Search

Supervised exercise dietary programs are recommended to relieve cancer-related fatigue and weight increase induced by adjuvant treatment of early breast cancer (EBC). As this recommendation lacks a high level of evidence, we designed a multicenter randomized trial to evaluate the impact of an Adapted Physical Activity Diet (APAD) education program on fatigue. We randomized 360 women with EBC who were receiving adjuvant chemotherapy and radiotherapy to APAD or usual care at eight French cancer institutions. Data were collected at baseline, end of chemotherapy, end of radiotherapy, and 6 months post-treatment. The primary endpoint was the general cancer-related fatigue score using the MFI-20 questionnaire. Fatigue correlated with the level of precariousness, but we found no significant difference between the two groups in terms of general fatigue (p = 0.274). The APAD arm has a smaller proportion of patients with confirmed depression at the end of follow-up (p = 0.052). A transient modification in physical activity levels and dietary intake was reported in the experimental arm. However, a mixed hospital- and home-based APAD education program is not enough to improve fatigue caused by adjuvant treatment of EBC. Cancer care centers should consider integrating more proactive diet–exercise supportive care in this population, focusing on precarious patients.

Supervised exercise dietary programs are recommended to relieve cancer-related fatigue and weight increase induced by adjuvant treatment of early breast cancer (EBC). As this recommendation lacks a high level of evidence, we designed a multicenter randomized trial to evaluate the impact of an Adapted Physical Activity Diet (APAD) education program on fatigue. We randomized 360 women with EBC who were receiving adjuvant chemotherapy and radiotherapy to APAD or usual care at eight French cancer institutions. Data were collected at baseline, end of chemotherapy, end of radiotherapy, and 6 months post-treatment. The primary endpoint was the general cancer-related fatigue score using the MFI-20 questionnaire. Fatigue correlated with the level of precariousness, but we found no significant difference between the two groups in terms of general fatigue ( p = 0.274). The APAD arm has a smaller proportion of patients with confirmed depression at the end of follow-up ( p = 0.052). A transient modification in physical activity levels and dietary intake was reported in the experimental arm. However, a mixed hospital- and home-based APAD education program is not enough to improve fatigue caused by adjuvant treatment of EBC. Cancer care centers should consider integrating more proactive diet-exercise supportive care in this population, focusing on precarious patients.

The goals of treatment for metastatic breast cancer (MBC) are to prolong overall survival (OS) while maximizing quality of life, palliating symptoms, and delaying tumor progression. For many years, anthracyclines and taxanes have been the mainstay of treatment for MBC, but these agents are now commonly administered earlier in the course of the disease. A recent meta-analysis revealed adverse effects on OS and overall response rates in patients with MBC receiving first-line anthracycline-based chemotherapy following relapse on adjuvant chemotherapy. Noncrossresistant cytotoxic agents and combinations that combine high clinical activity and acceptable tolerability while being convenient for patients are therefore needed for the first-line treatment of MBC patients. Capecitabine has substantial antitumor activity in the first-line treatment of patients with MBC in prospective, randomized, phase II/III clinical trials as monotherapy and in combination with biologic and novel agents. First-line capecitabine monotherapy has a favorable safety profile, lacking myelosuppression and alopecia, and does not compromise the administration of further lines of chemotherapy. Capecitabine is suitable for long-term administration without the cumulative toxicity that can limit the prolonged use of other chemotherapy agents. Here, we review the available data on capecitabine as a single agent for first-line treatment of patients with human epidermal growth factor receptor 2-negative MBC.

A 55-year-old man was treated during 22 months with chlorambucil (total dose : 4 218 g) for glomerulonephritis. Towards the end of the treatment, he developed acute myelomonocytic leukaemia and died of this complication. The authors underline the oncogenetic dangers of the association dysimmune disease/immunosuppressive treatment and draw attention to the almost regular preleukaemic phase with its well-known cytological, biochemical, immunological, cytogenetic and evolutive criteria.

The occurrence of a large cell lymphoma in the course of chronic lymphocytic leukemia is rare and its evolution is fatal at short term. This is the definition of Richter's syndrome. The authors report three cases documented by cytology, histology. The immunological study was performed for one of these by typing on a suspension of fresh bone marrow and lymph node cells. It showed the immunological identity of the chronic phase and the transformation phase (Richter's syndrome). These findings are in line with recent studies showing the immunocellular filiation of the two hemopathies despite the morphological differences, the transformation phase showing the differentiation of the B clone of the chronic phase.

Idiopathic thrombocytopenic purpura occurring in pregnancy has a risk for the fetus of severe thrombocytopenia. The handling of these cases obstetrically is controversial. Our experience and that derived from reading the literature suggests that counting the number of maternal platelets does not reflect on the risk for the fetus and the neonate. On the other hand it does seem that estimating the levels of circulating platelet antibodies in the maternal plasma does give an indication of platelet destruction in the fetus. Corticosteroid treatment improves greatly the number of maternal platelets and is probably good treatment for the fetus in utero. Giving gamma-globulins intravenously to the pregnant woman or to the newborn is an interesting therapeutic measure seeing how it is free of danger. How useful this treatment is in pregnancy has yet to be determined.

In the first 3 cases, the initial disorder was a renal problem (glomerulonephritis, renal homograft). The development of secondary neoplasms appeared to be related to long term immunosuppressive therapy. By contrast, in the fourth case the primary disease was already malignant in nature (breast neoplasm) and treatment was mixed (radiotherapy and chemotherapy). In the light of these cases, the risks of treatment using immunosuppressive chemotherapy should not be neglected.