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Leipzig, Germany

Patients with non-small-cell lung cancer who harbor an activating mutation of the epidermal growth factor receptor (EGFR) benefit regarding response, improvement of symptoms and progression-free survival significantly better from treatment with EGFR-tyrosine-kinase-inhibitors (TKI) compared to platinum-based chemotherapy. After a median time of 10 months several mechanisms as second-site mutations, MET-gene-amplification or overexpression of hepatocyte growth factor (HGF) induce a resistance to the TKI. Irreversible EGFR-TKI, MET-inhibitors or IGF-1-receptor-inhibitors are potential options to overcome the resistance and are currently proved in numerous trials. © 2012 Dustri-Verlag Dr. Karl Feistle. Source

Thuss-Patience P.C.,Charite - Medical University of Berlin | Kretzschmar A.,Klinikum St. Georg GGmbH | Dogan Y.,Charite - Medical University of Berlin | Rothmann F.,Klinikum Ernst von Bergmann | And 7 more authors.
British Journal of Cancer | Year: 2011

Background: No comparisons of different doses of docetaxel-capecitabine in patients with advanced gastric cancer have been performed. Methods: Patients with previously untreated metastatic/locally advanced gastro-oesophageal or gastric adenocarcinoma were enrolled in a prospective multicentre phase II trial. Two sequential cohorts received docetaxel 75 mg m2 (day 1) plus capecitabine 1000 mg m2 twice daily (days 1-14) (cohort I) or docetaxel 60 mg m2 (day 1) plus capecitabine 800 mg m2 twice daily (days 1-14) (cohort II) every 3 weeks. The primary end point was confirmed overall response rate. Results: In all, 91 patients were enrolled (cohort I, n=40; cohort II, n=51) and 87 were evaluable for efficacy (n=38, 49, respectively). Overall response rate was 50.0% in cohort I and 23.5% in cohort II (exploratory analysis, P=0.014). Median times to tumour progression and overall survival were 5.6 and 10.1 months in cohort I and 3.7 and 7.2 months in cohort II, respectively. Dose reductions for docetaxel and capecitabine were required in 50.0% and 57.5% of patients in cohort I and 11.8% and 15.7% in cohort II, respectively. Conclusion: Starting treatment with full doses and reducing promptly seems to be the more promisingly effective strategy than starting cautiously with lower doses. Docetaxel/capecitabine 75/2000 mg m 2 is a manageable, convenient outpatient combination with promising efficacy against advanced gastric cancer. © 2011 Cancer Research UK. Source

Teich N.,Internistische Gemeinschaftspraxis fur Verdauungsund Stoffwechselkrankheiten | Klugmann T.,Internistische Gemeinschaftspraxis fur Verdauungsund Stoffwechselkrankheiten | Tiedemann A.,Klinikum St. Georg GGmbH | Holler B.,University of Leipzig | And 2 more authors.
Deutsches Arzteblatt | Year: 2011

Background: Patients with chronic inflammatory diseases are at elevated risk of infections that can be prevented by vaccination. This elevated risk is due not just to these patients' primary illnesses, but also to the immunosuppressive treatment that they often receive. We studied the vaccination rate in a random sample of patients with two types of inflammatory bowel dis ease (IBD), namely, Crohn's disease and ulcerative colitis. In particular, we asked unvaccinated patients why they had refused the vaccine. Methods: From April to September 2009, we gave a 38-item questionnaire to 203 consecutive patients with IBD (57% with Crohn's disease, 63% female, median age 36 years) who had not received vaccination counseling for at least one year, and inspected the patients' vaccination cards. We compared the findings to the current recommendations of the German Federal Standing Committee on Vaccination (Ständige Impfkommission). Results: 83% of the patients had a vaccination card. Substantial deficiencies in vaccination were found. Only 67% of the patients had been immunized against tetanus in the previous 10 years, and only 21% against pertussis. Only 28% were vaccinated against seasonal influenza in 2008, and only 9% had ever received antipneumococcal vaccine. A subgroup analysis in which we compared 39 patients taking TNF-blockers to 67 patients who never had any type of immunosuppressive treatment revealed no difference in vaccination rates. 80% of all patients said they were willing to receive all of the officially recommended vaccinations. 22% of all patients said they avoided vaccinations for fear of side effects, while 15% said they did so because their immune system was supposedly "not intact", and 9% because they feared vaccination would worsen their IBD. Conclusion: In this random sample, the vaccination rate fell far behind the recommendations. In particular, there was a marked discrepancy between patients' willingness to be vaccinated and the actual provision of vaccination. These findings imply that physicians need to be more aware of the possibly inadequate vaccination state of their immunosuppressed patients. Source

Windisch W.,Witten/Herdecke University | Storre J.H.,Witten/Herdecke University | Storre J.H.,University Hospital Freiburg | Kohnlein T.,Klinikum St. Georg GGmbH
Expert Review of Respiratory Medicine | Year: 2015

There is an ongoing discussion on whether long-term non-invasive positive pressure ventilation (NPPV) should be used in chronic hypercapnic chronic obstructive pulmonary disease (COPD) patients. Early trials had failed to show convincing physiological and clinical effects using NPPV with assisted modes of ventilation and rather low inflation pressures. In particular, long-term survival could not be improved and findings on health-related quality of life had been conflicting. Remarkably, high-intensity NPPV using higher inflation pressures and back-up rates has recently been shown to be capable of improving blood gases, lung function, and health-related quality of life. Subsequently, a large study using this technique also showed a substantial improvement in the prognosis in these patients. Therefore, there is now increasing evidence to support physiologically effective NPPV in hypercapnic COPD patients, but how to best select patients still needs to be defined. The present article summarizes the physiological background and the current evidence on NPPV in COPD in addition to future considerations. © 2015 Informa UK, Ltd. Source

Stingel K.,University of Hohenheim | Schutz T.,Universitatsmedizin Leipzig | Koller M.,University of Regensburg | Lochs H.,Innsbruck Medical University | And 2 more authors.
Aktuelle Ernahrungsmedizin | Year: 2013

Purpose: Under the direction of the German Society of Nutritional Medicine the already existing guidelines of the German Society of Nutritional Medicine and the European Society for Clinical Nutrition and Metabolism (ESPEN) on the subjects Enteral Nutrition and Parenteral Nutrition will be updated and combined to one guideline on Clinical Nutrition. Methods: 13 interdisciplinary teams of altogether 96 experts in clinical nutrition were working on the guideline-update. A structured literature search applying a defined search strategy with inclusion criteria and specified keywords was the basis of the update. The strength of the evidence was evaluated according to published standards. Furthermore, the outcome-parameters of the trials were also evaluated by a system specially designed for this guideline-update. It was verified, if individual recommendations of other guidelines could be accepted or adapted. On this basis, recommendations were formulated which were not only based on the evidence levels of the studies but also on the judgment of the working groups concerning the consistence, clinical relevance and validity of the evidence. The initial recommendations were discussed and reworked under the nominal working group process. The voting of statements throughout the plenum took place in a preliminary voting and following consensus conference by the Delphi principle. Results: The several chapters of the guideline-update Clinical Nutrition reflect the current medical knowledge in the field of enteral and parenteral nutrition and summarize the evidence when nutritional support is indicated and which goals can be reached. They will be published gradually within a year. © Georg Thieme Verlag KG Stuttgart · New York. Source

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