[Clinical experience of a subcutaneously implantable drug delivery catheter (PORT-A-CATH)]

A drug delivery catheter system with subcutaneously implantable port, PORT-A-CATH, was applied for intra-arterial, intravenous and intraperitoneal chemotherapy and hyperalimentation in treating 99 cancer patients. The average implantation period was 135.1 days and this system was applied for more than one year in 5 cases. Any troubles due to port or catheter materials were not observed during the study. Catheter occlusion occurred in 11 cases infection in 7 (catheter-related infection 4, pocket infection 3), and skin necrosis in 4. This system was proved useful to reduce the risk of infection and enabled easy and safe long-term repeated administration, compared to the catheters with external end. Intra-arterial chemotherapy became possible to the outpatients with the use of this system, which seemed to contribute for the improvement of quality of life of the patients.

[A case of multiple myeloma responding very well to the combination of K18 with prednisolone]

A case of multiple myeloma refractory to various anticancer drugs was effectively treated with the combination of K 18 with prednisolone, which led to a remarkable decrease of serum M-protein and overall recovery. In 8 months of the treatment, although slight bone marrow suppression was noted, no severe side effect was observed. The patient has survived for more than one year in remission. We suggest that the combination of K18 with prednisolone may be effective for multiple myeloma which is unresponsive to treatment with anticancer drugs.

[Increase of blood flow in human tumor tissue under angiotensin II-induced hypertension]

On the basis of the functional characteristics of microcirculation in tumor tissue, the clinical results of angiotensin II-induced hypertension chemotherapy (IHC) have been reported. The present paper deals with the results of measurement of blood flow in human tumors transplanted into athymic rodents using the electrolytic hydrogen clearance method. When the mean arterial blood pressure was elevated to 140-150 mmHg by the continuous infusion of angiotensin II, the increase of blood flow was 30.4 +/- 4.7 ml/min/100g in H-111 human gastric carcinoma (the mean increase rate being 14.4 times that in the normotensive state), 15.6 +/- 2.6(X 3.0) in NS-8 gastric carcinoma and 11.0 +/- 2.9 (X 2.9) in TE-8 esophageal carcinoma, respectively. These results confirmed that blood flow remarkably increased not only in animal tumors but also in human tumors under the induced hypertension caused by angiotensin II. On dynamic CT under hypertension, enhancement of the delivery of contrast medium to the tumor area was also shown clinically, according to the increase in CT numbers in the same ROIs in a normotensive state.

[Hormonal control of zinc uptake in tumor cells]

Zinc is essential for the proliferation of tumor cells. It is suggested that tumor cell growth is inhibited by zinc deficiency in Yoshida sarcoma-bearing rats fed on a zinc-deficient diet. Clinically applicable methods for inducing a zinc-deficient condition in tumor cells were investigated for the therapeutic application of the above phenomenon. As one of these methods, the administration of progesterone to tumor-bearing rats was tried experimentally, and the changes in the zinc content of the tumor tissue and tumor growth were studied and compared with those of tumors in a control group. Progesterone is a competitive inhibitor of glucocorticoid which stimulates zinc uptake by tumor cells. In Yoshida sarcoma-or AH 109A-bearing rats, a tendency of reduction in zinc content in the tumor tissue and inhibition of the tumor growth in the progesterone-administered group was observed in comparison with the control group, although this was not very significant.

[The metabolism of high-molecular-weight substances in cells and the effect of anticancer drugs]

The term "high molecular weight substances" used in this paper implies mostly nucleic acids of certain molecular weight and protein, and the genetic aspects of anti-cancer chemotherapy were discussed. Studies on the mechanism of action of 5-FU have been focused on the inhibition of DNA synthesis, and it has been reported that 5-FU inhibits the growth of thymidylate synthesis deleted FM3A Thy 21 cells even in the presence of thymidine, and that the level of TTP is equal to that in control cells. On the other hand, the active metabolite of 5-FU, FdUMP, is known to bind to synthesized thymidylate and 5, 10-methylene-tetrahydrofolic acid to form a ternary complex. Recently, the cytocidal effect of 5-FU was observed in thymidylate synthetase-deficient cells in the presence of a sufficient amount of thymidine, suggesting that the cytocidal effect of 5-FU might be caused by inhibition of the RNA pathway. In this laboratory, the effect of 5-FU on polysomal patterns and the incorporation of 3H-UR into polysomes was studied in L1210 cells, but no significant difference was observed between normal and 5-FU-treated cells. Ribosomal RNA extracted from the polysomes of 5-FU treated cells appeared to contain a smaller 28S rRNA in comparison to 18S rRNA, indicating that the processing might be inhibited. Expression of mouse H-2Dd mRNA was not influenced by 5-FU at 10(-5) M up to 6 h. Methotrexate (MTX) has a chemical structure similar to folic acid, and is known to bind to DHFR (dihydrofolate reductase), and inhibit the synthesis of TMP. The cellular PRPP content is known to be increased by MTX, which inhibits purine synthesis. The level of PRPP content was found to be increased approximately 25 fold at 3 h after 10(-6) M MTX although normal bone marrow cells showed no increase even after MTX. This increased level of PRPP thus obtained in cancer cells was thought to be used for the phosphorylation of 5-FU. Clinically, sequential chemotherapy using MTX and 5-FU was employed successfully for solid tumors on the basis of the experimental evidence. In order to minimize the adverse effects of anti-cancer drugs, a technique involving the incorporation of the drug-resistant gene into normal bone marrow cells has been designed in this laboratory, and the MTX-resistant cells thus obtained are transplanted into the tumor-bearing mice.

[A model for the sensitivity determination of anticancer agents against human cancer using nude mice]

Human tumors transplanted into nude BALB/c-nu mice have been used to test the sensitivity of the tumors to various anticancer agents. Three cancer cell lines from the stomach and one from the colon were transplanted into nude mice to establish a standard assay method for selection of effective drugs on individual tumors using the criteria of the Japanese Association of Sensitivity Determination for Carcinostatic Agents. From the LD values of anticancer drugs in nude mice, the appropriate doses of drugs were 6 mg/kg of MMC X 1(i.p.), 50 mg/kg of 5-FU q4d X 3 (i.p.), 120 mg/kg of CPA (i.p.), 30 mg/kg of ACNU (i.p.) 8 mg/kg of CDDP (i.p.) and 8 mg/kg of ADM (i.v.). At 3 weeks after initial treatment, the inhibition rate (IR) of the tumor was calculated from the formula IR = (1-T/C) X 100%, where T is the mean tumor weight of the treated group and C is the mean weight of the untreated group at that time. The tumors respond well to the anticancer agents when IR is more than 58%.

Cytosolic sialidases of rat tissues with special reference to skeletal muscle enzyme

Using 4-methylumbelliferyl-N-acetylneuraminic acid as substrate, the cytosolic fractions of various rat tissues were assayed for sialidase activity. The activity was about 16 times greater in skeletal muscle than in liver, and the enzymes from the two sources were identical in chromatographic behavior, pH optimum, and substrate specificity. Apparently the same enzyme was found to be distributed in brain, heart, stomach, intestine, and testis, but not in lung and spleen. Sialidase was also present in kidney cytosol at a high level, but the enzyme resembled liver lysosomal sialidase rather than liver cytosolic sialidase in substrate specificity.

[Phase II trial of mitoxantrone in patients with relapsed and refractory acute leukemia]

Mitoxantrone, a new anthracenedione, was administered to thirty-nine patients with relapsed and refractory acute leukemia and to 12 patients with blastic crisis of chronic myelogenous leukemia between August 1981 and September 1984. Eleven patients were not evaluable and 40 were analysed. There were 24 males and 16 females with a median age of 37 yrs (range 6-73 yrs). Three of these were less than 15 yrs and 7 more than 60 yrs. The initial dose employed was 1.9 mg/m2/day X 5. Although eventually a starting dose of 12.3 mg/m2/day X 5 was used, about one half of cases were given more than 5 mg/m2/day X 5 by i.v. bolus. Among 25 patients with acute non-lymphocytic leukemia, there were 4 complete and 6 partial remissions. Among 7 patients with acute lymphocytic leukemia there was one complete remission and one partial remission. All patients except one who attained remissions had received prior anthracyclines. One of 8 patients with blastic crisis of chronic myelogenous leukemia had a partial remission. The durations of complete remission were 1, 1, 5+, 13+ and 17 weeks, respectively. Side-effects showed expected bone marrow depression. Mucositis occurred in ten patients. Gastrointestinal symptoms were noted in approximately 50%, but were mostly mild. Mild alopecia occurred occasionally. The trials were too short to allow evaluation of possible cardiac toxicity. These data indicate that mitoxantrone is non-toxic but hematological and a promising single drug for use in treating relapsed and refractory acute leukemia and suggest that further study would be worthwhile in order to identify its role in the first-line therapy of acute leukemia.

[Serum copper and the copper:zinc ratio in patients with gastric cancer]

Serum copper levels, serum zinc levels, and serum Cu:Zn ratios were evaluated in 100 patients with gastric cancer. The following conclusions were drawn from the results: Serum copper levels and the serum Cu:Zn ratio were elevated, while serum zinc levels were decreased, reflecting the progress of the disease. Since serum zinc levels varied more remarkably, it was suggested that this value was more useful than serum copper levels as an indicator of tumor activity. Serum copper and zinc levels were independent of the presence of liver metastasis and of the histological types. It was shown that the serum copper levels correlated (significantly) to the survival time (p less than 0.005).

[Electrolyte abnormalities associated with cancer: a review]

There are a variety of water and electrolyte disorders in patients with cancer. These disorders occur during the growth of tumors, generally as a consequence of inadequate intake and absorption of electrolytes, renal failure secondary to tumor or rapid tumor destruction and production of metabolically active substances by the tumor. In this paper, the electrolyte abnormalities associated with cancer were reviewed. Hyponatremia is one of the most common clinical electrolyte abnormalities in advanced cancer. Some patients may have hyponatremia, in spite of increased total body sodium and absence of a defect in water diuresis. This status is designated as "sick cell syndrome" or "essential hyponatremia". In addition, the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in association with various tumors has been described. This syndrome is principally due to water retention, but can also be due to continuous urinary loss of sodium, and hypo-osmolality. Hypercalcemia is associated with coexistent primary hyperparathyroidism, prostaglandin (PGE2) or osteoclast-activating factor. It now seems likely that ectopic PTH is rarely the cause of hypercalcemia in nonparathyroid cancer. There are no data supporting the ectopic production of vitamin D-like substance as an important factor in the hypercalcemia of cancer. There are three general categories in which patients with hypercalcemia and cancer may be placed: those with bone metastases, those without bone metastases of solid tumors and those with hematologic malignancies. Hypokalemia is associated with ectopic ACTH- and insulin--producing tumors, and is often found in patients with mucin-secreting, potassium-losing adenocarcinoma of the colon.

The inhibitory effects of 5-fluorouracil on the metabolism of preribosomal and ribosomal RNA in L-1210 cells in vitro

Addition of 5FU to the culture medium of mouse L-1210 cells resulted in inhibition of the maturation process of ribosomal RNA precursors in vitro. In the presence of 10(-6) M 5FU for 2 h, the 45S preribosomal RNA was processed to 32S preribosomal RNA, but 28S rRNA was not produced. The processing to 18S rRNA was intact at this drug concentration. Higher concentrations of 5FU for a longer incubation period affected the RNA processing more severely. At 10(-5) M of the drug for 24 h the processing to 28S rRNA and 32S preribosomal RNA. When the cells were labeled with 14C-UR for 2 h following 3H-5FU at 10(-6) M for 24 h, the radioactivities of newly synthesized RNA labeled with 14C-UR accumulated in the region of 45S and 32S preribosomal RNA, and no processing to 28S rRNA was observed. Radioactivity corresponding to 3H-5FU did not persist in the preribosomal RNA region, because further maturation proceeded in the condition of depletion of 5FU after the long incubation period. Thus, inhibition of the processing of preribosomal RNA to 28S rRNA was not brought about by the accumulation of 5FU-substituted 45S preribosomal RNA, but by some other, yet unknown, mechanism.

[Clinical study on angiotensin-induced hypertension chemotherapy (IHC)]

It has been found in experiments using rats that there is a lack of autoregulation of blood flow in tumor vessels and a selective increase of blood flow under angiotensin II-induced hypertension when the arterial blood pressure dose not exceed 150 mmHg, while there is no increase in normal tissues (Suzuki et al., JNCI:1981). On the basis of the functional difference of microcirculation, IHC has been developed clinically since 1978. In the procedure of treatment, the mean blood pressure of the patients was maintained at 140-150 mmHg when anti-cancer drugs were administered along with the continuous intravenous infusion of angiotensin II. In a randomized controlled study on gastric carcinoma treated with an AFM regimen, the response rate was 42.5% (8/21) in IHC vs. 10.5% (2/19) in non-IHC (p less than 0.05). The "initial response time" (15.5 vs. 28.8 days) and the "effective tumor reduction time" (36.7 vs. 57.5 days) were significantly shorter (p less than 0.01) in the IHC group. Frequency and grade of side effects were not different statistically. In an open trial, the overall response rate was 39.6% (54/134) and each response was closely related to the difference of drug sensitivity of tumor types. For example, it was 90.0% (9/10) in cancers of the head & neck, 66.7% (4/6) in the breast, 42.8% (12/28) in the stomach, 46.2% (6/13) in the pancreas, 23.1% (3/13) in the colon and 23.8% (5/21) in the lung. The effect on metastatic lymphnodes was 79.4% (27/34), which was higher than that of primary (48.1% : 26/54) and other organ metastases (34.6% : 18/52). Finally, this paper dealt with the problem of clinical evaluation of tumor lesions with a lot of fibrous granulation tissue and coagulative necrosis, and of the investigation of differential imaging.

[Randomized study of lentinan on patients with advanced gastric and colorectal cancer. Tohoku Lentinan Study Group]

A randomized study of mitomycin C (MMC)+5-FU [control group] vs MMC+5-FU+lentinan (LNT) [LNT group] was conducted in order to evaluate the effect of LNT against advanced gastric and colorectal cancers by the envelope method in 166 patients, comprising of 115 cases of gastric cancer and 51 cases of colorectal cancer. Significant increases were observed in the survival rates for the LNT group (p less than 0.05) for both patients with gastric and colorectal cancer. No significant difference was observed in response rates between the aforesaid two groups, though the response rate in the LNT group was slightly higher than the control group. These results suggest that LNT in combination with anticancer drugs prolong the survival time of patients with advanced gastric and colorectal cancer.

[The effects of neocarzinostatin on superoxide production by monocyte-derived macrophages]

Monocyte-derived macrophages (M phi) from cancer patients injected with low doses of Neocarzinostatin (NCS, 500 units/day, three times a week) 12 times produced significantly more superoxide (O2-) than controls. Lymphocyte functions, such as PHA response, surface marker and serum IAP, before and after NCS injections were the same. M phi from normal persons cultured with NCS (0.4 microgram/ml) for three days produced more O2- than controls, but those cultured with rINF gamma did not. These results suggest that the increased O2- production of M phi from patients taking low doses of NCS may be due to the direct action of NCS on the M phi.

[Phase II study of (2''R)-4'-O-tetrahydropyranyldoxorubicin (THP) in patients with advanced gastrointestinal cancer--a report of the Tohoku THP Study Group]

A phase II study of THP was performed in patients with advanced gastrointestinal cancer. The dose schedule was 25 to 40 mg/m2 i.v./cycle repeated every 3 to 4 weeks. One partial (PR) and one minor response (MR) were achieved in 16 evaluable patients with stomach cancer. A case of PR had previously been shown to be resistant to doxorubicin and a case of MR resistant to aclarubicin, respectively. No objective responses were observed in 19 evaluable patients with other tumor sites in the gastrointestinal tract. Forty-eight patients were evaluable for toxic effects. Leukopenia (less than 4 X 10(3)/mm3) occurred in 54% of the patients and was dose-limiting. Thrombocytopenia (less than 10 X 10(4)/mm3) was less frequently observed (13%) than leukopenia. However, no cumulative marrow suppression was observed in repeated courses of the therapy. Non-hematologic toxic effects consisted of gastrointestinal disturbances (23%), hair loss (10%), general malaise (8%), fever (6%), ECG changes (4%) and hepatic dysfunction (2%). Further trials with a high dose schedule (40 mg/m2, q 3-4 weeks) in good-risk patients are necessary to validate the antitumor activity of THP against advanced gastrointestinal cancer.

[Phase II study of (2''R)-4'-O-tetrahydropyranyladriamycin (THP) in patients with solid tumors. Multi-Institutional Cooperative Study]

A Phase II Study of (2''R)-4'-O-tetrahydropyranyladriamycin (THP) in patients with various solid tumors was carried out by 44 cooperative study institutions. Seven hundred fifty-six patients administered the drug intravenously were entered into this study. Of these, 499 patients were evaluated for objective responses. THP was given mainly at a dose of 40 to 60 mg/body every 3 to 4 weeks or 20 to 30 mg/body once a week. Response rates were 18.8% for head and neck cancer, 13.1% for stomach cancer, 21.4% for breast cancer, 22.2% for bladder cancer, 30% for renal pelvic and urinary tract tumor, 26.8% for ovarian cancer and 24.2% for uterine cancer. Overall response rate was 15.4% including 10 complete responses and 67 partial responses. Adverse reactions were similar to those previously reported in the phase I study, including gastrointestinal toxicities and myelosuppression. Alopecia and stomatitis, which are major side effects of other anthracyclines, were rather mild. Incidence of ECG changes was 2.8% and no congestive heart failure was observed.

Novel responses of peripheral lymphocytes of cancer patients to chemical induction of sister chromatid exchanges

Sensitivities to sister chromatid exchange (SCE) induction by chemicals of peripheral lymphocytes from 26 cancer patients were estimated under conditions identical to those for healthy humans which had been reported (Cancer Res., 43: 439-442, 1983). The sensitive individual was defined as one whose cells give a mean induced SCE frequency more than 2 standard deviation units above the population mean of induced SCEs in cells from the healthy humans. When cells were treated with 3-amino-1-methyl-5H-pyrido[4, 3-b]indole in the presence of rat liver S9 mix, 8 in 10 stomach cancer patients, 4 in 4 colon cancer patients, 3 in 9 lung cancer patients, 0 in 3 patients bearing other cancers, and 0 in 9 non-cancerous individuals were sensitive. The corresponding frequency of individuals in the healthy population, reported previously, was 1 in 33 persons. Thus, the frequency of sensitive individuals in the combined group of stomach and colon cancer patients was very significantly higher than were frequencies in control groups. Three in 10 patients with stomach cancer and 4 in 16 patients with other cancers were sensitive to induction of SCE by methyl methanesulfonate. Six in these 7 methyl methanesulfonate-sensitive patients were also 3-amino-1-methyl-5H-pyrido[4,3-b]indole sensitive. The frequency of methyl methanesulfonate-sensitive individuals in the healthy populations was 2 in 50. There was no patient who was sensitive to SCE induction by 4-nitroquinoline 1-oxide. The frequency was not significantly different from the healthy population, in which 3 in 50 persons were sensitive. These results suggest that a particular cancer correlates with the sensitivity of peripheral lymphocytes to SCE induction by particular chemicals.

[A phase I study of VP-16-213 (VP, etoposide) by single and 5-day intravenous administration]

A phase I study of VP was undertaken using the methods of a single (40 cases; range of dose levels 30-540 mg/m2) and 5-day (41 cases; range of dose levels 40-140 mg/m2/day) intravenous administration. The dose-limiting toxicity of VP was moderate to severe leukopenia. MTD was estimated to be 540 mg/m2 for a single and 140 mg/m2/day for 5-day administration. The median days to WBC nadir from the start of therapy and to recovery from reaching the nadir were 10 and 10.5 for single, and 15 and 7 for 5-day administration, respectively. Thrombocytopenia was less frequent and less pronounced than leukopenia. Mild gastrointestinal disturbances and alopecia were frequently observed. Transient hepatic dysfunction, fever, headache, fatigue, dyspnea, hypotension, and pain along the vein were also encountered in a small number of patients. There were no cases with renal, neurologic or cardiac toxicity. Objective tumor regression was seen in one case each of IBL(CR), bladder cancer, non-Hodgkin's lymphoma and ATL (PR). The post-infusion plasma decay of VP in 4 cases given 80-120 mg/m2 by a single administration was biphasic with t1/2 alpha ranging from 0.13 to 0.39 h and t1/2 beta ranging from 3.33 to 4.85 h. No accumulation of VP was found in plasma after five repeated daily doses. Doses of 360-480 mg/m2 by single and 80-100 mg/m2/day by 5-day administration repeated every 3 to 4 weeks can therefore be recommended for phase II studies in good-risk patients.

[Phase I study of 5'-deoxy-5-fluorouridine (5'-DFUR)]

A phase I study of a new fluorinated pyrimidine compound, 5'-deoxy-5-fluorouridine (5'-DFUR), was performed in 37 patients with various malignant cancers. Starting dose was 600 mg/m2/day (900 mg/body/day) and escalated up to 3900 mg/body/day. The dose given was divided into 3 administrations a day for 5 consecutive days. Subjective symptoms were observed in cases given a dose of over 2,100 mg/body/day. Gastro-intestinal disturbances such as nausea, vomiting and anorexia were the major side effects. In the hematological and urinary examinations, no severe abnormal signs were observed. The maximum tolerated dose was considered to be 2.100 mg/body/day, and the dose-limiting factor was gastro-intestinal disturbance. 5-FU levels were determined in the serum and tumor tissues. 5'-DFUR was well absorbed. The 5-FU level in tumor tissue was very high at 2 to 3 hours post-dose and then rapidly decreased, being 0.05 microgram/g 12 hours after administration. The optimal dosage for a phase II study was suggested to be less than 2,100 mg/body/day.