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This Week in NEJM: May 12, 2011

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This week in NEJM, a team of researchers in France published results from a study comparing the efficacy of FOLFIRINOX — a combination chemotherapy regimen consisting of oxaliplatin, irinotecan, fluorouracil, and leucovorin — versus gemcitabine for the treatment of metastatic pancreatic cancer. The researchers randomly split 342 patients into two groups to receive either treatment, and found that the median overall survival was 11.1 months in the FOLFIRINOX group, compared with 6.8 months in the gemcitabine group. Median progression-free survival was 6.4 months for the FOLFIRINOX group versus 3.3 months in the gemcitabine group and the objective response rate was 31.6 percent for the former and 9.4 percent for the latter. More adverse events were noted in the FOLFIRINOX group, however, at six months, 31 percent of the patients in the FOLFIRINOX group had a "definitive degradation of the quality of life," compared with 66 percent in the gemcitabine group, the researchers write. "As compared with gemcitabine, FOLFIRINOX was associated with a survival advantage and had increased toxicity. FOLFIRINOX is an option for the treatment of patients with metastatic pancreatic cancer and good performance status," they add.

Also in NEJM this week, researchers from the University of Tennessee and St. Jude Children's Research Hospital present their analysis of tumor lysis syndrome, the most common disease-related problem for patients with hematological cancers. The syndrome occurs when tumor cells release their contents into the bloodstream, leading to findings of hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, all of which can lead to clinical toxic effects, such as renal insufficiency, cardiac arrhythmias, seizures, and eventually death, the authors write. Although it has been difficult to classify patients' risk for tumor lysis syndrome, standards of care are starting to emerge, they add, and several groups have advocated for precise guidelines for risk stratification and prophylactic therapy. In the meantime, the authors suggest, "Optimal management of the tumor lysis syndrome should involve preservation of renal function. Management should also include prevention of dysrhythmias and neuromuscular irritability."

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