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Study Nordic Treatment Group FAR60 TAM40 No. Patients 214 201 Responses 14 + 33 CR1 + PR2 3 RR CR 21.3 19.1 20.4 Difference in RR 2.2 -0.4 -6.0 4 95% CI for Difference in RR -5.8 to 10.2 -9.5 to 8.6 -15.1 to 3.1 Time to Progression TTP ; Median TTP mo. ; 5.6 5.8 4.9 Hazard Ratio TAM FAR ; 1.01 1.02 0.80 CI for Hazard Ratio % ; 0.81 to 1.26 0.79 to 1.31 0.64 to 1.00 Survival S ; Median S mo. ; 33.6 34.0 25.4 Hazard Ratio TAM FAR ; 0.94 0.96 0.94 CI for Hazard Ratio % ; 0.74 to 1.24 0.72 to 1.28 0.73 to 1.22 1 2 complete response; PR partial response; RR response rate; CI confidence interval The high-dose groups, toremifene 200 mg daily in the North American Study and 240 mg daily in the Eastern European Study, were not superior to the lower toremifene dose groups, with response rates of 22.6% AND 28.7%, median times to progression of 5.6 and 6.1 months, and median survivals of 30.1 and 23.8 months, respectively. The median treatment duration in the three pivotal studies was 5 months range 4.2-6.3 months ; . INDICATION AND USAGE FARESTON is indicated for the treatment of metastatic breast cancer in postmenopausal women with estrogen-receptor positive or unknown tumors. CONTRAINDICATIONS FARESTON is contraindicated in patients with known hypersensitivity to the drug. WARNINGS Hypercalcemia and Tumor Flare: As with other antiestrogens, hypercalcemia and tumor flare have been reported in some breast cancer patients with bone metastases during the first weeks of treatment with FARESTON. Tumor flare is a syndrome of diffuse musculoskeletal pain and erythema with increased size of tumor lesions that later regress. It is often accompanied by hypercalcemia. Tumor flare does not imply failure of treatment or represent tumor progression. If hypercalcemia occurs, appropriate measures should be instituted and if hypercalcemia is severe, FARESTON treatment should be discontinued. Tumorigenicity: Since most toremifene trials have been conducted in patients with metastatic disease, adequate data on the potential endometrial tumorigenicity of long-term treatment with and coreg.
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TNHJ VOL. 5 No 1 & 2005 Page 283- 286 iodine deficient individuals continue to use the available, normally iodised salts. 3. Ways of monitoring thyroid gland disorders include the determination of goitre prevalence rates and urinary iodine levels in children aged 6-11 years.2, 17 These are however not frequently done as part of the monitoring of the salt iodisation programme in Nigeria.15, 20 However, regular monitoring for iodine levels and its impact should be integrated into the Salt Iodisation programme and women and children attending antenatal clinics, immunisation centres, outpatient departments of health facilities and schools can be the subjects for these monitoring activities. Community-based awareness programmes should be established and individuals informed about the potential danger of excessive consumption or inappropriate use of iodised salts. It is also essential to carefully monitor the iodine content of different foods to reduce these risks of toxicities from uncontrolled iodisation of different foods which will introduce multiple sources of iodine. Conclusion: Although Iodine deficiency disorders remain public health problems in our setting, the universal iodisation programme has been associated with a significant decrease in the percentage of deficient mothers and children. It has however increased proportion of women and children with higher than normal iodine levels and at therefore increased risk of toxicity. Our two cases confirm the existence of mixed pattern of deficiency and excess iodine levels highlighting the need for close monitoring of the health impact of supplementation programmes. This monitoring can be achieved by intensive health education and community-, health facility- and school health programme-based monitoring programmes. It is however recommended that iodisation programme should be limited to salt and the level reduced to about 20 ppm to reduce the current proportion of women and children with potentially toxic iodine levels. Non-iodised salts should however be provided for those with higher than normal iodine levels. References 1. World Health Organisation, United Nations Children's Fund. World Summit for Children 1990-2000; Review of progress at mid-decade and preparations for the year 2000 Excerptnutrition related goals ; JCHPSS 96.3 Add.1: 31-35. 2. Dunn JT, Frits Van Der Ilaar. A Practical Guide to the Correction of Iodine Deficiency. ICCIDD International Council for the Control of Iodine Deficiency Disorders ; , UNICEF, WHO. 1990. ACC SCN United Nation's Administrative Committee on Coordination- SubCommittee on Nutrition ; . Micronutrients: Third Report on the World Nutrition Situation.1997: 19-27. ACC SCN United Nation's Administrative Committee on Coordination- SubCommittee on Nutrition ; Iodine Deficiency Disorders. Second Report on the World Nutrition Situation1992; 1: 48-50. United Nations Children's Fund. Progress and Promise. The State of the World's Children, 1995; UNICEF; New York: 12-17. United Nations Children's Fund. Iodine: A Spanish Lesson. The State of the World's Children, 1993; UNICEF; New York: 34. ACC SCN United Nation's Administrative Committee on Coordination- Sub-Committee on Nutrition ; . Iodine Deficiency Disorders Update. Fourth Report on the World Nutrition Situation 2000: 27-29. United Nations Children's Fund. Vitamin A and Iodine: Eliminating Disorders. The State of the World's Children, 1991; UNICEF; New York: 40. Hetzel, SB. The Prevention and Control of Iodine Deficiency Disorders. ACC SCN. 1993 Reprint ; . ACC SCN United Nation's Administrative Committee on Coordination- SubCommittee on Nutrition ; . Iodine Deficiency. First Report on the World Nutrition Situation 1987: 39-42. United Nations Children's Fund. Iodine deficiency: the 10 years wars. The State of the World's Children, 1990; UNICEF; New York: 36. United Nations Children's Fund. The Progress of the Nations: 1995, UNICEF; New York. P. 15. ACC SCN United Nation's Administrative Committee on Coordination- SubCommittee on Nutrition ; . Iodine Deficiency Disorders. SCN News 1999; 18: 8 UNICEF: The silent emergency. The State of the World's Children 1998. UNICEF; New York: 9-69.
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