المؤلفون: Vinik, Aaron I., Raymond, Eric

المصدر: Therapeutic Advances in Gastroenterology; Sep2013, Vol. 6 Issue 5, p396-411, 16p

مستخلص: Pancreatic neuroendocrine tumors (pNETs) are relatively rare malignancies. With secretory tumors such as insulinomas, vasoactive intestinal peptideomas, and gastrinomas, the hormone produced causes the symptom complex (e.g. hypoglycemia, peptic ulcer disease). With nonsecretory NETs, the clinical condition is determined by tumoral growth and metastasis. The course of metastatic pNETs may be indolent for several years but progression is often more rapid at later stages, leading to significant disability and a markedly negative impact on quality of life. Until recently, there were few effective systemic treatments for pNETs. Standard chemotherapy produces limited responses and has considerable toxicity. Somatostatin analogues control symptoms in some types of pNETs, but have not yet demonstrated antitumor activity. The recent introduction of targeted therapies, including the tyrosine kinase inhibitor sunitinib and the mammalian target of rapamycin inhibitor everolimus, yielded new opportunities for patients with advanced/metastatic pNETs. These drugs, which target key pathways in tumor proliferation and angiogenesis, provided clear clinical benefits in phase III clinical trials, including delayed tumor progression. The pivotal sunitinib phase III trial was discontinued prematurely due to higher rates of death and serious adverse events with placebo and greater progression-free survival (PFS) with sunitinib. In this trial, sunitinib demonstrated encouraging long-term responses as well as PFS and overall survival benefits, and an acceptable safety profile that allowed patients to preserve their quality of life. In every patient subgroup, including secretory and nonsecretory tumors, the hazard ratio for progression or death favored sunitinib. Circulating biomarkers are being investigated for the prediction and monitoring of responses to sunitinib. Although not fully evaluated in pNETs, biomarkers associated with response to sunitinib in several tumor types include soluble vascular endothelial growth factor receptor 2 and 3, interleukin 8, and stromal cell-derived factor 1α. Based on recent data, treatment algorithms have been updated for advanced and metastatic pNETs. [ABSTRACT FROM PUBLISHER]

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المؤلفون: Holton, D. Robb, Colberg, Sheri R., Nunnold, Tanja, Parson, Henri K., Vinik, Aaron I.

المصدر: Diabetes Educator; Sep/Oct2003, Vol. 29 Issue 5, p837-846, 10p

مستخلص: PURPOSEThe purpose of this study was to determine the effect of 10 weeks of moderate aerobic exercise training on quality of life (QOL) and selected physiological parameters in previously sedentary persons with diabetes.METHODSA quality-of-life survey (SF36v2 health survey) and measurement of physiological parameters were completed before and after 10 weeks of supervised aerobic exercise training 3 days a week for 20 to 45 minutes by subjects with diabetes (n=9) and control subjects (n=1 0). Nontraining subjects with diabetes (n=12) and control subjects (n=1 0) also completed the QOL survey at equivalent times.RESULTSParticipants in all groups had similar characteristics. A training effect was evident in exercisers, with an increase in lactate threshold and a decrease in percent body fat for both groups. Training did not affect body mass index or interstitial nitric oxide levels. Physical and mental component scores on the QOL survey in the training and nontraining groups did not differ significantly before or after the training, and diabetes status had no significant effect on these scores.CONCLUSIONSNo physiological changes were significantly associated with scores on the SF36v2 health survey. In addition, neither training nor the presence of type 2 diabetes significantly affected the physical or mental component scores on the QOL survey. [ABSTRACT FROM PUBLISHER]

: Copyright of Diabetes Educator is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)