Clinical Abstracts from Overseas: September 2007

By Stanton R. Mehr
Published: Thursday, Jul 08, 2010

GAMEC for Untreated or Relapsed Refractory Germ-Cell Tumors

The treatment of refractory germ-cell tumors continues to be a challenge to the oncology community, but researchers from St. Bartholomew’s Hospital in London have tested a new approach to combination chemotherapy that appears promising.

Utilizing high-dose methotrexate, actinomycin-D, and etoposide every 14 days, as part of an intensive cisplatin regimen (overall, referred to as GAMEC therapy), these oncologists found that of 27 patients who had been untreated and had a poor prognosis, 20 patients (74%) were progression free after GAMEC and surgery. Of 35 patients who had experienced progression with use of platinum-based chemotherapy, 18 (51%) were progression free after GAMEC and surgery.

However, this approach was found to be toxic: All of the patients receiving GAMEC had at least one episode of febrile neutropenia, and five deaths (8%) were directly attributable to the chemotherapy combination.

The authors concluded that this small study of GAMEC and appropriate surgery resulted in encouraging results in patients with refractory germ-cell tumors and a poor prognosis. However, this intensive regimen is highly toxic and work must be done to determine if risk can be reduced through appropriate patient selection.

   Shamash J, Powles T, Ansell W, et al: GAMEC: A new intensive protocol for untreated poor prognosis and relapsed or refractory germ cell tumors. Br J Cancer 2007; July 3 (E-pub, ahead of print).

Preventing Oxaliplatin-Induced Peripheral Neuropathy

Oxaliplatin-containing medical regimens are commonly used to treat patients with advanced colon cancer, and nerve toxicity, specifically peripheral neuropathy, is a frequent side effect.

The oxaliplatin’s toxicity seems to be related to altered voltage-gated sodium channels inside neurons. British neurologists theorized that a structural analogue to the anticonvulsant carbamazine might be able to inhibit activity of these sodium channels, but with fewer side effects than the parent compound.

They conducted a controlled study of 32 patients with advanced colorectal cancer, randomized the group to receive oxcarbamazine 600 mg bid or not (but a placebo was not given in its place) as part of their medical regimen. The researchers found 31% of patients receiving oxcarbamazine developed chronic peripheral neuropathy compared with 75% of those not receiving the agent (P = .03). Differences in their total neuropathy scores were significant as well (P = .02).

  Mean Total Neuropathy Scores in Patients

  Receiving Oxcarbamazine as Part of Their

  Chemotherapy Regimen

  Mean Total Neuropathy Score

  Oxcarbamazine Group 4.1 ± 6.5
  No Oxcarbamazine 11.2 ± 9.0

   Argyriou A: Efficacy of oxcarbazepine against chronic oxaliplatin-induced peripheral neuropathy: A randomized controlled trial. Presented at the 2007 annual meeting of the European Neurological Society, June 19, 2007, Rhodes, Greece.


Immunodeficiency May Be Linked to Multiple Cancer Types

According to a paper in The Lancet, patients who have undergone kidney transplants or who have HIV/AIDS have a far higher risk of 20 different cancers compared with the general population.

Researchers from the University of New South Wales, Australia conducted a meta-analysis that incorporated seven studies of people with HIV/AIDS (N = 444,172) and five studies of kidney-transplant recipients (N = 31,977). They found an alarmingly high risk of cancer caused by infection, and could not identify any similarities in these patients other than the fact that they are markedly immune-compromised either through the disease itself or through medications to prevent rejection.

Those with HIV/AIDS were found to be at 11-fold greater risk than the general population for Hodgkin’s lymphoma. Patients undergoing kidney transplant were found to have a fourfold increased risk.

It has been well documented that patients with HIV/AIDS are at very high risk for Kaposi’s sarcoma (> 3,500 times the risk seen in the overall population). However, the investigators found that patients undergoing kidney transplant were also at significant risk (> 200 times that of the reference population). The researchers revealed that this pattern of risk extended to 20 different types of cancers, all of which are associated with viral infection (e.g., Epstein–Barr virus in Hodgkin’s lymphoma; human papilloma virus in cervical cancer, penile cancer, and oral cancer; hepatic cancer, hepatitis B or C viruses). The incidence of most common epithelial cancers was not increased in these patient groups.

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