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Oxaliplatin Neurotoxicity Not Prevented by Venlafaxine
Previous pilot data suggested that venlafaxine might prevent acute and chronic oxaliplatin-related neuropathy. However, benefit could not be confirmed in a small randomized trial involving 50 patients who were assigned to receive venlafaxine or placebo while being treated with oxaliplatin-based chemotherapy for colon cancer. Although there was a trend toward benefit for venlafaxine when evaluated by the oxaliplatin-specific neuropathy scale, and by some acute neuropathy measures (e.g., discomfort swallowing cold liquids) for the first two oxaliplatin doses, these were outweighed by the lack of any benefit in all other assessments, including the CIPN20 sensory subscale, physician-completed NCI-CTCAE scores, or in the cumulative administered dose of oxaliplatin, which was identical in both arms.
Androgen Deprivation Therapy and Venous Thromboembolic Disease
Multiple malignancies, including prostate cancer, are associated with an increased risk of venous thromboembolic disease (deep venous thrombosis or pulmonary embolus). In an observational study from the United Kingdom, the risk of venous thromboembolic disease in men with prostate cancer was significantly increased in men who were receiving androgen deprivation therapy (ADT), compared with those who were not taking ADT; the increased risk was limited to the period during ADT treatment. Confounding variables, related to differences in cancer status rather than use of ADT, may influence this finding. When ADT is used for appropriate indications, the potential benefits of ADT for men with prostate cancer appear to outweigh the possible risks.
Adjuvant Chemotherapy for High-Risk Urothelial Bladder Cancer
Neoadjuvant chemotherapy prior to radical cystectomy improves overall survival in patients with high-risk bladder cancer. However, multiple randomized trials of adjuvant chemotherapy following radical cystectomy either failed to complete planned accrual or were underpowered to demonstrate a statistically significant improvement in survival. An observational study from the National Cancer Data Base provides support for adjuvant chemotherapy; for patients who did not receive neoadjuvant chemotherapy prior to cystectomy, adjuvant chemotherapy was associated with improved overall survival compared with observation post cystectomy. Thus, adjuvant chemotherapy is an option for those with high-risk urothelial bladder cancer who did not receive neoadjuvant chemotherapy.
2016 ACOG Guidelines for Cervical Cancer Screening
The 2016 American College of Obstetricians and Gynecologists (ACOG) guidelines for cervical cancer screening have been released. ACOG continues to recommend screening for cervical cancer beginning at age 21 with cervical cytology, and co-testing (cervical cytology plus human papillomavirus [HPV] testing) for women age 30 and older. However, in agreement with the 2015 American Society for Colposcopy and Cervical Pathology guidelines, ACOG now also considers primary HPV testing as an option for screening in women age 25 years and older. Because HPV tests may be transiently positive in many younger women, UpToDate authors suggest that women age <30 years be screened with cervical cytology (Pap smear).
Sensitivity of Magnetic Resonance Spectroscopy in IDH-Mutant Gliomas
Mutations in isocitrate dehydrogenase (IDH) result in the accumulation of 2-hydroxyglutarate (2HG) in IDH-mutant gliomas. Small studies have shown that 2HG can be detected noninvasively by magnetic resonance spectroscopy, but the sensitivity of the technique has not been reported. In a study that included 80 biopsy-confirmed IDH mutant tumors, the sensitivity of spectroscopy for detecting 2HG ranged from 8 percent in small tumors (<3.4 mL) to 91 percent in large tumors (>8 mL). Levels of 2HG did not correlate with tumor grade or mitotic index.