Publications (5)58.47 Total impact
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Article: Zoledronic Acid for Prevention of Bone Loss in Patients Receiving Primary Therapy for Lymphomas: A Prospective, Randomized Controlled Phase III Trial.
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ABSTRACT: BACKGROUND: Patients with lymphoma are at risk of development of bone mineral density (BMD) loss from therapy with high-dose corticosteroids and alkylating agents. Zoledronic acid (ZA), a bisphosphonate, may prevent this complication of therapy. We evaluated the effect of ZA on the change in BMD and surrogate biomarkers in patients with lymphoma receiving initial chemotherapy. PATIENTS AND METHODS: Our phase III trial randomized 74 patients with newly diagnosed lymphoma and a baseline BMD of ≥ -2.0 to receive oral calcium and vitamin D daily with or without ZA at enrollment and at 6 months after enrollment. BMD was evaluated at baseline and 1 year after enrollment. Secondary biomarker endpoints were collected at baseline and at 3, 6, 9, and 12 months after enrollment. RESULTS: Forty-three percent of patients had baseline osteopenia. Fifty-three patients were evaluable for response: 24 received ZA and had stable BMD during the observation period, whereas 29 patients in the control group had decreased BMD (P < .05 at lumbar spine and bilateral femoral neck). Twenty-one randomized patients were not evaluable for response because of lymphoma progression or death, withdrawn consent/incomplete testing, or ineligibility. Bone biomarkers were higher in the control group at all intervals after treatment (P < .001). No fractures or intervention-related toxicities were observed during this trial. CONCLUSIONS: Newly diagnosed patients with lymphoma are at risk of low BMD, which may worsen with therapy. Treatment with ZA effectively stabilizes BMD and prevents bone loss. Our data suggest that BMD testing and prophylaxis should be considered as an early intervention for a preventable problem.Clinical lymphoma, myeloma & leukemia 12/2012; -
Article: Treatment of non-small-cell lung cancer with erlotinib or gefitinib.
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ABSTRACT: A 64-year-old woman receives the diagnosis of metastatic non-small-cell lung cancer (NSCLC), which has progressed during treatment with carboplatin, paclitaxel, and bevacizumab. Erlotinib therapy is recommended.New England Journal of Medicine 03/2011; 364(10):947-55. · 53.30 Impact Factor -
Article: The Effect of Zoledronic Acid on the Prevention of Bone Loss in Lymphoma Patients Receiving First-line Therapy.
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ABSTRACT: Patients with lymphoma are at high risk of osteoporosis. The majority have osteopenia at baseline, and the risk increases when treated with alkylating agents or corticosteroids. We conducted a randomized phase III trial to evaluate the effect of zoledronic acid on bone mineral density (BMD) in patients with lymphoma undergoing chemotherapy.Introduction: Osteoporotic bone cannot easily be restored to normal levels of strength; thus, the prevention of bone loss is crucial. Pamidronate can reduce the risk of bone loss and vertebral fractures in patients with lymphoma receiving chemotherapy. Zoledronic acid, a bisphosphonate approximately 100-fold more potent than pamidronate, has not been evaluated in lymphoma patients to date. We conducted a prospective trial to determine whether zoledronic acid reduces the risk of developing osteoporosis in this patient population. Patients and Methods: All patients with newly diagnosed lymphoma seen at our institution from 2005 to 2009 were evaluated for protocol eligibility. Exclusion criteria included bone fractures, bone mineral density (BMD) T-scores poorer than -2.0, creatinine clearance < 60 mL/min, dental problems, and recent steroid or bisphosphonate use. Patients on study were stratified according to sex and menopausal status. Accrued patients received randomized therapy of either: (1) oral calcium and vitamin D (Ca + D), or (2) Ca + D and 4 mg zoledronic acid intravenously (I.V.) at baseline and at 6 months. Results: To date, 33 patients have completed the study and have evaluable data. Patient characteristics included 17 men; 4 pre-menopausal women; 12 post-menopausal women; and median age, 62 years (range, 33-80 years). Seventeen patients had mild osteopenia upon enrollment. Patients who received zoledronic acid had stable median T-scores at all locations during the 12-month observation, whereas the T-scores of the control group decreased at every location evaluated (location: L1-4, P = .004; L neck, P = .001; L hip, P = .118; R neck, P = .009; R hip, P = .04). Conclusion: Treatment with zoledronic acid in patients with newly diagnosed lymphoma prevents the BMD loss commonly seen in this population. Bone mass loss is difficult to restore, thus necessitating effective prevention strategies; additional studies should be conducted to confirm these findings.Clinical Lymphoma & Myeloma 12/2009; 9(6):E30. · 1.13 Impact Factor -
Article: Azacitidine for the treatment of myelodysplastic syndrome.
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ABSTRACT: The myelodysplastic syndromes (MDS) encompass a heterogeneous group of malignant hematologic disorders characterized by ineffective hematopoiesis, peripheral cytopenias, frequent karyotypic abnormalities and significant risk for transformation to acute myeloid leukemia (AML). The prognosis of patients with intermediate- or high-risk MDS is very poor. This is due to the fact that standard therapeutic options are largely palliative. Neither autologous stem cell transplantation (SCT) nor chemotherapeutic regimens have been shown to prolong survival in patients with MDS. Allogeneic SCT, while potentially curative, is only available to a selected group of patients and is associated with high morbidity and mortality in elderly patients, which constitute the majority of patients with MDS. Hypermethylation of tumor-suppressor genes has been invoked as an important pathogenetic mechanism in MDS. The pyrimidine nucleoside analog azacitidine, which inhibits DNA methyltransferases, has recently become the first therapeutic to prolong survival in patients with MDS, thus changing the natural history of these malignancies. The activity of azacitidine in MDS has spurred the development of combinations of this agent with other epigenetic modifiers for the treatment of MDS and AML.Expert Review of Anti-infective Therapy 08/2009; 9(7):875-84. · 2.65 Impact Factor -
Article: What Hippocrates knew about hurricane Katrina: observations of the chief resident.
The American Journal of the Medical Sciences 12/2006; 332(5):301-2. · 1.39 Impact Factor
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2006
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University of Texas MD Anderson Cancer Center
Houston, TX, USA
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