Cancer treatment reports最新文献

We have evaluated the orally active anthracycline idarubicin at a dose of 40 mg/m2 in divided doses over 24 hours in 21 previously untreated patients with extensive-stage small cell carcinoma of the lung (SCCL). Subsequent iv therapy was cyclophosphamide (1000 mg/m2), vincristine (1 mg/m2), and etoposide (120 mg/m2 iv on Day 1 and 250 mg/m2 orally in divided doses on Day 2; CVE) in patients who failed to respond to idarubicin and in relapsed patients. Three (14%) of 21 patients treated with idarubicin responded, with two complete responses (CR). Patients failing to respond promptly and those who relapsed were treated with CVE. Seven patients did not receive CVE for the following reasons: early death, four patients; early CNS disease, two; and refusal, one. Fourteen patients received CVE. Of 12 patients failing to respond to idarubicin, eight progressed on CVE, three achieved partial response (PR), and one achieved CR. Two idarubicin responders who received CVE achieved PR and CR. The median survival of all 21 patients was 6 months. For those with World Health Organization performance scores of 0 or 1 the median survival was 6.2 months and for the rest it was 2.6 months. Although CVE chemotherapy was instituted promptly in patients not responding to idarubicin, these results seem inferior to those previously seen in our center with standard treatment from the start. We believe that patients with extensive SCCL often require a rapid and more guaranteed response to their first treatment.

Taxol inhibits cell division by promoting the assembly and stabilization of microtubules. This report describes the results of a phase I trial of taxol administered as a short iv infusion daily for 5 days every 4 weeks. Sixteen patients with refractory malignancy received 21 courses of taxol at five doses between 5 and 40 mg/m2/day X 5. The first nine patients received taxol as a 60-minute infusion. Two patients experienced anaphylactoid reactions, one at the 5-mg/m2/day and the second at the 15-mg/m2/day X 5 dose levels. These reactions were characterized by facial flushing, tachypnea, and hypotension within several minutes of drug administration. These anaphylactoid reactions occurred on the first day of treatment in the first patient and on the first day of the second course in the second patient. These reactions may be related to the rapid administration of the polyoxyethylated castor oil (Cremophor EL) vehicle in which taxol is formulated. No anaphylactoid reactions were observed in the seven patients who received taxol as a 6-hour infusion with antihistamine and prednisone premedication. Dose-related myelosuppression was seen; leukopenia (wbc count less than 1000/mm3) and granulocytopenia (granulocytes less than or equal to 200/mm3) occurred on Days 8 and 9 in two of two patients treated at the 40 mg/m2/day X 5 level. Thrombocytopenia was mild, with a platelet nadir of 87,000-95,000/mm3 at the highest dose level. Premedication with glucocorticoids and antihistamines coupled with a prolonged 6-hour infusion permitted taxol to be administered at 30 mg/m2/day X 5 safely without immediate life-threatening reactions.

Continuous infusion of homoharringtonine was administered to 17 children with refractory leukemia. Ten children with acute lymphoblastic leukemia received a total of 18 courses and seven children with acute nonlymphoblastic leukemia had a total of 13 courses. Doses were escalated from 1.65 to 8.5 mg/m2 for 5-10 consecutive days. Side effects included mild nausea and vomiting and transient changes in liver enzymes. Mucositis and diarrhea were more frequently seen at higher dose levels. Grade 3 hypotension and pain were seen at doses of 7 mg/m2 for 10 days. This is considered to be the maximum tolerated dose in this limited phase I trial. None of these previously heavily treated patients achieved a marrow remission.

Thirty patients with progressive metastatic breast cancer and one prior chemotherapy regimen were treated with iproplatin at a starting dose of 300 mg/m2 iv every 3 weeks. After the first 11 patients, the starting dose was decreased to 270 mg/m2. There were one complete remission, three partial remissions, and two minor responses. Responses were observed in soft tissue and osseous and visceral areas. Grade 3 nausea and vomiting were observed in 38% of patients, and grade 3 diarrhea occurred in 31%. The dose-limiting toxicity was thrombocytopenia, which required dose de-escalation in 15 patients. No nephrotoxicity, neurotoxicity, or ototoxicity was observed. Iproplatin has modest antitumor activity in this group of previously treated patients with metastatic breast cancer.

Taxol is a unique plant-derived antineoplastic agent that appears to exert its cytotoxic effect by interfering with microtubule structure and function. In this phase I trial, in which the drug was given as a brief iv infusion every 3 weeks, the dose-limiting toxicity was leukopenia, with thrombocytopenia being seen much less frequently. Sensory neuropathy was frequently seen at the highest dosage, with numbness and paresthesias appearing in a glove-and-stocking distribution. In some cases, this appeared to be a cumulative effect. Total alopecia was common. Other toxic effects observed included nausea and vomiting, mucositis, myalgias, and phlebitis. The frequent occurrence early in the study of acute cardiovascular and pulmonary toxicity suggestive of hypersensitivity reactions was decreased in frequency and severity by prolonging the infusions and premedication with corticosteroids and antihistamines. Two heavily treated patients appeared to respond to this agent, one with non-small cell lung cancer and one with ovarian cancer. Based on these data, we recommend a starting dose in phase II trials of 212 mg/m2 in patients with minimal prior therapy and 170 mg/m2 in heavily treated patients. At least initially, these trials should be carried out in institutions familiar with the use of this drug.

Pharmacokinetics of the cisplatin analog carboplatin were studied in ovarian cancer patients who received short-term iv infusions of 290-370 mg/m2. Platinum (Pt) was determined by atomic absorption spectrometry in plasma ultrafiltrate up to 24 hours and in plasma and urine up to 5 days following infusion. Carboplatin was determined in plasma ultrafiltrate and in urine by high-performance liquid chromatography with electrochemical detection. The final half-life of total Pt in plasma was 5.8 +/- 1.6 days. Pharmacokinetics of carboplatin and ultrafilterable Pt (free Pt) were similar with respect to alpha-half-life (16 +/- 6 and 23 +/- 8 mins), beta-half-life (118 +/- 15 and 120 +/- 11 mins), area under curve/dose (18 +/- 5 and 17 +/- 4 min/m2/L), total-body clearance (101 +/- 21 and 107 +/- 19 ml/min), and volume of distribution Vss (9.9 +/- 1.3 and 10.0 +/- 1.4 L/m2). After 6 hours the cumulative urinary excretion of carboplatin and Pt was 41% +/- 14% and 68% +/- 7% of the dose, respectively. After 5 days the cumulative urinary excretion of Pt was 84% +/- 6%. Renal and metabolic clearances of free Pt from plasma were 81 +/- 17 and 26 +/- 11 ml/minute, respectively. The first-order rate constant for metabolic elimination of free Pt (KM = CLM/Vss) was 1.5 X 10(-3) +/- 0.6 X 10(-3) min-1, which is ten times lower than the value calculated from literature data for cisplatin (15 X 10(-3) +/- 1 X 10(-3) min-1). This means that the overall in vivo reactivity of carboplatin is ten times lower than that of cisplatin.

Fresh specimens of human lymphatic neoplasms were tested with the differential staining cytotoxicity assay. Cells from relapsed patients with acute lymphoblastic leukemia (ALL) were significantly more resistant to vincristine, dexamethasone, and doxorubicin in the assay than were cells from previously untreated patients. The putative C kinase inhibitors verapamil (V), imipramine (I), lidocaine (L), tamoxifen (T), chlorpromazine (C), and haloperidol (H) were then tested singly, in combination with each other (VILTCH, ITCH, and VL), and in combination with vincristine. At concentrations judged to be clinically achievable, VILTCH itself was occasionally toxic to ALL and chronic lymphocytic leukemia. The VILTCH combination clearly potentiated the cytotoxic activity of vincristine in five of eight ALL specimens from relapsed patients and potentiated vincristine in 18 of 30 chronic lymphocytic leukemia specimens. It also potentiated vincristine in two of six specimens of multiple myeloma and five of six specimens of non-Hodgkin's lymphoma. The VILTCH combination had no significant effects in fresh cultures of normal human lymphocytes. The most active drugs in the VILTCH combination appeared to be verapamil and lidocaine. We conclude that the differential staining cytotoxicity assay is a useful tool to study the circumvention of clinically acquired drug resistance. While the mechanism of the observed enhancement of the cytotoxic effects of vincristine is not known, it is possible that combinations of putative C kinase inhibitors may reduce drug resistance in human lymphatic neoplasms.