No está claro cuán grande es el papel de los antibióticos https://antibioticos-wiki.es en las relaciones competitivas entre los microorganismos en condiciones naturales. Zelman Waxman creía que este papel era mínimo, los antibióticos no se forman sino en culturas limpias en entornos ricos. Posteriormente, sin embargo, se descubrió que en muchos productos, la actividad de síntesis de antibióticos aumenta en presencia de otros tipos o productos específicos de su metabolismo.
Evaluation of cardiac toxicity related to capecitabine chemotherapy: single centre audit of local practice
Evaluation of cardiac toxicity related to capecitabine
chemotherapy: single centre audit of local practice.
Coote J1., McPartlin A2., Lee K1., Misra V1.
1Christie Hospital, Wilmslow Road, Withington, Manchester, M20 4BX: 2University of Manchester, Oxford Road, Manchester, M13 3PL
Incidence of cardiotoxicity related to capecitabine
9 patients (9%) had a prior history of cardiac disease.
chemotherapy is around 3-9%. There are no National or
7 patients developed probable cardiac symptoms whilst
International guidelines on the use of capecitabine in
on capecitabine therapy. One of these patients had a prior
patients at risk of developing cardiac side effects. Based
history of cardiac disease, and one a history of atrial
on literature review, personal experience, and the New
fibrillation and previous transient ischaemic attack. The
York Heart Association (NYHA) classification of cardiac
remaining five patients experiencing symptoms had no
disease1, we have developed a set of standards (see
box) to guide its use with respect to cardiotoxicity,
3 patients discontinued capecitabine because of cardiac
including dose modifications where a history of cardiac
side effects. One patient died suddenly at home within 30
days of receiving chemotherapy (cause unknown).
We report the results of an initial audit of practise
Were standards met?
1. and 2. Documentation of cardiac history:
history was taken in 95% patients but documentation of
Cardiac history should be taken and documented for
all patients being considered for treatment with
2. Where there is a positive cardiac history, the
severity of symptoms should be recorded according to
3. All patients should be counselled regarding the risk
of cardiac toxicity as part of an informed consent process. 4. Any patient developing possible cardiac symptoms
3. Counselling of cardiac risk:
during a course of capecitabine chemotherapy should
cardiac risk is now printed on consent forms for
have appropriate cardiac investigations including
capecitabine and 5-fluorouracil so this standard was not
electrocardiogram (ECG) and cardiac enzymes.
Results should be clearly documented in case notes.
4. Appropriate investigations performed and results
5. Capecitabine dose should be electively modified
Patients experiencing chest pain usually
according to cycle number and NYHA class (table 1).
attend their local accident and emergency department so documentation of cardiac investigations was not always available in our case notes. Where results were
Table 1. Recommended dose modifications according
available there were no cases of abnormal ECGs or
cardiac symptoms and tolerating treatment
5. Dose modification recommendations followed:
Case notes of 100 consecutive patients receiving
Only 2 of the 9 patients with cardiac history had starting
capecitabine as adjuvant or metastatic treatment for
dose reduced as per guidelines. Dose was not
colorectal and gastric cancers in 2008 were reviewed.
increased at cycle 3 in either case.
Patient demographics were recorded, as well as regime
Conclusions and recommendations:
and dose of capecitabine used, dose reductions and early termination of treatment. Toxicity was assessed
Documentation of NYHA classification of cardiac
using National Cancer Institute Common Terminology
disease was poor and results of investigations were
Criteria for Adverse Events (CTCAE) version 3 and
often not available in our notes. Dose modification
documentation of cardiac history and investigations (if
To raise awareness of guidelines and audit
Results were processed using SPSS software.
results to improve documentation and adherence to dose modification recommendations.
A re-audit is planned following distribution of these
PUBBLICAZIONI Prof. CLAUDIO MANNA 1. STUDIO DELLA CAPACITA' FECONDANTE DEGLI SPERMATOZOI UMANI MEDIANTE L'USO DI OVOCITI DI HAMSTER PRIVI DI ZONA PELLUCIDA. Pat. e Clin. Ost. Gin., Vol. XIII, n.6 novembre-dicembre 1985 2. PREFERTILIZATION AND PREIMPLANTATION DIAGNOSIS OF GENETIC DISEASE. RECENT PROGRESS IN PERINATAL MEDICINE. Edited by I. Gati Prostgraduate Symposium. Budapest 1989 3.
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