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Wilson WH, Jamis-Dow C, Bryant G, Balis FM, Klecker RW, Bates SE, Chabner BA, Steinberg SM, Kohler DR, Wittes RE. Phase I and pharmacokinetic study of the multidrug resistance modulator dexverapamil with EPOCH chemotherapy. J Clin Oncol 1995; 13:1985-94. [PMID: 7636539 DOI: 10.1200/jco.1995.13.8.1985] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Dexverapamil is a competitive inhibitor of the P-glycoprotein (Pgp) efflux pump, a potent mechanism of multidrug resistance (mdr-1) in vitro. We performed a phase I study to determine the maximum-tolerated dose (MTD) and pharmacokinetics of dexverapamil with etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (EPOCH) chemotherapy. PATIENTS AND METHODS Eligible patients had relapsed or refractory lymphoma or sarcoma. Patients initially received EPOCH alone, and those with stable or progressive disease were crossed-over to received dexverapamil on subsequent cycles of EPOCH. Dexverapamil was administered orally for 6 days and escalated over eight dose levels ranging from 240 to 1,200 mg/m2/d. Pharmacokinetics of dexverapamil and its active metabolite, nor-dexverapamil, were obtained in most patients. In seven patients, pharmacokinetics of doxorubicin, doxorubicinol, and etoposide were determined on paired cycles of EPOCH with or without dexverapamil. RESULTS Sixty-five patients received 130 cycles of dexverapamil/EPOCH chemotherapy. The MTD of dexverapamil was 150 mg/m2 every 4 hours (900 mg/m2/d), and hypotension was the principal dose-limiting toxicity. The dexverapamil area under the curve (AUC) increased proportionally with dexverapamil dose, but significant interpatient variation occurred. At the MTD, the median plasma average concentrations of dexverapamil and nor-dexverapamil were 1.2 and 1.4 mumol/L, respectively. Dexverapamil did not affect the steady-state concentration (Css) of etoposide, but increased the Css of doxorubicin and doxorubicinol nearly twofold. The absolute neutrophil and platelet nadirs were significantly lower on the dexverapamil cycles compared with cycles of EPOCH alone, but other chemotherapy-related toxicities did not change. CONCLUSION The phase II recommended dose of dexverapamil with EPOCH is 150 mg/m2 every 4 hours. This dose was well tolerated on an outpatient basis and achieved plasma concentrations of dexverapamil and nor-dexverapamil within the effective range for Pgp inhibition in vitro. Although dexverapamil increased the hematopoietic toxicity of EPOCH, it was mild, readily reversible, and offset by EPOCH dose reductions. Dexverapamil should be considered for further study.
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Affiliation(s)
- W H Wilson
- Medicine Branch, National Cancer Institute, Bethesda, MD 20892, USA
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Wilson WH, Bates SE, Fojo A, Bryant G, Zhan Z, Regis J, Wittes RE, Jaffe ES, Steinberg SM, Herdt J. Controlled trial of dexverapamil, a modulator of multidrug resistance, in lymphomas refractory to EPOCH chemotherapy. J Clin Oncol 1995; 13:1995-2004. [PMID: 7636540 DOI: 10.1200/jco.1995.13.8.1995] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Overexpression of the multidrug resistance gene (mdr-1) is present in up to 60% of relapsed lymphomas. To study its role in lymphomas, we conducted a controlled trial of dexverapamil, an inhibitor of the mdr-1 gene product, P-glycoprotein (Pgp), in lymphomas refractory to etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (EPOCH) chemotherapy. PATIENTS AND METHODS Eligible patients had recurrent Hodgkin's (HD) or non-Hodgkin's lymphomas (NHL) and measurable disease. Patients initially received EPOCH alone and those with stable tumor over two cycles or progressive disease crossed over to receive dexverapamil and EPOCH on subsequent cycles. Dexverapamil was escalated eight dose levels, from 240 to 1,200 mg/m2/d. When possible, serial biopsies were obtained to measure mdr-1 expression by quantitative polymerase chain reaction (PCR). RESULTS Of 154 patients entered onto the trial, 109 had NHL and 45 had HD. The median age was 44 years, 67% had stage IV disease, and the median number of prior regimens was two (range, one to 12) in NHL and one (range, one to four) in HD. Sixty-four patients (42%) crossed over, of which eight were not assessable. The maximum-tolerated dose of dexverapamil was 900 mg/m2/d. Among 41 NHL patients (excluding mycosis fungoides), there were three complete responses (CRs) and two partial responses (PRs) (12%) and five minor responses (MRs); two of 10 HD patients achieved PRs. The mdr-1 level was measured in 44 biopsies from 19 patients. Pretherapy, mdr-1 was low (median, 2.5 U) but increased (median, 12.2 U) at crossover. Of six patients with mdr-1 levels greater than 15 U, three responded to dexverapamil, while only one of eight patients with mdr-1 levels less than 15 U responded. EPOCH and dexverapamil were well tolerated, but compared with EPOCH alone, produced more hematologic toxicity. CONCLUSION These results suggest that Pgp plays a role in clinical drug resistance of lymphomas. However, they also suggest that mechanisms other than Pgp are prominent in heavily pretreated patients and that, although Pgp inhibition may be necessary, it is probably insufficient. Earlier intervention with dexverapamil may be more effective and warrants further study.
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Affiliation(s)
- W H Wilson
- Medicine Branch, National Cancer Institute, Bethesda, MD 20892, USA
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Sundar KS, Kamaraju LS, Dingfelder J, McMahon J, Gollapudi S, Wilson WH, Kong LY, Hong JS, Weiss JM, Lee JE. beta-Endorphin enhances the replication of neurotropic human immunodeficiency virus in fetal perivascular microglia. J Neuroimmunol 1995; 61:97-104. [PMID: 7560019 DOI: 10.1016/0165-5728(95)00089-k] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The effect of an endogenous opiate, beta-endorphin, on the replication of HIV was investigated in brain perivascular microglia. Beta-endorphin enhanced the synthesis of p-24 antigen and transactivation of HIV promoter. Dialysed culture supernatants of endorphin-treated microglia re-activated latent HIV infection. These culture supernatants showed elevated levels of interleukin-1 beta, IL-6 and tumor necrosis factor alpha. Sub-optimal concentration of beta-endorphin potentiated GP-120-induced synthesis of these cytokines. Nalaxone reversed beta-endorphin-induced, but not GP-120-induced, cytokine production and enhanced HIV replication. These results suggest that endogenous opiates may contribute to the progression of AIDS dementia complex.
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Affiliation(s)
- K S Sundar
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
We investigated whether paclitaxel was active in AIDS-associated Kaposi's sarcoma. We gave 135 mg/m2 intravenously over 3 hours every 21 days. Follow-up is available on the first 20 patients, most of whom had advanced Kaposi's sarcoma and severe immunocompromise. Neutropenia was the most frequent dose-limiting toxic effect; novel toxic effects included late fevers, rash, and eosinophilia. Creatinine increased in 2 patients and 1 patient had cardiomyopathy. There were 13 partial responses (65%, 95% CI 41-85%). All 5 patients with pulmonary involvement responded. Paclitaxel appears to be active against Kaposi's sarcoma as a single agent. Further studies, including a randomised trial, are warranted.
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Affiliation(s)
- M W Saville
- National Cancer Institute, Bethesda, MD 20892, USA
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Abstract
OBJECTIVE A modified version of an instrument called the Mathew Materialism-Spiritualism Scale (MMSS), originally developed in India, was evaluated for possible use in substance abuse research in the U.S. METHOD The scale was administered to 62 individuals recovering from substance use, 20 clergy people and 61 general controls. RESULTS Test-retest reliability for the MMSS was verified by administering it to 18 control subjects on two separate occasions, 7 days apart. The Pearson correlation for the MMSS total scores was 0.83 (p < .0001). Internal consistency was examined with Cronbach's alpha in the entire sample of 143 subjects; the result for the total score was .93. Factor analysis showed a factor structure compatible with the subscales proposed by the developer. Women, in general, obtained higher spirituality scores. Members of the recovering group obtained significantly higher scores on "character" and "mysticism" than the general controls. When general controls were divided into MAST positive and MAST negative individuals, the MAST positive group obtained lower scores than the recovering group for "God," "mysticism" and "character." MAST negative individuals had lower scores on "mysticism" than the recovering group. Christians had higher scores on "God" and "religion" subscales than did nonChristians and agnostics. CONCLUSIONS The results of this study need confirmation using an improved methodology and larger sample sizes. However, they suggest that the scale may be useful for the study of spirituality in the U.S.
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Affiliation(s)
- R J Mathew
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA
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Mathew RJ, Georgi J, Wilson WH, Georgi JN, Lowe JV. Substance abuse consultation in a teaching hospital. N C Med J 1995; 56:329-33. [PMID: 7643930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- R J Mathew
- Department of Psychiatry, Duke University Medical Center, Durham 27710, USA
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Cheson BD, Wilson WH, Phillips PH. Clinical trials at the medicine branch of the NCI-part 2. Oncology (Williston Park) 1995; 9:506, 509-10. [PMID: 8719096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
A wide range of stimulants was rapidly and efficiently separated with symmetrical peak shapes with a tertiary supercritical mobile phase and a cyanopropyl liquid chromatography column. Compared with other drug families studied in this series, the stimulants exhibited a much broader range of retention. Several strong bases, including primary aliphatic amines, were easily eluted with a modified mobile phase. The stimulants were generally more retained than antipsychotic drugs. Compared with antidepressant drugs, a few stimulants behaved similarly, but most were more strongly retained. Modifier concentration proved to be the most effective means for changing both retention and selectivity. An over-the-counter eye drop solution (an aqueous buffer) was analyzed for tetrahydrozoline. The positive results with good peak shapes indicate that packed-column supercritical fluid chromatography is compatible with at least small aqueous samples.
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Affiliation(s)
- T A Berger
- Hewlett Packard Company, Wilmington, DE 19808-1610, USA
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Abstract
OBJECTIVE The atypical antipsychotic medication clozapine is an effective treatment for refractory psychosis; however, the efficacy of clozapine when used in public mental health programs has yet to be fully characterized. This study assessed the outcome of clozapine treatment in a state hospital. METHODS The medical records of the first 100 patients to receive clozapine in a state hospital, from six months before clozapine treatment through 18 months of treatment, were reviewed. RESULTS The patients had chronic psychotic disorders that had responded poorly to treatment with conventional antipsychotic medication. Eighteen months after beginning clozapine, 45 patients were much improved, and 18 were somewhat improved. All except one of the improved patients were continuing clozapine treatment. Forty patients were living in community settings, 59 remained hospitalized, and one had died of an illness unrelated to clozapine. Violent episodes in the hospital decreased during the first six months of clozapine treatment. Thirteen patients had one or two seizures while taking clozapine, 12 of whom successfully continued clozapine treatment. One patient developed agranulocytosis, and one developed leucopenia; each recovered fully after clozapine treatment was discontinued. CONCLUSIONS Clozapine was an effective treatment for refractory psychotic disorders when given as a part of routine state hospital treatment.
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Affiliation(s)
- W H Wilson
- Oregon Health Sciences University, Portland 97201, USA
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110
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Wolf M, Wolf S, Wilson WH. Clozapine treatment in Russia: a review of clinical research. Psychiatr Serv 1995; 46:256-9. [PMID: 7796213 DOI: 10.1176/ps.46.3.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This paper is intended to help American clinicians and investigators further their understanding of the clinical use of clozapine by reviewing experience with the drug in Russia, where it was introduced 17 years before it became available in the United States. METHODS Key articles on clozapine from the Russian clinical research literature were reviewed by the first two authors, former Russian clinical investigators. The third author comments briefly about the implications of this work from a contemporary American perspective. FINDINGS AND CONCLUSIONS The review found that although clozapine was not widely distributed in Russia, it was investigated at several large psychiatric research institutions and hospitals. It was not reserved for neuroleptic-resistant disorders but instead was used with some success as a first-line treatment in acute disorders. Although no controlled clinical trials were conducted, results of long-term outcome studies of treatment-resistant schizophrenia were largely in agreement with those of controlled trials and clinical follow-up studies in the U.S. The studies found short-term gains for previously refractory patients as well as improvements in social functioning that continued for extended periods in some cases. Russian investigators described clozapine as an effective antipsychotic agent that lacked the extrapyramidal side effects of other neuroleptics.
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Affiliation(s)
- M Wolf
- P.B. Gannishkin State Psychiatric Hospital, Moscow
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111
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Wilson WH, Bates SE, Fojo A, Chabner BA. Modulation of multidrug resistance by dexverapamil in EPOCH-refractory lymphomas. J Cancer Res Clin Oncol 1995; 121 Suppl 3:R25-9. [PMID: 8698739 DOI: 10.1007/bf02351068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We conducted a controlled trial of dexverapamil, an inhibitor of Pgp, in 45 Hodgkin's (HD) and 154 Non-Hodgkin's (NHL) lymphomas refractory to EPOCH chemotherapy. A total of 154 patients initially received EPOCH alone and (4.2%) with stable disease over two cycles or progressive disease "crossed over" to receive dexverapamil with EPOCH. Dexverapamil was escalated 8 dose levels, from 240 to 1200 mg/m2 per day. When possible, serial biopsies were obtained to measure MDR-1 expression by quantitative polymerase chain reaction. Median age was 44 years, 67% had stage IV disease, and median (range) prior regimens were 2 (1-12) in NHL and 1 (1-4) in HD. The maximum tolerated dose of dexverapamil was 900 mg/m2/day, and median plasma average concentrations of dexverapamil and nor-dexverapamil were 1.2 and 1.4 microM, respectively. There were 3 complete and 2 partial responses (12%) and 5 minor responses in NHL, and 2 of 10 HD patients achieved partial responses. MDR-1 was measured in 44 biopsies from 19 patients. Pre-therapy, MDR-1 was low (median 2.5 U) but increased (median 12.2 U) at cross-over. Among 6 patients with MDR-1 > 15, 3 responded to dexverapamil whereas only 1/8 patients with MDR-1 < 15 responded. EPOCH and dexverapamil were well tolerated. This study suggests that MDR-1 plays a role in clinical drug resistance of lymphomas, but also suggests that non-MDR-1 mechanisms are present in such patients. Earlier intervention with dexverapamil may be more effective and warrants further study.
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Affiliation(s)
- W H Wilson
- Medicine Branch, National Cancer Institute, Bethesda, MD 20892, USA
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Wilson WH, Chabner BA, Bryant G, Bates S, Fojo A, Regis J, Jaffe ES, Steinberg SM, Goldspiel BR, Cheson BD. Phase II study of paclitaxel in relapsed non-Hodgkin's lymphomas. J Clin Oncol 1995; 13:381-6. [PMID: 7531220 DOI: 10.1200/jco.1995.13.2.381] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To assess the efficacy and toxicity of paclitaxel administered as a 96-hour infusion to patients with relapsed non-Hodgkin's lymphomas (NHLs). PATIENTS AND METHODS Eligible patients had relapsed NHL and measurable disease and were considered incurable. Paclitaxel was infused at a dose of 140 mg/m2 every 3 weeks. Premedications to prevent paclitaxel hypersensitivity reactions were not administered and no patients received corticosteroids. Expression of the multidrug resistance (mdr-1) gene was determined in tumor from 17 patients by mRNA quantitative polymerase chain reaction (PCR). RESULTS Thirty-one patients received a total of 99 cycles of paclitaxel. Two patients were not assessable for response. The median age was 50 years, 71% had stage IV disease, and intermediate/high-grade histology was present in 65% of patients. Patients had received a median of three prior chemotherapy regimens, and 68% of patients had responded to the previous chemotherapy (chemotherapy-sensitive). Of 29 assessable patients, five (17%) achieved a partial response (PR). With a median potential follow-up time of 17 months, the median event-free and overall survival durations were 1.6 and 7.5 months, respectively. No correlation was found between response to paclitaxel and extent of prior treatment or response. The mdr-1 gene was easily detectable in 14 of 17 tumor biopsies, but was low in all but one sample. The most serious toxicity was grade 4 neutropenia, which occurred during 14% of cycles. CONCLUSION Paclitaxel was well tolerated, but had a low response rate in patients with relapsed NHLs. There was no clear association between response to paclitaxel and extent of our response to prior treatment. Most patients had chemotherapy-sensitive disease, which suggests that the low response rate to paclitaxel was probably not due to general chemotherapy resistance. Paclitaxel provided good palliation in a minority of patients and is a reasonable agent to consider for use in patients who have failed to respond to standard chemotherapy.
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Affiliation(s)
- W H Wilson
- Medicine Branch, National Cancer Institute, Bethesda, MD 20892
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Affiliation(s)
- W H Wilson
- Oregon Health Sciences University, Department of Psychiatry, Portland 97201-3098, USA
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Wilson WH, Berg SL, Bryant G, Wittes RE, Bates S, Fojo A, Steinberg SM, Goldspiel BR, Herdt J, O'Shaughnessy J. Paclitaxel in doxorubicin-refractory or mitoxantrone-refractory breast cancer: a phase I/II trial of 96-hour infusion. J Clin Oncol 1994; 12:1621-9. [PMID: 7913721 DOI: 10.1200/jco.1994.12.8.1621] [Citation(s) in RCA: 150] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE A phase I study of paclitaxel infused over 96-hours was performed to determine toxicity, maximum-tolerated dose (MTD), and pharmacokinetics in patients with incurable lymphomas and solid tumors. A phase II study was performed at the MTD of paclitaxel in patients with doxorubicin/mitoxantrone-refractory metastatic breast cancer. PATIENTS AND METHODS In the phase I study, paclitaxel dose levels ranged from 120 to 160 mg/m2, administered on a 21-day cycle. Patients with metastatic breast cancer who had either no response or a partial response (PR) to doxorubicin or mitoxantrone and had measurable disease were eligible for the phase I and II studies. Expression of the multidrug resistance (mdr-1) gene was determined in tumor biopsies by mRNA quantitative polymerase chain reaction. RESULTS Twelve patients received a total of 73 cycles of paclitaxel on the phase I study. Dose-limiting mucositis and/or grade IV granulocytopenia was reached at 160 mg/m2, and 140 mg/m2 was selected as the phase II dose. Thirty-six consecutive patients with metastatic breast cancer were treated, of whom three were not assessable. The median age was 49 years, with disease in the liver and/or lung in 76%. Patients received a median of two prior regimens for metastatic disease, and 73% had no response to prior doxorubicin or mitoxantrone. Of 33 patients treated with paclitaxel, 16 patients (48%) achieved a PR and five (15%) achieved a minor response (MR). With a median potential follow-up duration of 60 weeks, the median progression-free and overall survival durations were 27 and 43 weeks, respectively. No correlation was found between extent of prior treatment or prior response to doxorubicin/mitoxantrone, and response to paclitaxel. Paclitaxel pharmacokinetics showed a correlation between both granulocyte and mucosal toxicity, and serum steady-state concentrations (Css) more than 0.07 mumol/L. Patients with liver metastases had significantly decreased paclitaxel clearance and higher paclitaxel Css. Levels of mdr-1 were uniformly low in all tumor biopsies studied. CONCLUSION The recommended phase II dose of paclitaxel is 140 mg/m2 in patients without liver metastases and 105 mg/m2 in patients with liver metastases. Ninety-six-hour infusions of paclitaxel were effective and well tolerated in patients with doxorubicin/mitoxantrone-refractory breast cancer. Prolonged infusion schedules may be more effective than shorter schedules and deserve further study.
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Affiliation(s)
- W H Wilson
- Medicine Branch, National Cancer Institute, Bethesda, MD 20892
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Wilson WH, Claussen AM. Seizures associated with clozapine treatment in a state hospital. J Clin Psychiatry 1994; 55:184-8. [PMID: 8071267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The seizures associated with the atypical antipsychotic medication clozapine represent a serious side effect of treatment. In premarketing studies, seizures occurred at a crude rate of 3.5%. It is possible that the rate and character of seizures would vary in clinical settings because of differences in patient populations or differences in the manner in which treatment is administered. We studied the seizures that occurred during clozapine treatment in a state psychiatric hospital. METHOD We reviewed the medical charts and pharmacy records of 100 sequential patients who were to start clozapine treatment. The review period covered 6 months pretreatment through 1 year of follow-up. RESULTS The patients were 55 men and 45 women, aged 20 to 61 years. Ten (5 men, 5 women) had at least one seizure during clozapine treatment. Seizures occurred at all dose ranges (0-299 mg/day, N = 6; 300-599 mg/day, N = 2; 600-900 mg/day, N = 2). Of 12 patients with histories of previous seizures, 4 (33%) had a seizure while taking clozapine and anticonvulsants. Of 9 patients with histories of head trauma but no seizures, 1 (11%) had a seizure. Of 79 patients without seizure disorder or a history of head trauma, 5 (6.3%) had a seizure. Nine of the patients who had a seizure continued on clozapine treatment with temporary dose reduction and/or addition of an anticonvulsant, 2 having one additional seizure. CONCLUSION Clozapine-associated seizures were more frequent in this group of state hospital patients than they were in premarketing studies. Clozapine-related seizures did not preclude successful treatment with clozapine.
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Affiliation(s)
- W H Wilson
- Department of Psychiatry, Oregon Health Sciences University, Portland
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Abstract
Antidepressants can be rapidly and efficiently separated by packed-column supercritical fluid chromatography with a tertiary mobile phase. Ten antidepressants were nearly baseline resolved in < 6 min without programming. Calculated detection limits with a 5-microL injection volume were as low as 88 ppb. The effects of temperature, pressure, and modifier concentration on retention and selectivity were studied. Changing modifier concentration caused significant changes in selectivity. Several relationships between solute structure and selectivity changes were noted.
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Affiliation(s)
- T A Berger
- Hewlett Packard Company, Wilmington, DE 19808
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118
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Abstract
Studies of speed, resolution, and sensitivity indicate packed column supercritical fluid chromatography is a viable technique for the analysis of antipsychotic drugs. Fourteen such drugs (mostly phenothiazines) were studied from a cyanopropyl liquid chromatography packed column with a tertiary mobile phase of carbon dioxide, methanol, and isopropylamine. An arbitrary mix of 10 components was baseline resolved in approximately 11 min. Detection limits were as low as 125 ppb, with a feasible 10-fold decrease. Without the isopropylamine in the mobile phase, none of the solutes eluted. With the additive, all produced symmetrical peaks and high efficiency (i.e., > 80% of theoretical). Changing modifier concentration was the most effective physical parameter for changing retention but had little effect on selectivity. Temperature changes had a modest effect on retention but provided surprisingly large changes in selectivity, with numerous peak reversals occurring over only a 30 degrees C temperature range. In addition, temperature programming was the most effective means to optimize resolution of the 10-component mix. No noticeable loss in efficiency accompanied the temperature programs.
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Affiliation(s)
- T A Berger
- Hewlett Packard Company, Wilmington, DE 19808
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Abstract
To evaluate the sensitivity of a computerized cognitive-neuromotor test battery in assessing the effects of marijuana (delta-9-tetrahydrocannabinol [THC]), we conducted a study of 10 healthy male volunteers who were experienced marijuana smokers. After extensive training on the performance tasks, each subject was tested on three separate days after smoking a cigarette containing either 1.75% THC, 3.55% THC, or placebo according to a randomized double-blind repeated measures design. Testing was carried out before smoking and 30, 90, and 150 minutes after smoking the cigarette. Of the five tasks employed, the digit-symbol substitution test with memory and the reaction time task were the measures most sensitive to effects of marijuana. We examined the usefulness of the coefficient of variation and effect size as indices of sensitivity to be used across different types of tasks.
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Affiliation(s)
- W H Wilson
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710
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Wilson WH. The role of GM-CSF and G-CSF in stem cell transplantation. Oncology (Williston Park) 1994; 8:17-8. [PMID: 7513183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- W H Wilson
- Division of Cancer Treatment, National Cancer Institute, Bethesda, Maryland
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121
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Wilson WH. The Fifth Psychoactive Drug Usage Guide. J Clin Psychiatry 1994; 55:34-5. [PMID: 8294390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Chabner BA, Bates SE, Fojo AT, Spolyar M, Wilson WH. Drug resistance in adult lymphomas. Semin Hematol 1994; 31:70-87. [PMID: 8122136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- B A Chabner
- Clinical Oncology Program, National Cancer Institute, Bethesda, MD 20892
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123
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Davidson JR, Potts N, Richichi E, Krishnan R, Ford SM, Smith R, Wilson WH. Treatment of social phobia with clonazepam and placebo. J Clin Psychopharmacol 1993; 13:423-8. [PMID: 8120156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Clonazepam and placebo were administered in a double-blind pilot study to 75 outpatients with social phobia. The mean maximum dose of clonazepam was 2.4 mg/day at endpoint (range, 0.5 to 3 mg). Treatment was continued for up to 10 weeks. The results of an intent-to-treat analysis indicated superior effects of clonazepam on most measures. Response rates for clonazepam and placebo were 78.3 and 20.0%. Drug effects were apparent on performance and generalized social anxiety, on fear and phobic avoidance, on interpersonal sensitivity, on fears of negative evaluation, and on disability measures. Significant differences were evident by week 1, 2, or 6, depending upon the rating scale used. Clonazepam was well tolerated in general, although unsteadiness and dizziness were more severe and persistent than was the case for placebo subjects.
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Affiliation(s)
- J R Davidson
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710
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Goldspiel BR, Kohler DR, Koustenis AG, Wilson WH, Tolcher AW, O'Shaughnessy JA, Wittes RE, Chabner BA. Paclitaxel administration using portable infusion pumps. J Clin Oncol 1993; 11:2287-8. [PMID: 7901343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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125
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Wilson WH, Bryant G, Bates S, Fojo A, Wittes RE, Steinberg SM, Kohler DR, Jaffe ES, Herdt J, Cheson BD. EPOCH chemotherapy: toxicity and efficacy in relapsed and refractory non-Hodgkin's lymphoma. J Clin Oncol 1993; 11:1573-82. [PMID: 7687667 DOI: 10.1200/jco.1993.11.8.1573] [Citation(s) in RCA: 194] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Based on in vitro evidence that tumor cells are less resistant to prolonged exposure to low concentrations of the natural product class, compared with brief higher concentration exposure, we developed a chemotherapy regimen (etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone [EPOCH]) in which the natural products are administered as a continuous infusion. PATIENTS AND METHODS This is a phase II study of etoposide, vincristine, and doxorubicin, administered as a 96-hour continuous infusion, with intravenous (IV) bolus cyclophosphamide and oral prednisone (EPOCH) in 74 consecutive patients who relapsed from or failed to respond to most of the same drugs administered on a bolus schedule. Patients with aggressive lymphomas who achieved a good response after EPOCH were eligible to undergo bone marrow transplantation. RESULTS Patients with intermediate- or high-grade lymphoma comprised 76% of this series and 77% had stage IV disease. Seventy-one percent had previously received all of the drugs contained in the EPOCH regimen and 92% had received at least four of the drugs. Seventy patients were assessable for response, of whom 19 (27%) achieved a complete remission (CR) and 42 (60%) a partial remission (PR). Among 21 patients who had no response to prior chemotherapy, 15 (71%) responded, but only one achieved a CR. Patients who relapsed from an initial CR had a 100% response rate, with 76% CRs. With a median potential follow-up duration of 19 months, there was a 28% probability of being event-free at 1 year. Toxicity was primarily hematologic with neutropenia during 51% of cycles, but only a 17% incidence of febrile neutropenia. Gastrointestinal, neurologic, and cardiac toxicity were minimal. CONCLUSION EPOCH chemotherapy was well tolerated and highly effective in patients who were resistant to or relapsed from the same drugs administered on a bolus schedule, suggesting that continuous infusion of the natural drug component of this regimen is capable of partially reversing drug resistance and reducing toxicity. Dose-intensity (DI) was > or = that achieved in primary treatment regimens for aggressive lymphomas.
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Affiliation(s)
- W H Wilson
- Medicine Branch, National Cancer Institute, Bethesda, MD 20892
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126
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Schalk DC, Wilson WH. Impact of clozapine on medication use in a state hospital. Hosp Pharm 1993; 28:647-53. [PMID: 10127299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Medical records of 90 consecutive patients who started clozapine were reviewed to see how this drug is being used with other psychotropic medications and to evaluate what impact it has had on the drug regimens of these patients. Data from up to 6 months before to 12 months after clozapine's initiation was included. The percent of patients receiving medications for antipsychotic side effects decreased from 86% 6 months prior to clozapine to 13% 12 months after. The use of benzodiazepines decreased from 43% to 23% during this time period as did lithium use from 57% to 17%. While 28% of the patients were receiving carbamazepine prior to starting clozapine, no patients remained on this drug concurrently with clozapine. The average number of psychiatric medications per patient decreased from 3.39 +/- 1.37 6 months prior to clozapine to 1.61 +/- .83 at month 12. Concern for drug interactions along with clozapine's reduced incidence of extrapyramidal side effects and increased efficacy contributed to the reduction in medication use observed.
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Affiliation(s)
- D C Schalk
- Dammasch State Hospital, Wilsonville, OR 97070
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127
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Abstract
This article examines patients with schizophrenia and controls to determine whether asymmetry and anteroposterior (AP) gradient of cerebral blood flow (CBF) are related to duration of illness, and whether they are themselves correlated. CBF was measured with the 133xenon inhalation technique in 108 patients and 108 age-matched and gender-matched controls while the subjects were at rest. Two sets of analyses were performed. The first analyses indicated AP-gradient to be reduced in patients, and hemispheric asymmetry scores to be different from controls only in the temporal area. The second set of analyses were based on two groups of 27 patients, selected to represent extremes on duration of illness (less than 5 and greater than 12 years) and equal numbers of age-matched and gender-matched controls. These analyses revealed patients of both short and long duration of illness to have significantly greater temporal asymmetry, whereas only long-duration patients had significant AP-gradient relative to both controls and short-duration patients. Regression analyses from each data set found AP-gradient to be related to duration of illness, whereas temporal asymmetry was not, temporal asymmetry and AP-gradient were not correlated. These results suggest AP-gradient and temporal asymmetry may reflect independent processes.
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Affiliation(s)
- W H Wilson
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710
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128
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Abstract
OBJECTIVE The authors examined differences in the prevalence of psychiatric disorders in individuals who did or did not have alcoholic parents. METHOD They used data from the National Institute of Mental Health Epidemiologic Catchment Area project, specifically from the Piedmont of North Carolina. Prevalence of psychiatric disorders was estimated in 408 ECA participants who reported problem drinking in their mother, their father, or both and in 1,477 age- and sex-matched subjects who did not report having alcoholic parents. RESULTS The adult children of alcoholics showed significantly higher current (6-month) prevalence rates of simple phobia and agoraphobia and lifetime rates of dysthymia, generalized anxiety disorder, panic disorder, simple phobia, and agoraphobia. Adult children of alcoholics also had significantly more antisocial symptoms. Male children of alcoholics had higher rates of alcohol and drug abuse and reported more antisocial symptoms than did female children of alcoholics. Male children of alcoholics had a significantly higher rate of lifetime diagnoses of alcohol and drug abuse than men who were not children of alcoholics. More female children of alcoholics had generalized anxiety disorder than women who were not children of alcoholics. Both male and female children of alcoholics had significantly more antisocial symptoms than their matched comparison subjects. Sons of alcoholic fathers had a higher rate of substance abuse and more antisocial symptoms than did daughters of alcoholic fathers. Daughters of alcoholic fathers had a higher rate of generalized anxiety disorder. CONCLUSIONS These data on adult children of alcoholics in a large community sample add to a literature based mainly on descriptive material or studies of smaller samples.
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Affiliation(s)
- R J Mathew
- Department of Psychiatry, Duke University Medical Center, Durham, N.C. 27710
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129
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Berger TA, Wilson WH. Separation of Anilines, Benzamides, Benzylamines, and Phenylethylamines by Packed-Column Supercritical Fluid Chromatography. J Chromatogr Sci 1993. [DOI: 10.1093/chromsci/31.4.127] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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130
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Abstract
Depersonalization and other behavioral and physiological indices were monitored before and after the administration of high- and low-potency marijuana cigarettes and a placebo cigarette in 35 physically and mentally healthy normal volunteers. The cigarettes were administered under double-blind conditions during three visits to the laboratory separated by a minimum of 1 week. Marijuana smoking, but not placebo smoking, was associated with significant depersonalization that was maximal 30 min after smoking the high-potency cigarettes. Other behavioral changes induced by marijuana included disintegration of time sense, sensation of "high," increased state anxiety, tension, anger, and confusion. Respiration, pulse rate, and systolic blood pressure also increased after marijuana smoking. Multiple regression identified temporal disintegration as the most significant predictor of depersonalization.
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Affiliation(s)
- R J Mathew
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710
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131
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Abstract
OBJECTIVE To determine the incidence and characterize the occurrence of cardiac toxicity with high-dose ifosfamide. DESIGN Retrospective chart review. SETTING Biomedical research referral center. PATIENTS Fifty-two consecutive patients with advanced lymphoma or carcinoma enrolled in phase I trials of high-dose ifosfamide as part of combination chemotherapy with autologous bone marrow transplantation. INTERVENTIONS Patients were given escalating doses (10 to 18 g/m2) of ifosfamide in combination with carboplatin and etoposide or with lomustine and vinblastine. MEASUREMENTS The chart review focused on clinical, radiographic, or electrocardiographic evidence of cardiovascular dysfunction. Data from invasive hemodynamic monitoring, radionuclide cineangiography, and echocardiography were also reviewed. RESULTS Nine of the patients treated with ifosfamide developed congestive heart failure (17%; 95% Cl, 8% to 30%). Eight of these patients, experiencing dyspnea, tachycardia, weight gain, and signs of pulmonary edema, required admission to an intensive care unit. Left ventricular contractility was found to be depressed when evaluated by radionuclide cineangiography, echocardiography, or both. Most patients responded to diuretic, vasodilator, and inotropic therapies. Two patients developed malignant ventricular arrhythmias. One patient died of intractable cardiogenic shock. Five patients died of multiorgan failure, despite showing improvement in left ventricular ejection fraction. Three patients survived and regained baseline left ventricular ejection fraction. CONCLUSIONS High-dose ifosfamide is associated with severe but usually reversible myocardial depression and malignant arrhythmias.
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Affiliation(s)
- Z M Quezado
- Warren G. Magnuson Clinical Center, Bethesda, Maryland
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132
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Wilson WH. Addition of lithium to haloperidol in non-affective, antipsychotic non-responsive schizophrenia: a double blind, placebo controlled, parallel design clinical trial. Psychopharmacology (Berl) 1993; 111:359-66. [PMID: 7870975 DOI: 10.1007/bf02244953] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This double-blind placebo controlled, parallel design clinical trial compared the therapeutic effects of the addition of lithium or placebo to haloperidol in 21 seriously ill state hospital patients with DSM-III-R schizophrenia, who did not have concurrent affective disorders and who had not responded to previous trials of conventional antipsychotic medication. During a baseline period of 6 weeks, patients were switched to a stable dose of haloperidol (mean +/- SD dose = 13.6 +/- 8.1 mg/day). Patients were then randomized to receive either lithium or placebo in addition to haloperidol for 8 weeks (mean +/- SD lithium level = 0.98 +/- 0.13 mEq/l). Symptoms and side effects were assessed weekly. Improvement in symptoms correlated with the non-blind adjustment of antipsychotic dose, but not with lithium or placebo treatment. Side effects ratings did not differ between the two groups, but one patient developed a reversible delirium associated with combined lithium/haloperidol treatment. For these long-term, severely ill patients, combined treatment afforded no advantage over treatment with haloperidol alone.
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Affiliation(s)
- W H Wilson
- Oregon Health Sciences University, Portland
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133
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Abstract
In experienced marijuana smokers, marijuana smoking was accompanied by a significant bilateral increase in cerebral blood flow (CBF) especially in the frontal regions and cerebral blood velocity. The post-marijuana CBF increase could not be explained on the basis on changes in general circulation or respiration. Similarly, the CBF increase was unrelated to plasma levels of tetrahydrocannabinol and extracranial circulation. Behavioral changes showed significant correlations with CBF. CBF and brain function are closely coupled and therefore it seemed highly likely that CBF changes after marijuana were closely related to its effect on mood and behavior.
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Affiliation(s)
- R J Mathew
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710
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134
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Urba WJ, Wilson WH, Duffey PL, Wittes R, Chabner BA, Longo DL. Recent National Cancer Institute lymphoma trials of etoposide-containing combination chemotherapy. Semin Oncol 1992; 19:26-32. [PMID: 1283467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Short-course prednisone/doxorubicin/cyclophospha- mide/etoposide-cytarabine/bleomycin/vincristine/methotrexate (ProMACE-CytaBOM) contains the same drugs as standard ProMACE-CytaBOM but is delivered weekly for 16 weeks rather than 2 weeks out of 3 for 18 weeks. This results in a significant increase in dose intensity, ranging from 27% to 65% for all drugs. A total of 46 patients have been treated with short-course ProMACE-CytaBOM. The overall complete response rate of 91% and relapse rate of 17% compares favorably with results obtained using standard ProMACE-CytaBOM (86% and 27%, respectively). Toxicity was slightly greater with short-course therapy, but in general the regimen was well tolerated. Further dose intensification is possible in eligible patients by dose escalating myelotoxic drugs. A second strategy for augmenting the dose intensity is to deliver the drugs by continuous intravenous infusion. Infusional chemotherapy with doxorubicin/etoposide/vincristine/oral prednisone/bolus cyclophosphamide (EPOCH) results in significant antitumor activity in heavily pretreated patients with chemotherapy-resistant Hodgkin's disease and non-Hodgkin's lymphomas. Complete responses or partial responses were seen in 91% of 21 evaluable patients.
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Affiliation(s)
- W J Urba
- Clinical Services Program, Program Resources, Inc/DynCorp, NCI-FCRDC, Frederick, MD 21702
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135
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Wilson WH, Jain V, Bryant G, Cowan KH, Carter C, Cottler-Fox M, Goldspiel B, Steinberg SM, Longo DL, Wittes RE. Phase I and II study of high-dose ifosfamide, carboplatin, and etoposide with autologous bone marrow rescue in lymphomas and solid tumors. J Clin Oncol 1992; 10:1712-22. [PMID: 1403054 DOI: 10.1200/jco.1992.10.11.1712] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE High-dose chemotherapy produces durable disease-free remissions in a minority of patients with resistant lymphomas and solid tumors. In an attempt to improve on the available regimens, ifosfamide, carboplatin, and etoposide (ICE) were selected for a new high-dose regimen because of their favorable spectrum of nonhematopoietic toxicity and evidence of synergy in in vitro systems. PATIENTS AND METHODS Forty-one patients with drug-resistant Hodgkin's and non-Hodgkin's lymphomas, and breast and testicular cancers were entered onto a phase I and II trial of a single course of ICE with autologous bone marrow rescue. Before transplantation, all patients received combination chemotherapy until maximal tumor response was achieved. RESULTS Patients received total doses of ifosfamide from 10 to 18 g/m2, carboplatin from 0.9 to 1.98 g/m2, and etoposide from 0.6 to 1.5 g/m2 administered during a 4-day period, with a maximum-tolerated dose (MTD) of ifosfamide 16 g/m2, carboplatin 1.8 g/m2, and etoposide 1.5 g/m2. The dose-limiting toxicities included irreversible renal, cardiac, and CNS dysfunction. There were three toxic deaths (7%), and all occurred above the MTD. Thirteen patients who were treated at the MTD tolerated the regimen well; reversible renal dysfunction and grade 2 mucositis commonly were observed. Of 23 heavily pretreated patients with persistent disease at the time of transplant, 10 (43%) achieved complete remissions (CRs) and 11 (48%) achieved partial remissions (PRs). Hodgkin's and non-Hodgkin's lymphoma patients who were treated at or below the MTD had a median potential follow-up of 11.9 months, and 12-month progression-free survivals of 62% and 48%, respectively. CONCLUSION High-dose ICE with bone marrow rescue was well tolerated with a high response rate, and should be considered for further testing.
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Affiliation(s)
- W H Wilson
- Medicine Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
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136
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Abstract
Regional CBF was measured with the 133Xe inhalation technique before and thrice after smoking marijuana of two strengths and placebo in 20 physically and mentally healthy male volunteers with a previous history of exposure to marijuana. They were drug-free at the time of the study. Blood pressure, pulse rate, end-tidal carbon dioxide, end-tidal carbon monoxide, and forehead skin perfusion were quantified during the CBF measurements. Blood samples were drawn for quantification of plasma levels of delta 9-tetrahydrocannabinol (THC) before and during the 2 h after smoking marijuana or placebo. Drug-induced intoxication and changes in mood were quantified with rating scales. Marijuana smoking was associated with bilateral CBF increase, which was maximal 30 min later. Greater CBF increases were seen in the frontal region and right hemisphere. No significant CBF changes were seen after placebo. Pulse rate and respiration increased significantly after marijuana but not placebo. Both marijuana and placebo smoking were associated with increased end-tidal carbon monoxide. CBF increase in both hemispheres correlated significantly with degree of intoxication, plasma levels of THC, and pulse rate.
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Affiliation(s)
- R J Mathew
- Cerebral Blood Flow Laboratory, Duke University Medical Center, Durham, North Carolina 27710
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137
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Abstract
The authors report four patients whose initial symptom of tumor recurrence or progression was unilateral numbness of the chin. Two patients had Hodgkin lymphoma, one had malignant melanoma, and one had prostate cancer. Physical examination was notable only for unilateral anesthesia of the chin and lower lip. Diagnostic evaluation, including computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain, plain radiographs of the mandible, and cerebrospinal fluid analysis for protein, glucose, and cytology were normal. Bone scans revealed osseous lesions in the axial skeleton of all patients, whereas only two patients had abnormal uptake in the mandible. The authors conclude that in the setting of a negative evaluation for central nervous system (CNS) or local mandibular disease, mental neuropathy is associated with recurrent or progressive skeletal disease. In addition, to document relapsed or progressive cancer, the skeletal system may have to be examined at sites distant from the mandible.
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Affiliation(s)
- R K Burt
- Clinical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
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138
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Abstract
Marijuana is known to cause symptoms suggestive of orthostatic hypotension such as dizziness and fainting during upright posture. We examined changes in cerebral blood velocity (CBV) and peripheral circulation during upright posture after smoking marijuana in 10 right-handed male subjects with a previous history of exposure to marijuana. The participants were physically and mentally healthy and drug-free for a minimum of 3 months before the experiment. Middle cerebral artery CBV, blood pressure and pulse rate were recorded during reclining position and standing, before and after smoking a high-potency marijuana cigarette or a placebo cigarette administered during 2 separate visits to the laboratory. The participants were questioned about dizziness during the upright position. Six of 10 subjects reported moderate to severe dizziness during standing after marijuana but not placebo. Subjects who experienced severe dizziness during standing showed marked decreases in blood pressure and CBV. Those who reported moderate dizziness showed reduction in CBV but not blood pressure. Subjects who reported mild dizziness after marijuana and after placebo smoking showed minimal changes in blood pressure and CBV. Cerebral ischemia during upright position after marijuana smoking may be caused by hypotension and impaired cerebral autoregulation.
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Affiliation(s)
- R J Mathew
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710
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139
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Abstract
Velocity of blood flow in the middle cerebral artery was measured with transcranial Doppler flowmeter before, during, and 1 hr after smoking a marijuana cigarette and a placebo cigarette during two separate visits to the laboratory. Ten healthy, right-handed male volunteers with a history of marijuana smoking took part in the study. The participants were drug-free for a minimum of 3 mo before the project. During the experiment, blood pressure, pulse rate, and end tidal levels of carbon dioxide were continually monitored. Marijuana smoking was associated with a significant increase in middle cerebral artery velocity. Although marijuana smoking was associated with increased pulse rate, the changes in blood velocity and pulse rate followed different time courses. Marijuana smoking was not associated with significant changes in blood pressure or end tidal carbon dioxide.
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Affiliation(s)
- R J Mathew
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710
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140
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Abstract
Medical records of the first 37 patients to begin clozapine treatment at a state hospital in Oregon were reviewed for six months before clozapine treatment and six months after. Patients had a long history of schizophrenia and had responded poorly to antipsychotic medication. Clozapine treatment was generally well tolerated, although the rate of seizures (8 percent) was slightly higher than expected. Psychotic symptoms decreased as measured by the Brief Psychiatric Rating Scale, as did symptoms of tardive dyskinesia as measured by the Abnormal Involuntary Movement Scale. Thirty-four patients remained hospitalized after six months of treatment. However, indicators of social function (hospital privilege level, community passes, violent episodes, and episodes of seclusion and restraint) all showed that patients improved markedly after receiving clozapine.
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141
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Abstract
Cerebral blood velocity (CBV) was measured with transcranial Doppler in 6 normal right-handed male volunteers before and for 50 min after an intravenous injection of 0.1 mg/kg of diazepam and normal saline during 2 separate visits to the laboratory. Blood pressure, pulse rate, end tidal levels of carbon dioxide and mood changes were quantified before and after the injections. Diazepam injection was associated with significant increases in fatigue and sleepiness. There were no significant changes in end tidal carbon dioxide, respiration, pulse rate, and blood pressure after the injection. Postdiazepam CBV was significantly lower following diazepam compared to CBV following placebo.
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Affiliation(s)
- R J Mathew
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710
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142
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Abstract
In 1989, the Public Psychiatry Training Program of the Oregon Health Sciences University Department of Psychiatry and Dammasch State Hospital opened a collaborative Professional Education Unit with the author as Director. This article describes the Unit's structure and programs, as an example of successful state/university collaboration and a possible model for other training programs in public psychiatry.
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Affiliation(s)
- W H Wilson
- Oregon Health Sciences University, Portland, Wilsonville 97070
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143
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Abstract
RU486 is a synthetic glucocorticoid antagonist. The authors used RU486 to examine the hypothesis that the elevated plasma cortisol and ACTH in patients is due to suprahypophyseal stimulation of the anterior pituitary. Seven patients and matched controls were studied before and after the administration of RU486. RU486 produced an increase in HPA activity in depressed patients. Thus providing support for the hypothesis that there is increased suprahypophyseal stimulation of the anterior pituitary.
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Affiliation(s)
- K R Krishnan
- Department of Psychiatry, Duke University Medical Center, Durham, NC
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144
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Abstract
Congenital anomalies of the alimentary tract can evade detection into adulthood because they cause only moderate symptoms or they escape purview of a prepared observer. In other instances, evolution or copathogenesis may need to occur before the lesions become manifest. We have managed 17 of these patients presenting at ages 23 to 71 years. The median duration of symptoms was 5 years, ranging from 1 months to 23 years. Defects of foregut embryogenesis predominated (71%). We were able to establish the correct diagnosis before operating on nine patients, but three had already had a previous celiotomy for the same problem so a truly preoperative diagnosis was possible in only six (35%). The literature validates the dominance of foregut anomalies in adults. There is no older age limit that would exclude consideration of these lesions. Endoscopy, computerized tomography, and ultrasonography have greatly facilitated recognition, but our experience suggests that the principal obstacle to timely diagnosis is the reluctance to consider a congenital cause for an adult's symptoms.
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Affiliation(s)
- A G Samaniego
- Department of Surgery, University of California Davis--East Bay, Oakland
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145
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Abstract
In the normal brain, cerebral blood flow (CBF) and function are closely coupled. Thus, changes in brain function associated with drug-induced anxiety reduction should be accompanied by parallel CBF changes. Benzodiazepines such as diazepam have been reported to reduce CBF. It is unclear, however, if this CBF decrease is specifically a function of the anti-anxiety property of the drug. To examine the relationship between drug-induced anxiety reduction and CBF changes more closely, i.v. injections of an established anxiolytic agent and an experimental anti-anxiety drug were given to patients with generalized anxiety disorder. CBF and anxiety levels were measured before and 30 min after i.v. administration of diazepam (0.12 mg/kg), ondansetron (0.24 mg/kg), and normal saline during separate visits to the laboratory. The order of drug administration was randomized, and the injections were given under double-blind conditions. Diazepam but not ondansetron or saline reduced anxiety. Global CBF reduction was seen after diazepam, but no changes were found following the other two experimental conditions. The CBF values were adjusted for test-retest changes in carbon dioxide levels. Postdiazepam decreases in CBF and anxiety levels did not correlate.
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Affiliation(s)
- R J Mathew
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710
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146
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Abstract
OBJECTIVE AND METHOD This paper reviews acute and chronic effects of drugs of abuse on cerebral blood flow (CBF) and metabolism and their clinical significance. The most important source of information for the review is human research reports published in refereed journals. A few animal studies, book chapters, and abstracts that are especially relevant are also included. RESULTS In humans, ethanol in small doses produces cerebral vasodilation; higher doses induce cerebral vasoconstriction. Chronic alcoholism is associated with reduced CBF and cerebral metabolism. Sedatives and antianxiety drugs lead to global reduction in CBF and cerebral metabolism. Caffeine, even in small doses, is a potent cerebral vasoconstrictor. Cerebral vasodilation is seen immediately after cigarette smoking, but chronic smokers show global reduction in CBF. Changes in CBF after marijuana smoking are variable; both increases and decreases are seen. Chronic marijuana smoking, however, seems to reduce CBF. Most inhalants and solvents are vasodilators; chronic abuse is accompanied by a decrease in CBF. A number of drugs of abuse, including ethanol, amphetamines, cocaine, nicotine, and caffeine-phenylpropanolamine combinations, increase the risk for stroke. Reduction in CBF associated with chronic use of ethanol, nicotine, inhalants, and solvents is at least partially reversible upon abstinence. CONCLUSIONS Topics for future research include regional brain function, which mediates drug-induced mood changes (euphoria); CBF concomitants of psychological and physiological characteristics that increase addiction potential; changes in CBF that accompany withdrawal syndromes; mechanisms responsible for drug-induced stroke; and effects of functional and organic complications on CBF.
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Affiliation(s)
- R J Mathew
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710
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147
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Abstract
Comparing Crow's schizophrenia model with the defect state and Huber's basic symptoms shows that this model is an oversimplification of the complex reality of schizophrenic outcomes. The concept of negative symptoms is undermined by several factors, such as differing definitions, other confounding cross-sectional variables (e.g., akinesia and depression), short follow-ups and lack of confirmation by factorial analysis. The longitudinal concept of a defect state, which has been used in long-term follow-up studies, includes enduring symptoms currently classified as positive and negative. Huber's conceptualization of basic symptoms describes prodromal and enduring residual symptoms of schizophrenia associated with structural brain abnormalities. The overlap and lack of equivalence of these concepts and the limited empirical evidence does not allow firm conclusions. New longitudinal studies using clinical, psychosocial, and neuropsychological measures are needed to understand the natural history and etiology of the defect state.
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Affiliation(s)
- J de Leon
- Medical College of Pennsylvania/EPPI, Philadelphia 19129
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148
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Krishnan KR, Ritchie JC, Manepalli AN, Wilson WH, Saunders WB, Venkataraman SS, Carroll BJ. Role of serotonin in hypothalamo pituitary adrenal axis escape from dexamethasone suppression. Prog Neuropsychopharmacol Biol Psychiatry 1991; 15:637-42. [PMID: 1659724 DOI: 10.1016/0278-5846(91)90053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
1. The authors investigated the role of serotonin in the hypothalamo pituitary adrenal escape from depression. 2. Maximal dose of fenfluramine was administered to normal individuals pretreated with dexamethasone. 3. Fenfluramine had only a minimal and inconsistent effect on the hypothalamo pituitary adrenal axis in the presence of dexamethasone.
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Affiliation(s)
- K R Krishnan
- Department of Psychiatry, Duke University Medical Center, Durham, NC
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149
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Abstract
Comprehensive treatment programs for individuals with schizophrenia usually include a variety of groups, many of which have concrete tasks as a focus: medication management, social skills training, meal preparation, etc. These groups can simultaneously serve more general rehabilitative purposes if leaders apply principles of group leadership which recognize the neuropathological substrate of schizophrenia and which take into account the specific interpersonal characteristics and needs of individuals who have the illness. This paper presents a framework for leading task-oriented groups for individuals with schizophrenia and give examples from a medication group in a psychosocial rehabilitation program.
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Affiliation(s)
- W H Wilson
- Oregon Health Sciences University, Portland
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150
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Abstract
The relationship between anxiety and cerebral blood flow (CBF) is of considerable clinical and research significance. Although a considerable amount of information is available on mechanisms through which anxiety may influence CBF, this topic has not received much attention in psychiatry. Earlier techniques for the measurement of CBF were cumbersome and invasive. With the advent of noninvasive techniques, study of CBF in psychiatric disorders, including anxiety, became easier, and a number of such studies have been conducted. In this article the literature on psychophysiological and clinical aspects of changes in CBF associated with anxiety is reviewed.
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Affiliation(s)
- R J Mathew
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710
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