Methotrexate treatment of squamous-cell head and neck cancers: dose-response evaluation

Seventy-two patients with advanced squamous-cell carcinomas of the head and neck were randomised to receive weekly intravenous methotrexate at doses of either 50 mg/m2 (low dose), 500 mg/m2 (medium dose), or 5 g/m2 (high dose). Patients who failed to respond after four treatments at their initial dose were given four further treatments at the next higher dose. There were two complete responses and 21 partial responses to the initial dose--in 10 out of 22 patients given the high dose, seven out of 27 given the medium dose, six out of 23 given the low dose. A further five out of 16 patients responded after crossing over to a higher dose. Toxicity was more severe with the high-dose regimen. Responders survived significantly longer than non-responders (p less than 0.05), but there was no significant difference in durations of survival among the three treatment groups. Analysis of patients who completed the first four treatments indicated an improved response rate and duration of survival for the high-dose group. Because of toxicity associated with high-dose methotrexate this treatment produces no overall greater benefit than low-dose regimens.

Presentation of unknown primary cancer with metastatic liver disease--management and natural history

Initial blind liver biopsy established a histological diagnosis of metastatic cancer in 27 out of 34 patients who presented with clinical signs of liver metastases and no obvious primary tumour. Twenty-two of the patients had metastatic adenocarcinoma, and a primary tumour site was identified before death in only four patients.

Cyclical combination chemotherapeutic regimen in adult soft tissue sarcoma

A cyclical combination chemotherapeutic regimen of Adriamycin and cyclophosphamide alternating with actinomycin D and DTIC was administered to 20 evaluable patients with metastatic soft tissue sarcoma. Responses included four (20%) partial remissions and five (25%) patients with stable disease. There was a significant prolongation of survival for responding patients (median 42.5+ weeks) compared to patients with progressive disease (median 17.5 weeks). Principal toxicity was nausea and vomiting particularly with the actinomycin D/DTIC combination and four patients found this so intolerable they withdrew from study. These results are inferior to those reported for Adriamycin alone and other combinations. Further evaluation of the concept of sequential non-cross-resistant combinations would only seem appropriate if newer more active agents are identified and each combination is administered for a set duration before crossing over to the alternative regimen.

Cancer chemotherapy--what have we achieved?

The outcome of referral to a medical oncology unit in a university teaching hospital has been determined for the first 500 patients seen in 1978. Their median age was 58 years, and half had been referred within 6 weeks of diagnosis. 316 had already received some form of treatment. Compared with the overall figures for New South Wales, there was an excess of lung cancer, breast cancer, head and neck cancer, ovarian carcinoma, and testicular cancer, but a smaller proportion of gastrointestinal cancers. No treatment was recommended for one-third. Of the 334 treated, 247 received cytotoxic drugs. By Aug. 1, 1979, 56% from the treated group and 52% of the untreated group had died, the median survival times for the two groups being 45 and 35 weeks, respectively. But, of the 50 who received "curative" or "adjuvant" chemotherapy, only 17 had died by Aug. 1, 1979. Serious complications of treatment occurred in 22 (8.8%) patients. The cytotoxic drugs used by the unit between January, 1978, and August, 1979, cost A$212 000 (9.3% of the hospital's total pharmacy budget for the period). The findings suggest that the widespread use of cancer chemotherapy is not justified outside well conducted clinical trials or specialist cancer centres.

Cis-platinum treatment of metastatic adrenal carcinoma

Cis-platinum was used in the management of four patients with metastatic carcinoma of the adrenal cortex. In each instance, clinical and objective response was observed. This agent would appear to warrant further trial in the management of this rare tumour.

Metastatic basal cell carcinoma: report of a case responding to chemotherapy

Metastases of basal cell carcinoma are very uncommon. Only 10 reported cases have been treated with cytotoxic chemotherapy, and no good responses have been documented. The case is presented of a 54-year-old male who had several basal cell carcinomas (BCCs) removed surgically and who, 12 years after his first presentation, developed respiratory symptoms related to metastatic pulmonary BCCs. These failed to respond to initial chemotherapy with methotrexate, bleomycin, and vincristine, but regressed when treated with cyclophosphamide and cis-diamine dichloroplatinum.

Immunoblastic lymphoma in husband and wife

Cases of an identical diffuse immunoblastic lymphoma in husband and wife are reported. The disease was fatal in both cases, deaths occurring within weeks of each other, and similar clinical characteristics were present in both patients.

Advanced male non-seminomatous germ-cell tumours. Combination chemotherapy with cis-platinum, vinblastine and bleomycin

Nineteen men with advanced germ-cell tumours were treated with a combination of vinblastine, bleomycin and cis-diamminedichloroplatinum II (cis-platinum). One patient died nine days after starting chemotherapy. Seventeen patients responded to therapy (14 completely and three partially). Toxicity was very high, and three patients died of septicaemia during therapy. Eight patients remain in complete remission 36 to 80 weeks after starting chemotherapy.

Burkitt's lymphoma in Australia

Three patients with Burkitt's lymphoma have been seen at Royal Prince Alfred Hospital during the past 18 months. Following treatment, two patients are in complete clinical remission.

Treatment of small cell bronchogenic carcinoma with VM-26

VM-26 is active in small cell bronchogenic carcinoma even in patients resistant to previous chemotherapy. The overall response rate was 28%, with a response rate of 29% in patients resistant to previous chemotherapy. This response rate is similar to that obtained with other single agents including Adriamycin, vincristine, cyclophosphamide, and procarbazine. The mild subjective and objective toxic effects of the drug make it a potentially useful agent in the treatment of this tumor.

Combination chemotherapy with vincristine, bleomycin, and methotrexate for advanced head and neck cancers

Thirty-three patients with a histologically confirmed diagnosis of advanced squamous cell carcinoma of the head and neck were treated with a combination of vincristine, methotrexate, and bleomycin. The regimen was as follows: Day 1, vincristine (2 mg iv) and methotrexate (200 mg/m2 iv over 24 hours); Day 2, bleomycin (15 mg/day by iv infusion for 48 hours). Folinic acid rescue began 36 hours after the start of methotrexate. The regimen was repeated at intervals of 3 weeks. Toxicity was minimal but the overall response rate was only 24% (three complete responses and five partial responses) and the median duration of remission was only 16 weeks overall. The combination of vincristine, methotrexate, and bleomycin in this dosage schedule has a response rate lower than that reported with single-agent treatment of advanced head and neck cancers.

Undifferentiated carcinoma in young men: the atypical teratoma syndrome

In 5 young men with apparent undifferentiated carcinoma involving lung, mediastinum, and lymph-nodes subsequent response to treatment, tumour-marker analysis, and histology review suggested a diagnosis of embryonal-cell carcinoma. It is suggested that atypical presentation of extragonadal germ-cell tumours may be common. Because such tumours respond to chemotherapy, accurate diagnosis is essential.

Cis-dichlorodiammine platinum (II) in advanced ovarian carcinoma

Twenty-seven patients with advanced ovarian cancer were treated with a total of 80 courses of cis-dichlorodiammine platinum (II) (cisplatin). The doses in three courses were less than 50 mg/m2, in 64 courses they were 50 mg/m2, and in eight courses they were 100 mg/m2. In addition, five courses of low-dose daily treatment (20 mg/m2 for five days) were administered. Twelve patients received cisplatin alone, 12 received cisplatin and cyclophosphamide (750 mg/m2), and three patients received cisplatin with other drugs. There were eight responders (33%) in the 24 evaluable patients. Renal toxicity occurred in four patients, ototoxicity in four, and leucopenia (which was life-threatening in one patient) occurred in 16 patients (white cell count less than 3.0 X 10(9)/L). There were two early drug-related deaths. The median survival of patients who responded to cisplatin treatment was longer than 30 weeks compared with nine weeks for non-responders.

Unknown primary adenocarcinoma: incidence of overinvestigation and natural history

Out of 1300 patients referred to a medical oncology unit, there were 87 with metastatic cancer in whom a primary tumour site was not evident from the history and after physical examination and chest radiography had been carried out. An analysis of the investigations performed in these patients and their results showed that in only eight of the 87 patients did non-surgical investigations at presentation determine the primary site. In two patients it was identified by diagnostic laparotomy, and in a further 13 clinical follow-up led to recognition of the primary tumour site before death. Few investigations should be performed in patients in whom the primary site is known since they have a low yield, and in our population identifying the primary tumour did not improve the outcome or alter management. Treatable tumours should be excluded, and this may be done in most cases by simple blood tests, particularly those measuring acid phosphatase activity and other tumour markers.