Medical News: Media Downplay Failings of Cancer Treatments (palliative care, side effects....) - MedPage Today

Impact of platinum-based chemotherapy on the progression of atherosclerosis

Definition: Atherosclerosis (also known as arteriosclerotic vascular disease or ASVD) is the condition in which an artery wall thickens as the result of a build-up of fatty materials such as cholesterol

A phase I trial of dose-dense (biweekly) carboplatin combined with paclitaxel and pegfilgrastim: A feasibility study in patients with untreated Stage III and IV ovarian, tubal or primary peritoneal cancer: GOG study (serious side effects)

Purpose

Dose-dense regimens have been shown to improve outcome when given as adjuvant therapy to patients with breast cancer compared with their three weekly counterparts. We investigated the feasibility of a dose-dense regimen with carboplatin/paclitaxel followed by pegfilgrastim in patients with advanced ovarian cancer. We also investigated the toxicities including the percentage of patients with grade 2 or greater peripheral neurotoxicity and the clinical response of this regimen.

Conclusion

Dose-dense carboplatin/paclitaxel appears to be effective. However, based on dose limiting toxicities occurring when administering 6 cycles of treatment, it is not feasible. Given the neuropathy and thrombocytopenia, we do not recommend 6 cycles of this regimen without modification.

Neurological side-effects caused by recently approved chemotherapy drugs - e-Grand Round - Cancer World (full access)

Is it safe, is it tolerable? Why not ask the patients? - Editorial + NEJM link

"A thought-provoking perspective by oncologist Ethan Basch, published recently in the New England Journal of Medicine, highlighted the absence of any patient input into establishing a drug’s safety. This might seem surprising, given that distressing symptoms – which patients are best placed to report on – account for a large number of drug-related side-effects....cont'd

 NEJM:
The Missing Voice of Patients in Drug-Safety Reporting, by Ethan Basch, can be accessed at http://content.nejm.org/cgi/reprint/362/10/865.pdf 

EvidenceUpdates-Cochrane Collaboration review: Interventions for treating oral mucositis for patients with cancer receiving treatment

Note:"* Ratings pending – login to http://plus.mcmaster.ca/evidenceupdates in a few days if interested."


Abstract

Background

Treatment of cancer is increasingly effective but associated with short and long term side effects. Oral side effects, including oral mucositis (mouth ulceration), remain a major source of illness despite the use of a variety of agents to treat them.

Objectives

To assess the effectiveness of interventions for treating oral mucositis or its associated pain in patients with cancer receiving chemotherapy or radiotherapy or both.


Plain language summary:

Interventions for treating oral mucositis for patients with cancer receiving treatment
Using a low level laser may reduce the severity of ulcers caused by cancer treatment.
Treatments for cancer can cause severe ulcers (sores) in the mouth. These can be painful and slow to heal. The review found weak and unreliable evidence that using a laser may relieve or cure the ulcers. Morphine can control the pain. Although using morphine automatically on a constant drip, or self controlled use, provide similar relief, people use less morphine when they are controlling it themselves.

Taste Alterations in Cancer Patients Receiving Chemotherapy: A Neglected Side Effect? abstract

"Although TAs (taste alterations) have been incorporated in the National Cancer Institute Common Toxicity Criteria since 1999, the literature on underlying biological mechanisms, on physical and physiological consequences, and even on prevalence is scarce. It has to be taken into account that even though taste and smell are anatomically distinct systems, in the sensory perception of food, they are intimately connected ."

Angiogenesis Inhibitors: Current Strategies and Future Prospects

Abstract/Full free access (chapters): 

Introduction
Inhibition of Angiogenesis for Anticancer Purposes 
Process of Carcinogenesis and Subsequent Tumor Angiogenesis
Angiopoietins and TIE Receptors
Delta/Jagged-Notch Signaling
HIF
Antiangiogenesis Compounds
Inhibitors of Growth Factors, RTKs, and Signaling Pathways
Monoclonal Antibodies Directed at EGFRPI3K/AKT/mTOR Pathway Inhibitors
MAPK-Farnesyltransferase Rho and Ras InhibitorsHIF Pathways and Binding...
Known and Potential Side Effects From the Inhibition of AngiogenesisConclusions
References

Conclusions:
The complex molecular pathways that govern tumor angiogenesis are logical targets for pharmacological manipulation given the important role they play in the growth and development of cancers.

abstract: (Avastin) Bevacizumab Increases Risk for Severe Proteinuria in Cancer Patients

Note: one very good caution when undergoing investigational drugs

"Treatment with the chemotherapeutic agent bevacizumab, a humanized mAb that neutralizes vascular endothelial growth factor, can lead to proteinuria and renal damage. The risk factors and clinical outcomes of renal adverse events are not well understood.
We performed a systematic review and meta-analysis of published randomized, controlled trials to assess the overall risk for severe proteinuria with bevacizumab.
We analyzed data from 16 studies comprising 12,268 patients with a variety of tumors. The incidence of high-grade (grade 3 or 4) proteinuria with bevacizumab was 2.2% (95% confidence interval [CI] 1.2 to 4.3%). Compared with chemotherapy alone, bevacizumab combined with chemotherapy significantly increased the risk for high-grade proteinuria (relative risk 4.79; 95% CI 2.71 to 8.46) and nephrotic syndrome (relative risk 7.78; 95% CI 1.80 to 33.62); higher dosages of bevacizumab associated with increased risk for proteinuria.
Regarding tumor type, renal cell carcinoma associated with the highest risk (cumulative incidence 10.2%).
We did not detect a significant difference between platinum- and non–platinum-based concurrent chemotherapy with regard to risk for high-grade proteinuria (P = 0.39).
In conclusion, the addition of bevacizumab to chemotherapy significantly increases the risk for high-grade proteinuria and nephrotic syndrome."

GI Topics, 2010 - Commonly used antidepressants are associated with increased risk of upper GI bleeds

Listings of different resources: Side Effects | Cancer.Net

abstract: Safety and efficacy results of the advanced renal cell carcinoma Sorafenib expanded access program in North America

Note: while this is not specific to ovarian cancer knowing the side effects which patients experienced may be helpful