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In this issue: Drug shortages; metformin and cancer prevention; migraine prevention guidelines; and FDA actions.
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To investigate the attitudes and practices of health care providers toward intrauterine device (IUD) use in nulliparous women, the authors performed a national survey of both office-based physicians and Title X health care providers from December 2009 to March 2010.
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For years, clinicians have been trying to find ways to predict shoulder dystocia (SD), a complication that can have serious consequences for some infants and, on occasion, for the providers who delivered these babies.
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The authors performed a randomized, single-blind trial of the effects of a paracervical block (PCB) or sham block on pain with cervical dilation and aspiration during first trimester abortion. Enrollment of subjects was stratified by gestational age (early: < 8 weeks, n = 60; late: 8-10 6/7 weeks, n = 60).
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In this Phase 2 trial, 11 patients with relapsed/refractory primary central nervous system lymphoma after high-dose, methotrexate-based regimen were treated with pemetrexed 900 mg/m2 every 3 weeks, dexamethasone 4 mg bid, folate, and B12 supplementation. The treatment had an overall response rate of 55%, disease control rate of 91%, median progression free survival of 5.7 months, and median overall survival of 10.1 months. Toxicities were more than expected with the standard pemetrexed dose (500 mg/m2) and were primarily hematologic and infectious, which were easily managed. Although single-agent activity of pemetrexed in this study is novel and promising, optimal dosing and efficacy need to be studied further.
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A multi-institutional study examined the addition of a purine analog, either cladribine or fludarabine, to the standard induction regimen ("7 & 3") in adult patients 60 years of age and younger with acute myelogenous leukemia, and found improved outcomes for those receiving cladribine. The added benefit from cladribine appears to be the result of a reduction in the incidence of resistant disease. The study arm containing cladribine, daunorubicin, and cytaribine yielded an overall survival at 3 years of 45% while conventional "7 & 3" therapy was only 33% at 3 years. Cladribine added to daunorubicin and cytarabine during remission induction improves leukemia control and patient survival for those 60 years of age and younger.
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Side effects of finasteride; new ruling on pharmaceutical companies paying generic manufacturers; and FDA actions.
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Four large data sets were analyzed to evaluate the effect of adjuvant treatment on survival in patients with stage III colon cancer diagnosed after age 75. While adjuvant chemotherapy was associated with a survival benefit, oxaliplatin-based regimens offered no more than a small incremental benefit over non-oxaliplatin-containing regimens.
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In this case-control study, dietary lignan intake was inversely associated with risk of breast cancer in both premenopausal and postmenopausal women. Also noted were more favorable prognostic characteristics associated with lignan intake, especially in premenopausal women.
