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Fluorouracil and folinic acid in colon cancer
Biomrd
& Pharmacothrr
1996;50:92-94 0 Elsevier, Paris
Notes
Fluorouracil
and folinic
acid in colon cancer
In a recent issue of The Lancet, the Investigators of the International Multicenter Pooled Analysis of Colon cancer Trials (IMPACT) confirmed the efficacy of adjuvant fluorouracil plus high-dose folinic acid after radical surgery in patients with colon cancer. In this study, the results from three multicenter randomised trials of fluorouracil plus high dose folinic acid where pooled for a combined analysis. The groups included the Gruppo Italian0 Valutazione Interventi in Oncologia (GIVIO), the National Cancer Institute Clinical Trial Group, and the Foundation Francaise de Cancerologie Digestive. Each trial was multicentre and used the same regimen of fluorouracil 370 to 400 mg/mz plus folinic acid 200 mglm’ daily for five days, every 28 days for six cycles. With 1,493 eligible patients (736 in the treatment group and 757 in the control group), fluorouracil plus folinic acid reduced the relapse rate by 35% and the overall mortality by 22%, increasing the three year survival from 78% to 83% with high consistency of results among trials. Compliance with treatment was good and more than 80% of patients completed the planned treatment. Side effects were clinically acceptable, with only one treatment-related death. The most common side effects were gastrointestinal; severe toxic effects occurred in fewer than 3% of cases. The authors concluded that fluorouracil plus high dose folinic acid is a well-tolerated and effective six-month adjuvant regimen for patients with completely resected colon cancer. The improvement of survival in colon cancer can now be achieved with different schedules, dosages and duration of treatments. Istituto “Mario
common means to diagnose DVT. However, as with all diagnostic tests, sensitivity and specificity are not perfect. As such. it should be possible to determine which test results are most likely to be false negative and false positive if one could accurately determine the pretest probability; ie, prevalence, in the patients being tested. We developed and evaluated a clinical model using a simple scoring system in order to perform this task. We were able to categorize patients as having high probability (85% had DVT), moderate probability (33% had DVT). and low probability (5% had DVT). We determined that abnormal ultrasound result in the moderate and high pretest probability groups, predicts for DVT in almost 100% of cases where as in the low probability, there is significant false positive rate of approximately 37%. Thus. we recommend performing confirmatory venography for abnormal ultrasound results in the low pretest probability group. On the contrary. a normal ultrasound result and a low pretest probability essentially excludes DVT but in the moderate group there is a 16% false negative rate, 32% false negative rate, with a high pretest probability. This suggests that at the very least, the moderate and high pretest probability groups require serial testing and a case could be made for performing venography to rule out DVT in high probability patients with a normal ultrasound. Use of the above diagnostic approach could save a large number of patients from the usual strategy of serial ultrasound testing and would decrease the rate of false positive diagnoses. Although a formal cost effective analysis has yet to be performed, this approach most likely would result in savings to the health care system.
V Torri ( 1) di Ricerche Farmacologiche Negri”, 20157 Milan. Italy
Ottawa,
(2) Lancer (1) Lancer
1995:345:
PS Wells (2) Ottawa Civic Hospital Ontario K IY 158, Canada
1326-30
1995:345:939-44
Prophylactic
aspirin induced ulcer bleeding
Clinical assessment of deep vein thrombosis The clinical diagnosis of deep vein thrombosis (DVT) has in the past been considered unreliable, most providing little help in the diagostic process. Non-invasive tests, especially venous ultrasound imaging are the most
Data obtained in 1,144 patients aged 60 and over admitted to hospital with bleeding gastric or duodenal ulcers, and in age and sex matched hospital and community controls indicated that irrespective of aspirin dose there were raised risks of associated ulcer
& Pharmacothrr
1996;50:92-94 0 Elsevier, Paris
Notes
Fluorouracil
and folinic
acid in colon cancer
In a recent issue of The Lancet, the Investigators of the International Multicenter Pooled Analysis of Colon cancer Trials (IMPACT) confirmed the efficacy of adjuvant fluorouracil plus high-dose folinic acid after radical surgery in patients with colon cancer. In this study, the results from three multicenter randomised trials of fluorouracil plus high dose folinic acid where pooled for a combined analysis. The groups included the Gruppo Italian0 Valutazione Interventi in Oncologia (GIVIO), the National Cancer Institute Clinical Trial Group, and the Foundation Francaise de Cancerologie Digestive. Each trial was multicentre and used the same regimen of fluorouracil 370 to 400 mg/mz plus folinic acid 200 mglm’ daily for five days, every 28 days for six cycles. With 1,493 eligible patients (736 in the treatment group and 757 in the control group), fluorouracil plus folinic acid reduced the relapse rate by 35% and the overall mortality by 22%, increasing the three year survival from 78% to 83% with high consistency of results among trials. Compliance with treatment was good and more than 80% of patients completed the planned treatment. Side effects were clinically acceptable, with only one treatment-related death. The most common side effects were gastrointestinal; severe toxic effects occurred in fewer than 3% of cases. The authors concluded that fluorouracil plus high dose folinic acid is a well-tolerated and effective six-month adjuvant regimen for patients with completely resected colon cancer. The improvement of survival in colon cancer can now be achieved with different schedules, dosages and duration of treatments. Istituto “Mario
common means to diagnose DVT. However, as with all diagnostic tests, sensitivity and specificity are not perfect. As such. it should be possible to determine which test results are most likely to be false negative and false positive if one could accurately determine the pretest probability; ie, prevalence, in the patients being tested. We developed and evaluated a clinical model using a simple scoring system in order to perform this task. We were able to categorize patients as having high probability (85% had DVT), moderate probability (33% had DVT). and low probability (5% had DVT). We determined that abnormal ultrasound result in the moderate and high pretest probability groups, predicts for DVT in almost 100% of cases where as in the low probability, there is significant false positive rate of approximately 37%. Thus. we recommend performing confirmatory venography for abnormal ultrasound results in the low pretest probability group. On the contrary. a normal ultrasound result and a low pretest probability essentially excludes DVT but in the moderate group there is a 16% false negative rate, 32% false negative rate, with a high pretest probability. This suggests that at the very least, the moderate and high pretest probability groups require serial testing and a case could be made for performing venography to rule out DVT in high probability patients with a normal ultrasound. Use of the above diagnostic approach could save a large number of patients from the usual strategy of serial ultrasound testing and would decrease the rate of false positive diagnoses. Although a formal cost effective analysis has yet to be performed, this approach most likely would result in savings to the health care system.
V Torri ( 1) di Ricerche Farmacologiche Negri”, 20157 Milan. Italy
Ottawa,
(2) Lancer (1) Lancer
1995:345:
PS Wells (2) Ottawa Civic Hospital Ontario K IY 158, Canada
1326-30
1995:345:939-44
Prophylactic
aspirin induced ulcer bleeding
Clinical assessment of deep vein thrombosis The clinical diagnosis of deep vein thrombosis (DVT) has in the past been considered unreliable, most providing little help in the diagostic process. Non-invasive tests, especially venous ultrasound imaging are the most
Data obtained in 1,144 patients aged 60 and over admitted to hospital with bleeding gastric or duodenal ulcers, and in age and sex matched hospital and community controls indicated that irrespective of aspirin dose there were raised risks of associated ulcer