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The favourable tolerability and evidence of antitumor activity of GEM in patients with bladder cancer and prior M-VAC at doses > or = 875 mg/m2/wk are encouraging and deserve confirmation in larger phase II studies.

Data obtained from 209 patients who entered different prospective randomized antiemetic trials were analyzed to establish the prognostic value of some variables on the control of cisplatin-induced emesis. The antiemetic regimens evaluated included the following: metoclopramide (M) at 1,2, and 4 mg/kg total dose and a combination of M (4 mg/kg) with dexamethasone (D) (40 mg). Vomiting lasting more than 1 hour (no protection [NP]) was the endpoint selected for the analysis. A logistic model carried out, first on the 110 subjects receiving the M + D regimen and then on the whole sample, selected sex (P = O.OOOl), Eastern Cooperative Oncology Group performance status (PS) (P = 0.006), and age (P = 0.01) among the six factors considered. Since the prognostic value of these variables is mostly related to their interaction, three major risk classes were identified. The corresponding NP rates were 26.3%, 42.4%, and 70.8% for the low-risk, intermediate-risk, and high-risk groups, respectively (P = 0.000002). Except for the lowest M level, the observed N P rates were significantly associated to the risk classes, whereas the antiemetic regimen influenced the antiemetic outcome only in the low-risk class. Regardless of the regimen employed, certain patient characteristics, such as sex, PS, and age, significantly affect cisplatin-related emesis and should be carefully considered in planning further studies.

Metastatic involvement of the extrahepatic digestive system is rare. We here report the case of a 62-year-old woman who presented with a bowel obstruction related to a metastasis of breast cancer occurring 12 years after a mastectomy for lobular carcinoma. No other distant metastases were detected except for two nodules of 20 and 5 mm on the right chest wall. Biopsy of the larger nodule showed a lobular carcinoma. The patient underwent a right hemicolectomy and then received chemotherapy combined with letrozole, resulting in a partial response. The literature revealed only a few cases of breast cancer metastatic to the colon. Patients with known breast cancer, particularly of the lobular histological type, who present with specific or less specific abdominal symptoms or signs such a microcytic anemia, should be endoscopically explored in order to detect possible metastases of the primary breast tumor.