No abstract

Background: Neoadjuvant chemotherapy with methotrexate-vinblastine-doxorubicin-cisplatin (MVAC) is the standard of care for muscle-invasive urothelial bladder cancer. Gemcitabine plus cisplatin (GC) shows similar efficacy with less toxicity in the metastatic setting and has therefore often been used interchangeably with MVAC. We report on the efficacy and safety of neoadjuvant GC in patients with locally advanced urothelial cancer. Materials and Methods: We prospectively evaluated 87 patients in 2 centers. Their median age was 68 years. Treatment consisted of 3× GC prior to radical cystectomy. The primary endpoint was pathologic response. The secondary endpoints were safety, progression-free survival (PFS), and overall survival (OS). Results: In all, 83 patients finished chemotherapy; 80 patients were evaluable for the primary endpoint. Pathologic complete response (pCR) was achieved in 22.5% and near pCR was seen in 33.7% of the patients. The 1-year PFS rate was 79.5% among those patients achieving ≤pT2 versus 100% among those patients achieving pCR or near pCR (p = 0.041). Five-year OS was 61.8% (95% CI 67.6 to NA). GC was well tolerated. Grade 3/4 toxicities occurred in 38% of the patients. There was no grade 3/4 renal toxicity, febrile neutropenia, or death. Conclusion: Neoadjuvant GC is a well-tolerated regimen. Although the pathologic response is lower than that reported with MVAC, our data support GC as a feasible option in the absence of a prospective randomized comparison, particularly for older patients, since its toxicity is lower than that of MVAC.

We report the case of a 55-year-old non–insulin-dependent diabetic man with well-controlled hyperlipidemia who presented himself with temporarily blurred vision in both eyes occurring during chemotherapy with adjunctive glucocorticoid treatment for colon carcinoma. Fundus examination revealed lipemia retinalis in his both eyes that resolved after 6 weeks when the chemotherapy was finished, and the patients' triglyceride and glucose levels decreased.

Vitamin D und Calcium werden für den gesunden Knochenstoffwechsel in ausreichender Konzentration benötigt. Die erhobenen Normwerte für die tägliche Aufnahme sind mit der Nahrung kaum abzudecken. Bisher ist abgesehen vom Knochenstoffwechsel eine Reihe von chronischen Erkrankungen bekannt, die wahrscheinlich mit einer Hypovitaminose D in Zusammenhang stehen. Da derzeit in den überwiegenden Studien eine Supplementation von Vitamin D und Calcium einen nachweisbaren Effekt zeigte und fixer Bestandteil des Therapieregimes ist, sollte die derzeit praktizierte Applikation als Standard gelten. Einen positiven Effekt auf Frakturdaten zeigen auch Metaanalysen, allerdings bei einer Dosierung von 700-800 IU. Da eindeutige Vitamin D-Defizite in der gesunden Bevölkerung nachweisbar sind, sollte vermehrt Vitamin D durch Sonne, Ernährung oder auch mittels Supplementation propagiert werden. Wünschenswert ist allerdings zukünftig eine Vitamin D-Anreicherung von Nahrungsmitteln wie etwa Milch. Somit kann zumindest bei Risikogruppen wie Altenheimbewohnern eine den Richtlinien entsprechende Versorgung gewährleistet werden.

Osteoporosis is defined as a continuous loss of bone mineral density accompanied by an increased fracture risk in females and males. A fall of estrogen concentrations at the menopause and the consecutive rapid bone loss are an established pathogenic mechanism in female osteoporosis. Males do not have a menopause equivalent during which significant amounts of bone are lost. Several diseases, therapeutic strategies and nutritional deficiencies may also result in bone loss and reduced bone mineral density. Prostate cancer is the most common visceral malignancy in men. Suppression of endogenous androgen production as a therapeutic tool is commonly used in patients with non-metastatic prostate cancer and is associated with significant bone loss and an increased fracture risk. Androgen deprivation therapy is prescribed both for men with locally advanced or high-risk non-metastatic prostate cancer. Osteoclast inhibition with any of several bisphosphonates improves bone mineral density and reduces fracture risk. Denosumab (a monoclonal antibody against RANK ligand) and toremifene (a selective estrogen receptor modulator) recently have been shown to be effective to reduce vertebral fractures in patients with non-metastatic prostate cancer receiving androgen-deprivation therapy. This overview focuses on cancer-treatment-induced bone loss in patients with non-metastatic prostate cancer.