Chemotherapy cycle

A German study randomized 98 patients with unresectable hypopharyngeal head and neck carcinoma to sequential or concomitant chemoradiotherapy (64). Patients on the sequential arm received two courses of cisplatin (25 mg/m2 for 5 d) and continuous infusion 5-FU (750 mg/m2 for 5 d) followed by G-CSF for 6 d. The second cycle was repeated on d 14 and then followed by standard radiotherapy. Identical dosages of chemoradiotherapy were used in the concomitant arm but incorporated a 21-d interval between each chemotherapy cycle and G-CSF support. Sequential treatment resulted in a CR of 49% in comparison to the concomitant arm of 57%. At 2-yr, the median survival was improved in the concomitant arm (53% vs 33%). However, one-third of the initial patients enrolled were withdrawn from study due to medical or socioeconomic problems whether this resulted in a significant disparity between the two different treatment arms was not noted. Mature data from this trial have not been published to date. 

I. 18-1.62), number-needed-to-treat (NNT) was 6 for complete control of nausea relative risk was 1.28 (Cl 1.08-1.51), NNT 8 for complete control of vomiting. Cannabinoids were not more effective in patients receiving very low or very high emetogenic chemotherapy. In crossover trials, patients preferred cannabinoids for future chemotherapy cycles relative risk 2.39 (2.05-2.78), NNT 3. Some potentially beneficial side effects occurred more often with cannabinoids high 10.6 (6.86-16.5), NNT 3 sedation or drowsiness 1.66 (1.46-1.89), NNT 5 euphoria 12.5 (3-52.1), NNT 7. Harmful side effects also occurred more often with cannabinoids dizziness 2.97 (2.31-3.83), NNT 3 dysphoria or depression 8.06 (3.38-19.2), NNT 8 hallucinations 6.10 (2.41-15.4), NNT 17 paranoia 8.58 (6.38-... 

Myelosuppression Subcutaneous Give as a single 6-mg injection once per chemotherapy cycle. 

E. Therapeutic response The primary end point of one randomized, placebo-controUed trial was whether the patient required one or more platelet transfusions in the subsequent chemotherapy cycle. More patients avoided platelet transfusion in the Neumega arm (28%) than in the placebo arm (7%). 

Recommended dosage and monitoring requirements The recommended dosage of Neulasta is a single subcutaneous injection administered once per chemotherapy cycle. Neulasta should not be administered in the period between 14 days before and 24 hours after administration of cytotoxic chemotherapy. 

Fig. 15.12 Mean (SE) duration of grade 4 neutropenia in patients with breast cancer during the first chemotherapy cycle. The responses for the different body weight subsets were similar after a single fixed dose of pegfilgrastim 6 mg and after daily doses of filgrastim 5 pg/kg. (Data from [41]).

Siena S, Piccart MJ, Holmes FA, Glaspy J, Hackett J, Renwick JJ. A combined analysis of two pivotal randomized trials of a single dose of pegfilgrastim per chemotherapy cycle and daily filgrastim in patients with stage II-IV breast cancer. Oncol. Rep. 2003 70 715-724. 

In 130 patients treated with raltitrexed 3 mg/m (n = 52) or raltitrexed plus oxaliplatin (n = 78), of whom 78 had hver metastases and 25 had raised transaminases, hepatotoxicity caused delays of a week or more in 60 of 584 chemotherapy cycles and was the reason for withdrawal of chemotherapy in eight patients (4). Raised baseline transaminases, the number of chemotherapy cycles, the... 

Several smdies have attempted to improve treatment results by increasing chemotherapy dose (i.e., dose-intensity), shortening the interval between chemotherapy cycles (i.e., dose-density), or both. Because of the increased risk of severe neutropenia, these approaches require growth factor support. Although results of these studies have not consistently shown improved survival, encouraging results from several recently published smdies suggest that these approaches be evaluated in future randomized trials. ... 

Number of postremission chemotherapy cycles is dependent on patient characteristics and inclusion of hematopoietic stem cell transplantation in treatment plan. 

A randomised, double blind, placebo controlled trial was conducted in collaboration with Tata Memorial Hospital, Mumbai, in order to evaluate the efficacy of Tinospora cordifolia in reducing the cytotoxic chemotherapy-induced leucopenia in patients with breast cancer [17]. For the study, 38 patients were recruited and randomised to receive either the active drug (Tinospora cordifolia in syrup form) or matching placebo syrup for a period of 14 days prior to the first chemotherapy cycle. The drug administration was continued throughout the subsequent cycles (consisting of cyclophosphamide 750 mg/m, methotrexate 40 mg/m and 5 flurouracil 750 mg/m every three weeks ) with a break of 4-5 days after each injection. A complete blood count was performed on days -10, 0,4, 7,10 and 14 in each... 

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