Methotrexate | Health and Prostate

Posts Tagged ‘Methotrexate’

Systemic Therapy for Bladder Cancer

Posted by admin on October 28th, 2011 No Comments

Despite radical treatments with curative intent, the chance of long-term survival for patients with muscle-invasive bladder cancer remains disappointing. In a large series of more than 1000 patients with apparently organ-confined disease, 5-year overall survival was only 47% for all muscle-invasive tumours, ranging from 72% for T2 tumours to only 33% for T4 disease. Death from bladder cancer following radical primary treatment is largely due to occult systemic disease, present at the time of surgery, which is below the limits of resolution of currently available cross-sectional imaging. This post reviews systemic therapy for muscle-invasive cancer of the urothelium and describes the common drugs that are used, the various clinical scenarios when they may be indicated and the selection of patients for treatment. Drugs in use Orthodox cytotoxic agents Transitional cell carcinoma (transitional cell carcinoma) is sensitive to a variety of drugs as shown by complete or partial response in patients with measurable metastatic or locally advanced disease. Of the older cytotoxic drugs, Read more [...]

Posted in Urological Oncology

Comparison of well-known combination regimens

Posted by admin on October 28th, 2011 No Comments

CMV and MVAC The CMV regimen is a combination of cisplatin, methotrexate and, vinblastine. In the context of a randomized controlled phase III clinical trial, treatment with CMV resulted in an objective response rate of 46%, with a median survival of 7 months. MVAC combines cisplatin with methotrexate, vinblastine and doxorubicin (Adriamycin®). In randomized controlled trials, this regimen has been found superior to single-agent cisplatin, combination chemotherapy with cisplatin, cyclophosphamide and doxorubicin (CISCA) and also methotrexate, carboplatin and vinblastine (MCAVI). For these phase III studies, overall response rates have varied between 39% and 65%, with median survivals up to 16 months. Dose escalation of MVAC has been attempted using recombinant haematopoietic growth factors. Better objective response rates have been reported with the more dose-intense regimen; this did not translate into improved time to disease progression or overall survival in a large randomized controlled trial. However, toxicity was significantly less in the accelerated arm, suggesting that the accelerated Read more [...]

Posted in Urological Oncology

Principles of therapy

Posted by admin on October 28th, 2011 No Comments

Selection of patients suitable to receive systemic chemotherapy Bladder cancer is a condition associated with smoking, the incidence of which rises with age with no demonstrable peak. The average age of unselected patients in large institutions is over 75 years. It is not surprising then that up to half of all patients with locally advanced/metastatic transitional cell carcinoma of the bladder are not fit to receive cisplatin-based chemotherapy. Commonly encountered reasons for this include poor renal function due to renovascular disease or obstructive uropathy due to bladder cancer, poor cardiac status, inadequate bone marrow reserve, poor performance status and a variety of comorbid conditions. Various strategies have been considered to account for this problem. These include modulation of cisplatin's nephrotoxicity by using nephro-protective agents such as N-acetyl cysteine and amifostine, modifying the scheduling of cisplatin or use of less cisplatin-intense regimens. Other strategies avoid the use of cisplatin completely (e.g. the use of the MV regimen rather than CMV), but these are Read more [...]

Posted in Urological Oncology

Drugs in Superficial Bladder Cancer

Posted by admin on October 28th, 2011 No Comments

Since the introduction of thiotepa as an intravesical agent by Swinney et al. in 1961, drugs have been used in patients with superficial bladder cancer to try and both reduce the recurrence rate and prevent progression of superficial disease to invasive bladder cancer. Whilst new agents have been introduced as intravesical therapies and there is a greater understanding both of the progress of superficial disease and of the action of these agents on superficial bladder cancer since that time, optimal therapy, optimal timing and an optimal agent still remain to be definitively identified. Rationale for intravesical therapy Because even patients with well-differentiated superficial bladder tumours have a high recurrence rate of the order of 70% and because with the risk of recurrence the possibility of both progression of stage and grade can occur, the elimination of superficial disease is essential. Although the rate of progression, at possibly 20% overall, is smallest in the pTa Gl lesion (at 2-3%) and greatest in the pTl G3 lesion, at possibly 40%, the treatment of muscle-invasive disease carries Read more [...]

Posted in Urological Oncology

Opportunities for Chemoprevention

Posted by admin on June 21st, 2011 No Comments

Vitamin E The term "vitamin E" is used to refer to a group of naturally occurring substances that have vitamin E activity including a-, β-, δ-, and y-tocopherols (that have saturated side chains) and tocotrienols (that have unsaturated side chains). These agents have some degree of difference in biopotency with the naturally occurring d-a-tocopherol approximately 30% more potent than the synthetic forms — d- or d, l-a-tocopherol alone, acetate, or succinate. The principal food sources of vitamin E are vegetable and seed oils as well as alfalfa and lettuce. A primary function of vitamin E is as an antioxidant, interacting with free radicals (e.g., singlet oxygen, superoxide anion, organic peroxide radicals, hydrogen peroxide, and others) that are generated as a normal part of cellular metabolism. These free radicals can interact with cellular structures, primarily membranes, and lead to cellular damage, generally through lipid peroxidation. Over time, the oxidative stress in humans increases and, similarly, with aging, the endogenous antioxidant capability (from glutathione, vitamins A, C, Read more [...]

Posted in Prostate Cancer

Chemotherapy and Immunotherapy

Posted by admin on June 21st, 2011 No Comments

Management of Hormone-Refractory Prostate Cancer: Chemotherapy and immunotherapy The effective treatment of prostate cancer patients with advanced disease is a major challenge. Metastatic disease can initially be effectively managed using the relatively nontoxic intervention of androgen ablation, that is, orchiectomy, diethylstilbestrol, and luteinizing hormone-releasing hormone analogues. As the response rate exceeds 80% and the approach affords little morbidity in comparison to the cytotoxic approaches necessary for the treatment of other epithelial malignancies, it is the therapy chosen by most patients and physicians. However, most patients eventually experience biochemical or clinical evidence of disease progression in a median time of 12 to 18 months. Second-line treatment options are then considered, and usually consist of additional hormonal manipulations. Despite this approach, progression is the norm with the development of androgen-independent or hormone-refractory prostate cancer. For patients with hormone-refractory prostate cancer, the prognosis is poor with a median survival of 9 Read more [...]

Posted in Chemotherapy and Immunotherapy

Combination Chemotherapy

Posted by admin on June 21st, 2011 No Comments

With a few notable exceptions, reported combinations of cytotoxic chemotherapeutic agents have added little benefit to single-agent chemotherapy in the treatment of hormone-refractory prostate cancer. It must be emphasized that early trials of combination chemotherapy were performed in the pre-prostate-specific antigen era with patients exhibiting very advanced and usually symptomatic hormone-refractory prostate cancer. In addition, an understanding of basic prostate cancer biology has provided insights for the rational selection of drug combinations such as Estramustine phosphate and paclitaxel targeting the cytoskeleton and nuclear matrix. Cytoxan + Methotrexate + 5-Fluorouracil The regimen of cytoxan (Cy), methotrexate, and 5-FU (CMF) is a combination active in epithelial malignancies including breast carcinoma. This regimen was evaluated in 52 eligible patients with measurable (19 patients), evaluable (29 patients), or bone scan only (4 patients) metastatic prostate cancer using a dosing schedule of 100 mg per m per day by mouth of cyclophosphamide, 15 mg per m weekly IV methotrexate, and Read more [...]

Posted in Chemotherapy and Immunotherapy

Fluorouracil

Posted by admin on August 12th, 2010 No Comments

(British Approved Name, US Adopted Name, rINN) Drug Nomenclature International Nonproprietary Names (INNs) in main languages (French, Latin, Russian, and Spanish): Synonyms: 5-FU; 5-Fluorouracil; Fluorouracil; Fluorouracilas; Fluorouracilo; Fluorouracilum; Fluorourasiili; Fluorourasil; Fluoruracil; NSC-19893; Ro-2-9757; WR-69596 BAN: Fluorouracil USAN: Fluorouracil INN: Fluorouracil [rINN (en)] INN: Fluorouracilo [rINN (es)] INN: Fluorouracil [rINN (fr)] INN: Fluorouracilum [rINN (la)] INN: Флуороурацил [rINN (ru)] Chemical name: 5-Fluoropyrimidine-2,4(1H,3H)-dione Molecular formula: C4H3FN2O2 =130.1 CAS: 51-21-8 ATC code: L01BC02 Read code: y02l6 Pharmacopoeias. In China, Europe, International, Japan, and US. European Pharmacopoeia, 6th ed., 2008 and Supplements 6.1 and 6.2 (Fluorouracil). A white or almost white, crystalline powder. Sparingly soluble in water; slightly soluble in alcohol. A 1% solution in water has apH of 4.5 to 5.0. Protect from light. The United States Pharmacopeia 31, 2008 (Fluorouracil). A white to practically white, practically odourless, Read more [...]

Posted in Drugs

Posts Tagged ‘Methotrexate’

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