Clinical response versus clinical benefit in oncology: not necessarily equivalent terms.
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Biomedical subjects
Publications and source records attributed to M Markman.
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Twenty-nine patients with gynecologic malignancies were treated with a fixed low dose of intravenous ondansetron (8 mg) plus dexamethasone (20 mg) in an effort to develop an effective and less expensive antiemetic regimen for the control of carboplatin-induced emesis. Twenty-six (90%) of the women participating in this trial experienced complete control of both acute nausea and vomiting (developing within the first 24 h after chemotherapy administration), while 27 (93%) patients exhibited either complete or major control (< or = 2 episodes of vomiting, < or = 5 episodes of retching, minimal interference with eating) of emesis. On the basis of our experience in this trial, we conclude that the combination of low dose (8 mg) intravenous ondansetron plus dexamethasone is a well-tolerated and highly cost-effective antiemetic strategy for individuals receiving carboplatin-based chemotherapy.
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Although screening of natural products remains the major method of discovering new anticancer drugs, newer techniques of rational drug design, computer-aided drug design, and combinatorial synthesis promise to broaden the scope of compounds available for screening. Recent changes in Food and Drug Administration rules allow for accelerated approval of drugs for treating cancer and other life-threatening illnesses, although the three-phase process of clinical trials remains largely unchanged.
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Over more than a decade of clinical use, CA-125 has proven itself to be one of the most useful tumor markers in cancer medicine. The major clinical utility of this serum marker is in following the clinical course of women with known ovarian cancer. Other potential uses of CA-125 include the evaluation of the effectiveness of new antineoplastic agents in this malignancy, and in the modification of treatment strategies in individuals whose CA-125 levels fail to decline at an acceptable rate following the institution of therapy. At the present time, the use of CA-125 as a method to screen for ovarian cancer should be considered investigational.
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A randomized trial conducted by the Gynecologic Oncology Group in women with suboptimal residual advanced ovarian cancer has shown that the combination chemotherapy regimen of cisplatin plus paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) results in a higher objective response rate, as well as improved progression-free and overall survival, compared with treatment with cisplatin and cyclophosphamide. Future clinical research efforts in this area will likely focus on attempting to optimize the delivery of a platinum agent and paclitaxel, as well as on adding agents with demonstrated activity in this malignancy to the regimen.