[Evaluation of the "squamous cell carcinoma antigen" as marker of epidermoid cancer of the anal canal]

The authors studied the value of Squamous Cell Carcinoma Antigen (SCC) in squamous carcinoma of the anal canal in 66 patients. Assays were made at the time of diagnosis, before any treatment and during follow-up. A total of 353 assays were made. The positive threshold was selected at 2 ng/ml. At the time of diagnosis, sensitivity of the marker was 44 per cent and its specificity 92 per cent. In our series, pre-treatment SCC levels were not correlated with T by the Papillon classification, but were correlated with lymph node involvement (p less than 0.05). They had no prognostic value at the time of the initial diagnosis. During follow-up, at the time of recurrence, SCC levels were 20.3 +/- 43 ng/ml. This rise was significant (p less than 0.01), the sensitivity of the marker being 77 per cent. In patients who had a recurrence, the outcome was correlated with SCC levels and the latter were of prognostic value (p less than 0.01). In conclusion, SCC levels should form part of the clinical monitoring of patients with a squamous carcinoma of the anal canal.

Prognostic value of total cathepsin D in breast tumors. A possible role in selection of chemoresistant patients

Evaluation of prognostic factors for breast cancers is important for therapeutic decisions both at the time of surgery and during postoperative surveillance. In 1979, H. Rochefort described an induced protein with a molecular weight of 52,000 Daltons identified as procathepsin D. Total cathepsin D (TCD) (52K + 48K + 34K), expressed in pmol/mg protein, can be measured by an immunoradiometric method commercialized by Cis-Biointernational. Total cathepsin D was assayed in 413 breast cancer tumors from patients who underwent surgery between January 1, 1978, and December 31, 1985. Using a cut-off of 35 pmol/mg protein, patients with an elevated level had a significantly poorer survival than those with a low level (p = 0.03). This difference was not found for node-negative patients but was very significant for node-positive patients (p less than 0.008). The survival of node-positive patients with a low total cathepsin level was not statistically different from that of node-negative patients. Analysis of the N+ subgroup of patients who did not receive adjuvant chemotherapy revealed that TCD no longer had any prognostic value, whereas it was still important for the N+ subgroup who received an adjuvant treatment. Cox multivariate analysis of prognostic value for survival placed total cathepsin D in third position, after nodal invasion and progesterone receptor status, for the entire population, and in first position before progesterone receptor status for the node-positive population. The association of a low cathepsin level and positive progesterone receptors characterized the subgroup of patients with the longest survival. TCD levels played the same role for prediction of the outcome of metastasis.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidermal growth factor receptor assay: validation of a single point method and application to breast cancer

Epidermal growth factor (EGF) is a 6000 kDa peptide which exerts its biological effects by binding to a specific cell membrane receptor (EGF-R). Extensive studies on EGF-R in breast tumors have demonstrated the prognostic value of such assays. EGF-R measurement is also reportedly potentially useful in other tumors. Classically, the EGF-R content of tumor cell membrane preparations is evaluated by competition between a given concentration of labeled ligand and various concentrations of unlabeled ligand. The large quantity of tumor tissue required (approx. 0.5 g) is a serious limitation for wide-spread use of EGF-R assays. In order to validate a miniaturized EGF-R assay method, the principle of a single-dose technique (SD) using a single concentration of labeled ligand (1 nM) was investigated in the present work. Only 100-150 mg wet tissue were required for routine analysis by the SD method. The correlation between the SD method and Scatchard analysis calculated from 41 different breast carcinoma samples was very satisfactory (r = 0.973, p less than 0.001). Analysis of intra-assay and inter-assay reproducibility revealed a comparable EGF-R status in given samples. The correlation between EGF-R levels and steroid receptors was investigated in 105 individual breast tumors. EGF-R levels were inversely correlated with the estradiol receptor values. No correlation was found with progesterone receptors. The simplified SD method for EGF-R measurement appears suitable for large scale clinical studies aimed at investigating the potential utility of this biological tumor marker.

[Hepatic x-ray computed tomography. Value of delayed (6 hours) scanning in patients with normal biliary function]

Delayed hepatic CT (DH-CT) was studied in 250 patients without any major bile duct pathology. One hundred thirty-five of these patients had liver metastases. All patients were administrated 76 grams of iodine. Tolerance of the examination was good. Six hours after injection, average contrast enhancement in the normal liver was 24 HU (greater than 1.3 g/kg iodine), 22 HU (1 to 1.3 g/kg) and 14 HU (1 g/kg). Comparison of scans taken before, immediately after, and 6 hours post-injection revealed the frequent superiority of postinjection scans for diagnosis of liver metastases. Focal steatosis is the only benign pathology to benefit from DH-CT, because of the parallelism in the difference in density between the normal and steatotic tissue regardless of the time of scanning. Aside from isolated tumors requiring exploration by conventional CT (pre- and post-contrast studies), the workup of liver metastases can be optimized by postcontrast and DH-CT scans.

[Conservative treatment of epidermoid cancer of the anal canal combining radiotherapy and curietherapy. Experience at the Antoine-Lacassagne Center]

From 1973 to 1987, 33 patients aged from 46 to 86 years (25 female, 8 male) were treated for a tumour of the anal canal with radiotherapy and curietherapy. Tumour distribution was 7 T1, 19 T2, 7 T3, and 4 patients were N+. After treatment it was possible to assess 31 patients; 29 were in complete remission, remission was obtained in 2 others following surgery. Tolerance was comparable to other series but 4 patients developed necrosis of the anal canal; 2 patients died under general anesthesia and 1 patient had a radiation injury of the small intestine. The sphincter was conserved in 65 p. cent of cases. Relapse occurred in 8 patients within 6-92 months, and 6 patients developed metastases. Overall survival was 78 p. cent at 3 years and 74 p. cent at 5 and 10 years. Disease-free survival was 65 p. cent at 3 and 5 years and 52 p. cent at 10 years. Our results confirm those of other series using a similar treatment plan. This treatment is difficult to put into practice. Patients must be carefully selected preferably by a team including proctologist, surgeon and radiotherapist.

Tamoxifen metabolism: pharmacokinetic and in vitro study

The qualitative and quantitative importance of tamoxifen (TMX) metabolism in vivo led us to investigate further the metabolic profile of this major anti-oestrogenic drug in a significant group of 81 breast cancer patients and to evaluate the respective in vitro activity of each metabolite. TMX and its four metabolites described until now (NDT, 4-OHT, Y, Z) were measured in blood (HPLC method) at the time of first drug intake and at the steady state. Between these two states, the unchanged drug relative proportion dropped from 65% to 27%. Demethylation was the major metabolic pathway. For 13 clinically evaluable patients, there was no significant difference in the distribution of serum levels of TMX and metabolites as a function of response to treatment. In vitro studies were performed on two human breast cancer cell lines: MCF-7, oestrogen receptor and progesterone receptor positive (ER+, PR+) and CAL-18 B (ER-, PR-). Cytostatic effects were evaluated by the tritiated thymidine incorporation test. TMX and all metabolites were active on these two cell lines, but the 50% inhibitory concentrations (IC50) were 4-250-fold higher in CAL-18 B than in MCF-7, depending on the metabolite considered. For the MCF-7 cells only, the antiproliferating activity was parallel to the relative binding affinity for ER. Moreover, for the MCF-7 cells only, the effects of these drugs were partially reversed by oestradiol (E2), the higher the metabolite affinity for ER, the lower the reversal efficacy. These compounds were tested in mixtures at proportions duplicating those found in patients after initial drug intake (mixture D1), and the steady state (mixture Css). The mixtures were also compared to the equimolar unchanged drug. No differences were seen among these three experimental conditions for either MCF-7 or CAL-18 B. A dose-effect relationship was noted. Overall, TMX and its metabolites exert a dual effect: when concentrations are below a threshold between 2 x 10(-6) and 10(-5) M, the drugs are mainly cytostatic; this effect is related to their affinity for ER. At higher relevant clinical concentrations, a cytotoxic activity is observed and it appears independent of the presence of ER.

Pharmacokinetics of weekly low dose doxorubicin

Weekly low dose doxorubicin (WLD-dox) is an interesting alternative to the classical 3 week schedule because of its reduced cardiotoxicity, the major dose-related side-effect. This study characterized the pharmacokinetic behaviour of WLD-dox with particular attention to the effect of treatment duration on the variability of individual pharmacokinetic parameters. Twenty-eight patients with advanced breast cancer were treated by WLD-dox (12 mg/m2 week). Individual pharmacokinetic analyses were performed at the first injection and every month thereafter; residual drug levels were measured every week before injection. Dox and its main metabolite doxol were measured by HPLC and fluorescence. Pharmacokinetic data were available for 51 cycles. The mean concentration-time profile for 25 patients with normal liver function tests fitted well with a two-compartment model: COext (nM) = 2905 +/- 1834; t 1/2 alpha = 0.08 +/- 0.03 h; t 1/2 beta = 10.4 +/- 3.6 h; clearance (1/h) = 55.4 +/- 24.8; Vd (1) = 809 +/- 434. The findings concur with those for classical 3-week dox schedule (45 mg/m2) analysed in six patients as controls. Exceptions were the initial extrapolated concentration and area under curves which were reduced for WLD-dox according to the dose. Dox and/or doxol overexposure was patent in all three patients with elevated pre-treatment serum bilirubin. During treatment, up to 48 WLD-dox administrations, no significant trends were noted for 10 patients in the evolution of initial extrapolated concentration, terminal half-life, total body clearance or the proportion of doxol formed. Residual drug levels were controlled up to 40 WLD-dox administrations (135 samples); in half the cases they comprised between 1 and 20 nM without particular sign of increasing along the treatment course. In this case WLD-dox can be assimilated to a continuous exposure to low drug levels with intermittent pulses thus representing an original pharmacological profile for dox.

Liver, spleen, and vessels: preliminary clinical results of CT with perfluorooctylbromide

This phase 1-2 trial investigated the use of a 100% wt/vol emulsion of perfluorooctylbromide (PFOB) in computed tomography (CT) of 30 patients with metastatic cancer. Injection of 3 g/kg (maximum dose administered to these patients) provided an average liver enhancement of +31 HU on CT scans obtained after 48 hours. Maximum splenic opacification occurred immediately after injection; 1 g/kg, which allowed an immediate enhancement of +35 HU, appeared sufficient for the diagnosis of splenic conditions. Vascular opacification was insufficient for diagnostic purposes. In four patients with metastases, more lesions were seen with the use of PFOB with CT than with conventional CT. Adverse effects included five cases of low back pain that were reversible when the infusion rate was reduced. Fever and trembling were also noted 6 hours after injection in five patients. In all patients, symptoms regressed spontaneously within several hours. Clinically inapparent and dose-independent splenomegaly (volume increase of at least 20% on CT examinations) was noted in eight patients.

[Liver involvement in syphilis]

The authors report two cases of syphilitic hepatitis. In the first case, acute hepatitis occurred during the secondary stage of syphilis. The diagnosis was made without waiting for the hepatitis to respond to penicillin treatment, on the basis of the following signs: icterus involving inflammatory syndrome, moderate cytolysis, clear retention, eruption of papular syphilids and a strongly positive test for syphilis. The second case involved a female patient who had been treated 15 years earlier for bone syphilis with ulcerous gummas. The signs were sclerotic, gummatous, hepatic lesions revealed by a syndrome of calcified hepatic lesions. The serologic test for syphilis was negative in this patient. Laparotomy and biopsy were necessary before a firm diagnosis could be made. The authors examine literature data concerning this pathology.