12018
2014
eng
648-55
3
7
article
1
2015-10-13
--
--
Intensified neoadjuvant chemotherapy with nab-paclitaxel plus gemcitabine followed by FOLFIRINOX in a patient with locally advanced unresectable pancreatic cancer
The prognosis of patients with locally advanced pancreatic cancer can be improved if secondary complete (R0) resection is possible. In patients initially staged as unresectable this may be achieved with neoadjuvant treatment which is usually chemoradiotherapy based. We report the case of a 46-year-old patient with an unresectable, locally advanced pancreatic cancer (pT4 Nx cM0 G2) who was treated with a sequential neoadjuvant chemotherapy regimen consisting of 2 cycles of nab-paclitaxel plus gemcitabine followed by 4 cycles of FOLFIRINOX. Neoadjuvant chemotherapy resulted in secondary resectability (R0 resection). After 2 cycles of nab-paclitaxel plus gemcitabine, the patient already had a complete metabolic remission as measured by integrated fludeoxyglucose ((18)F) positron emission tomography and computerized tomography. After a follow-up of 18 months the patient is alive without progression of disease. We propose to assess the clinical benefit of sequencing the combinations nab-paclitaxel plus gemcitabine and FOLFIRINOX as neoadjuvant therapy for patients with locally advanced and initially unresectable pancreatic cancer in a controlled clinical trial.
Case Reports in Oncology
10.1159/000367966
1662-6575
25408659
urn:nbn:de:bvb:20-opus-120189
Case Reports in Oncology 2014;7:648–655 DOI: 10.1159/000367966
Volker Kunzmann
Ken Herrmann
Christina Bluemel
Markus Kapp
Ingo Hartlapp
Ulrich Steger
eng
uncontrolled
nab-paclitaxel
eng
uncontrolled
neoadjuvant chemotherapy
eng
uncontrolled
oxaliplatin
eng
uncontrolled
pancreatic cancer
eng
uncontrolled
locally advanced disease
eng
uncontrolled
irinotecan
eng
uncontrolled
gemcitabine
eng
uncontrolled
folinic acid
eng
uncontrolled
5-Fluorouracil
Krankheiten
open_access
Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie (Chirurgische Klinik I)
Klinik und Poliklinik für Nuklearmedizin
Medizinische Klinik und Poliklinik II
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/12018/080_Kunzemann_Case_Rep._Oncol.pdf
12496
2014
eng
74
4
article
1
2016-01-22
--
--
Prediction of clinically relevant hyperkalemia in patients treated with peptide receptor radionuclide therapy
Background
Peptide receptor radionuclide therapy (PRRT) is applied in patients with advanced neuroendocrine tumors. Co-infused amino acids (AA) should prevent nephrotoxicity. The aims of this study were to correlate the incidence of AA-induced hyperkalemia (HK) (≥5.0 mmol/l) and to identify predictors of AA-induced severe HK (>6.0).
Methods
In 38 patients, standard activity of \(^{177}Lu\)-labelled somatostatin analogs was administered. Pre-therapeutic kidney function was assessed by renal scintigraphy and laboratory tests. For kidney protection, AA was co-infused. Biochemical parameters (potassium, glomerular filtration rate, creatinine, blood urea nitrogen (BUN), sodium, phosphate, chloride, and lactate dehydrogenase (LDH)) were obtained prior to 4 and 24 h after the AA infusion. Incidence of HK (≥5.0) was correlated with pre-therapeutic kidney function and serum parameters. Formulas for the prediction of severe hyperkalemia (>6.0) were computed and prospectively validated.
Results
At 4 h, HK (≥5.0) was present in 94.7% with severe HK (>6.0) in 36.1%. Values normalized after 24 h in 84.2%. Pre-therapeutic kidney function did not correlate with the incidence of severe HK.
Increases in K+ were significantly correlated with decreases in phosphate (r = −0.444, p < 0.005) and increases in BUN (r = 0.313, p = 0.056). A baseline BUN of >28 mg/dl had a sensitivity of 84.6% and a specificity of 60.0% (AUC = 0.75) in predicting severe HK of >6.0 (phosphate, AUC = 0.37).
Computing of five standard serum parameters (potassium, BUN, sodium, phosphate, LDH) resulted in a sensitivity of 88.9% and a specificity of 79.3% for the prediction of severe HK >6.0 (accuracy = 81.6%).
Conclusions
A combination of serum parameters predicted prospectively the occurrence of relevant HK with an accuracy of 81.6% underlining its potential utility for identifying ‘high-risk’ patients prone to PRRT.
EJNMMI Research
10.1186/s13550-014-0074-y
urn:nbn:de:bvb:20-opus-124963
EJNMMI Research (2014) 4:74 DOI 10.1186/s13550-014-0074-y
Constantin Lapa
Rudolf A. Werner
Christina Bluemel
Katharina Lueckerath
Dirk O. Muegge
Alexander Strate
Heribert Haenscheid
Andreas Schirbel
Martin S. Allen-Auerbach
Ralph A. Bundschuh
Andreas K. Buck
Ken Herrmann
eng
uncontrolled
amino acids
eng
uncontrolled
kidney function
eng
uncontrolled
hyperkalemia
eng
uncontrolled
PRRT
eng
uncontrolled
NET
eng
uncontrolled
MAG3
Medizin und Gesundheit
open_access
Institut für Klinische Biochemie und Pathobiochemie
Klinik und Poliklinik für Nuklearmedizin
Förderzeitraum 2015
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/12496/Lapa_13550-014-0074-y.pdf
11061
2014
eng
article
1
2015-02-27
--
--
Influence of the amount of co-infused amino acids on post-therapeutic potassium levels in peptide receptor radionuclide therapy
Background
Peptide receptor radionuclide therapy (PRRT) is routinely used for advanced or metastasized neuroendocrine tumours (NET). To prevent nephrotoxicity, positively charged amino acids (AA) are co-infused. The aim of this study was to correlate the risk for therapy-related hyperkalaemia with the total amount of AA infused.
Methods
Twenty-two patients undergoing PRRT with standard activities of 177Lu-DOTATATE/-TOC were monitored during two following treatment cycles with co-infusion of 75 and 50 g of AA (L-arginine and L-lysine), respectively. Mean serum levels of potassium and other parameters (glomerular filtration rate [GFR], creatinine, blood urea nitrogen [BUN], phosphate, chloride, lactate dehydrogenase) prior to, 4 h and 24 h after AA infusion were compared.
Results
Self-limiting hyperkalaemia (>5.0 mmol/l) resolving after 24 h occurred in 91% (20/22) of patients in both protocols. Potassium levels, BUN, creatinine, GFR, phosphate, chloride and LDH showed a similar range at 4 h after co-infusion of 75 or 50 g of AA, respectively (p > 0.05). Only GFR and creatinine levels at 24 h varied significantly between the two co-infusion protocols (p < 0.05).
Conclusions
Hyperkalaemia is a frequent side effect of AA infusion in PRRT. Varying the dose of co-infused amino acids did not impact on the incidence and severity of hyperkalaemia.
10.1186/s13550-014-0046-2
urn:nbn:de:bvb:20-opus-110617
EJNMMI Research 2014, 4:46. doi:10.1186/s13550-014-0046-2
Rudolf A. Werner
Constantin Lapa
Christina Bluemel
Katharina Lückerath
Andreas Schirbel
Alexander Strate
Andreas K. Buck
Ken Herrmann
eng
uncontrolled
NET
eng
uncontrolled
PRRT
eng
uncontrolled
Hyperkalaemia
eng
uncontrolled
Arginine
eng
uncontrolled
Lysine
Medizin und Gesundheit
open_access
Institut für Klinische Biochemie und Pathobiochemie
Klinik und Poliklinik für Nuklearmedizin
Förderzeitraum 2014
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/11061/120_Werner_EJNMMI.pdf