First-line Therapy In Elderly Patients Research Articles

Long-term remissions with weekly chlorambucil therapy in patients with intermediate-risk chronic lymphocytic leukaemia.

Chlorambucil (Chl) has a proven and well-accepted track record in the treatment of patients with advanced or progressive chronic lymphocytic leukaemia (CLL), albeit only as palliative therapy. Chl is currently recommended as first-line therapy for elderly patients with poor performance status or patients who do not tolerate fludarabine: the preferred first-line option (Kalil & Cheson, 2000). However, there is little information in the literature on the use of Chl as maintenance therapy in patients who show a good response to initial treatment with Chl. This report describes 21 patients (13 men, 8 women; age 50–94 years, median 73 years) with intermediate-risk CLL (modified Rai Stage II or Binet Stage B) who were treated with Chl for one or more indications (Table I), according to the National Cancer Institute guidelines (Cheson et al, 1996), and were kept on long-term maintenance therapy. Initial treatment comprised Chl 0·06 mg–0·08 mg/kg daily for 2 to 4 months. Following documentation of a good clinical response (resolution of clinical symptoms/signs, normal blood counts), the frequency of therapy was reduced to 2 consecutive days each week for 4–6 months and then to once weekly. The latter was continued indefinitely or ceased if there was evidence of disease progression. Thirteen patients have remained in complete remission without lymphocytosis in the peripheral blood for 7+ to 148+ months (median 48 months); all are alive. Six patients achieved remission but had slight/stable lymphocytosis (6–12 × 109/l); four are alive at 8, 12, 13 and 67 months respectively; two patients have died as a result of unrelated causes at 18 months (road accident) and at 102 months (cardiac failure) respectively. Two patients who showed a good response initially developed progressive disease at 9 months and 3 years, respectively, and are currently on combination chemotherapy. There have been no adverse side-effects attributable to Chl therapy. Weekly maintenance therapy with Chl appears to sustain remission status in the majority of patients with initial Chl-sensitive intermediate-risk CLL; an observation which should be seen in light of the following facts: CLL is an incurable disease, predominantly afflicting the elderly (Kalil & Cheson, 2000) While fludarabine, given as initial treatment, can achieve higher responses and longer duration of remission than Chl, it has not been shown to improve the overall survival (Rai et al, 2000) Weekly maintenance therapy with Chl is simple and inexpensive

Weekly docetaxel as first-line therapy for elderly patients with advanced non-small cell lung cancer (NSCLC)

Weekly docetaxel as first-line therapy for elderly patients with advanced non-small cell lung cancer (NSCLC)

Review: Diuretics are more efficacious than β-blockers as first-line therapy for elderly patients with hypertension

TherapeuticsNovember 1, 1998Review: Diuretics are more efficacious than β-blockers as first-line therapy for elderly patients with hypertensionS. George Carruthers, MDS. George Carruthers, MDUniversity of Western Ontario, London, Ontario, Canada (S.G.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-1998-129-3-060 SectionsAboutFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationMesserli FH, Grossman E, Goldbourt U. Are β-blockers efficacious as first-line therapy for hypertension in the elderly? A systematic review. JAMA. 1998 Jun 17;279:1903-7.References1 Neaton JD, Grimm RH Jr, Prineas RJ,et al. Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group. JAMA. 1993;270:713-24. Google Scholar2 The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med. 1997;157:2413-46. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Western Ontario, London, Ontario, Canada (S.G.C.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails November 1, 1998Volume 129, Issue 3Page: 60KeywordsAgingBlood pressureCardiovascular diseasesCoronary heart diseaseDiureticsDrugsElderlyGeriatricsGoutHypertensionInformation storage and retrievalMorbidityMyocardial infarctionPrimary hypertensionQuality of lifeSecondary hypertensionSexual dysfunctionStrokeSurvival analysisSystematic reviews ePublished: 9 March 2020 Issue Published: November 1, 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.Loading ...

Noninvasive positive pressure ventilation.

Preview In most cases of acute respiratory failure, mechanical ventilation and endotracheal intubation are the preferred treatment. However, a noninvasive approach is proving valuable in selected patients and has some advantages over standard mechanical ventilation. How are patients selected for this therapy? What are its risks and benefits? The authors discuss the usefulness and potential role of this important new technique.

Mitozantrone and cytosine arabinoside as first‐line therapy in elderly patients with acute myeloid leukaemia

We have prospectively evaluated a regimen of mitozantrone and cytosine arabinoside (Ara-C) as first-line therapy in elderly patients with acute myeloid leukaemia (AML). One hundred and four patients with a median age of 68 (range 60-81) were studied, in whom 86 had de-novo AML, and 18 had preceding myelodysplasia or secondary AML. Complete remission was achieved in 64% of de-novo cases, in 28% of MDS/secondary cases, and in 58% overall. The incidence of early death within 28 d of chemotherapy was 11%. The median disease-free survival (DFS) was 11 months with an actuarial DFS of 15% at 43 months. The median overall survival was 9 months with an actuarial survival of 10% at 44 months. The incidence of non-haematological toxicity was acceptably low, and usually of mild to moderate severity. Quality of life was improved, or unchanged, in 90% of responders. We conclude that mitozantrone and ara-C is an effective and well-tolerated regimen which produces high remission rates in elderly patients with AML.