group B, n = 15) received a total of 169 cycles (median 4, range 1-16/patient). Eight patients in each group had sarcopenia. Common toxicities were thrombocytopenia (25 and 14 in groups A and B, respectively; p = 0.65) and peripheral neuropathy (44 and 54% in groups A and B, respectively; p = 1). Neither febrile neutropenia nor toxic death occurred. One patient in each group experienced grade 3 oesophageal varices bleeding. The response and disease control rates were 18% (95% CI 0-35.8) and 58.8% (95% CI 35.4-82.2) in group A, and 27% (95% CI 4.3-49.1) and 60.0% (95% CI 35.2-84.8) in group B. The median progression-free survival and OS did not differ between the two groups, but median OS was significantly shorter in sarcopenic patients. Conclusions: The GEMOX regimen appears feasible in HCC patients with Child-Pugh B cirrhosis and exerts anti-tumour activity. These data need to be confirmed in a prospective study.Oncology 10/2012; 84(1):32-38. · 2.27 Impact Factor -
Article: Aprepitant for pruritus: drug-drug interactions matter.
The lancet oncology 09/2012; 13(10):964-5. · 14.47 Impact Factor -
Article: LETTER TO THE EDITOR: Hypersensitivity to Lamivudine and Emtricitabine.
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ABSTRACT: A 65-years-old Caucasian woman presented with treatment-naive HIV infection since 2001 and no other medical history. She was started on tenofovir, emtricitabine and ritonavir-boosted atazanavir in July 2010 due to a viral load of 4∙76 log with a CD4 count of 723/µl (19%). Renal function and liver function tests were normal. Ten days later, she developed fever (up to 40°C) and extensive maculo-papular, erythematous skin rash (Figure 1). No evidence of infection was found and laboratory tests were normal. Antiretrovirals were discontinued immediately, and symptoms regressed over ten days. Due to its frequent cutaneous side effects (1), atazanavir was initially incriminated. The patient subsequently received AZT, lamivudine and etravirine. Skin rash and fever recurred seven days later, leading to discontinuation of antiretrovirals. Symptoms regressed over two weeks. Since etravirine was then believed to have caused skin rash (1, 2), the patient was started on raltegravir (combined with a backbone of tenofovir and emtricitabine), with the aim to use a different antiretroviral class. After 24 hours on therapy, similar symptoms recurred. Because emtricitabine and lamivudine are similar from a pharmacological point of view (both being cytidine analogs), and were given in each regimen causing skin hypersensitivity, these drugs were finally suspected. Once again, symptoms regressed over two weeks after treatment withdrawal. The subsequent treatment including ritonavir-boosted lopinavir and maraviroc, and was well tolerated with immunological and virological efficacy. According to the Naranjo adverse drug reactions algorithm (3), the imputability of lamivudine was probable, and that of cytidine analogs (lamivudine and emtricitabine) was definite. Nucleosidic reverse transcriptase inhibitors (NRTIs) such as lamivudine and emtricitabine cause extensive skin rash in 1-10% of patients (4). The incidence of lamivudine and emtricitabine-related cutaneous side effects is probably under-estimated because side effects induced by recent third agents are overlooked. Careful examination of medication lists is needed in order to detect the causative drug and adapt treatment regimen in patient receiving NRTIs-based antiretroviral therapy.Current HIV research 09/2012; 10(7):620-3. · 1.98 Impact Factor
