Gemcitabine as first-line therapy in patients with metastatic breast cancer: a phase II trial

OBJECTIVES

This phase II study was conducted to evaluate the efficacy and safety of gemcitabine in patients with metastatic breast cancer (MBC).

METHODS

Women with histologically or cytologically confirmed bidimensionally measurable MBC not amendable to curative surgery or radiation were eligible. Prior chemotherapy for metastatic disease was not permitted. Patients received gemcitabine 1,200 mg/m(2) on days 1, 8 and 15 for 3 weeks every 28 days for a maximum of 8 cycles.

RESULTS

Thirty-nine patients, with a median age of 58 years, were enrolled. The overall response rate for the 35 evaluable patients was 37.1% (95% confidence interval [CI], 21.5-55.1%), with 2 complete responses and 11 partial responses. Median time to progression and survival were 5.1 months (95% CI, 3.5-8.8 months) and 21.1 months (95% CI, 11.0-26.9 months), respectively. Chemotherapy was well tolerated, with a median of 4 cycles completed. Grade 4 toxicities were 1 infection and 1 abnormal pulmonary function. Grade 3 neutropenia and thrombocytopenia occurred in 30.3% and 6.3% of patients, respectively. The most common grade 3 non-hematologic toxicity was nausea/vomiting (10.3%). Five of 21 patients had improved Karnofsky performance status (KPS) scores.

CONCLUSION

Single-agent gemcitabine is active and well tolerated as first-line treatment in patients with MBC.

A conserved MYB transcription factor involved in phosphate starvation signaling both in vascular plants and in unicellular algae

Plants have evolved a number of adaptive responses to cope with growth in conditions of limited phosphate (Pi) supply involving biochemical, metabolic, and developmental changes. We prepared an EMS-mutagenized M(2) population of an Arabidopsis thaliana transgenic line harboring a reporter gene specifically responsive to Pi starvation (AtIPS1::GUS), and screened for mutants altered in Pi starvation regulation. One of the mutants, phr1 (phosphate starvation response 1), displayed reduced response of AtIPS1::GUS to Pi starvation, and also had a broad range of Pi starvation responses impaired, including the responsiveness of various other Pi starvation-induced genes and metabolic responses, such as the increase in anthocyanin accumulation. PHR1 was positionally cloned and shown be related to the PHOSPHORUS STARVATION RESPONSE 1 (PSR1) gene from Chlamydomonas reinhardtii. A GFP::PHR1 protein fusion was localized in the nucleus independently of Pi status, as is the case for PSR1. PHR1 is expressed in Pi sufficient conditions and, in contrast to PSR1, is only weakly responsive to Pi starvation. PHR1, PSR1, and other members of the protein family share a MYB domain and a predicted coiled-coil (CC) domain, defining a subtype within the MYB superfamily, the MYB-CC family. Therefore, PHR1 was found to bind as a dimer to an imperfect palindromic sequence. PHR1-binding sequences are present in the promoter of Pi starvation-responsive structural genes, indicating that this protein acts downstream in the Pi starvation signaling pathway.

Enhanced neutrophil response in chronic obstructive pulmonary disease

BACKGROUND

Neutrophils are likely to play a major role in the inflammatory response seen in chronic obstructive pulmonary disease (COPD). This study sought to address the hypothesis that an enhanced neutrophil response to proinflammatory agents in COPD may contribute to their recruitment and activation in the lungs.

METHODS

Circulating neutrophils were obtained from 10 patients with COPD, eight long term smokers with normal lung function, and eight healthy never smoking controls. The in vitro production of reactive oxygen species (ROS) was measured by the NADPH oxidase method (respiratory burst) and the surface expression of several adhesion molecules (Mac-1, LFA-1 and L-selectin) was measured by flow cytometry. Measurements were obtained under basal conditions and after stimulation with phorbol myristate acetate (PMA) and tumour necrosis factor alpha (TNFalpha). mRNA levels of p22-phox (a subunit of NADPH oxidase) and Mac-1 (CD11b) were also determined by reverse transcriptase polymerase chain reaction (RT-PCR).

RESULTS

Patients with COPD showed enhanced respiratory burst compared with smokers with normal lung function, both under basal conditions (mean (SE) fluorescence intensity (MFI) 15.1 (0.5) v 11.6 (0.5); mean difference -3.4 (95% CI of the difference -5.1 to -1.8), p<0.01) and after PMA stimulation (MFI 210 (7) v 133 (10); mean difference -77 (95% CI of the difference -102 to -52), p<0.01). Mac-1 surface expression was also enhanced in patients with COPD, both under basal conditions (MFI 91 (5) v 45 (3); mean difference -46 (95% CI of the difference -61 to -31), p<0.001) and after stimulation with TNFalpha (MFI 340 (15) v 263 (11); mean difference -77 (95% CI of the difference -119 to -34), p=0.001). These differences were also apparent when patients with COPD were compared with non-smokers (p<0.05). The mRNA levels of p22-phox and Mac-1 (CD11b) were similar in patients with COPD and smokers with normal lung function, suggesting that the observed differences were due to post-transcriptional regulation.

CONCLUSIONS

These results demonstrate an enhanced neutrophil response to proinflammatory agents in patients with COPD which may contribute to their enhanced recruitment and activation in the lungs of these patients. These findings support those of other studies which have indicated that the neutrophil is likely to play a major role in the pathogenesis of this disease.

[Comparative study of reduced-size and whole liver transplantation in children]

It is difficult to find adequate donors for many children with low weight. In order to increase the pool size of donors and decrease mortality on the waiting list, several reduction techniques have been developed in the last years (reduced, segmental and split liver). The aim of this study is to compare morbility and mortality in our serie between children who received a full-size liver and those who received a partial one. We retrospectively compared 27 cases of reduced-size liver transplants (RLTx) with 102 cases of full-size liver transplants (FLTx) performed between june of 1985 and february of 2000. Mean age in RLTx was 38.1 months (range 6-144) vs 70.8 months (range 5-192) in FLTx. Mean weight was 11.9 k (range 5.8-30) in RLTx vs 20.48 k (range 4.4-68) in FLTx. Mean donor/recipient body ratio was 4.88 in RLTx and 2.03 in FLTx. The indication of transplantation was urgent in 14 patients (51.8%) from the RLTx group and in 12 (11.7%) from the FLTx one. The requirements of transfusions during surgery was greater in the RLTx (177 cc/kg of RBC transfusions vs 124 cc in FLTx). There was no differences between both groups regarding other postoperative complications (portal thrombosis, need of reintervention and biliary complications). Arterial thrombosis was observed only in FLTx (12 cases). Graft survival at 3 months was 49% for the RLTx and 73% for the FLTx. It was 43% and 67%, respectively, at 1 year, and 43% and 53% at 5 years after liver transplantation (p = 0.06). If we consider only elective transplants, survival was 72% for RLTx and 75% for the FLTx at 3 months. Although survival is lower in the RLTx group, the difference is not significant. If we consider only the elective transplants, survival is almost the same in both groups. The reduction techniques are a good method to decrease mortality in the waiting list without increasing post-transplant morbidity and mortality.

Analysis of risk factors following pediatric liver transplantation

Several recipient, donor and operation factors as well as postoperative complications related to patient survival after liver transplantation (LT) in children were studied by univariate and multivariate analyses. In a 13-year period, 103 patients under 15 years of age underwent 120 LT; the mean age was 63 months and 36% were under 2 years of age. Indications for LT were cholestatic disease in 68 (56%), metabolic diseases in 18 (14%), fulminant hepatic failure in 8 (7.5%), cirrhosis in 7 (5.8%), and retransplants in 17 (14%). Whole liver was transplanted in 79% of cases and partial liver in 21%. Actuarial survival at 1, 5, and 10 years was 70%, 61%, and 57%, respectively. United Network of Organ Sharing (UNOS) I recipients (RR = 2.7), primary non-function (PNF) (RR = 13.9), and hepatic artery thrombosis (HAT) (RR = 3.8) were independent factors for lower patient survival in multivariate analysis. Thus, in our experience, postoperative mortality as a consequence of the patient's condition before transplantation, or complications such as PNF or HAT, are the major causes of decreased survival in pediatric LT.

Enhanced neutrophil response in chronic obstructive pulmonary disease

BACKGROUND

Neutrophils are likely to play a major role in the inflammatory response seen in chronic obstructive pulmonary disease (COPD). This study sought to address the hypothesis that an enhanced neutrophil response to proinflammatory agents in COPD may contribute to their recruitment and activation in the lungs.

METHODS

Circulating neutrophils were obtained from 10 patients with COPD, eight long term smokers with normal lung function, and eight healthy never smoking controls. The in vitro production of reactive oxygen species (ROS) was measured by the NADPH oxidase method (respiratory burst) and the surface expression of several adhesion molecules (Mac-1, LFA-1 andl-selectin) was measured by flow cytometry. Measurements were obtained under basal conditions and after stimulation with phorbol myristate acetate (PMA) and tumour necrosis factor alpha (TNFα). mRNA levels of p22-phox (a subunit of NADPH oxidase) and Mac-1 (CD11b) were also determined by reverse transcriptase polymerase chain reaction (RT-PCR).

RESULTS

Patients with COPD showed enhanced respiratory burst compared with smokers with normal lung function, both under basal conditions (mean (SE) fluorescence intensity (MFI) 15.1 (0.5) v 11.6 (0.5); mean difference –3.4 (95% CI of the difference –5.1 to –1.8), p<0.01) and after PMA stimulation (MFI 210 (7) v 133 (10); mean difference –77 (95% CI of the difference –102 to –52), p<0.01). Mac-1 surface expression was also enhanced in patients with COPD, both under basal conditions (MFI 91 (5)v 45 (3); mean difference –46 (95% CI of the difference –61 to –31), p<0.001) and after stimulation with TNFα (MFI 340 (15) v 263 (11); mean difference –77 (95% CI of the difference –119 to –34), p=0.001). These differences were also apparent when patients with COPD were compared with non-smokers (p<0.05). The mRNA levels of p22-phox and Mac-1 (CD11b) were similar in patients with COPD and smokers with normal lung function, suggesting that the observed differences were due to post-transcriptional regulation.

CONCLUSIONS

These results demonstrate an enhanced neutrophil response to proinflammatory agents in patients with COPD which may contribute to their enhanced recruitment and activation in the lungs of these patients. These findings support those of other studies which have indicated that the neutrophil is likely to play a major role in the pathogenesis of this disease.

Growth hormone/insulin-like growth factors axis in children undergoing cardiac surgery

OBJECTIVES

To describe the sequential changes in the growth hormone (GH)/insulin-like growth factors axis and their relationship with nitrogen balance in children following cardiac surgery.

DESIGN

Prospective, descriptive study.

SETTING

Pediatric intensive care unit of a university hospital.

PATIENTS

Twenty three postoperative cardiac surgical patients after bypass.

INTERVENTIONS

Blood and urine samples were taken on days 1, 2, and 7 of pediatric intensive care unit admission. An intraanesthesia, presurgery sample was also obtained.

MEASUREMENTS AND MAIN RESULTS

Serum concentrations of insulin, insulin growth factor-I (IGF-I), insulin growth factor binding proteins 1 and 3 (IGFBP-1 and IGFBP-3), growth hormone binding protein (GHBP), and urinary concentrations of GH and free cortisol (UFC) were measured on days 1, 2, and 7 of the study period. C-reactive protein and prealbumin, were also measured in blood samples as conventional markers of inflammatory or nutritional status. Pediatric Risk of Mortality II score and UFC were used as indicators of acute stress. The nitrogen balance and urinary nitrogen urea excretion were used as markers of catabolic state. Urinary concentrations of GH were high from days 1 to 7. Plasma concentrations of IGF-I and GHBP were low and remained low throughout the study period. IGFBP-3 levels were below normal but without reaching statistical significance. The IGFBP-1 levels were initially high but descended progressively toward normal values. Urinary nitrogen urea production was persistently elevated and was associated with a negative nitrogen balance. No relationship was found between nitrogen balance and IGF-I, prealbumin, or C-reactive protein.

CONCLUSIONS

A GH-resistant state is observed in postoperative children following cardiac surgery. Stress response is characterized by an elevation of growth hormone secretion that is not followed by the corresponding increment in IGF-I and IGFBP-3 concentrations. These hormonal changes may be permissive for the catabolic state of these patients. IGF-I and IGFBP-1 and -3 are not related to either nitrogen balance or urinary nitrogen urea excretion.

Influence of cytokinins on the expression of phosphate starvation responsive genes in Arabidopsis

The increase in the ratio of root growth to shoot growth that occurs in response to phosphate (Pi) deprivation is paralleled by a decrease in cytokinin levels under the same conditions. However, the role of cytokinin in the rescue system for Pi starvation remains largely unknown. We have isolated a gene from Arabidopsis thaliana (AtIPS1) that is induced by Pi starvation, and studied the effect of cytokinin on its expression in response to Pi deprivation. AtIPS1 belongs to the TPSI1/Mt4 family, the members of which are specifically induced by Pi starvation, and the RNAs of which contain only short, non-conserved open reading frames. Pi deprivation induces AtIPS1 expression in all cells of wild-type plants, whereas in the pho1 mutant grown on Pi-rich soils, AtIPS1 expression in the root was delimited by the endodermis. This supports the view that pho1 is impaired in xylem loading of Pi, and that long-distance signals controlling the Pi starvation responses act via negative control. Exogenous cytokinins repress the expression of AtIPS1 and other Pi starvation-responsive genes in response to Pi deprivation. However, cytokinins did not repress the increase in root-hair number and length induced by Pi starvation, a response dependent on local Pi concentration rather than on whole-plant Pi status. Our results raise the possibility that cytokinins may be involved in the negative modulation of long-distance, systemically controlled Pi starvation responses, which are dependent on whole-plant Pi status.

The influence of gemcitabine and cisplatin schedule on response and survival in advanced non-small cell lung cancer

PURPOSE

Gemcitabine-cisplatin combinations are among the most active for the treatment of non-small cell lung cancer. Previous reports have suggested that the day of cisplatin administration affects both toxicity and drug delivery. We undertook this retrospective analysis to determine whether it also affects response and survival.

PATIENTS AND METHODS

This was a retrospective analysis of six studies of gemcitabine and cisplatin. Gemcitabine, 1000-1500 mg/m(2) was administered on days 1, 8, and 15 of a 28 day cycle. In four studies cisplatin 100 mg/m(2) was administered with mannitol diuresis every four weeks on either day 1, day 2 or day 15. In two studies cisplatin 25-30 mg/m(2) was administered on day 1, 8 and 15. Standard prognostic factors including age, gender, stage, performance status, and histologic subtype were analyzed along with day of cisplatin administration. Single variable Cox proportional hazards regressions were performed. This was followed by multiple variable Cox proportional hazards regression, beginning with a full model containing terms for gender, age, performance status and stage. The least statistically significant terms were subsequently dropped from the model to reach a final model with only statistically significant variables. A similar approach was followed to fit a multiple variable logistic regression model to overall response data.

RESULTS

Overall response rates were highest (36-46%) in the three studies that administered cisplatin on days 2 or 15, and these studies had the highest 1-year survival rates (52-58%). Survival was better for patients who received cisplatin on day 2 or 15 compared to those treated on either day 1 or weekly on days 1, 8, 15 (P=0.020). In the final model of the Cox regression analysis, survival was better for cisplatin on days 2 or 15 (hazard ratio=0.69, P=0.008) and female gender (hazard ratio=0.72, P=0.036). Only cisplatin delivery on day 2 or day 15 predicted for significantly better response (42 vs. 29%, P=0.036).

CONCLUSION

In a 28 day cycle in which gemcitabine is administered day 1, 8 and 15, the best therapeutic index is achieved with cisplatin administration on day 2 or 15.

Diagnosis of human oligodendrogliomas with the help of the NeuroShell Easy Classifier neural network

OBJECTIVE

To examine whether a suitable solution can be found concerning the ability to reproduce the histologic classification of human oligodendrogliomas with the assistance of the NeuroShell Easy Classifier neural network.

STUDY DESIGN

Histologic sections of 449 human oligodendrogliomas were selected. The diagnostic task was given by differentiation of three oligodendroglioma types: 121 low grade oligodendrogliomas, World Health Organization grade 2; 180 low grade oligoastrocytomas; and 148 anaplastic oligodendrogliomas, grade 3. Age, sex and 50 histologic characteristics were examined in each case, describing the presence of a specific histologic feature on a scale of four (zero, absence of the feature; three, abundant presence). From each group, two-thirds of randomly selected tumors were available for the training set and one-third for the testing set.

RESULTS

In the three-class problem, 98.88% of the tumors were correctly classified (testing set). Ninety-nine percent of new testing tumors were correctly classified with Easy Classifier as low grade and anaplastic oligodendrogliomas. In the case of low grade oligodendrogliomas versus low grade oligoastrocytomas, 99% of new tumors were correctly classified.

CONCLUSION

The main conclusion from this study is that Easy Classifier was able to differentiate, with high accuracy, sensitivity and specificity, among the three types of oligodendrogliomas.

Non-heart-beating donors from the streets: an increasing donor pool source

BACKGROUND

Non-heart-beating donors have become a source for organ donation, especially kidneys. The emergency room and the critical care unit are the two sources for this kind of donor. Three years ago, our hospital began a policy of obtaining organs and tissues successfully from subjects who died in the streets.

METHODS

We consider as potential organ donors people who die out-of-hospital, are less than 50 years old, with less than 15 min of asystolia without cardiac massage, with a known etiology of death, and without general contraindications for donating. After death diagnosis, the cadaver is taken to the hospital where an emergency room doctor certifies the death. Afterward, the cadaver is transferred to the operating room where a cardiopulmonary bypass is performed to preserve the organs while the legal aspects of donation go on.

RESULTS

Up to now, 111 cadavers have been taken as non-heart-beating donors; 53 of them have been actual donors. The average time before arrival to the hospital was 68+/-2.64 min, and the average interval between cardiac arrest and the beginning of cardiopulmonary bypass was 111.33+/-7.09 min. We have obtained 105 kidneys, 12 livers, 84 corneas, and 31 pancreata for islets isolation as well as 49 long bones. Seventy-two kidneys were transplanted, with a probability of survival of 83% at 36 months.

CONCLUSIONS

Our experience indicates that it is possible to obtain organs for transplant from donors who die in the streets and are brought to the hospital under strict selection criteria.

[Neural bases of perception and recognition of faces]

OBJECTIVE

To analyze the neural bases of perception and the recognition of faces. First of all we consider the concept of functional hemisphere specialization; then we look at the results obtained with regard to the neuroanatomy of processing faces and finally refer to the disorders of recognition of faces in humans. For this we review the clinical evidence obtained from the neuropsychological studies of prosopagnostic patients and the data derived from psychophysiological experiments done using intracranial recordings of nonhuman primates.

DEVELOPMENT

The agreement between the results analysed allows us conclude that in both cerebral hemispheres there are neural mechanisms specialized in the perception and recognition of faces, and in particular the ventral and posterior regions of the occipito-temporal cortex play a decisive part in these processes. Similarly experimental findings in nonhuman primates permits explanation of the neural nature of certain neuropsychological disorders seen in man, such as the case of the dissociation between disorders of the recognition of facial identity and disorders of recognition of emotional expression, and also dissociation between the difficulty in recognizing familiar faces and difficulty in recognizing non-familiar faces.

CONCLUSION

The use of modern neuroimaging techniques and electrophysiological studies using evoked potentials are necessary for greater understanding of these and other disorders related to processing facial information.

Making features relevant: learning faces and event-related potentials recording using an analytic procedure

We present a procedure designed for the learning of faces (represented by realistic drawings) and a task for the subsequent recording of Event-Related Potentials (ERPs), with the aim of investigating the psychobiological mechanisms involved in the recognition of familiar (or known) faces. The learning procedure consisted in a series of six sessions in which subjects familiarized themselves with the faces through a forced-choice features task: after the study of a set of 40 faces, each of these was presented at random in an incomplete way (without the eyes/eyebrows fragment), together with two sets of eyes and eyebrows for the subject to decide which of them corresponded to each face. This procedure is thought to facilitate for subjects the acquisition of the information related to the structural description of the faces (that is, without associated verbal/semantic information) using preferentially analytic processing strategies. The parameter d' of the Theory of Signal Detection allowed us to evaluate in the course of the learning sessions the degree of familiarization achieved with the studied faces. Subsequently, an ERPs' recording session was carried out, during which subjects executed a face-feature matching task. In this task, similar in structure to that carried out in the learning sessions, the subject had to decide whether the automatic completion of the faces that was made was correct or incorrect. ERPs' effects related to mismatching features were obtained, which indicate the existence of specific cerebral mechanisms involved in the recognition of faces.

Albumin is a major serum survival factor for renal tubular cells and macrophages through scavenging of ROS

We have previously shown that lysophosphatidic acid (LPA), an abundant serum lipid that binds with high affinity to albumin, is a potent survival factor for mouse proximal tubular cells and peritoneal macrophages. We show here that BSA also has potent survival activity independent of bound lipids. Delipidated BSA (dBSA) protected cells from apoptosis induced by FCS withdrawal at concentrations as low as 1% of that in FCS. dBSA did not activate phosphatidylinositol 3-kinase, implying that its survival activity occurs via a mechanism distinct from that for most cytokines. On the basis of the following evidence, we propose that dBSA inhibits apoptosis by scavenging reactive oxygen species (ROS): 1) FCS withdrawal leads to ROS accumulation that is inhibitable by dBSA; 2) during protection from apoptosis, sulfhydryl and hydroxyl groups of dBSA are oxidized; and 3) chemical blockage of free sulfhydryl groups or preoxidation of dBSA with H(2)O(2) removes its survival activity. Moreover, dBSA confers almost complete protection from cell death in a well-established model of oxidative injury (xanthine/xanthine oxidase). These results implicate albumin as a major serum survival factor. Inhibition of apoptosis by albumin occurs through at least two distinct mechanisms: carriage of LPA and scavenging of ROS.

Randomized phase II study of high-dose paclitaxel with or without amifostine in patients with metastatic breast cancer

PURPOSE

To determine whether the neurotoxicity of paclitaxel 250 mg/m(2) given over 3 hours every 3 weeks could be reduced by pretreatment with amifostine 910 mg/m(2). Secondary objectives included comparing myelosuppression, myalgias, and response rates of the two groups.

PATIENTS AND METHODS

Forty women with metastatic breast cancer were randomized to receive either paclitaxel alone (arm 1) or paclitaxel preceded by amifostine (arm 2). All were assessable for toxicity, and 37 were assessable for response. At baseline and after each cycle, all patients completed questionnaires for neurologic symptoms and had standardized neurologic examinations, including objective assessments of power and vibration sense. In addition, standard follow-up assessments for other toxicities and tumor response were undertaken. Changes from baseline after courses 1, 2, and 3 were assessed. The sample size was sufficient to detect a 50% improvement in the expected determination in sensory change.

RESULTS

There were no differences observed in any of the measures of neurotoxicity. Other toxicity was similar in arms 1 and 2, including hair loss (95% v 90%), neurosensory changes (100% v 100%), fatigue/lethargy (85% v 90%), myalgia (95% v 90%), and grade 4 neutropenia (47% v 60%). Nausea, vomiting, dizziness, hypotension, and sneezing were more common in the amifostine arm. Response rates (22.2% v 36.8%) and paclitaxel pharmacokinetics were not significantly different.

CONCLUSION

There was no protection from paclitaxel-related neurotoxicity or hematologic toxicity in this study. These results suggest that the mechanism of action of paclitaxel-related toxic effects is not amenable to the cytoprotective action of amifostine.

Phase II study of first-line LY231514 (multi-targeted antifolate) in patients with locally advanced or metastatic colorectal cancer: an NCIC Clinical Trials Group study

BACKGROUND

Metastatic colon cancer is difficult to treat with treatment being palliative and with little effect on survival. This trial has evaluated the effects of LY231514 (Multitargeted antifolate (MTA)) given to previously untreated patients with recurrent or metastatic colorectal carcinoma.

PATIENTS AND METHODS

All patients were required to have a histological diagnosis of colorectal adenocarcinoma with measurable disease and no prior chemotherapy for metastatic disease. Patients had to have had performance status of 0-2, pretreatment absolute granulocyte count of > or = 1.5 x 10(9)/l and a platelet count of > or = 150 x 10(9)l. Patients received MTA at a dose of 600 mg/m2 by 10 minute infusion on day 1 repeated every 21 days. After the first 9 patients, this dose was reduced down to 500 mg/m2 every 21 days because of toxicity. Doses of MTA were modified depending on nadir counts.

RESULTS

Thirty-two eligible patients were enrolled and twenty-nine were evaluable for response. Three patients did not have repeat radiological testing to determine response because they went off study after only one cycle of treatment due to toxicity. In the 29 evaluable patients, there was 1 complete response, 4 partial responses and 14 patients with stable disease. Response rate was 17.2% (95% confidence intervals: 5.8%-35.8%). All responses occurred in the patients receiving a starting dose of MTA 500 mg/m2. Median time to progression for all eligible patients was 3.3 months. The most common toxicities experienced were mild to moderate fever, lethargy, anorexia, nausea, vomiting, stomatitis, abdominal pain, diarrhea, and skin rash. There was one death due to sepsis.

CONCLUSION

Single-agent MTA at 500 mg/m2 given every three weeks has modest activity in metastatic colorectal carcinoma.