Abdul Rahman Jazieh

The use of complementary and alternative medicine by cancer patients undergoing radiation therapy

Objective:Use of complementary alternative medicine (CAM) is widespread among patients with chronic diseases including cancer. The purpose of our study was to examine the pattern of alternative medicine use in patients undergoing radiation treatment of cancer. Methods and Materials:A cross-sectional study was conducted among cancer patients treated with radiation therapy from July 2003 through July 2005 at the University of Cincinnati. We defined CAM as the use of dietary supplements, massage therapy, prayer, acupuncture, chiropractic, and other novel therapies undertaken after their diagnosis with cancer. Results:There were 152 patients that participated in the study. Their median age was 59 (range, 21–85), 82 (54%) were males, 108 (69%) were Caucasian. Out of 152 patients, 104 (68%) patients were users of CAM. The most common CAM modality reported was prayer 85 (82%) and use of dietary supplements 84 (80%). The majority of users were female and well-educated. Among CAM users 60 (58%) had discussed its use with their physician. Level of education, employment status and income showed a significant correlation with the use of CAM. Conclusion:This study demonstrates that the use of complementary alternative medicine among cancer patients receiving radiation therapy is frequent. Given the potential risks with some CAM therapies, physicians should actively ask patients whether they use CAM and provide appropriate counseling.

A Phase II trial of Denileukin Diftitox in patients with previously treated advanced non-small cell lung cancer.

Introduction:Denileukin diftitox, a chimeric protein, uses the cytocidal properties of diphtheria toxin to cells expressing interleukin-2 receptors. The aim of this study was to evaluate the efficacy and safety of denileukin diftitox in the treatment of advanced relapsed nonsmall cell lung cancer (NSCLC). Patients And Methods:Multicenter phase II trial in patients with NSCLC with Eastern Cooperative Oncology Group PS 0–2, stage IIIB/IV at diagnosis, who had failed at least 1 previous chemotherapy regimen. Denileukin diftitox was infused at 18 &mgr;g/kg/d × 5 days, every 21 days for 6 cycles. Results:For the 41 patients enrolled, the median age was 56 years (range, 21–80), 25 were men, and the median number of previous chemotherapy regimens was 2 (range, 1–5). The median number of treatment cycles was 2 (range, 1–6). By RECIST criteria, 18 (44%) had stable disease, 10 (24%) progressive disease, and 13 (32%) were not evaluable for response as they received less than 2 treatment cycles. The median time to disease progression was 1.8 months [range, 0.3–11.3; 95% confidence interval (CI) 1.3–2.6]. Median survival was 5.8 months (range, 0.3–33.6; 95% CI 3.4–11.4). The median follow-up time was 16.1 month. One death from myocarditis verified at autopsy was attributed to treatment. One grade 4 toxicity (vascular leak syndrome) was encountered, and 18 grade 3 toxicities, primarily gastro-intestinal, vascular leak syndrome, and constitutional symptoms. Conclusion:Denileukin diftitox at current dose schedule has limited activity in patients with previously treated NSCLC, manifested by disease control without impact on survival.

Can lung cancer screening by computed tomography be effective in areas with endemic histoplasmosis

OBJECTIVE Low-dose chest computed tomography (CT) is being evaluated in several national trials as a screening modality for the early detection of lung cancer. The goal of the present study was to determine whether lung cancer screening could be done while minimizing the number of benign biopsy specimens taken in an area endemic for histoplasmosis. METHODS The subjects were recruited by letters mailed to area physicians and local advertisement. The inclusion criteria were age older than 50 years and at least a 20 pack-year smoking history. The exclusion criteria were symptoms suggestive of lung cancer or a history of malignancy in the previous 5 years. The participants completed a questionnaire and underwent a chest CT scan at baseline and annually for 5 years. The management of positive screening results was determined using a defined algorithm: annual follow-up CT scan for nodules less than 5 mm; 6-month follow-up CT scan for nodules 5 to 7 mm; review by our multidisciplinary tumor board for nodules 8 to 12 mm; and biopsy for nodules greater than 12 mm. RESULTS A total of 132 patients were recruited. Of the 132 patients, 61% had positive baseline CT findings and 22% had positive findings on the annual CT scans. Six cancers were detected. Of these 6 patients, 5 had stage I disease and underwent lobectomy, and 1 had stage IIIA disease and underwent induction chemotherapy and radiotherapy followed by lobectomy. All patients were alive and disease free at a mean follow-up of 41.7 ± 18.6 months. No biopsies were performed for benign lesions. Also, no cancers were missed when the protocol was followed. CONCLUSIONS Screening with CT can be done effectively in an area endemic for histoplasmosis while minimizing benign biopsies.

Hematologic Complications of Alternative Remedies

The use of alternative therapies increased dramatically over the last decade with a wide variety of methods and interventions. Dietary supplements are a very common form of alternative therapy used by healthy people as well as patients with serious health problems.The use of these untested, unregulated therapies may carry inherent risks. Hematologic complications are known side effects of these remedies and may present potentially life-threatening events. This manuscript discusses the clinical manifestations and mechanisms of action of these remedies and provides recommendations for patients’ evaluation and counseling.

Phase I Clinical Trial of Concurrent Paclitaxel, Carboplatin, and External Beam Chest Irradiation with Glutamine in Patients with Locally Advanced Non-Small Cell Lung Cancer

Esophagitis is a dose-limiting toxicity of combined chemoradiation therapy in patients with locally advanced lung cancer. Our study aimed at minimizing this complication by using glutamine in an attempt to escalate the dose of chemotherapy. This was a Phase I trial of escalating the dose of weekly paclitaxel and carboplatin with concurrent radiation therapy. Fifteen patients were enrolled, with median age 62 years (58–78), 13 males and 12 Caucasians. Due to multiple severe toxicities including hematological toxicities and esophagitis, the combination was deemed not feasible. In conclusion, the addition of glutamine does not prevent serious toxities of this concurrent chemoradiotherapy regimen.

Phase II Trial of Thalidomide, Irinotecan and Gemcitabine in Chemonaive Patients with Advanced Non-Small Cell Lung Cancer

ABSTRACT This study aim was to determine the efficacy and safety of the combination of Gemcitabine 1000mg/m2 day 1 & 8 and Irinotecan 100 mg/m2 day 1 & 8 with escalating dose of thalidomide in chemonaive patients with advanced non-small cell lung cancer. Among the 20 patients who met eligibility criteria and received treatment, two patients (10%) experienced partial response and 14 (70%) experienced stable disease. The median time to disease progression was 4 months (95% CI: 2.8–6.6). The 1 year and 2 year survival rates were 36% and 27%, respectively. This combination is active in advanced NSCLC with manageable toxicity profile.

A phase II study of sequential neoadjuvant gemcitabine and paclitaxel, radiation therapy with cisplatin and 5-fluorouracil and surgery in locally advanced esophageal carcinoma.

Objective:To evaluate the feasibility and efficacy of sequential neoadjuvant chemotherapy, chemoradiation, and surgery in patients with locally advanced esophageal cancer. Patients and Methods:There were 29 patients who received paclitaxel 150 mg/m2 and gemcitabine 3000 mg/m2 2 weeks apart. Two weeks later, patients received cisplatin 75 mg/m2 and 5-fluorouracil (5-FU) 1000 mg/m2/d continuous infusion for 4 days with concurrent radiotherapy in 15 fractions to a total dose of 4000 cGy. After 6 weeks, cisplatin and 5-FU were repeated at the above doses. After 4 to 6 weeks, patients were restaged and underwent surgical resection. Results:All 29 patients completed the prescribed gemcitabine, paclitaxel, and radiation therapy. Febrile neutropenia occurred in 1 patient and 4 patients received growth factor support. After neoadjuvant treatment, 1 patient refused surgery, 23 underwent R0 resection (82%), while 5 developed progressive disease. Four patients developed anastomotic leaks (17%). Four patients had complete pathologic responses (14%) and 4 (14%) had only residual microscopic disease. Nine patients remain alive at a median follow-up of 48 months. Three-year survival for the entire cohort was 36%. Conclusion:This regimen was associated with a high rate of compliance and induction therapy had an acceptable toxicity profile. The R0 resection rate and 3-year survival data are similar to recently reported studies. While active, gemcitabine and paclitaxel induction therapy was associated with an increased rate of postoperative complications, but no increase in survival. Patterns of failure continue to demonstrate the need for regimens incorporating greater emphasis on systemic therapy for locally advanced esophageal cancer.

Phase II Clinical Trial of Gefitinib for the Treatment of Chemonaïve Patients with Advanced Non-small Cell Lung Cancer with Poor Performance Status

Background Patients with advanced non-small cell lung cancer (NSCLC) have no curative treatment options; therefore, improving their quality of life (QOL) is an important goal. Gefitinib, an epidermal growth factor receptor (EGFR) inhibitor, is a safe oral agent that may be of benefit to a specific population of NSCLC. Patients and Methods A Phase II clinical trial included chemonaïve patients with advanced NSCLC and poor performance status (PS). Response rate, progression-free survival, overall survival, QOL using the Functional Assessment of Cancer Therapy – Lung (FACT-L) questionnaire, and Trial Outcome Index (TOI) were evaluated. Results Twelve out of 19 enrolled patients were evaluable. The median age for the evaluable patients was 68.8 years (59.7–74.6). Out of all the patients, 7 (58.3%) had adenocarcinoma and 5 (41.7%) had squamous cell carcinoma. The median duration of treatment was 62.5 days (26.5–115.0) in the evaluable patients. Grade 3/4 toxicities included fatigue, rash, diarrhea, and nausea. One patient had partial response, eight patients had stable disease (SD), and three patients progressed. The median overall survival for the evaluable population was 4.9 months (2.3–16). The median progression-free survival was 3.7 months (1.9–6.6). TOI was marginally associated with the overall survival, with a hazard ratio of 0.92 (95% confidence interval: 0.84, 1.0) (P = 0.061). FACT-L score and the TOI were highly correlated (r = 0.96, P < 0.0001). TOI scores were higher in African Americans compared to Caucasians and increased with age. Conclusion Our results suggest that gefitinib use in patients with NSCLC and poor PS may improve the QOL of older patients and African American patients.

Fabrication and Characterization of a Multiwall Carbon Nanotube Needle Biosensor

A nanotube electronic needle biosensor was developed to provide fast, low cost, accurate detection of biomolecules. The sensor was formed by synthesizing highly aligned multi-wall carbon nanotube arrays. Nanotube bundles from the array were welded onto the tips of tungsten needles using a microscope. The needles were then encased in glass and a polymer coating. Cyclic voltammetry (CV) for the respective reduction of 6 mM K3Fe(CN)6in a 1.0 M KNO3was performed to examine the redox behavior of the nanotube needle. The CV results showed a steady-state response attributable to radial diffusion with a high steady-state current density. An amperometric sensor was then developed for glucose detection by physical attachment of glucose oxidase on the nanotube needle. A label-free immunosensor based on electrochemical impedance spectroscopy was also formed. The nanotube needle amperometric have good sensitivity with a low detection limit, and the possibility exists to keep decreasing the size of the needle to increase the sensitivity.

A Patient with Myeloid Metaplasia of the Skin and Mouth

To the Editor: Post-polycythemic myeloid metaplasia is characterized by increasing splenomegaly, dacryocytes, anemia, extensive bone marrow fibrosis, and a leukoerythroblastic blood picture.1 We de...