Potentially Overestimated Efficacy of Nanoparticle Albumin-bound Paclitaxel compared with Solvent-based Paclitaxel in Breast Cancer: A Systemic Review and Meta-analysis
Journal of Cancer. 2021;12(17):5164-5172
Background: Nanoparticle albumin-bound paclitaxel (nab-PTX) has exhibited clinical efficacy in breast cancer treatment, but toxicities can be yielded more at the same time. We did this meta-analysis aiming to unambiguously compare nab-PTX with conventional solvent-based paclitaxel (sb-PTX) in breast cancer patients of all stages. Method: Pubmed, Embase and Cochrane Library were searched for head-to-head randomized controlled trials of nab-PTX and sb-PTX in breast cancer. Risk ratio (RR) with 95% confidence interval was used for dichotomous variables while Hazard ratio (HR) was used for time-to-event outcomes. Results: Our review finally included 9 studies with 3508 patients. Nab-PTX showed a benefit on objective response rate (ORR) (RR=1.22 [1.04-1.43], P=0.01) as well as non-inferiority compared with sb-PTX in disease control rate (DCR) (RR=1.01 [0.98-1.04], P=0.44), overall survival (OS) (HR=0.99 [0.93-1.05], P=0.81) and disease free survival/progression free survival (DFS/PFS) (HR=0.92 [0.81-1.05], P=0.21). However, when it comes to toxicities (fatigue, nausea or vomiting, peripheral sensory neuropathy and adverse event related discontinuation), results favored sb-PTX (RR=2.89 [1.07-7.8], 3.15 [1.78-5.59], 2.11 [1.32-3.37], 2.02 [1.61-2.53]; P<0.05). Patients with metastatic tumors or undergoing conventional schedule responses better to nab-PTX than the compared groups (RR of ORR in metastatic vs early or locally advanced patients: 1.46 [1.09-1.96] vs 1.01 [0.94-1.08]; conventional vs dose dense group: 1.59 [1.23-2.06] vs 1.01 [0.91-1.12]). Conclusions: Nab-PTX can improve ORR compared with paclitaxel and should be given priority to when aiming to reduce tumor load in breast cancer. Sb-PTX of dose dense schedule is recommended when toxicity of nab-PTX is hard to bear for breast cancer patients.
Comparison of different modes of using tranexamic acid administration on reducing hidden blood loss in total hip arthroplasty . Chinese
Zhongguo Gushang. 29(8):713-717, 2016 Aug 25.. 2016;29((8):):713-717
OBJECTIVE To compare the clinical efficacy of using tranexamic acid in different ways to reduce the hidden blood loss in patients who receiving total hip arthroplasty (THA). METHODS Totally 68 patients with osteonecrosis of the femeral head treated by total hip arthroplasty in our hospital from February 2010 to July 2015 were randomly divided into the intravenous drip group (group A) and the topical application group (group B). In group A, there were 19 males and 15 females, with an average age of (62.0+/-6.4) years old, preoperative average hemoglobin was (121.30+/-8.15) g/L, average Hematocrit was (0.470+/-0.039) L/L. In group B, there were 18 males and 16 females, with an average age of (64.0+/-7.5) years old, preoperative average hemoglobin was (125.28+/-9.37) g/L, average Hematocrit was (0.490+/-0.041) L/L. The operation incision were performed through the posterolateral approach and the normal operation mode, biological prosthesis was selected. Through different ways the tranexamic acid was used to control of intraoperative and postoperative bleeding. Tranexamic acid was intra articular injection as a dose of 10 mg/kg 10 min to patient before anesthesia in intravenous drip group. In topic group, 3 g of tranexamic acid was dissolved in 120 ml saline and divided into three equal parts, then two pieces of gauze were immersed in 40 ml tranexamic acid solution. One gauze with 40 ml tranexamic acid was used to soak the acetabulum for 5 minutes after the acetabular preparation, another gauze was inserted in the femoral canal for 5 minutes after femoral canal broach preparation. The remaining 40 ml tranexamic acid fluid was injected into the hip joint after fascia closure. Place the drainage tube and clip it for 3 hours. Hemoglobin (Hb) and Hematocrit (Hct) were recorded at 72 hours after operation. The total blood loss, dominant blood loss, and hidden blood loss were calculated. RESULTS In group A, postoperative hemoglobin difference before and after operation was (32.34+/-7.42) g/L, total blood loss was (833.6+/-81.4) ml, the hidden blood loss was (276.3+/-57.9) ml, red blood cell volume was (10.1+/-1.4) L/L;In group B, hemoglobin difference before and after operation was (28.2+/-6.1) g/L, total blood loss was (792.5+/-61.8) ml, the hidden blood loss was (297.5+/-50.3) ml, red blood cell volume was (9.2+/-1.2) L/L. There was no statistical significance about those aspect (P>0.05). Compared of blood coagulation function between two groups, in group A: PT (12.78+/-2.03) s, APTT (34.27+/-3.91) s, INR (32.34+/-7.42); and in group B: PT (13.17+/-2.19) s, APTT (32.36+/-3.18) s, INR (28.24+/-6.14). There was no significant differences also (P>0.05). CONCLUSIONS Compared with intravenous application, topical application of tranexamic acid could also effectively reduce total blood loss and hidden blood loss, postoperative blood transfusion rate in primary total hip arthroplasty, while does not increase the risk of DVT.
Efficacy of immunosuppressive therapy in children with acquired aplastic anemia
Chinese Journal of Pediatrics. 2009;47((1):):53-6.
OBJECTIVE This study was designed to evaluate the efficacy of immunosuppressive therapy (IST) regimens as treatment of children with acquired severe aplastic anemia (SAA). METHODS Data of consecutive 112 children with SAA who had no HLA-matched sibling seen from January 2000 to June 2006 were retrospectively analyzed. The patients were randomized to receive one of the following IST regimens: cyclosporine A (CSA) alone (IST regimen I); CSA and intravenous immunoglobulin (IVIG) [400 mg/(kg x d) x 5 d] (IST regimen II); rabbit anti-T-lymphocyte globulin (R-ATG) [3-5 mg/(kg x d) x 5 d] and CSA (IST regimen III). No repeated courses of R-ATG were given for nonresponders. All the patients also received stanozolol or testosterone propionate. The dose of CSA was adjusted to maintain trough drug levels above 100 microg/L and peak drug levels above 300 microg/L. RESULTS The overall rate of response to IST regimen I was 26. 92% and to IST regimen II was 33. 33%. The response to IST regimen III (62. 5%) was significantly higher (P = 0. 001). The response to IST regimen I and IST regimen II had no significant difference. The 5-year overall survival for IST regimens I, II, and III was 20. 50% +/- 15. 41%, 39. 77% +/- 9. 77%, and 66. 27% +/- 6. 84%, respectively. CONCLUSION If patients had no HLA-matched sibling, the combination of R-ATG and CSA remains the best combination for the treatment of children with SAA, providing a survival advantage at 5 years.