Background: Children with congenital heart diseases (CHD) are now surviving to adulthood but may deteriorate requiring cardiac transplantation. However, this treatment option has been associated with a high mortality. Method: A retrospective analysis of our heart/heart–lung transplant program was performed and patients with CHD were evaluated in relation to aetiology, surgical methods and outcome. Results: Since 1990, 2.2% (7/322) transplants were performed for CHD. Six out of seven heart alone and one in seven heart–lung transplantation. Mean age 29.5 years (range 9–45). Indication: tetralogy of fallot (three in seven), transposition great arteries (two in seven), tricuspid atresia (one in seven) and one double outlet hypoplastic right ventricle with pulmonary stenosis, VSD. Previous surgical episodes; mean of 2.4 (range 1–5). Mean bypass time was 4.2 hours and transfusion requirements were 15.4 units (range 3–39 units). Three patients required reopen for haemorrhage. Perioperative mechanical support was used in three patients (one BiVAD, one LVAD, and one IABP). Two out of seven (29%) patients died within 30 days of transplantation, related to bleeding complications. Both had four or more pre-transplant operations and their peri-transplant transfusion requirements were 39 and 14 units. Eighty-three percent of patients had at least one episode of 3R rejection. Post transplant complications included stable stage II or III chronic kidney disease (2) and chronic myeloid leukaemia at 10 years (1). All survivors had a LVEF greater than 50% at last review. Mean follow up was 7.1 years. Conclusion: Transplantation in adult CHD poses significant challenges owing to their complex anatomy, previous operations and immune sensitisation. Cardiac transplantation in this patient population is a rare indication but has high perioperative/early mortality.

Bladder cancer, most often of the transitional cell type (TCC), is the fourth most commonly diagnosed malignancy in the United States (1). About 75% of patients are diagnosed with localized disease at initial presentation, with about 20% having, loco-regionally advanced (stage II/III) disease (2). Following radical cystectomy or definitive radiation therapy, recurrence risk in these patients exceeds 50% (3). Table 22.1 summarizes the data of the recent outcome for patients with locally advanced bladder cancer treated with cystectomy alone. The high incidence of distant recurrence in patients with presumed early stage disease is principally due to the presence of distant micrometastases at the time of local therapy. Because of this, recent research has revolved around peri-operative systemic therapy, either as neoadjuvant or adjuvant treatment, aimed at eradicating micrometastatic deposits. Alternative (non-cystectomy) approaches for localized disease have also been investigated, particularly radiation therapy with or without chemotherapy. This review summarizes current data on therapeutic strategies for locally advanced bladder cancer.

4642 Background: Perifosine is an oral alkylphospholipid that inhibits cancer cell growth via decreased AKT phosphorylation. To evaluate its efficacy and tolerability in early stage prostate cancer, we conducted a phase II trial of perifosine in patients (pts) with HSPC. Methods: Eligible pts had: histologically confirmed prostate cancer, prior prostatectomy and/or radiation, and a rising PSA without radiographic metastasis. Prior androgen deprivation therapy of < 9 mo completed 1 yr prior to registration was allowed. Primary endpoint was PSA response (PSA decrease ≥ 50% from baseline). Secondary endpoints were PSA doubling time and progression-free survival (PFS). A 2-stage optimal design was used. Treatment: loading dose of 900mg PO on day 1 in divided doses at least 6 hrs apart, then 100mg PO daily starting 24 hrs later. Cycle length = 28 days. Results: Of 25 pts enrolled, 22 pts are evaluable for response. Pt characteristics: median age = 67 yrs; Karnofsky 80/90/100 = 2/17/13; median number of cycles = 5. Median follow-up = 8 months. 18 pts (82%) had stable disease and 3 (14%) had PSA progression. No pt had a PSA decline ≥ 50%, thus accrual was halted per protocol design. However, 5 pts (23%) had PSA decline of < 50%. Median PFS was 9.5 months. There was no change in the PSA doubling time (7 mo) prior to and during treatment. Grade (gr) 3–4 toxicities included gr 3 hyponatremia, gr 3 arthritis, gr 3 hyperuricemia, and gr 3 vision change. Conclusions: Oral perifosine in HSPC pts is feasible, well-tolerated, and can reduce PSA (by < 50%) in some pts. Based on its inhibitory effects on P13K/AKT, there remains a strong preclinical rationale for testing perifosine as a means of enhancing apoptosis in combination with androgen ablation and chemotherapy. (N01-CM 17101, ACSCRTG 1970 CCE) No significant financial relationships to disclose.

Purpose of review Metastatic or unresectable urothelial cancer of the urinary bladder has traditionally been treated with systemic chemotherapy, which is most often platinum-based. The long-term survival data and the associated toxicities from this form of therapy have spurred continuing interest in finding novel treatment options for this malignancy.Recent findings Recently, trials of new chemotherapy combinations, many incorporating platinum analogs or deleting platinum entirely, have been reported. None has yet been shown to be superior to cisplatin-based regimens. In addition, recent advances in imaging and laboratory technologies have provided new avenues to understand urothelial cancer behavior and prognosis. These advances provide optimism for improvements in the diagnosis, staging, and ultimately, selection of therapy for patients with urothelial cancer.Summary This review will summarize recent developments (circa 2004) in the diagnosis and management of advanced bladder cancer.

Overexpression of the HER‐2/neu oncoprotein has been reported to occur in ≤ 60% of patients with prostate carcinoma and to correlate with shortened survival. Trastuzumab is a humanized monoclonal antibody to the HER‐2 receptor and has activity against HER‐2–positive breast carcinoma, more so when combined with a taxane. The authors screened for HER‐2 overexpression in patients developing hormone‐refractory prostate carcinoma (HRPC) and conducted a Phase II trial of trastuzumab plus docetaxel in HER‐2–positive patients.