Clinical Oncology

[Management of febrile neutropenia in the oncological practice]

SINKÓ János

FEBRUARY 20, 2014

Clinical Oncology - 2014;1(01)

[Febrile neutropenia is one of the most feared complications of anti-tumor therapy. It can either herald potentially fatal infection or contribute to suboptimal dose-intensity of cancer treatment. Optimal management of affected patients is based upon a multi-disciplinary approach dependent on several factors. Knowledge on institutional epidemiology and predefi ned management strategies improve quality and outcome of anti-infective therapy. In an era of more and more resistant pathogens and erosion of the antimicrobial armamentarium clinicians taking care of cancer patients carry increased responsibility in their professional activity. Here questions of practical importance related to prevention and therapy of neutropenic infections are outlined.]

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Clinical Oncology

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[The restructuration of Hungarian oncological attendance and medicinal fi nancing resulted in the more intensive participation of clinical oncologists in the therapy of patients with ovarian cancer. The aim of the authors was not to defi ne the taxative therapeutic recommendations, but to give an overview on the development of the therapy and to introduce the deliberation aspects and therapeutic alternatives. While the primary and secondary prevention have developed in case of cervical cancer - with the possibility of eradication - the improvement of surgical techniques and clinical oncological treatments may result in the decrease of mortality in ovarian cancer. It is important to emphasis that only the appropriately aligned application of the two therapeutic modalities can lead to the desired outcome. It has become clear by the end of the ‘90s, that paclitaxel-carboplatin combination is the standard chemotherapy against ovarian cancer. Alternative cytostatic treatments like intraperitoneal treatment and triplets were not breakthroughs. The dose intensive treatment increased the survival rates besides good tolerability, however the results require further confi rmation. Neoadjuvant therapy should be considered in case of patients with advanced and metastatic disease in selected cases. Recently, therapeutic use of angiogenesis inhibition comes with signifi cant improvement. Bevacizumab is the fi rst of targeted therapies, and studies on the effectiveness of similar compounds are under way.]

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[Pancreatic cancer (PC) is a major health problem with a poor prognosis. The number of patients with PC is increasing globally. There are no screening tests for early detection of PC, but even when diagnosed early, surgery is possible in only a minority of cases. Managing PC remains a big challenge. For selected patients with borderline or unresectable disease, neoadjuvant therapy offers the potential for tumor downstaging. In patients with resectable disease, adjuvant chemotherapy improves the fi ve year survival rate, whereas the use of adjuvant radiochemotherapy is still controversial. In metastatic cancer, monotherapy with gemcitabine remained the main therapeutic option during more than 10 years. Many different combinations with other drugs and new targeted therapies have been tested with gemcitabine. Only a combination of erlotinib and gemcitabine has shown a modest survival benefi t until now. Many gene alterations that directly contribute to pancreas tumorigenesis have been identifi ed or are under active investigation. Recently, the FOLFIRINOX regimen has been reported to be more active than gemcitabine in selected metastatic patients. Quality of life is an extremly important factor, when treating a patient with PC. CA 19-9 serum level can provide important information with regards to prognosis, overall survival, and response to chemotherapy as well as predict post-operative recurrence. There is a strong need for other predictive biomarkers to select patients, who might benefi t from available and new therapeutic options.]

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