The studied treatment for the neoadjuvant setting of HER2 positive breast cancer seems to be an effective therapeutic option. Despite the expected high rate of cardiotoxicity of this regimen, the study results shows that this treatment regimen appears to be safe. The combination of trastuzumab, non-pegylated liposomal-encapsulated doxorubicin and paclitaxel should be considered for the treatment of HER2-overexpressing breast cancer.

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Background Subcutaneous (SC) versus intravenous (IV) administration is advantageous in terms of patient convenience and hospital efficiency. This study aimed to compare the effect of optimizing the processes involved in SC versus IV administration of rituximab and trastuzumab on hospital capacity and service quality. Methods This cross-sectional resource utilization study interviewed oncologists, hematologists, nurses, and pharmacists from 10 hospitals in Spain to estimate changes in processes associated with conversion from IV to SC rituximab and trastuzumab, based on clinical experience and healthcare use from administrative databases. Results Efficient use of SC formulations increased the monthly capacity for parenteral administration by 3.35% (potentially increasable by 5.75% with maximum possible conversion according to the product label). The weekly capacity for hospital pharmacy treatment preparation increased by 7.13% due to conversion to SC formulation and by 9.33% due to transferring SC preparation to the cancer treatment unit (potentially increasable by 12.16 and 14.10%, respectively). Monthly hospital time decreased by 33% with trastuzumab and 47% with rituximab. In a hypothetical hospital, in which all processes for efficient use of SC rituximab and/or trastuzumab were implemented and all eligible patients received SC formulations, the estimated monthly capacity for preparation and administration increased by 23.1% and estimated hospital times were reduced by 60–66%. Conclusions Conversion of trastuzumab and rituximab to SC administration could improve the efficiency of hospitals and optimize internal resource management processes, potentially increasing care capacity and improving the quality of care by reducing time spent by patients at hospitals.

Background Bendamustine is an alkylating agent recently approved in several European countries for non-Hodgkin's lymphoma (NHL) refractory to rituximab (R). Purpose To describe bendamustine use in lymphomas and review safety in our clinical practice. Materials and methods Retrospective study carried out during 2010. The following data were collected: sex, age, previous treatment, bendamustine dosage, treatment duration, % adverse reactions (ARs), % colony-stimulating factor required and reduction of the initial dose of bendamustine. Results 7 patients received bendamustine: 71.4% male, age 53.9 at the beginning of bendamustine treatment. 42.8% Hodgkin's lymphoma (HL) and 57.2% NHL, 50.0% were mucosa-associated lymphoma tissue (MALT) and 50.0% follicular NHL. An average of 3 treatment lines were used before bendamustine was used. In NHL patients (n=4), first-line treatment was CHOP±R; several schemes were used in the second line (BEACOPP-14, DHAP). Bendamustine was used as third line: 50% combined with rituximab and 50.0% in monotherapy. There were no standard dose criteria for bendamustine: 90 mg/m2 (2 patients), 100 mg/m2 and 120 mg/m2 one each. In HL patients (n=3), 2 patients received ABVD followed by bone marrow transplant and 1 patient BEACOPP-14 at first. In second and third-line treatment different schemes were administered (BEACOPP-14, GEMOX, DHAP and CNOP). As the fourth line bendamustine was requested as off-label at 110-120 mg/m2. In this study, bendamustine treatment was continued for 22.85 weeks (95% CI 19.11 to 26.60). The most common AR was haematological toxicity (85.7%); grade 3-4 neutropenia appeared in 9.5% and anaemia in 4.8% of patients. Use of colony-stimulating factor and epoetin alfa were essential in 71.4% patients; it was not necessary to reduce the dose of bendamustine. Other ARs were fatigue 14.3%, fever, nausea or vomiting 9.5%. Conclusions Experience with bendamustine in Hodgkin's and Non-Hodgkin's lymphoma in our institution is limited. Haematological toxicity is common and can be managed with colony-stimulating factor.

Background Intoxication by drugs requires often quick attention in the emergency department (ED), so an antidote kit to combat drug intoxication would be helpful. Purpose To analyse intoxication by drugs treated in the emergency department as a preliminary step to making up an antidote kit. Materials and methods All patients treated in ED for drug intoxication in a Spanish hospital were included, from January to June 2010. Data collected were: sex, age, cause, measures, days of stay in ED, admission, ward, duration of admission, complications. Results Data from 137 patients were analysed, 79 females (57.7%), median (minimum-maximum) age was 37 (92–0) years. 77 patients (56.2%) were intoxicated by drugs affecting the central nervous system, 19 (13.9%) by analgesic/anti-inflammatory drugs, 11 (8.0%) by cardiovascular system drugs, 5 (3.6%) by systemic endocrine drugs and the drug(s) involved were unknown in 21 (15.3%) of cases. In 20.4% the intoxication was due to several drugs. 65.0% needed drug-specific treatment. Gastric lavage was necessary in 29.9%. In addition, activated charcoal was administered in 32.1%, flumazenil in 25.5%, naloxone in 4.4% and N-acetylcysteine in 4.4%. Other drugs used were norepinephrine, digoxin-specific antibody (Fab) fragments, a potassium chelator, antiemetics, blood coagulation factors and anticholinergics. The median stay in ED was 1 (0–2) day. 27 patients (19.7%) were admitted and 2 (1.5%) requested voluntary discharge. Of the inpatients, 26.9% were to the psychiatry ward, 19.2% to the critical care unit, cardiology and internal medicine wards, and 15.4% to the paediatric ward. The stay in hospital was 6 (17–0) days. Seven patients had complications related to intoxication (three acute kidney injury, two rhabdomyolysis, two aspiration pneumonia) but none of them died. Conclusions The analysis of intoxications treated in ED will guide the contents of the antidote kit. It is important to increase the control of drugs that affect the central nervous system.