Intermittent versus continuous oxaliplatin and fluoropyrimidine combination chemotherapy for first-line treatment of advanced colorectal cancer: results of the randomised phase 3 MRC COIN trial

Background: When cure is impossible, cancer treatment should focus on both length and quality of life. Maximisation of time without toxic effects could be one effective strategy to achieve both of these goals. The COIN trial assessed preplanned treatment holidays in advanced colorectal cancer to achieve this aim. Methods: COIN was a randomised controlled trial in patients with previously untreated advanced colorectal cancer. Patients received either continuous oxaliplatin and fluoropyrimidine combination (arm A), continuous chemotherapy plus cetuximab (arm B), or intermittent (arm C) chemotherapy. In arms A and B, treatment continued until development of progressive disease, cumulative toxic effects, or the patient chose to stop. In arm C, patients who had not progressed at their 12-week scan started a chemotherapy-free interval until evidence of disease progression, when the same treatment was restarted. Randomisation was done centrally (via telephone) by the MRC Clinical Trials Unit using minimisation. Treatment allocation was not masked. The comparison of arms A and B is described in a companion paper. Here, we compare arms A and C, with the primary objective of establishing whether overall survival on intermittent therapy was non-inferior to that on continuous therapy, with a predefined non-inferiority boundary of 1·162. Intention-to-treat (ITT) and per-protocol analyses were done. This trial is registered, ISRCTN27286448. Findings: 1630 patients were randomly assigned to treatment groups (815 to continuous and 815 to intermittent therapy). Median survival in the ITT population (n=815 in both groups) was 15·8 months (IQR 9·4—26·1) in arm A and 14·4 months (8·0—24·7) in arm C (hazard ratio [HR] 1·084, 80% CI 1·008—1·165). In the per-protocol population (arm A, n=467; arm C, n=511), median survival was 19·6 months (13·0—28·1) in arm A and 18·0 months (12·1—29·3) in arm C (HR 1·087, 0·986—1·198). The upper limits of CIs for HRs in both analyses were greater than the predefined non-inferiority boundary. Preplanned subgroup analyses in the per-protocol population showed that a raised baseline platelet count, defined as 400 000 per µL or higher (271 [28%] of 978 patients), was associated with poor survival with intermittent chemotherapy: the HR for comparison of arm C and arm A in patients with a normal platelet count was 0·96 (95% CI 0·80—1·15, p=0·66), versus 1·54 (1·17—2·03, p=0·0018) in patients with a raised platelet count (p=0·0027 for interaction). In the per-protocol population, more patients on continuous than on intermittent treatment had grade 3 or worse haematological toxic effects (72 [15%] vs 60 [12%]), whereas nausea and vomiting were more common on intermittent treatment (11 [2%] vs 43 [8%]). Grade 3 or worse peripheral neuropathy (126 [27%] vs 25 [5%]) and hand—foot syndrome (21 [4%] vs 15 [3%]) were more frequent on continuous than on intermittent treatment. Interpretation: Although this trial did not show non-inferiority of intermittent compared with continuous chemotherapy for advanced colorectal cancer in terms of overall survival, chemotherapy-free intervals remain a treatment option for some patients with advanced colorectal cancer, offering reduced time on chemotherapy, reduced cumulative toxic effects, and improved quality of life. Subgroup analyses suggest that patients with normal baseline platelet counts could gain the benefits of intermittent chemotherapy without detriment in survival, whereas those with raised baseline platelet counts have impaired survival and quality of life with intermittent chemotherapy and should not receive a treatment break.

Targeted therapies in the treatment of advanced/metastatic NSCLC

The treatment of advanced non-small cell lung cancer (NSCLC) has evolved substantially during the last years. Chemotherapy remains the cornerstone of treatment and prolongs survival with a positive impact on quality of life. However, we seem to have reached a plateau of activity in the treatment of NSCLC. Recently, the addition of bevacizumab or cetuximab to chemotherapy doublets has improved the outcome in selected patients with advanced NSCLC. Furthermore, the use of erlotinib and gefitinib is an alternative for second line treatment. Advances in our understanding of molecular biology of cancer and mechanisms of tumourigenesis have further enabled the discovery of several potential molecular targets and development of novel 'targeted therapies'. The purpose of this study is to review current data on the role of targeted therapies in the treatment of advanced NSCLC. (C) 2009 Elsevier Ltd. All rights reserved.

Advanced educational parallel DSP system based on TMS320C25 processors

This paper describes the design, application, and evaluation of a user friendly, flexible, scalable and inexpensive Advanced Educational Parallel (AdEPar) digital signal processing (DSP) system based on TMS320C25 digital processors to implement DSP algorithms. This system will be used in the DSP laboratory by graduate students to work on advanced topics such as developing parallel DSP algorithms. The graduating senior students who have gained some experience in DSP can also use the system. The DSP laboratory has proved to be a useful tool in the hands of the instructor to teach the mathematically oriented topics of DSP that are often difficult for students to grasp. The DSP laboratory with assigned projects has greatly improved the ability of the students to understand such complex topics as the fast Fourier transform algorithm, linear and circular convolution, the theory and design of infinite impulse response (IIR) and finite impulse response (FIR) filters. The user friendly PC software support of the AdEPar system makes it easy to develop DSP programs for students. This paper gives the architecture of the AdEPar DSP system. The communication between processors and the PC-DSP processor communication are explained. The parallel debugger kernels and the restrictions of the system are described. The programming in the AdEPar is explained, and two benchmarks (parallel FFT and DES) are presented to show the system performance.

Recent Innovations in Antibody-Mediated, Targeted Particulate Nanotechnology and Implications for Advanced Visualisation and Drug Delivery

Research into the targeting of drug substances to a specific disease site has enjoyed sustained activity for many decades. The reason for such fervent activity is the considerable clinical advantages that can be gained when the delivery system plays a pivotal role in determining where the drug is deposited. When compared to conventional formulations where no such control exists, such as parenteral and oral systems, the sophisticated targeting device can reduce side effects and limit collateral damage to surrounding normal tissue. No more so is this important than in the area of oncology when dose-limiting side effects are often encountered as an ever present difficulty. In this review, the types of colloidal carrier commonly used in targeted drug delivery are discussed, such as gold and polymeric colloids. In particular, the process of attaching targeting capabilities is considered, with reference to antibody technologies used as the targeting motifs. Nanotechnology has brought together a means to carry both a drug and targeting ligand in self-contained constructs and their applications to both clinical therapy and diagnosis are discussed.

Novel pyridyl-stabilised rigid-rod organometallic polymers and their monomeric precursors

Reaction of trans-[Pt(NC5H4CHBu2n)(2)Cl-2] 1 with an excess of HC=CR (R = Ph, C6H4Me, C6H4NO2) affords the monomeric complex trans-[Pt(NC5H4CHBu2n)(2)(C=CR)(2)] (R = Ph 2a, C6H4Me 2b, C6H4NO2 2c), the trans arrangement of the alkynyl ligands being confirmed from spectroscopic data and by an X-ray analysis of 2c;when 1 is treated with 1 equiv, of HC=CC6H2(Me)(2)C=CH the polymer [Pt(NC5H4CHBu2n)(2)C=CC6H2Me2C=C](n) is formed, which is soluble in a range of organic solvents.

Organometallic polymers: An infinite organoplatinum chain in the solid state formed by (C CH center dot center dot center dot ClPt)hydrogen bonds

The new platinum complex [PtCl[C6H2(CH(2)NMe(2))(2) -2,6-(C=CH)-4)] exhibits a polymeric linear -C=CH ... ClPt-hydrogen-bonded structure in the solid state.