Allele loss at the c-Ha-ras1 locus in human ovarian cancer

Recent reports have shown allele loss at the c-Ha-ras1 locus on the short arm of chromosome 11 in some types of tumors. To determine whether loss of heterozygosity occurs at the c-Ha-ras1 locus in uncultured human ovarian carcinomas we used Southern blot analysis to study DNA from 17 pairs of ovarian tumors and matched white blood cell samples from the same patients. In one of these 17 tumors, the c-Ha-ras1 locus was rearranged, and in five tumor DNAs from ten informative patients, a c-Ha-ras1 allele was lost. This loss, of relatively high incidence, appears to be an important characteristic of human ovarian cancer and may provide a useful tool for understanding its biological behavior.

Treatment of advanced epithelial ovarian cancer with cisplatin and cyclophosphamide

Between June 1981 and June 1984, 50 patients with stage III or IV epithelial ovarian cancer underwent initial surgery followed by combination chemotherapy with cisplatin 50 mg/m2 iv and cyclophosphamide 500-1000 mg/m2 iv at 28-day intervals. No patients with borderline or well-differentiated tumors were included. If patients were clinically disease-free after 12 cycles of therapy, a second-look laparotomy was performed. A complete response was noted in 12 patients (24%), 11 of whom were surgically evaluated. A partial response was noted in 4 patients (8%), 3 of whom were surgically evaluated. Thirty-four patients (68%) had no response to therapy. The median progression-free survival (PFS) for the entire group was 19.8 months, with a median survival of 27 months. Patients with less than or equal to 2 cm residual disease had a superior median PFS (25.4 months vs 18 months) and median survival (29.4 months vs 19.5 months) to those patients with greater than 2 cm residual disease. Patients who underwent primary debulking had a longer median survival than patients who underwent "interval" debulking after two to four cycles of chemotherapy (29.2 months vs 17.3 months). Thirteen patients (26%) are alive without evidence of disease, 4 patients are alive with disease, and 33 patients are dead of disease. Toxicity was very moderate. In summary, the activity and toxicity of the combination of cisplatin and cyclophosphamide compare favorably to other cisplatin combination regimens.

Leuprolide acetate in the treatment of refractory or persistent epithelial ovarian cancer

Leuprolide acetate (Lupron, TAP Pharmaceuticals, North Chicago), a gonadotropin-releasing hormone analogue, was administered subcutaneously at a 1-mg dose for a minimum of 8 weeks to 23 patients with refractory epithelial ovarian cancer. Eighteen of these patients were evaluable. There were no complete responses. Four patients (17%) had a partial response, with a median duration of 52 weeks. Three of six patients with grade 1 carcinomas had a partial response and two had stabilized disease. There was only one response among 15 patients with grade 2 or 3 disease. Therapy was well tolerated, with three patients complaining of hot flashes and two of mild pedal edema. Leuprolide acetate thus shows evidence of antitumor activity against refractory grade 1 epithelial adenocarcinoma of the ovary. Further trials with larger numbers of patients should be conducted.

Infiltration of interleukin-2-inducible killer cells in ascitic fluid and pleural effusions of advanced cancer patients

Using ascitic fluid or pleural effusion obtained from 13 ovarian or metastatic breast cancer patients, we separated tumor cells from effusion-associated lymphocytes (EAL) with Percoll density centrifugation. Lymphocytes were incubated with recombinant interleukin 2 (IL-2) for 3-4 days and then assessed for tumoricidal activity in a 51chromium-release assay. The IL-2-activated EAL were found to lyse autologous fresh tumor cells, as well as allogeneic fresh tumor cells and FMEX tumor cells, a melanoma cell line which is resistant to natural killer cell activity but is sensitive to lysis by lymphokine-activated killer cells. There was little or no tumoricidal activity seen in freshly isolated EAL or in EAL which were cultured in medium without IL-2. Phenotypically, the IL-2-activated EAL were largely CD3-, although some cytolytic activity was found in CD3+ populations. Also, most activity was found in cells positive for CD2 (OKT11) and CD16 (Leu 11b), and negative for the monocyte marker Leu M3. These results indicate that the activated cell types found in EAL were predominantly natural killer/lymphokine-activated killer-like with a small contribution from T-cells. Finally, EAL were readily activated by IL-2 in medium containing autologous effusion fluid, indicating that in situ activation of tumoricidal activity by IL-2 can occur in the face of potentially inhibitory substances or cells that may exist in the effusions. Direct introduction of IL-2 may therefore be a potential therapeutic modality of effusion-forming cancers.

Restaging laparotomy and ovarian cancer

We retrospectively reviewed the records of 41 patients who had restaging laparotomy after initial surgery and chemotherapy for ovarian cancer. In 37 of them, the cancer was epithelial. Stage and amount of residual disease after initial cytoreductive surgery correlated with laparotomy outcome. There were no operative deaths, and perioperative morbidity was relatively minor. Of the 25 patients with residual disease after initial cytoreductive surgery ten had a complete response, eight had a partial response, two had stable disease, and five had progression. Three patients (11.5%) had recurrent disease after a negative restaging laparotomy. We discuss salvage therapy and the value of restaging laparotomy in ovarian cancer.

Treatment of recurrent and metastatic cervical cancer with cis-platin, doxorubicin, and cyclophosphamide

The combination of cisplatin, doxorubicin, and cyclophosphamide was used to treat 28 patients with recurrent and metastatic cervical cancer. Five patients had a complete response and one patient had a partial response, yielding a total response rate of 21%. Eleven patients had stable disease. The median survival for the whole group was 42 weeks. Responders had a statistically significant prolongation of survival at a median of 113 weeks (P less than 0.01). There was no statistically significant difference in progression-free interval between responders and patients with stable disease. The overall median progression-free survival was 26 weeks. The toxicities noted were primarily nausea, vomiting, and myelosuppression. The combination of cis-platin, doxorubicin, and cyclophosphamide has modest effectiveness in the treatment of metastatic or recurrent carcinoma of the cervix.

Treatment of metastatic stromal tumors of the ovary with cisplatin, doxorubicin, and cyclophosphamide

From September 1981 until June 1986, eight patients with metastatic ovarian stromal tumors were entered into a prospective phase II study to determine the efficacy of a chemotherapy regimen combining cisplatin, doxorubicin, and cyclophosphamide. Patients received cisplatin 40-50 mg/m2 intravenously (IV), doxorubicin 40-50 mg/m2 IV, and cyclophosphamide 400-500 mg/m2 IV, all on day 1 every 28 days. The median age was 43 years (range 24-65 years). Two patients had stage II disease, one had stage III, and five had recurrent disease (original stage: four stage I and one stage III). The median number of chemotherapy cycles was six (range four to 14). Three patients (38%) had a complete response to therapy (two confirmed by second-look laparotomy), and two patients (25%) achieved a partial response (one verified by second-look laparotomy). The overall response rate was 63%. Toxicity was minimal. Four patients are disease-free at 13+ to 48+ months, one patient is alive with disease at six+ months, and three patients are dead of tumor at four, 17, and 36 months from the start of chemotherapy. These results indicate that the combination of cisplatin, doxorubicin, and cyclophosphamide has modest activity in the treatment of metastatic ovarian stromal tumor.

Combination chemotherapy for metastatic or recurrent adenocarcinoma of the cervix

Twenty-four patients with recurrent or widespread adenocarcinoma of the cervix were treated with combination chemotherapy. The drugs used were 5-fluorouracil (5-FU) (500 to 800 mg/m2), doxorubicin (40 to 50 mg/m2), and cisplatin (50 to 60 mg/m2). The chemotherapy was administered as a 76-hour continuous infusion via a silastic central venous catheter and repeated every 28 days. The total response rate was 42% (25% complete and 17% partial). Median duration of response was 7 months. Areas of response were usually lung and lymph node metastases. Toxicity, mainly neutropenia, was acceptable. All patients relapsed. This combination chemotherapy results in a modest response rate for a malignancy about which there is little information regarding the treatment of disseminated disease. Future studies should determine the activity of this combination administered in a bolus fashion.

Intrahepatic infusional therapy for metastatic ovarian carcinoma

Twenty-four women with ovarian carcinoma that had metastasized to the liver were treated with intrahepatic infusional therapy. No consistent drug regimen was used. There were no complete responders; however, 33% had a partial response. All responses were noticed after the first course of therapy. The median length of response was 6.3 months. The median survival from the time of the first hepatic infusion was 7.5 months for all patients. In this series, there were two treatment-related deaths, one secondary to the chemotherapy, the other to improper catheter placement. Because of the multiplicity of chemotherapy regimens employed, no definite conclusions can be made concerning the efficacy of intrahepatic infusional therapy for metastatic ovarian carcinoma. It is suggested that its future use be restricted to patients with disease limited to the liver and who are being treated according to a study protocol.

Cisplatin therapy for disseminated mixed mesodermal sarcoma of the uterus

Eighteen patients with metastatic mixed mesodermal sarcoma of the uterus received cisplatin therapy at the University of Texas (UT) M.D. Anderson Hospital and Tumor Institute at Houston. The dose of cisplatin varied from 75 mg/m2 to 100 mg/m2. Previous therapy included surgery in 11 patients, radiotherapy in two patients, and surgery plus radiotherapy in four patients. One patient had no prior therapy. Seven patients had also received prior chemotherapy with doxorubicin. Of 12 patients with measurable disease, one (8%) had a complete response and four (33%) had a partial response for an overall response rate of 42%. The median progression-free survival of patients treated with cisplatin as first- and second-line therapy was 4.5 and 5.5 months, respectively. Cisplatin demonstrated moderate activity with mild toxicity in this group of patients with metastatic mixed mesodermal uterine sarcomas. Further studies including cisplatin-containing combination regimens seem to be warranted.

High-dose doxorubicin infusion therapy for disseminated mixed mesodermal sarcoma of the uterus

Fifteen patients with metastatic mixed mesodermal sarcoma of the uterus received high dose doxorubicin infusion therapy. For 12 patients, the initial dose was 90 mg/m2; the other three patients' starting doses were 50, 75, and 75 mg/m2 respectively. Twelve patients received doxorubicin as firstline chemotherapy, with a cumulative dose of 90 mg/m2 to 675 mg/m2 (median = 495 mg/m2). Three patients treated secondarily received cumulative doses of 90, 205, and 425 mg/m2. Of nine patients who had measurable disease, none had an objective response. The median survival of the 15 patients was 11.3 months, with a range of 0.5 to 51+ months. Two patients died of neutropenia related sepsis. Cardiotoxicity occurred in two patients. Eleven patients are dead of disease, and two patients are alive without evidence of disease at 49, and 51 months. Extending the doxorubicin dosage to its tolerable limits did not appear to result in improved efficacy in patients with metastatic mixed mesodermal uterine sarcomas. Future clinical trials should concentrate on doxorubicin-containing combination regimens and Phase II single agent studies.

A trial of continuous-infusion vinblastine in refractory endometrial adenocarcinoma

Fourteen patients with refractory or metastatic adenocarcinoma of the endometrium were treated with continuous infusion vinblastine. No patient had a response. One patient had stable disease. Although well tolerated, vinblastine sulfate given by this method has no activity in this malignancy.

Chemotherapeutic complete remission in patients with metastatic ovarian dysgerminoma. Potential for cure and preservation of reproductive capacity

Two patients with metastatic dysgerminoma of the ovary were treated with a combination of etoposide, bleomycin, and cisplatin at The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston. Both patients achieved a complete remission. Patient 1 developed a massive recurrence in the para-aortic lymph nodes 21 months after diagnosis and treatment with right salpingo-oophorectomy alone. She received four cycles of chemotherapy and is free of disease 21 months from the start of chemotherapy. Patient 2 had Stage III dysgerminoma and a lymphangiogram positive for tumor in the para-aortic lymph nodes. After surgery she received three cycles of chemotherapy and is free of disease 20 months from the start of chemotherapy. Both complete remissions were documented with second-look laparotomy. Chemotherapy may be an alternative to radiotherapy for the treatment of metastatic dysgerminoma and should also be considered for selected patients with Stage I disease. A literature review further supports the conclusion that additional clinical trials might expand the indications for chemotherapy in patients with this disease.

Cisplatin, vinblastine, and bleomycin combination therapy in resistant gestational trophoblastic disease

Eleven patients were treated with cisplatin, vinblastine, and bleomycin (PVB) combination chemotherapy after failure of conventional triple-agent therapy with methotrexate, dactinomycin, and cyclophosphamide for gestational trophoblastic disease. Of ten evaluable patients, five (50%) achieved negative titers. Sustained remission was achieved in only two patients (20%). Major hematologic toxicities and two deaths due to sepsis occurred in this group of patients. Although this combination does exhibit activity, its clinical use in the treatment of refractory trophoblastic disease is limited.

Endodermal sinus tumor of the ovary associated with pregnancy

The association of endodermal sinus tumor of the ovary with pregnancy is a rare event. Reported is a patient with stage Ic endodermal sinus tumor diagnosed in the 25th week of gestation. She received two cycles of combination chemotherapy consisting of vinblastine, bleomycin, and cisplatin, and delivered a healthy male infant by cesarean section at 32 weeks' gestation. She subsequently completed three more cycles of chemotherapy and remains alive and well. This is the first reported case of a patient with endodermal sinus tumor treated with combination chemotherapy during pregnancy that had a successful outcome for both mother and infant. The literature concerning the association of endodermal sinus tumor and pregnancy and the use of chemotherapy during pregnancy is reviewed.

Percutaneous nephrostomy catheter use in gynecologic malignancy: M.D. Anderson Hospital experience

The clinical courses of 30 patients with 41 nephrostomy catheters were followed. Duration of drainage ranged from 2 days to 15 months with a mean of 3.7 months. The most common complications were hemorrhage (28%), infection (70%), and blockage of catheter (65%). No deaths occurred as a result of these complications. Renal function recovered in 14 of 20 patients (70%) who presented with elevated creatinine values. Twenty-six of 28 patients with malignant obstruction were able to receive further therapy. The only long-term survivors presented with primary advanced cervical cancer.

Treatment of malignant nondysgerminomatous germ cell tumors of the ovary with vinblastine, bleomycin, and cisplatin

Fifteen patients with malignant nondysgerminomatous germ cell tumors of the ovary seen at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston, were treated with a combination of vinblastine, bleomycin, and cisplatin (VBP). All patients underwent initial surgery: biopsy alone in one patient, unilateral salpingo-oophorectomy in ten patients, and bilateral salpingo-oophorectomy with or without hysterectomy in four patients. Seven patients received VBP as primary postoperative therapy. One patient died of progressive disease at 15 months following diagnosis. The other six patients are alive without evidence of disease 9 to 47 months from the time of diagnosis. Eight patients received VBP as second-line treatment; three patients had a complete response to therapy and are surviving disease-free 41 to 71 months from the time of diagnosis. Four patients treated secondarily had a partial response; three of these patients subsequently developed progressive disease and died, while one patient survived after undergoing salvage therapy with an etoposide-containing regimen. One patient had no discernible response to VBP therapy and died. The VBP regimen represents an aggressive, moderately toxic, short-term combination regimen that has promising activity against malignant germ cell tumors of the ovary.

A phase II trial of 4-demethoxydaunorubicin in refractory epithelial ovarian cancer

Sixteen evaluable patients with refractory epithelial ovarian cancer were treated with oral 4-demethoxydaunorubicin. The drug was given in divided doses over 5 days and dosage was repeated every 3 weeks. There were no objective remissions. Three patients had stabilized disease of 5 to 7 months duration. Although well tolerated, this anthracycline has modest effectiveness against previously treated ovarian cancer.

A phase II trial of bisantrene (CL216,942) in refractory epithelial ovarian cancer

Twenty-three evaluable patients with refractory epithelial ovarian cancer were treated with bisantrene (CL216,942). The drug was given as a single-dose injection every 3 weeks. One patient (4%) showed a partial response. The compound thus has limited activity against this malignancy.

Activity of 2-fluoro-Ara AMP against gynecologic tumors in the soft agar assay

To characterize in vitro activity of 2-fluoro-Ara AMP and its relation to the activities of cisplatin and doxorubicin, 28 specimens from patients wit gynecologic tumors (predominantly ovarian) were tested in a soft agar assay. Twenty-six of 28 (93%) grew when the medium was supplemented with four hormones (epidermal growth factor, hydrocortisone, estradiol-17, and insulin). Normal bone marrow cells were utilized as a biologic control to define in vitro concentrations of the three drugs. Tumors were exposed continuously to three different concentrations of each drug. 2-fluoro-Ara AMP was tested against 26 tumors, cisplatin against 24, and doxorubicin against 14. In vitro sensitivity was defined as greater than or equal to 50% colony inhibition at a drug concentration within the bone marrow inhibitory range. Seven of 26 (27%) tumor specimens were sensitive to 2-fluoro-Ara AMP. Among these, four tumors were derived from previously treated patients. However, in the 2-fluoro-Ara AMP concentration range (0.26 micrograms/ml to 0.78 micrograms/ml) tested, five of eight (62.5%) tumors from untreated patients achieved IC50 compared to only seven of 18 (39%) tumors from treated patients. Five of six (83%) specimens demonstrated cross-sensitivity between cisplatin and 2-fluoro-Ara AMP. Seventeen of 18 (94%) specimens demonstrated cross-resistance between cisplatin and 2-fluoro-Ara AMP, and 13 of 13 (100%) specimens demonstrated cross-resistance between 2-fluoro-Ara AMP and doxorubicin. A higher proportion of tumors from previously untreated patients achieved greater than or equal to 50% colony inhibition when exposed to 2-fluoro-Ara-AMP or cisplatin than did those from previously treated patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of malignant nondysgerminomatous germ cell tumors of the ovary with vincristine, dactinomycin, and cyclophosphamide

Eighty patients with malignant nondysgerminomatous germ cell tumors of the ovary were treated with the combination of vincristine, dactinomycin, and cyclophosphamide (VAC) at The University of Texas M.D. Anderson Hospital and Tumor Institute. All patients underwent initial surgery: biopsy alone in 3 patients, unilateral salpingo-oophorectomy in 48 patients, and bilateral salpingo-oophorectomy with or without hysterectomy in 29 patients. Sixty-six patients received VAC as primary postoperative therapy; 46 patients (70%) achieved a sustained remission. VAC produced sustained remission in 86% of patients with Stage I, 57% of patients with Stage II, 50% of patients with Stage III, and no patients with Stage IV disease. For patients with Stage I disease, survival rates did not differ among histologic groups, but in advanced disease, patients with immature teratoma did significantly better than the others. Four of the 20 patients who failed primary VAC therapy were salvaged with other therapies, and 8 of 14 treated with VAC after relapse or failure of other treatments were salvaged. Although VAC produces excellent results with very acceptable toxicity in patients with Stage I disease and advanced immature teratoma, survival of patients with other advanced histologic types has been disappointing. The authors are therefore treating this latter group with alternative therapy such as vinblastine, bleomycin, and cisplatin with the goal of achieving improved efficacy.

Phase I clinical evaluation of oral and intravenous 4-demethoxydaunorubicin

Thirteen patients were treated with both the oral and intravenous preparations of 4-demethoxydaunorubicin (DMDR). The drug was well tolerated in both forms. Neutropenia was the dose-limiting side-effect. Approximately 30% of the compound was absorbed when given orally. The maximum tolerated dose was 12.5 mg/m2 intravenously or 50 mg/m2 (10 mg/m2 q d X 5) orally, given every 21-28 days.

Tamoxifen therapy of epithelial ovarian cancer

The activity of the antiestrogen tamoxifen was evaluated in 23 patients with epithelial ovarian carcinoma. All patients had received cytotoxic chemotherapy. The patients were given daily doses of 20 or 40 mg tamoxifen orally for a minimum of eight weeks. No objective tumor regressions were noted. In 19 patients disease remained stable for a median duration of 17 weeks (range: eight to 47 weeks). Estrogen and/or progesterone levels available for six patients did not correlate with stability of disease. The authors conclude that tamoxifen does not induce objective response in patients with epithelial ovarian carcinoma who have been treated with cytotoxic chemotherapy. However, in the current study about 80% of such patients had short-lived objective stabilization of their disease.

Phase I study of fludarabine (2-fluoro-ara-AMP)

Fludarabine phosphate is a derivative of adenosine arabinoside. The compound is an antimetabolite which resists deamination by the addition of a phosphate moiety. A phase I trial was conducted and showed the safe dose to good-risk patients to be 20 mg/m2 in 125 ml of 5% dextrose given over 30 min every 12 hr for 6 doses. The cycle can be repeated every 21 days. The major side-effect is myelosuppression, which can be severe at higher doses.

Alveolar rhabdomyosarcoma of the female genitalia

Eight cases of alveolar rhabdomyosarcoma of the female genitalia were diagnosed from 1963 to 1983 at The University of Texas M. D. Anderson Hospital. The primary sites were vulva in two, perineum in five, and broad ligament in one patient. When possible, therapy was initiated with local tumor excision (five patients). Surgery was followed by local or regional radiation (six patients) and chemotherapy (seven patients). Of the eight patients, five died within 9 months, one died 27 months after diagnosis, and only two are 5-year survivors. The aggressive behavior of this tumor is evidenced by autopsy findings of widespread metastases. Metastatic disease to the bone was present in four patients and to the breast in three patients. Local disease was controlled in two patients who died of distant metastases. Current therapy recommendations include excisional surgery, local radiation, and combination chemotherapy. A need for more effective chemotherapeutic programs is evident.

Continuous-infusion vinblastine in refractory carcinoma of the cervix: a phase II trial

Twenty patients with recurrent or metastatic squamous cell carcinoma of the cervix were treated with continuous-infusion vinblastine sulfate. Two patients (10%) had partial responses of 4 and 7 months' duration. Neutropenia was dose limiting. Vinblastine sulfate given by continuous infusion has limited activity in this malignancy.

Endodermal sinus tumor of the vagina and cervix

This report describes six patients with endodermal sinus tumor of the vagina and cervix, a polypoid friable tumor whose clinical presentation in girls younger than age 3 years simulates the presentation of sarcoma botryoides. In four of the six patients, the referring diagnosis was sarcoma botryoides. Five patients were treated with excisional surgery, and all six with chemotherapy. One patient with pulmonary metastases maintained a complete clinical response to vincristine, actinomycin-D, and cyclophosphamide (VAC) for 11 months. This is the first report of such a response. One patient with a vaginal lesion remains clinically free of disease 2 years after local excision and 18 months of VAC chemotherapy. This is the first report of apparently successful therapy that allowed retention of childbearing potential. Four of the six patients have been disease-free from 2 to 23 years. After examining the world literature, it is concluded that a combination of chemotherapy and surgery offers a reasonable prospect of cure with a minimum of serious side effects.

High-risk metastatic gestational trophoblastic disease

The clinical course of 61 patients with high-risk metastatic gestational trophoblastic disease was reviewed. Currently, 34 patients (56%) are alive and in complete remission. The survival rate after full-term pregnancy was significantly worse than after any other type of antecedent pregnancy. Analyzing survival by individual high-risk criteria revealed significantly improved survival for those patients with elevated beta-human chorionic gonadotropin titer alone when compared with all other high-risk criteria. Fifty-eight percent of patients (14 of 24) primarily treated with alternating-sequential therapy consisting of methotrexate and actinomycin-D experienced a complete remission. Of those patients primarily treated with methotrexate, actinomycin-D, and cyclophosphamide, 63% (20 of 32) achieved a complete remission. Treatment with second-line chemotherapy was largely unsuccessful. Aggressive early treatment is warranted in this group of patients, using multiagent chemotherapy. A search for newer more effective regimens should continue.

Successful treatment of leptomeningeal relapse of epithelial ovarian cancer

A case of isolated leptomeningeal recurrence of an epithelial ovarian cancer was recently diagnosed and treated successfully with methotrexate placed via an Ommaya reservoir in combination with radiation therapy. A review of the literature revealed no other cases of epithelial ovarian leptomeningeal malignancy similarly treated.

Phase II trail of PCNU in refractory advanced breast cancer

An evaluation of PCNU was carried out in 28 patients with extensively treated refractory breast cancer. The starting dose was 60 mg/m2 in 13 patients and 90 mg/m2 in 15 patients given intravenously every 6 weeks. The major side effect was myelosuppression, manifested mainly as thrombocytopenia. Nonhematologic side effects were minimal, consisting mainly of transient nausea. One mixed response was seen. Four patients had stable disease. PCNU demonstrated limited activity in advanced breast cancer and was not effective in the treatment of central nervous system metastases.