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Background Artesunate is an antimalarial agent with broad anti-cancer activity in in vitro and animal experiments and case reports. Artesunate has not been studied in rigorous clinical trials for anticancer effects. Aim To determine the anticancer effect and tolerability of oral artesunate in colorectal cancer (CRC). Methods This was a single centre, randomised, double-blind, placebo-controlled trial. Patients planned for curative resection of biopsy confirmed single primary site CRC were randomised (n = 23) by computer-generated code supplied in opaque envelopes to receive preoperatively either 14 daily doses of oral artesunate (200 mg; n = 12) or placebo (n = 11). The primary outcome measure was the proportion of tumour cells undergoing apoptosis (significant if > 7% showed Tunel staining). Secondary immunohistochemical outcomes assessed these tumour markers: VEGF, EGFR, c-MYC, CD31, Ki67 and p53, and clinical responses. Findings 20 patients (artesunate = 9, placebo = 11) completed the trial per protocol. Randomization groups were comparable clinically and for tumour characteristics. Apoptosis in > 7% of cells was seen in 67% and 55% of patients in artesunate and placebo groups, respectively. Using Bayesian analysis, the probabilities of an artesunate treatment effect reducing Ki67 and increasing CD31 expression were 0.89 and 0.79, respectively. During a median follow up of 42 months 1 patient in the artesunate and 6 patients in the placebo group developed recurrent CRC. Interpretation Artesunate has anti-proliferative properties in CRC and is generally well tolerated., Highlights • Artesunate is a cheap and orally available, widely used antimalarial drug that has anticancer properties in in vitro models • Tested the effects of artesunate on colorectal cancer in patients before they have had surgery to remove the tumour • Results from this pilot study are promising and support further studies to explore anticancer effects of artemisinins

In 2005, 224 patients received adjuvant/neoadjuvant chemotherapy for breast cancer in a single institution according to daily practices. Regimens consisted of epirubicin-based chemotherapy (FEC100, four or six cycles), or three cycles of FEC100 followed by three cycles of docetaxel. An absolute blood count was carried out every 3 weeks, 1-3 days before planned chemotherapy cycle. Overall, 1238 cycles were delivered. An absolute neutrophil count (ANC)1.5 x 10(9) l(-1) before planned chemotherapy was found in 171 cycles. Of these, 130 cycles (76%) were delivered as planned regardless of whether ANC levels recovered, and 41 (24%) were delayed. None of these patients developed a febrile neutropaenia. Haematopoietic support (granulocyte colony-stimulating factor (G-CSF)) was required in 12 cycles. We found that the majority of patients with an ANC1.5 x 10(9) l(-1) before planned chemotherapy received planned doses, without complications and need for G-CSF.

Clozapine is associated with haematological side effects, including neutropaenia, which can signal impending life-threatening agranulocytosis. Patients with COVID-19 infection frequently experience lymphopaenia, but not neutropaenia. We present 13 patients established on clozapine who developed COVID-19 infection. There were no significant differences in total white cell or neutrophil counts between pre-COVID-19, intra-COVID-19 or post-COVID-19 periods. We therefore suggest that patients who develop COVID-19 should generally have their clozapine treatment continued. Patients taking clozapine who develop neutroapaenia during COVID-19 infection should be investigated and monitored as in normal practice, because changes in neutrophil counts cannot be assumed to be due to the viral infection.