[Carboplatin-VP16 combination in non small cell lung cancers in the aged patient. A study of the French group in pneumology (GFPC)]

Between February 1992 and May 1993, 22 patients older than 75 years, with non small cell lung cancer, were treated with carboplatin and oral etoposide. There were 18 men and four women with a median age of 79 years. Fourteen patients had an epidermoid carcinoma: four had an adenocarcinoma and four had an undifferentiated carcinoma. Carboplatin was administered intravenously on day 1 at a dose of 300 mg/m2; oral etoposide was administered at a dose of 600 mg/m2 (two capsules daily) for 9, 10, 11, or 12 days according to body surface. Courses were repeated every 28 days for a total of three courses.

TOXICITY

15 patients (68%) had received previous chemotherapy. Myelosuppression was the main problem with one grade IV and five grade III hematologic toxicities. We observed one mild neurologic toxicity.

RESULTS

19 patients were evaluable for response. We observed one complete response (5%), five disease stabilizations (26%) and 13 disease progressions. Median survival was 5 months. These results led to discontinue this study.

Comparison between late onset and childhood asthma

BACKGROUND

The onset of asthma frequently occurs after the age of 50 yr and the severity and causes of this late onset disease are poorly known.

METHODS

25 chronic asthmatics (65.7 +/- 6.5 yr) whose asthma started after the age of 50 yr were compared with 23 chronic asthmatic children (11.6 +/- 2.8 yr) and 24 COPD patients (61.6 +/- 3.4 yr). Both asthmatic groups had a similar apparent duration of asthma. None of the asthmatics was a smoker. All COPD were smokers. The severity of asthma was defined according to the Aas score. FVC, FEV1, MMEFR, Raw were tested and reversibility of bronchial obstruction was determined on Raw after salbutamol inhalation. Allergy was assessed by skin prick tests, RAST and total serum IgE (PRIST).

RESULTS

Patients with childhood asthma had: 1) a significantly lower clinical severity of asthma; 2) a significantly less severe bronchial obstruction, and 3) a significantly greater reversibility than old age asthmatics. There was no significant difference between pulmonary function tests pre- and post-bronchodilators between COPD and old-age asthmatics. All asthmatic children and 40% of older patients were allergic.

CONCLUSIONS

The occurrence of asthma in old age patients leads to a more severe course of the disease and allergy appears to play a role in many old age patients.

Pharmacokinetics of vinorelbine in man

The pharmacokinetics of vinorelbine has been investigated by a new HPLC method in 8 cancer patients receiving 8 weekly doses (30 mg.m-2) administered by brief infusion (15 min). The plasma concentration-time curves showed a tri-exponential decay with a long terminal half-life (44.7 h) and a high volume of distribution (Vz = 75.61.kg-1). The concentrations after the 8th infusion were significantly lower than after the 1st infusion, but without significant modification of CL (1.28 l.h-1.kg-1) or AUC (0.80 mg.l-1.h). The pharmacokinetic parameters exhibited wide interindividual variations. The results are consistent with those of previous RIA studies, although the HPLC method appears to be more specific and more precise.

[Treatment of asthma in the adult using a combination of salbutamol 100 micrograms--beclomethasone 50 micrograms. Results of a study on 1917 patients seen in general medicine]

Efficacy and safety of salbutamol--beclomethasone combination were studied in a multicentre trial in general practice which included 1917 asthmatic patients. During a 7 day run-in period, the number of dyspnea episodes, the morning and evening PEFR values were recorded daily. Patients were then treated with 2 puffs of salbutamol--beclomethasone combination t.i.d. or q.i.d. Results showed a significant improvement of the daily number dyspnea episodes (from 2.7 to 1.4) and of the daily number of salbutamol puffs used as rescue medication (from 5,1 to 2,5) (p less than 0.001). Morning and evening PEFR were increased by 50 litres min-1 (p less than 0.001). Symptoms were significantly improved, particularly nocturnal dyspnea (p less than 0.001). Minor and usual adverse events were noted in only 2,7% of the population. Salbutamol--beclomethasone allows a good control of asthma, particularly a good nocturnal cover. This efficacy with a good safety profile makes salbutamol--beclomethasone combination a well-adapted maintenance treatment of asthma.

[Specific immunotherapy using Alpha-Fraction-Retard-D. pteronyssinus. Double-blind study in asthma]

A multicenter, double blind clinical study on two homogeneous, treated and untreated groups, has allowed an objective appreciation of the results of specific immunotherapy using the alpha-fraction of D. pteronyssinus in asthma. A statistically significant difference was seen of the consumption of drugs in the treated group and in infants of less than 5 years (p = 0.047). Tolerance, evaluated as a function of local and secondary effects was excellent and comparable in the two groups.

[Inflammation: a major role in the occurrence of bronchospasm]

Until now, when bronchospasm occurs, modifications of the contractility of smooth muscle and mediator release have been considered as the main causes. Better understanding of the epithelial barrier indicates that it takes part in all stages of the reduction of bronchial diameters. Inflammation is also implicated in hyper-reactivity of smooth muscle, in mediator release and in the production of cellular factors such as the cytokines by the epithelium. There are many causative cells, but it is probable that the eosinophils are the group that plays the preponderant role in the appearance of bronchospasm.

Pirarubicin phase II study in untreated metastatic small-cell lung carcinoma. A cooperative study of the Groupe Français de Pneumo-Cancérologie (GFPC)

Pirarubicin (THP) (Roger Bellon Laboratory, France) is a new anthracycline under clinical development. In order to assess the efficacy and toxicity of the drug in small-cell lung carcinoma (SCLC), we have undertaken this trial in front-line therapy in patients with metastatic disease, PS less than 3 and at least one evaluable lesion. Responses were assessed after two cycles of THP (60 mg/m2 i.v. bolus every 3-4 weeks) and a further cross over to VP16 + CDDP (three cycles) was systematic whatever the response to THP. This crossover was performed after only one cycle in case of obvious progression. From June 1988 to April 1990, 32 patients were enrolled: 6 were ineligible (4 non-SCLC, 2 M0), 26 patients were fully evaluable for THP and 18 patients for VP16-CDDP. The characteristics of the patients were as follows: mean age 57.4 years (38-71); T4: 54%; T3: 27%; T2: 19%; N3: 62%; N2: 35%; No: 4%. The efficacy was as follows 1 complete response and 2 partial responses (confirmed by endoscopy); 12 patients received only one cycle because of obvious progression; the overall response rate is 12% (95% confidence interval 0-24%). The patient who had complete response after pirarubicin remained in CR after VP16-CDDP, whereas the 2 patients who had partial response achieved CR for one and PR for the other; among the 15 who did not respond 1 CR and 7 PR were observed. The only significant toxicity of THP was granulopenia without infection. THP seems to be an effective anthracycline in SCLC, and the study is continuing. A response could be reached in 50% of the nonresponders with standard therapy and 10 of 24 patients (42%) finally responded. Therefore, this schedule for testing new drugs in metastatic SCLC appears ethically acceptable.

Hyperthyroidism without elevated levels of thyroxine and triiodothyronine in a patient with pulmonary tuberculosis

We have reported a case of toxic thyroid adenoma with low T3 and low T4 syndrome in a patient who received antituberculous drugs for active pulmonary tuberculosis. Search for thyroid-hormone-binding antibodies was negative. Thyroid lobectomy was done and histologic examination confirmed toxic thyroid adenoma; two months after operation the patient was clinically and biologically euthyroid. During the course of a severe nonthyroidal illness, normal thyroid hormone levels must be regarded as an indicator of hyperthyroidism. In addition, we believe that rifampin has a significant effect on thyroid function tests and results of thyroid physiology.

[Intravenous theophylline in the treatment of asthma attacks]

Intravenous administration of theophylline for acute asthmatic attacks treatment requires statistical adjustment of the dosage. In the absence of a residual level the former one is of 6 mg/kg for the loading dose and 0.6 mg/kg/h for the maintenance dose. In case of non estimated residual rate, it's possible either not to use the loading dose, or to use a reduced dosage of 3 mg/kg. In both cases, the maintenance dose is 0.7 mg/kg/h. In future, rapid theophylline dosage technics should allow a more appropriate adaptation in emergency treatment.

[Skin tests in the exploration of perianesthetic complications]

Adverse reactions in anesthesia are more and more frequent. The favoring factors are multiple but the physiopathology of these reactions are not right known: non specific histamine-release, complement activation is anaphylaxis can occur. Skin tests are an very important data for the diagnosis of these accidents. Forty patients and ten healthy subjects were tested with systematic research of a cross-reactivity for curare family; myorelaxants, fluid gelatin, dextran are the tests the most frequently positive. Cross reactivity for curare family is sure and sensibilization by some medicine is possible. Then the behavior of the data is looked at; the research of the favoring factors, the non utilization of some substances and prophylactic treatment are recommended.

[Significance and evaluation of theophyllinemia in clinical medicine]

The theophyllinemia variations depend upon some factors: -observance of treatment, time of blood swab posology, laboratory technic, concomitant drugs, method of adaptation selected and the mean of administration. The theophylline title is a very important biologic parameter, necessary to the asthma treatment survey through such drug. Daily posology may be adapted to this titrate.

[Extrinsic allergic alveolitis (extrinsic allergic broncho- alveolitis, pneumopathies with precipitins, hypersensitivity pneumopathies)]

The author does a general survey on this subject. Having evoked the EAA history, he describes the clinical syndrome with 3 forms (sharp to chronic). He relates in a first part, the main forms linked with rural occupation, from farmer's lung disease, the most frequent, to illnesses dues to cereals, woods exposition, then the one in touch with industry as coffee workers disease, and breeders of silkworms. At last, the ones in connection with urban activities as air-conditioner disease. These descriptions ended with EAA caused by a drug. Having evoked the complementary investigations necessary for diagnosis, he insists on the alveolitis washing and biochemicals studies. In conclusion, the author insists on the interest of steroids treatment in attacks.