[Clinical features and managements of breast cancer patients with pulmonary metastasis]

One hundred-thirty-nine patients with advanced breast cancer were treated during five years since 1977 in our Department. Treatments consisted of chemotherapy (ACF and ACFM), hormone therapy (tamoxifen) and their combination (ACFT). Seventy patients had lung metastases at the initiation of these therapies. An overall response rate was 41%, whereas a response rate for metastatic lung lesions was 26% (18/69). Breast cancer is known as a systemic disease, thus other therapies such as pulmonary resection or irradiation had a limited indication to control the lung metastasis. Our result indicates that favorable responses to advanced breast cancer with systemic therapies will improve the prognosis of breast cancer patients with lung metastasis.

[Combination chemotherapy of advanced gastric cancer with adriamycin, mitomycin C, and ftorafur]

Thirty patients with advanced gastric cancer were treated with a combination chemotherapy consisting of adriamycin 20-30 mg/m2 iv day 1 q3wks, mitomycin C 2.7-4 mg/m2 iv day 1 weekly, and ftorafur 267 mg/m2 po b.i.d. daily. Five (28%) of 18 patients with measurable lesions achieved partial responses with a median duration of 2 months ranging 1.5 to 8 months. The median survival time from initiation of the chemotherapy was 4 months in responders, and 5 months in non-responders, respectively. The response rate did not correlate with the various baseline parameters including initial performance status, resectability of the primary tumor, histologic differentiation of the tumor, and prior chemotherapy. Gastrointestinal and hematologic toxicities were mild and well manageable. Cumulative thrombocytopenia and renal damage probably due to mitomycin C, were seen in 5(17%) and 2(7%) patients, respectively. Clinical cardiotoxicity induced by adriamycin was observed in one patient. The result indicated that the enhancement of antitumor effect with a combination of adriamycin, mitomycin C, and ftorafur for advanced gastric cancer was not significantly remarkable as expected. Thus, further study will be required for obtaining more favorable result.

[Co-administration of adriamycin and 5-fluorouracil for the treatment of advanced stomach cancer]

Twenty-one patients with advanced gastric cancer were treated with a combination chemotherapy of adriamycin and 5-fluorouracil (AF). The AF regimen consisting of adriamycin 35-50 mg/m2 intravenously on day 1, 5-fluorouracil 350-500 mg/m2 intravenously on days 1-3 was repeated in every three weeks intervals. Partial response was obtained in four patients (25%) in 16 evaluable patients and responded lesions were abdominal mass and skin metastasis. Two patients had minor responses, seven had stable diseases, and three had progressive diseases. The median duration of response for responders was three months ranging one to five months and the median survival time of responders was twelve months ranging two to fourteen months, whereas that of non-responders was eight months. Moderate bone marrow suppression was seen; that is, seven (33%) out of twenty-one patients had leukopenia less than 2,000/mm3 and two (10%) out of twenty-one patients had thrombocytopenia less than 10 X 10(4)/mm3. Moderate nausea occurred in thirteen patients (62%), whereas vomiting did in nine patients (43%). Nearly total alopecia was observed in sixteen patients (76%). Based on these results, we conclude that AF regimen can be administered without severe toxicities and it is one of the useful regimens for advanced gastric cancer.

Phase I clinical trial of a new anthracycline: 4'-o-tetrahydropyranyl adriamycin

The phase I study of a new anthracycline, 4'-o-tetrahydropyranyl adriamycin, was performed. A dose-limiting factor was leukopenia while thrombocytopenia was less frequent and a maximum tolerated dose was determined as 54 mg/m2. Mild gastrointestinal toxicities including anorexia, nausea and vomiting occurred in about half of the patients, while very minimal alopecia was seen in only one patient. A recommended dose for phase II study was established: 40 mg/m2 at 3-week intervals.

[Colony formation of solid tumors in in vitro colony assay (human tumor stem cell assay)]

Colony forming ability of solid tumor cells was studied in a tumor colony assay (human tumor stem cell assay). In 50 cases of solid tumors, cloning efficiencies of 5 X 10(5) cells plated were as follows: breast cancer 12/12 (100%), colon cancer 10/11 (91%), ovarian cancer 9/9 (100%), sarcomas 7/9 (78%), gastric cancer 3/6 (50%), endometrial cancer 2/2 and pancreatic cancer 1/1. An overall cloning efficiency was 88% (44/50) and this rate is higher than those reported in literatures. Ovarian cancer showed the highest plating efficiency of 0.07% (number of colonies/number of cells plated X 100%) in various solid tumors tested. Subsequently, plating efficiencies of colon and breast cancer were 0.03 and 0.01%, respectively. In the cases of sarcomas and gastric cancer, low plating efficiencies were seen (0.008%, 0.003%). The overall rate succeeded colony growth of solid tumors was somewhat higher in enzymatically treated tumor cells, that is, cloning efficiencies in mechanical and enzymatic methods were 85 and 90%, respectively. The enzymatic disaggregation is an advantageous method in gastric cancer and sarcomas. Various solid tumors can be formed colonies in soft agar and chemosensitivity test using in vitro colony assay is expected in solid tumors.

[Combination chemotherapy of Hodgkin's disease with vincristine, cyclophosphamide, procarbazine, and prednisolone]

Nineteen patients with stages II B-IV of Hodgkin's disease were treated with a combination of vincristine, cyclophosphamide, procarbazine, and prednisolone (CVPP regimen), given in a 3 week intervals for 3 months. Eighteen patients were available for responses. A complete remission (CR) was obtained in 9 (50%) out of 18 patients. The median duration of CR and relapse-free survival were 7 months and 26+ months, respectively. Hematologic toxicity was mild, although occasionally cumulative for aged patients and for previously treated patients. Other toxicities such as alopecia and neurotoxicity were troublesome but reversible. Thus, a further study by modification of the regimen warranted to improve the response rate and relapse-free survival.

[Arterial infusion of combination chemotherapy using adriamycin and mitomycin C for hepatoma and metastatic tumors of the liver]

Forty patients with hepatoma and metastatic tumors of liver were treated with rapid arterial infusion administered simultaneously using 30-40 mg of adriamycin and 10-20 mg of mitomycin C into the hepatic artery by Seldinger catheter. They were 16 patients with breast cancer, 21 with gastrointestinal tumors including hepatoma; 6, gastric cancer; 5, colon cancer; 7, gallbladder cancer; 2, pancreas cancer; 1, and three with other malignancies, respectively. Partial responses were obtained in 14 of 40 patients (35%). The response rate in patients with breast cancer was 44% (7/16), while it was 29% (6/21) with gastrointestinal tumors. The median duration of response was relatively short, being 3.5 months in the former patients and 2.3 months in the latter patients. The median duration of survival was 4.0+ months. The results indicate that this arterial infusion therapy is one of the useful treatments in the management of malignant tumors of the liver. Leukopenia less than 4 x 10(3)/cmm was seen in 63%, while thrombocytopenia less than 100 x 10(3)/cmm in 38%, and decreased hemoglobin value of more than 2 g/dl in 13%, which were quite tolerable. Gastrointestinal symptoms and hair loss were milder than those from systemic chemotherapy. Renal toxicity was seen in three patients, and two patients died of renal failure, thus the renal toxicity, which may be related to contrast media as well as anticancer agents, should be carefully prevented by proper hydration.

[A combination chemotherapy of ACNU and DTIC for advanced malignant melanoma]

Fourteen patients with advanced malignant melanoma were treated with a combination chemotherapy consisting of ACNU 100 mg/m2 i.v. on Day 1 in 6 week intervals and DTIC 200 mg/m2 i.v. on Days 1 to 5 at 3 week intervals. Four patients had prior chemotherapy and 2 had prior immunotherapy. Excluding 4 patients received the regimen for adjuvant chemotherapy, 10 of 14 patients were evaluable for response. There were 3 patients of partial responses, 3 minor responses, 1 no change, and 3 progressive diseases. The durations of partial responses were 1, 1, and 8 months, respectively, while the survival times in these patients were 5, 21, and 10 months, respectively. Leukopenia less than 4,000/cmm occurred in 10 of 14 patients (71%) and thrombocytopenia less than 100 X 10(3)/cmm in 9 of 14 patients (64%), moreover, these hematologic toxicities were cumulative. Serum GOT and GPT elevated to 3,460 mu/ml and 1,365 mu/ml, respectively in one patient, but this returned to a normal level one month later. Nausea and vomiting were mild to severe in 12 of 14 patients, being most marked on Day 1 and decreasing intensity during the next several days. Other non-hematologic toxicities including skin rash, fever, and phlebitis were noted in each one patient, respectively. Hematologic toxicity of this regimen was a dose limiting toxicity; therefore, intensive supportive therapy to prevent infection and hemorrhage is essential for the management of the patients during this chemotherapy.

[Clinical effect of human fibroblast interferon on malignant cancer. (2) Immunological study of the patients under treatment]

Several immunological studies were performed in patients with various malignant diseases under treatment of human fibroblast interferon (HFIF). Lymphocyte natural killer (NK) activity against culture cell lines was measured before and at various time after HFIF treatment. The majority of patients reached the highest level of NK activity at 18-24 hours, mostly at 24 hours after initiating HFIF. In one group of patients, thereafter, NK activity remained the highest level during HFIF treatment, and in another group of patients, NK activity declined even with daily infusion of HFIF but usually remained above pre-treatment level. There seemed to be no correlation between NK activity and clinical activity. In contrast to NK activity against culture cell lines, an increase in lymphocyte cytotoxic activity against autologous tumor cells was not observed following HFIF treatment. Mixed lymphocyte tumor cell reaction performed in 6 patients showed that a slight increase of 3H-thymidine uptake was seen in one patient, but the rest of them had no change. In vitro sensitization to assess the in vitro generation of cytotoxic cells were negative in all 6 patients. Lymphocyte blastogenic responses to non-specific mitogens showed no significant change. Delayed type hypersensitivity reaction to recall antigens was increased in about half of the patients after HFIF treatment.

[Phase I-II studies of a new antineoplastic agent, 4'-(9-acridinylamino)-methanesulfon-m-anisidide (AMSA)]

AMSA, an acridine derivative with significant antitumor activity in experimental tumors, was administered to 17 patients with advanced tumors refractory to standard chemotherapies. A phase I study was undertaken in 10 patients with solid tumors and lymphomas. Dose-limiting toxicity was myelosuppression. With a median dose of 90 mg/m2 (75-148 mg/m2), median lowest WBC count was 1,000/mm3 (100-3,200) on day 11 and its recovery up to 4,000/mm3 was seen on day 21, while lowest platelet count was 42 X 10(3)/mm3 (7-300 X 10(3) on day 12 and its recovery up to 100 X 10(3)/mm3 was on day 20. Non-hematological toxicities were nausea (39%), vomiting (11%) and phlebitis (17%) in 18 courses of therapy. The result indicated that the recommended dose schedule for a phase II evaluation was 90 mg/m2, every three weeks. Therapeutic activity was observed in patients with non-Hodgkin's lymphoma (one partial response and two minor responses out of four). Two out of five breast, one ovarian, and one melanoma patients showed stable diseases. Five leukemic patients (three AMLs, one MoL, and one blastic CML) were treated with AMSA, and in these cases cytoreduction of peripheral and bone marrow blasts was seen, but it was not adequate to induce remission. Further clinical trials with this agent are warranted, especially in patients with acute leukemia, lymphoma and breast cancer.

[Clinical effects of human fibroblast interferon on malignant tumors]

Human fibroblast interferon(HFIF) was used in 26 patients with various malignant diseases, most of whom had previous chemotherapy. The dosages used were 3 X 10(6) IU or 6 X 10(6) IU of HFIF i. v. daily. Out of 24 evaluable patients, there were 2 partial remissions (CLL 1 and multiple myeloma 1), and 7 stable diseases (multiple myeloma 2, stomach cancer 2, non-Hodgkin's lymphoma 1, CLL 1 and malignant melanoma 1). The majority of the patients experienced fever exceeding 38 degrees C and chills, which became uncommon within several days of treatment. Other side effects included myelosuppression, general malaise, anorexia, hepatic dysfunction and renal dysfunction, which were mild and tolerable.

Antibody responses of remission leukemia patients receiving active specific and nonspecific immunotherapy

A solid-phase radioimmunoassay was utilized to evaluate the antibody response of 21 acute myelogenous leukemia (AML) patients to active specific immunotherapy with either pooled allogeneic AML blast cells or leukemia-associated antigen (LAA), admixed with BCG cell-wall skeleton (CWS). Five of 13 patients treated with LAA had a significant antibody response to LAA after immunotherapy. Antibody response correlated with an increased remission duration (159+ vs. 75+ weeks) and an increased survival (164+ vs. 98+ weeks). Two of eight patients treated with cells responded to LAA, and three patients had initially high anti-LAA antibody levels. In the total study, eight of 11 patients surviving longer than 2 1/2 years and six of seven patients maintaining a complete remission longer than 2 years were antibody responders. Neither protocol induced significant antibody to a normal spleen extract, BCG-CWS, or a measles recall antigen. However, five of seven patients with initially high levels of antibody to BCG (following weekly BCG scarification) were long-term survivors. These data suggest that the humoral immune response to immunotherapeutic agents may be a useful parameter for monitoring immunotherapy of AML patients.

A preliminary study of polyamines in the bone-marrow plasma of adult patients with leukemia

Polyamines (mainly putrescine, spermidine, and spermine) whose biosynthesis is a prerequisite for cell proliferation, are potential indicators of malignant growth. To investigate the mechanism of alterations of polyamine levels in physiological fluids in human cancer, polyamine levels of bone-marrow plasma from adult patients with leukemia were studied. Significant correlations were observed between bone-marrow cellularity and spermidine, between peripheral white blood cell counts and spermidine and spermine, and between absolute blast count and spermidine and spermine among untreated patients with acute leukemia. Untreated patients with chronic leukemia showed significantly elevated levels of polyamines relative to untreated patients with acute leukemia, indicating a higher turnover of bone-marrow cells in chronic leukemia than in acute leukemia. Chemotherapy-treated patients with acute leukemia who were in remission or who did not respond to the agent showed low polyamine levels. Patients who showed a destruction of tumor cell during chemotherapy gave high levels of polyamines. Overall, these studies indicate that elevated polyamine levels are markers of cell death.

Mixed lymphocyte-tumor cell reaction between remission lymphocytes and autochthonous leukemia cells and its relationship to the prognosis of acute leukemia

The mixed lymphocyte-tumor cell reaction (MLTR) between peripheral lymphocytes and cryopreserved autochthonous leukemia cells was studied in 36 adult patients with acute leukemia after complete remission as a result of chemotherapy. In 20 patients the lymphocytes showed a significant blastogenic response to autochthonous leukemia cells. Eleven out of 18 patients with acute myeloblastic leukemia and 4 out of 5 with acute monocytic leukemia showed positive MLTR, whereas 5 out of 13 with acute lymphoblastic leukemia gave a positive reaction. Cryopreserved leukemia cells of the patients with not only positive but also negative MLTR were able to stimulate allogeneic lymphocytes, except in one case. The relationship between MLTR and the prognosis of leukemia was analyzed in 30 patients who were alive more than 6 months after diagnosis. No apparent correlation was observed between MLTR and the survival time from diagnosis.