Capecitabine and bevacizumab as first-line treatment in elderly patients with metastatic colorectal cancer

BACKGROUND: The efficacy and safety of capecitabine and bevacizumab in elderly patients with metastatic colorectal cancer (mCRC) considered unsuitable for receiving first-line chemotherapy with an irinotecan or oxaliplatin-based combination were assessed in a phase II, open, multicentre, uncontrolled study. METHODS: Treatment consisted of capecitabine 1250 mgm 2 (or 950 mgm 2 for patients with a creatinine clearance of 30–50ml min 1) twice daily on days 1–14 and bevacizumab (7.5 mg kg 1) on day 1 every 3 weeks. RESULTS: A total of 59 patients aged X70 years with mCRC were enrolled. In an intention-to-treat analysis, the overall response rate was 34%, with 71% of patients achieving disease control. Median progression-free survival and overall survival were 10.8 months and 18 months, respectively. In all, 32 patients (54%) had grade 3/4 adverse events (AEs), the most common being hand–foot syndrome (19%), diarrhoea (9%) and deep venous thrombosis (7%). Four patients died because of treatment-related AEs. A relationship was detected between creatinine clearance p50 ml min 1 and the development of non-bevacizumab-related grade 3/4 AEs. The incidence of bevacizumab-associated AEs (hypertension, thromboembolic events and proteinuria) was consistent with that of previous reports in elderly patients. CONCLUSION: Bevacizumab combined with capecitabine represents a valid therapeutic alternative in elderly patients considered to be unsuitable for receiving polychemotherapy.This study was supported by Hoffmann-La Roche, Nutley, NJ, USA

Response of the primary tumor in symptomatic and asymptomatic stage IV colorectal cancer to combined interventional endoscopy and palliative chemotherapy

Background: The treatment of the primary tumor in advanced metastatic colorectal cancer (CRC) is still a matter of discussion. Little attention has thus far been paid to the endoscopically observable changes of the primary in non-curatively resectable stage IV disease. Methods: 20 patients [14 men, 6 women, median age 67 (39-82) years] were observed after initial diagnosis of non-curatively resectable metastasized symptomatic (83%) or asymptomatic (17%) CRC, from June 2002 to April 2009. If necessary, endoscopic tumor debulking was performed. 5-FU based chemotherapy was given immediately thereafter. In 10 patients, chemotherapy was combined with antibody therapy. Results: Response of the primary was observed in all patients. Local symptoms were treated endoscopically whenever necessary (obstruction or bleeding), and further improved after chemotherapy was started: Four patients showed initial complete endoscopic disappearance of the primary. In an additional 6 patients, only adenomatous tissue was histologically detected. In both these groups, two patients revealed local tumor relapse after interruption of therapy. Local tumor regression or stable disease was achieved in the remaining 10 patients. 15 patients died during the observation time. In 13 cases, death was related to metastatic disease progression. The mean overall survival time was 19.6 (3-71) months. No complications due to the primary were observed. Conclusion: This study shows that modern anti-cancer drugs combined with endoscopic therapy are an effective and safe treatment of the symptomatic primary and ameliorate local complaints without the need for surgical intervention in advanced UICC stage IV CRC

Analyzing the cause of human electrical accidents using Swiss Cheese model

Purpose – This study aims to explore the factors influencing electrical accidents. Here, the authors aim to understand and model the causes of electrical accidents at multiple levels. Design/methodology/approach – In the study, the authors have tried to put causes of accidents in the electricity distribution segment, in the framework of the Swiss Cheese model. Delphi kind of expert survey was conducted to find the Cheese Slice (level) and the causes (holes) for electrical accidents. Inputs from a hundred experts having more than five years of experience in electrical utility companies have been used to find Cheese Slice and holes, to explain the occurrence of an electrical accident. Findings – Effective training for safe work practices, safe knowledge and closer supervision would go a long way to plug the holes in the Cheese Slice in human factors. The difference in perception of managers, supervisors and workers on the importance of various causes of electrical accidents are also presented and discussed. Research limitations/implications – This research is based on expert opinion and survey where respondent perception is reported. Actual accident data has not been used here. Practical implications – The holes or causes of accidents at different levels (Cheese Slice) have been identified for plugging or removal for better safety. Social implications – Electrical energy is widely used, and therefore, electrical safety is a social concern and also improving it is a social need. Originality/value – The study contributes to electrical safety issues in the electrical utility sector

Analyzing the cause of human electrical accidents using Swiss Cheese model

Purpose This study aims to explore the factors influencing electrical accidents. Here, the authors aim to understand and model the causes of electrical accidents at multiple levels. Design/methodology/approach In the study, the authors have tried to put causes of accidents in the electricity distribution segment, in the framework of the Swiss Cheese model. Delphi kind of expert survey was conducted to find the Cheese Slice (level) and the causes (holes) for electrical accidents. Inputs from a hundred experts having more than five years of experience in electrical utility companies have been used to find Cheese Slice and holes, to explain the occurrence of an electrical accident. Findings Effective training for safe work practices, safe knowledge and closer supervision would go a long way to plug the holes in the Cheese Slice in human factors. The difference in perception of managers, supervisors and workers on the importance of various causes of electrical accidents are also presented and discussed. Research limitations/implications This research is based on expert opinion and survey where respondent perception is reported. Actual accident data has not been used here. Practical implications The holes or causes of accidents at different levels (Cheese Slice) have been identified for plugging or removal for better safety. Social implications Electrical energy is widely used, and therefore, electrical safety is a social concern and also improving it is a social need. Originality/value The study contributes to electrical safety issues in the electrical utility sector. </jats:sec