Seiichirou Hoshino

Prospective Evaluation of Occlusive Hydrocolloid Dressing Versus Conventional Gauze Dressing Regarding the Healing Effect After Abdominal Operations: Randomized Controlled Trial

OBJECTIVE To compare occlusive hydrocolloid dressing (OHD; Karayahesive) and gauze dressing (GD) with regard to the cost and incidence of wound infection after abdominal surgery. METHODS A total of 134 patients who underwent incisions were randomized to have their wounds dressed with either OHD or GD. OHD was left on until the sutures were removed, and GD was changed everyday postoperatively. The cost calculations represent the number of dressings required for each treatment group as determined by the frequency of required dressing changes and cost per dressing. RESULTS There were no differences between the groups regarding the need for dressings to be changed or the incidence of infection. OHD was less expensive and complicated than GD, which needed to be changed everyday (p < 0.0001). CONCLUSION The results suggest that OHD is less expensive to use than GD, and the risk of wound infection is not increased compared to GD.

A single-arm Phase II validation study of preventing oxaliplatin-induced hypersensitivity reactions by dexamethasone: the AVOID trial

Background Patients with colorectal cancer treated with oxaliplatin are at risk of hypersensitivity reactions, with the incidence estimated to be 12%–20%. Coinfusion of dexamethasone and oxaliplatin could potentially reduce the incidence of these reactions, but oxaliplatin is reported to be incompatible with alkaline compounds in solution. However, in a previous retrospective study we found that the pH of a solution of dexamethasone and oxaliplatin was less than 7.4, and that hypersensitivity to oxaliplatin could have been prevented by coinfusion of dexamethasone. We aimed to evaluate the effectiveness of coinfusion of dexamethasone and oxaliplatin to prevent oxaliplatin-induced hypersensitivity reactions. Patients and methods The AVOID trial was a prospective, multicenter, open-label, single-arm Phase II trial conducted from January to September 2013. The study included 73 patients who received capecitabine plus oxaliplatin (XELOX) or XELOX plus bevacizumab therapy for colorectal cancer. In all patients, oxaliplatin was administered in combination with dexamethasone. The primary outcome measure was the presence of hypersensitivity reactions. Results Hypersensitivity reactions occurred in three patients (4.1%); all three experienced a cutaneous reaction (grade 1 erythema). None of the 73 patients developed respiratory symptoms, ocular symptoms, or anaphylaxis. Grade 3 or higher hemotoxicity occurred in 13.7% of the patients and grade 3 or higher nonhematological toxicity occurred in 13.7%. The response rate to treatment was 64.4%. Conclusion The coinfusion of dexamethasone and oxaliplatin effectively reduced oxaliplatin-induced hypersensitivity reactions in patients with colorectal cancer. This approach should be considered for all patients treated with oxaliplatin, allowing treatment to be completed as planned.

1608PCHEMOTHERAPY FOR DIHYDROPYRIMIDINE DEHYDROGENASE-DEFICIENT PATIENT

ABSTRACT Aim: 5-FU is metabolized by thymidine phosphorylase and orotate phosphoribosyl transferase and is principally degraded in the blood or liver by dihydropyrimidine dehydrogenase (DPD). DPD, the catalyzing enzyme in the first and rate-limiting step of the degradation process, degrades approximately 85% of the administered 5-FU. DPD activity in peripheral blood mononuclear cells has been reported to correlate inversely with 5-FU clearance. In reports of DPD deficiency, the prognosis is poor, and approximately 60% patients die. With a reported high mortality rate, chemotherapy is generally contraindicated for patients with DPD deficiency, and there have been no reports of continued chemotherapy in patients with a DPD activity level of Methods: Chemotherapy for a 73-year old man with jejunal cancer was initiated. Capecitabine was administered in incrementally increasing doses, beginning with a single pill (dose-escalation method), while monitoring plasma 5-FU concentration, leukocyte, neutrophil, and platelet counts. Results: DPD protein measurement in the peripheral blood mononuclear cells yielded a level of 2.35 U/mg using the ELISA method (the same method yielded DPD measurements ranging from 33.6 to 183.6 U/mg in peripheral blood mononuclear cells from 10 healthy individuals). Ultimately, after increasing the Capecitabine dose to 1800 mg, oxaliplatin and bevacizumab were added and XELOX+bevacizumab treatment was initiated. Subsequent DPD protein measurement showed that the level had increased to approximately 10-fold the level before chemotherapy. Furthermore, the peritoneal metastases disappeared following chemotherapy. Conclusions: Because of serious adverse events, the chemotherapy-associated mortality rate among DPD-deficient patients is high, and there have been no reports of continuous chemotherapy in patients with DPD activity levels of Disclosure: All authors have declared no conflicts of interest.