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SARS Update

A total of 8,098 people (November 2002 through July 2003) worldwide became sick with severe acute respiratory syndrome that was accompanied by either pneumonia or respiratory distress syndrome. In the United States, only eight persons were laboratory-confirmed as SARS (a corona virus) cases. There were no SARS-related deaths in the United States. By late July, 2003 the global outbreak was officially over. To date this winter, there have been a few isolated case reports in the far east.

The illness usually begins with a high fever (greater than 100.4°F). The fever is sometimes associated with chills or other symptoms, including headache, general feeling of discomfort, and body aches. Most patients develop pneumonia. The disease may start with mild respiratory symptoms. Diarrhea is seen in approximately 10 percent to 20 percent of individuals. After 2 to 7 days, SARS patients may develop a dry, nonproductive cough that may progress to hypoxia. In 10 percent to 20 percent of cases, patients require mechanical ventilation.

The primary way that SARS appears to spread is by close person-to-person contact. SARS is thought to be transmitted most readily by respiratory droplets produced when an infected person coughs or sneezes. The virus also can spread when a person touches a contaminated surface or object and then touches his or her mouth, nose, or eyes. Early studies suggest that the virus may survive in the environment for several days. In addition, it is possible that SARS might be spread more broadly through the air or by other ways that are not now known.

If transmission of SARS recurs, there are some common- sense precautions that can be taken that apply to many infectious diseases. The most important is frequent hand washing with soap and water or use of an alcohol-based hand rub. Avoid touching eyes, noses, and mouth with unclean hands and encourage others to cover their nose and mouth with a tissue when coughing or sneezing.

During the 2003 global outbreak, most persons reported as SARS cases in the United States were exposed through foreign travel to countries with outbreaks of SARS, with only limited secondary spread to close contacts. Transmission of SARS on airplanes and boats can occur, but the overall risk appears to be low.

Guidance for the management of SARS exposures in healthcare settings, as well as infection control precautions for SARS patients and their close contacts in household settings, is provided in the January, 2004 Supplement I, Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SP).

Reference: www.cdc.govlncidod/sars
 

Avastin for Metastatic Colorectal Cancer

AvastinTM (bevacizumab by Genentech), a monoclonal antibody, was approved by the FDA on February 26th, 2004. This exciting new therapy will be co-administered with chemotherapy for the treatment of metastatic colorectal cancer.

According to the CDC, colorectal cancer is the third most common cancer in the US. About 150,000 new cases of this cancer are expected in the US in 2004. Metastases are seen in about half of patients with this disease. Sadly, about 150 Americans die DAILY from colorectal cancer. Risk factors for this disease include advancing age, a high fat and cholesterol diet, inflammatory bowel disease, and genetics. Treatment may include surgery, chemotherapy and/or radiation. Standard chemotherapy, the "Salz regimen", is made up of irinotecan, fluorouracil (5FU), and leucovorin. Disease metastasized to the liver may be treated with FUDR, which is given directly into the hepatic artery. Therapy may include fluorouracil (5FU) and leucovorin alone.

Avastin provides a new approach for the treatment of colorectal cancer. This new drug is a monoclonal antibody and is NOT a chemotherapeutic agent. It binds to vascular endothelial growth factor and prevents the formation of new blood vessels that are needed to provide oxygen and nourishment to the developing tumor.

Avastin is used in combination with irinotecan, fluorouracil, and leucovorin (IFL). It has been shown to extend patients' lives by about 5 months in comparison to patients treated with IFL alone. Avastin is administered by an intravenous infusion following chemotherapy every 2 weeks. The dose is 5mg/kg in 100ml normal saline over 90 minutes. The second dose, may be given over 60 minutes if the patient tolerated the first dose. Subsequent doses, if tolerated, may be given over 30 minutes. The drug should NOT be given by IV push.

The most serious adverse effects to Avastin occurring during clinical trial included bowel perforation, weakened wound healing and internal bleeding. Due to these effects, the drug should be stopped 28 days prior to surgery, and should not be re-started until the surgical incision has healed. Other side effects include infusion reactions, serious blood pressure elevations, protein in the urine, clots, low white blood cell counts, respiratory infections, decreased appetite, headache and mouth sores.

Since this is the first therapy to impede the blood supply to tumors, Avastin is also being investigated as an adjunct to chemotherapy in many other cancers, including kidney, breast, prostate, and ovary.

Due to the drug's pharmacology, adverse effect profile, and method of administration, it is anticipated that Avastin will be administered in the physician's office or clinic setting. (ANV)

References: www.avastin.com  and www.gene.com

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The articles herein are provided for general information and are not intended to provide specific advice or recommendations for any reader.