Combination chemotherapy using cyclophosphamide, vincristine, methotrexate, 5-fluorouracil, and prednisone in solid tumors

Three hundred and ninety-eight patients with disseminated solid tumors other than breast cancer, were treated with a combination chemotherapy protocol utilizing cyclophosphamide, vincristine sulfate, methotrexate, 5-fluorouracil, and prednisone. Three hundred and eighty were evaluable (95.5%). Partial or complete tumor regressions were noted in 73 of 380 (19%) evaluable patients. Response to therapy was associated with a prolongation and survival. The largest tumor categories were lung, ovary, and gastrointestinal. The proportion of complete plus partial responses in evaluable lung cancer patients was 40/236 (17%), compared to 20/44 (45%) for ovarian cancer patients and 6/39 (15%) for gastrointestinal tumors. Of the patients who could be evaluated for toxicity, 47% had minimal or no toxicity, 51% had moderate to severe toxicity, and 2% had life threatening toxicity. Virtually all patients were treated and managed as outpatients.

Bis chloroethyl nitrosourea, vincristine, dimethyl triazeno imidazole carboxamide and chlorpromazine combination chemotherapy in disseminated malignant melanoma

One hundred twenty-one patients with disseminated malignant melanoma were treated with BCNU, vincristine, DTIC, and chlorpromazine (BVD). A response rate of 22% was observed; 28% of the patients had stable disease and 50% had increasing disease. Similar response rates were obtained with both the high dose and low dose treatment schedules. Patients who exhibited some degree of improvement during their initial course of treatment had the highest overall response rate (72%) to BVD chemotherapy. The median survival from onset of therapy was six months for all patients and 18 months for patients who responded to chemotherapy. The median duration of response was 9.9 months. Thus, the addition of chlorpromazine to BVD chemotherapy did not increase tumor response, and the overall results obtained were comparable to DTIC alone. Patients were found to be lymphopenic prior to the onset of therapy. Their median absolute lymphocyte count was 1800/mm3. Those patients with absolute lymphocyte counts above the 2710/mm3 normal mean had significantly higher response rates (35% vs. 19%, P less than .05) and longer survivals (9.8 months vs. 4.3 months, P less than .05) than patients with lower initial lymphocyte levels. Pretreatment eosinophil and monocyte counts were not closely correlated with patient response or survival.

Effects of riboflavin deficiency on the ultrastructure of rat sciatic nerve fibers

Ultrastructural studies indicate that riboflavin deficiency induced by either dietary restrictions alone or with the addition of the antagonist galactoflavin severely affects the structural integrity of myelin lamellae. The degenerative process induced by riboflavin deficiency is time dependent. Nonmyelinated nerve fibers are not affected ultrastructurally by the deficiency. Cellular organelles of both myelinated and nonmyelinated nerve fibers remain intact and presumably functional.

Hydroxyldaunomycin (Adriamycin) combination chemotherapy in malignant lymphoma

Combination chemotherapy with CHOP (cyclophosphamide, Adriamycin, vincristine, and prednisone) and HOP (Adrimycin, vincristine, and prednisone, was used as treatment for patients with pathologically staged, advanced non-Hodgkin's lymphoma. Among 204 evaluable patients treated on CHOP there were 71% complete remissions with 92% overall responses. Among the 216 evaluable patients on HOP there were 61% complete remissions and 88% responses. Complete remission rates among patients with histiocytic lymphoma were comparable to those of patients with lymphocytic disease. Patients with nodular lymphoma had higher rates of complete remission than their counterparts with diffuse lymphoma. This was noted with both CHOP (78% vs. 67%) and HOP (67% vs. 60%) induction therapy. Rapid responses were common, as more than 14% of complete remissions and 66% of overall responses were achieved with the first course of treatment. Patients in complete remission have been maintained with either cyclophosphamide, vincristine, and prednisone (COP) or arabinosyl cytosine, vincristine, and prednisone (OAP). After 1 year, 86% of patients on COP and 80% on OAP are projected to be free of disease.

The effects of bleomycin on immunocompetence in man

Bleomycin was administered to six patients with advanced cancer. Multiple parameters of both antibody- and cell-mediated immunity were followed serially to characterize the effects of bleomycin on immunocompetence in humans. Antibody-mediated immunity, including primary vaccination with keyhole limpet hemocyanin, was not depressed. While there was no significant suppression of cell-mediated immunity, phytohemagglutinin-stimulated lymphocyte blastogenesis was reduced after treatment with bleomycin. The in vitro effects of bleomycin on lymphocyte stimulation were studied, and while thymidine incorporation was significantly inhibited by bleomycin, leucine incorporation was not reduced even at high concentrations of bleomycin. We have concluded that bleomycin does not suppress immunocompetence in man.

The nitroblue tetrazolium test in patients with advanced neoplastic diseases

The nitroblue tetrazolium test (NBT) was evaluated in 111 patients with cancer. Patients were placed into control and "presumed infected" groups. The mean NBT score for the control group, 6.3, was significantly greater than the mean for a group of normal volunteers, 3.1, but the mean score for the "presumed infected" group, 15.6 was significantly higher. Less than 10 percent of the patients with bacterial infection had scores below 10, while 15 percent of the control patients had unexplained high scores. A method for concentrating leukocytes is described which makes the NBT test feasible in patients with granulocytopenia. Morphological changes in granulocytes used as indicators of infection are unreliable markers in cancer patients, in whom such changes occur frequently in the absence of infection. We have found that the NBT test is more useful as an indicator of infection in patients with cancer.

In vitro studies of contact hypersensitivity. The effect of the haptens 2,4-dinitrochlorobenzene (DNCB) and 2,4-dinitrofluorobenzene (DNFB) and of hapten-protein conjugates on the migration of guinea-pig peritoneal exudate cells

The inhibition of macrophage migration test has been used to study the in vitro effect of simple chemical sensitizers, 2,4-dinitrochlorobenzene (DNCB) and 2,4-dinitrofluorobenzene (DNFB) on peritoneal exudate cells harvested from animals exhibiting contact hypersensitivity to the haptens. Specific inhibition of migration of cells from eleven out of twelve sensitized animals was achieved when cells were cultured in the presence of a dinitrophenyl-guinea-pig serum conjugate in a concentration which had no effect on cells from normal animals. The unconjugated haptens were toxic to cells and inhibited, non-specifically, the migration from capillary tubes of cells from normal guinea-pigs and from guinea-pigs sensitized to DNCB and DNFB, cultured in the presence of low concentrations of the haptens. Non-specific inhibition also occurred with high concentrations of the conjugates, dinitrophenyl-lysine and dinitrophenyl-guinea-pig erythrocyte stromata, while lower concentrations of these conjugates had little effect.