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Limb Hypothermia Diminishes Paclitaxel Neuropathy
A few early reports suggest that limb hypothermia might diminish neurotoxicity from weekly paclitaxel. Benefit was supported by a prospective trial in which 40 women with breast cancer receiving weekly paclitaxel wore frozen gloves and socks on their dominant side before, during, and after each infusion (90 minutes total); symptoms on the treated side were compared with the untreated (nondominant) side. Improvements were reported in both objective and subjective measures of neuropathy, and treatment was well tolerated. While frozen socks and gloves may be useful to diminish objective and subjective signs and symptoms of neuropathy in patients receiving weekly paclitaxel, the data remain limited by the small numbers of patients evaluated, and we await confirmation in additional larger studies before recommending this approach.
Multianalyte Blood Test Detects Eight Common Cancer Types
A multianalyte blood test, CancerSEEK, has been developed that can detect eight cancer types through assessment of circulating tumor-related proteins and mutations in cell free DNA. For detection of five cancer types for which no screening tests are available for high-risk patients (ovary, liver, stomach, pancreas, and esophagus), sensitivity ranged from 69 to 98 percent, and specificity was above 99 percent. However, to establish clinical utility and demonstrate that early diagnosis of cancer using this assay saves lives, prospective trials in large populations will be required.
Bowel Preparation Before Elective Colon Surgery
Whether mechanical bowel preparation (MBP) and/or oral antibiotics (OA) are necessary before elective colon surgery is controversial. In a cohort study of over 45,000 elective colectomies with anastomosis, bowel preparation with MBP plus OA was associated with fewer surgical site infections (SSIs), fewer anastomotic leaks, and lower 30-day mortality compared with MBP only, OA only, or no preparation. By multivariate analyses, MBP plus OA was associated with fewer SSIs in right, left, and segmental colectomies, and fewer anastomotic leaks in left and segmental colectomies. We suggest MBP plus OA for all patients undergoing elective colon resection.
Combination Immunotherapy Plus Targeted Therapy for Renal Cell Carcinoma
Rapid advances in checkpoint inhibitor immunotherapy for advanced renal cell carcinoma have led to the evaluation of combinations of immunotherapy with antiangiogenic therapy. In a phase III trial, the combination of atezolizumab plus bevacizumab prolonged progression-free survival compared with sunitinib. Additional results from this and other ongoing phase III trials will be required to determine whether the improved results with combination therapy are synergistic or simply additive, with similar results achievable through sequential use of these agents.
Gemcitabine Plus S-1 for Advanced Biliary Cancer
The ABC trial established the superiority of gemcitabine plus cisplatin over gemcitabine alone for advanced biliary tract cancer, but this regimen has not been compared with other combinations. S-1 is an oral fluoropyrimidine that includes three different agents: Ftorafur (tegafur), gimeracil (an inhibitor of dihydropyridine dehydrogenase), and oteracil (which diminishes diarrhea by inhibiting intestinal phosphorylation). In the randomized FUGA-BT trial, including 354 previously untreated patients with advanced biliary tract cancer, gemcitabine plus S-1 was noninferior to gemcitabine plus cisplatin in terms of median overall survival, median progression-free survival, and objective response rate, and clinically relevant adverse effects were less frequent. Where S-1 is available, gemcitabine plus S-1 is a reasonable alternative to first-line gemcitabine plus cisplatin for advanced biliary tract cancer.
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