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Russia's legislation to ban smoking in public places
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A randomised trial comparing liposomal daunorubicin (L-DNR) with idarubicin as part of induction treatment for paediatric patients with acute myeloid leukaemia (AML) showed that efficacy was similar, but that the L-DNR regimen was less toxic. In the trial, 257 patients were randomly assigned to receive L-DNR (80 mg/m² per day/×3), and 264 to receive idarubicin (12 mg/m² per day/×3). 5-year overall survival was 76% (SE 3) for patients receiving L-DNR versus 75% (3) for those receiving idarubicin (p=0·65), and 5-year event-free survival was also similar between the two groups (59% [SE 3] for L-DNR vs 53% [3] for idarubicin, p=0·25). L-DNR resulted in significantly improved 5-year event-free survival in patients with t(8;21) AML (76% [SE 8] vs 54% [9]). Treatment-related mortality was lower after L-DNR than after idarubicin (two vs ten deaths, p=0·04), and grade 4 cardiotoxic
effects were rare after induction (four vs five events). Ursula Creutzig (Hannover Medical School, Germany), principal investigator of the study commented, “the study was done to further intensify the anthracycline-dosage during induction without increasing cardiotoxicity. Therefore, the potentially less cardiotoxic L-DNR was compared with idarubicin at a higher than equivalent dose”. She continued, “our results offer the possibility to reduce the risk of experiencing the acute and probably also long-term toxicities associated with other anthracyclines. This is especially important in childhood, because children have a developing heart muscle and are more susceptible to anthracycline cardiotoxicity”. Elihu Estey (University of Washington School of Medicine, Seattle, WA, USA) told The Lancet Oncology that although this was an interesting study, which
suggests that it might be reasonable to replace idarubicin with L-DNR, “the major problem in AML, and particularly paediatric AML, would seem to be lack of efficacy not excess toxicity: indeed, the death rate due to toxicity was only 3% in the idarubicin group and, in general, relapse was ten-fold more common than toxic death”. Jeffrey Rubnitz (St Jude Children’s Research Hospital, Memphis, TN, USA) concludes that, although L-DNR is an active agent for the treatment of AML, “the excellent outcome [reported in this study] is similar to that reported by other cooperative groups, implying that further improvements in outcome cannot be achieved by using only conventional chemotherapy. We have reached the limits of dose intensification and therefore need to identify new agents and move them quickly into clinical trials”.
Pr. J. Bernard/Cnri/Science Photo Library
Daunorubicin is less toxic than idarubicin in paediatric AML
Published Online May 31, 2013 http://dx.doi.org/1016/ S1470-2045(13)70265-1 For the study see Blood 2013; published online May 23. DOI:10.1182/ blood-2013-02-484097
Holly Baker
As of June 1, Russia has banned smoking in some public places; these include public transport, stairways of housing blocks, and the workplace. The ban will be extended to other public spaces in 2014. “The ban represents the success of a large number of Russian cardiovascular, cancer, and public health specialists who, over the years, have demonstrated the dreadful effects of tobacco smoking, coupled in men with heavy alcohol drinking, in increasing the burden of death and disease”, said Paolo Boffetta (Icahn School of Medicine at Mount Sinai, New York, NY, USA). Currently, about 40% of the Russian population are smokers and in 2012, nearly 400 000 Russians died from smoking-related illnesses. According to John Britton (UK Centre for Tobacco Control Studies, University of Nottingham, Nottingham, UK), smoking is the biggest avoidable cause www.thelancet.com/oncology Vol 14 July 2013
of premature death and disability, especially in Russia, where the prevalence of smoking in men has been particularly high for many years, and is still about 50%. He explained, “This high prevalence of smoking is already manifested in a massive toll of disease, particularly lung cancer, COPD, and cardiovascular disease”. Boffetta explained that a reduction in opportunities to smoke in public settings has been repeatedly shown to reduce exposure to second-hand smoke. He said, “The same arguments [against the ban] were used in California, Ireland, Italy, and France, to name a few, and each time they turned out to be wrong: the overwhelming majority of the population—nonsmokers and smokers alike—supported the ban, smokers complied with the new regulation, and business in bars and restaurants went up, not down”.
Giuseppe Gorini (Cancer Research and Prevention Institute, Florence, Italy) has faith in the ban being successful—“No one would have bet that the Italians would have accepted the smoking ban. Unexpectedly, Italians complied with the ban. Why? One of the most important things that, in my opinion, favoured this acceptance was the high levels of news media coverage of this issue. In Italy the smoke-free policy development went on for at least 3 years”. Although Britton believes that the smoking ban in Russia will reduce the prevalence of smoking much more quickly than has been the case, it will be decades before this trend translates into reductions in death and disability due to smoking.
Alexander Natruskin/Reuters/Corbis
Russia’s legislation to ban smoking in public places
Published Online June 7, 2013 http://dx.doi.org/10.1016/ S1470-2045(13)70266-3 For more on Russia’s smoking ban see http://www. independent.co.uk/news/world/ europe/smoking-banintroduced-in-russia-the-landof-the-60p-pack-ofcigarettes-8640524.html
Farhat Yaqub e295
A randomised trial comparing liposomal daunorubicin (L-DNR) with idarubicin as part of induction treatment for paediatric patients with acute myeloid leukaemia (AML) showed that efficacy was similar, but that the L-DNR regimen was less toxic. In the trial, 257 patients were randomly assigned to receive L-DNR (80 mg/m² per day/×3), and 264 to receive idarubicin (12 mg/m² per day/×3). 5-year overall survival was 76% (SE 3) for patients receiving L-DNR versus 75% (3) for those receiving idarubicin (p=0·65), and 5-year event-free survival was also similar between the two groups (59% [SE 3] for L-DNR vs 53% [3] for idarubicin, p=0·25). L-DNR resulted in significantly improved 5-year event-free survival in patients with t(8;21) AML (76% [SE 8] vs 54% [9]). Treatment-related mortality was lower after L-DNR than after idarubicin (two vs ten deaths, p=0·04), and grade 4 cardiotoxic
effects were rare after induction (four vs five events). Ursula Creutzig (Hannover Medical School, Germany), principal investigator of the study commented, “the study was done to further intensify the anthracycline-dosage during induction without increasing cardiotoxicity. Therefore, the potentially less cardiotoxic L-DNR was compared with idarubicin at a higher than equivalent dose”. She continued, “our results offer the possibility to reduce the risk of experiencing the acute and probably also long-term toxicities associated with other anthracyclines. This is especially important in childhood, because children have a developing heart muscle and are more susceptible to anthracycline cardiotoxicity”. Elihu Estey (University of Washington School of Medicine, Seattle, WA, USA) told The Lancet Oncology that although this was an interesting study, which
suggests that it might be reasonable to replace idarubicin with L-DNR, “the major problem in AML, and particularly paediatric AML, would seem to be lack of efficacy not excess toxicity: indeed, the death rate due to toxicity was only 3% in the idarubicin group and, in general, relapse was ten-fold more common than toxic death”. Jeffrey Rubnitz (St Jude Children’s Research Hospital, Memphis, TN, USA) concludes that, although L-DNR is an active agent for the treatment of AML, “the excellent outcome [reported in this study] is similar to that reported by other cooperative groups, implying that further improvements in outcome cannot be achieved by using only conventional chemotherapy. We have reached the limits of dose intensification and therefore need to identify new agents and move them quickly into clinical trials”.
Pr. J. Bernard/Cnri/Science Photo Library
Daunorubicin is less toxic than idarubicin in paediatric AML
Published Online May 31, 2013 http://dx.doi.org/1016/ S1470-2045(13)70265-1 For the study see Blood 2013; published online May 23. DOI:10.1182/ blood-2013-02-484097
Holly Baker
As of June 1, Russia has banned smoking in some public places; these include public transport, stairways of housing blocks, and the workplace. The ban will be extended to other public spaces in 2014. “The ban represents the success of a large number of Russian cardiovascular, cancer, and public health specialists who, over the years, have demonstrated the dreadful effects of tobacco smoking, coupled in men with heavy alcohol drinking, in increasing the burden of death and disease”, said Paolo Boffetta (Icahn School of Medicine at Mount Sinai, New York, NY, USA). Currently, about 40% of the Russian population are smokers and in 2012, nearly 400 000 Russians died from smoking-related illnesses. According to John Britton (UK Centre for Tobacco Control Studies, University of Nottingham, Nottingham, UK), smoking is the biggest avoidable cause www.thelancet.com/oncology Vol 14 July 2013
of premature death and disability, especially in Russia, where the prevalence of smoking in men has been particularly high for many years, and is still about 50%. He explained, “This high prevalence of smoking is already manifested in a massive toll of disease, particularly lung cancer, COPD, and cardiovascular disease”. Boffetta explained that a reduction in opportunities to smoke in public settings has been repeatedly shown to reduce exposure to second-hand smoke. He said, “The same arguments [against the ban] were used in California, Ireland, Italy, and France, to name a few, and each time they turned out to be wrong: the overwhelming majority of the population—nonsmokers and smokers alike—supported the ban, smokers complied with the new regulation, and business in bars and restaurants went up, not down”.
Giuseppe Gorini (Cancer Research and Prevention Institute, Florence, Italy) has faith in the ban being successful—“No one would have bet that the Italians would have accepted the smoking ban. Unexpectedly, Italians complied with the ban. Why? One of the most important things that, in my opinion, favoured this acceptance was the high levels of news media coverage of this issue. In Italy the smoke-free policy development went on for at least 3 years”. Although Britton believes that the smoking ban in Russia will reduce the prevalence of smoking much more quickly than has been the case, it will be decades before this trend translates into reductions in death and disability due to smoking.
Alexander Natruskin/Reuters/Corbis
Russia’s legislation to ban smoking in public places
Published Online June 7, 2013 http://dx.doi.org/10.1016/ S1470-2045(13)70266-3 For more on Russia’s smoking ban see http://www. independent.co.uk/news/world/ europe/smoking-banintroduced-in-russia-the-landof-the-60p-pack-ofcigarettes-8640524.html
Farhat Yaqub e295