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Report of two cases of acute cardiac adverse events in patients with colorectal carcinoma receiving oral capecitabine.
Lampropoulos, S, Roditis, P, Koulouris, E, Zafiris, A, Tzimou, M, Kyratlidis, K, Pavlidis, K, Godwin, SA, Kosmas, C
Anti-cancer drugs. 2017;(7):801-807
Abstract
Capecitabine is an oral fluoropyrimidine chemotherapeutic agent, which, after oral administration, is metabolized to its active cytotoxic compound: 5-fluorouracil (5-FU). Cardiotoxicity is a recognized side effect of 5-FU, a closely related fluorinated pyrimidine antagonist. In the present report, we report on two patients who were admitted to our department after being treated with oral capecitabine for colorectal carcinoma and developed symptoms and signs of acute myocardial infarction that resolved after appropriate treatment and monitoring. The above two cases are discussed in the context of fluoropyrimidine, 5-FU, and capecitabine-induced cardiotoxicity; in addition, a detailed literature review of relevant cases and patient series reports is presented.
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Obesity as Predictor of Mortality of Colorectal Cancer: an Evidence-based Case Report.
Billy, M, Sholihah, H, Andanni, K, Anggraeni, MI, Siregar, SM, Mirtha, LT
Acta medica Indonesiana. 2016;(3):242-246
Abstract
AIM: to determine all-cause mortality and cancer-spesific mortality of colorectal cancer patient with obesity. METHODS a search was conducted on Pubmed, Proquest, Ebsco, Scopus, and Cochrane based on clinical query. The screening of title and abstract using inclusion and exclusion criteria, filtering double, and reading full text led to one useful article. This study, which is meta-analysis was critically appraised for its validity, importance and applicability. RESULTS the relative risk of colorectal cancer patient with pre-existing obesity having cancer-specific mortality and all-cause mortality is 1.22 (95% CI, 1.003-1.35) and 1.25 CI (95% CI, 1.14-1.3) respectively, when compared with non-obese colorectal cancer patient. CONCLUSION pre-existing obesity is related to increased risk of all-cause mortality and cancer-spesific mortality of in colorectal patient. Control of body weight is recommended in this patient through combination of diet, physical activity, behavior therapy, pharmacotherapy, and surgery.
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Genetics: The Future Is Now with Interprofessional Collaboration.
Regier, DS, Hart, TC
Dental clinics of North America. 2016;(4):943-9
Abstract
With the growing complexity of health care, interprofessional communication and collaboration are essential to optimize the care of dental patients, including consideration of genetics. A dental case exemplifies the challenges and benefits of an interprofessional approach to managing pediatric patients with oligodontia and a family history of colon cancer. The interprofessional team includes dental, genetic, nutritional, and surgical experts.
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Multidisciplinary approach and anesthetic management of a surgical cancer patient with methylene tetrahydrofolate reductase deficiency: a case report and review of the literature.
Cascella, M, Arcamone, M, Morelli, E, Viscardi, D, Russo, V, De Franciscis, S, Belli, A, Accardo, R, Caliendo, D, De Luca, E, et al
Journal of medical case reports. 2015;:175
Abstract
INTRODUCTION Hyperhomocysteinemia is a known risk factor for myocardial infarction, stroke, peripheral vascular disease, and thrombosis. Elevated plasma homocysteine levels have been demonstrated in patients with recurrent episodes or a single episode of thrombosis. Here we describe the development of cardiovascular disease as a complication of a surgical intervention in a patient with colorectal cancer and hyperhomocysteinemia. CASE PRESENTATION A 65-year-old Caucasian man complained of pain and constipation, attributed to previously diagnosed adenocarcinoma (stage IIB) of the hepatic flexure. An anamnestic investigation showed that he had undergone two surgical interventions. During both, he suffered thrombotic postoperative complications, a deep vein thrombosis of the upper extremity after the first operation and retinal vein occlusion after the second. He was diagnosed with hyperhomocysteinemia associated with a homozygous C677T mutation of the gene encoding the enzyme methylenetetrahydrofolate reductase. Our patient was initially treated with folic acid and high-dose B vitamins. On day 7 he underwent a right hemicolectomy. Anesthesia was performed with sevoflurane in 40% O2 and without the use of nitrous oxide. Postoperatively, our patient remained on folic acid and B vitamins and was without immediate or subsequent complications. CONCLUSIONS Neoplastic disease and related surgery followed by the administration of chemotherapeutic drugs alter the hemostatic balance in cancer patients. Those suspected of also having a thrombophilic disease require a thorough laboratory diagnostic workup, including a molecular analysis aimed at identifying the genetic mutation responsible for the hyperhomocysteinemia, as indicated. The case described in this report highlights the importance of a multidisciplinary approach that includes expertise in peri-operative anesthesia, surgery, oncology, and hematology.
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Segmental and lobar administration of drug-eluting beads delivering irinotecan leads to tumour destruction: a case-control series.
Jones, RP, Dunne, D, Sutton, P, Malik, HZ, Fenwick, SW, Terlizzo, M, O'Grady, E, Koelblinger, C, Stättner, S, Stremitzer, S, et al
HPB : the official journal of the International Hepato Pancreato Biliary Association. 2013;(1):71-7
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Abstract
BACKGROUND Irinotecan-loaded drug-eluting beads represent a novel drug delivery method that allows for the locoregional delivery of irinotecan to colorectal liver metastases (CRLM). The method has shown impressive response rates. However, the pathological response to this treatment has not previously been demonstrated. METHODS Patients with easily resectable CRLM were treated with drug-eluting beads delivering irinotecan (DEBIRI) 4 weeks prior to resection. Pathological tumour response was graded using a validated system. The intraoperative detection of previously unidentified disease allowed for the assessment of pathological responses directly attributable to bead treatment. RESULTS In Patient 1, segmental embolization of the target lesion in segment VIII resulted in 100% necrosis (0% viability). An untreated lesion in segment IV was found to be 30% viable. In Patient 2, subsegmental embolization of the target lesion in segment VI resulted in 60% necrosis and 40% fibrosis (0% viability). An untreated lesion in segment VI remained 60% viable. In Patient 3, lobar embolization of the target lesion in segment II resulted in 0% viability. Two further lesions within the treated hemiliver, both with 0% viability, and one lesion in the untreated hemiliver with 45% viability were discovered at laparotomy. CONCLUSIONS This series demonstrates the effectiveness of DEBIRI in the treatment of CRLM. High rates of tumour destruction are possible, even with the proximal lobar administration of DEBIRI. Lobar administration appears to be an appropriate method of delivery for integration into future therapeutic regimens.
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Multiple mutations in the Kras gene in colorectal cancer: review of the literature with two case reports.
Macedo, MP, Andrade, Lde B, Coudry, R, Crespo, R, Gomes, M, Lisboa, BC, Aguiar, S, Soares, FA, Carraro, DM, Cunha, IW
International journal of colorectal disease. 2011;(10):1241-8
Abstract
PURPOSE Kras mutations are negative predictors of anti-EGFR therapy, occurring in 40% of colorectal carcinomas (CRCs). Point substitutions in codon 12 or 13 are the most frequent mutations in Kras, but multiple mutations (MMs) in other codons can also develop. Few data exist on MMs with regard to their frequency and the codons and amino acids that are affected. We report two cases of Kras double mutations in codons 12 and 13 and review Kras MMs in primary CRC in PubMed databases. CASE REPORT A 53-year-old woman and a 70-year-old man presented with deep, invasive, moderately differentiated CRC at an advanced clinical stage. The former had regional lymph node involvement and vaginal wall neoplastic implantation, and the latter had liver metastasis. Primary tumors were examined for Kras mutations by pyrosequencing, which were confirmed by direct sequencing. Both tumors had a mutation in codons 12 and 13, wherein codon 12 was mutated to GAT, and codon 13 became GAC. CONCLUSIONS We identified 69 reported cases of Kras MMs and reported two other cases, representing 2.1% of all mutated tumors; the incidence of such mutations is 1.0% in CRC patients. In most cases (59%), MMs develop in a single codon, usually codon 12. Codons 12 and 13 are affected simultaneously in only 27% of cases. These findings add information about the impact of specific amino acid changes in the Kras gene.
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[Acneiform eruptions induced by cetuximab].
Walon, L, Gilbeau, C, Lachapelle, JM
Annales de dermatologie et de venereologie. 2003;(4):443-6
Abstract
INTRODUCTION Many drugs may induce acneiform eruptions: vitamine B12, corticosteroids, androgens, lithium, tuberculostatics, halogens, some antidepressants, anticonvulsives and immunosuppressors. Many cases of acneiform eruptions can be observed following treatment with cetuximab, a drug used for solid cancers at advanced stages in experimental protocols. CASE REPORTS Case 1. A 56 year-old woman, suffering from a colorectal cancer, developed a sudden acneiform eruption after 6 cures of cetuximab, at a one-week interval. She was treated with bisoprolol hemifumarate, sodium levothyroxin, cyproterone acetate and estradiol valerate. Clinical examination revealed inflammatory and follicular papulopustules localized on the face and upper chest. Comedos were absent. Itching sensations were discrete. Histopathological examination of a papulopustule revealed a folliculitis with polymorphonuclear neutrophils. PAS staining did not reveal the presence of bacteria or yeasts. Bacterial and fungal cultures were negative. Lesions faded in approximately 2 weeks following minocycline treatment (100 mg/day). Case 2. A 65 year-old man, treated by cetuximab for a colorectal adenocarcinoma, suddenly developped follicular inflammatory papulopustules on the face, trunk and extensor surfaces of both arms, after 3 weeks of treatment. Itching was discrete. Comedos were absent. Histopathology revealed the presence of a folliculitis with polymorphonuclear neutrophils. Bacteriology and mycology were negative. Lesions were partly controlled by administration of minocycline (100 mg/day) but worsened again in the days following each cure of cetuximab. DISCUSSION Cetuximab is a monoclonal antibody binding to the epidermal-growth-factor-receptor. It is used in the treatment of solid cancers at advanced stages. Both case reports share some similarities: the development of follicular inflammatory papulopustules distributed on the face and trunk typical, of acneiform drug eruptions. Itching is discrete. Comedos are absent. Quick onset of lesions is the rule. Cetuximab can be added to the list of drugs responsible for acneiform eruption.
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Irinotecan and thalidomide in metastatic colorectal cancer.
Govindarajan, R
Oncology (Williston Park, N.Y.). 2000;(12 Suppl 13):29-32
Abstract
Fifteen patients with metastatic colorectal cancer were treated with irinotecan (CPT-11, Camptosar) at 300 to 350 mg/m2 every 21 days and thalidomide (Thalomid) at 400 mg/d. Of the 15 patients, 11 were in a pilot study and 4 were in an ongoing phase II protocol. There were 12 men and 3 women, with a median age of 56 years (range: 29 to 79 years). Patients were treated with a median of three cycles (range: one to eight cycles). The four patients enrolled in the formal protocol were not evaluable for response at the time of this report. Of the 11 patients in the pilot study, 10 were evaluable for response; there were two complete responses, two partial responses, and six progressions. Investigators noted a remarkable absence of grade 3/4 gastrointestinal toxicities, and concluded that further testing of the complete response and toxicity profile of the irinotecan/thalidomide regimen was warranted.