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.

Phase II study of VM-26 in acute leukemia, neuroblastoma, and other refractory childhood malignancies: a report from the Children's Cancer Study Group

VM-26, a semisynthetic podophyllotoxin, was tested for antitumor activity and clinical toxicity in 181 children. The drug was administered iv at weekly intervals, beginning at a dose of 130 mg/2/week. The dose was increased, as tolerated, after 3 and 6 weeks to 150 and 180 mg/m2/week, respectively. The only major toxicity was hematologic, with neutropenia predominating. Anaphylaxis occurred in one patient. The drug demonstrated significant activity in acute lymphocytic leukemia (four responses among 15 patients) and neuroblastoma (ten responses among 31 patients). Objective responses were also noted in one patient each with acute myelogenous leukemia, Hodgkin's disease, histiocytic lymphoma, Wilms' tumor, Ewing's sarcoma, undifferentiated carcinoma, and sacrococcygeal sarcoma. Further trials of VM-26 in these childhood malignancies are warranted.

Combination chemotherapy with VM 26 and CCNU in primary malignant brain tumors

Twenty-seven patients with inoperable or recurrent primary malignant brain tumors after previous resection and/or radiotherapy, were treated with corticosteroids and a combination chemotherapy consisting of VM 26 and CCNU. There were 15 (55%) patients that responded, three with a complete and 12 with a partial response with a mean duration of response of 13.4 months. Toxicity was mainly hematological and of acceptable degree. Combination chemotherapy with VM 26 and CCNU is well tolerated and can be administered on an out-patient basis. In our experience it is better than single agent chemotherapy.

VM-26 as a second drug in the treatment of brain gliomas

Twenty patients previously treated with surgical resection, radiation therapy, and a nitrosourea for malignant gliomas of the brain were given VM-26 as a second chemotherapeutic agent when evidence of tumor progression occurred. Thirty-five percent achieved an arrest or decrease of neurologic symptoms, with a median length of response (arrest and tumor regression) of 22 weeks.

Adjuvant therapy of T1 bladder carcinoma: preliminary results of an EORTC randomized study

This paper reports the preliminary results of an ongoing clinical trial in patients with category T1 bladder cancer who are randomized after transurethral resection to receive either thiotepa, VM-26, or no treatment. While there are no significant differences between the three treatment groups with respect to the time until first recurrence, thiotepa has significantly reduced the recurrence rate as compared to either VM-26 (P = 0.03) or no treatment (P = 0.04) among the 215 patients for whom follow-up information is currently available.

VM-26, a new anticancer drug with effectiveness in malignant lymphoma: an Eastern Cooperative Oncology Group Study (EST 1474)

Thirty-six patients with stage III and IV Hodgkin's disease and non-Hodgkin's lymphoma, who had become refractory to conventional chemotherapy, were treated with VM-26. Complete remissions were documented in two patients with diffuse histiocytic lymphoma. Six patients (four with non-Hodgkin's lymphomas and two with Hodgkin's disease) had partial remissions. The overall response rate was 22% (eight of 36 patients). Hematologic toxicity was the most frequent dose-limiting toxicity. Nonhematologic toxic effects were mild and acceptable. This study demonstrates that VM-26 can produce tumor responses in refractory lymphomas. The Eastern Cooperative Oncology Group is currently planning two new phase II studies to incorporate VM-26 with other active new agents, one involving hexamethylmelamine and the other involving cis-dichlorodiammineplatinum(II).

[Surgically treated supratentorial gliomas in the adult. Favourable action of a podophyllin derivative (VM 26) administered alone (author's transl)]

The action of VM 26 on cerebral glioblastomas was suggested by studies of phase II or protocols in which the drug was used in association. The randomised protocol presented here, involving 10 treated subjects and 11 controls, showed that VM 26 was active in terms of the duration of survival of patients undergoing surgery for a glioblastoma. The mean survival was 16.4 months as against 9.6 months in the controls (statistically significant difference at p less than 0.05). This activity would tend to characterise the drug as one of the essential factors in the chemotherapy of all malignant gliomas, in particular since it is itself free of all haematological complications, even at high doses, and causes scarcely any allergic problems.

[Neurogliale cerebral tumors: test of chemotherapy treatment. Forty five cases (author's transl)]

It is impossible to tell the exact prognosis of the patients affected with neuroglial cerebral tumors which are being treated with cytostatic chemotherapy. This impossibility has made it necessary to repeat the different examinations given before and during the treatment of 45 patients. We contemplate a series of clinical, immunological, biological, hematological tests; then electro-encephalogram, brain scan and a echography reveal the variations in volume of the tumor. If some of the examinations are not conclusive, the others, specifically the electro-encephalogram, the mental state evaluation are accurate in determining the final evolution. Immunological shows modification of cellular immunity with a decrease of T cells (57% +/- 5,9) which are hyporeactive (PHA 1/10: 42% +/- 7,5). EEG pertubations and clinical evolution are in agreement in 80% of cases. The median survival of patients as far as EEG signs are concerned in the third month is 375 days if there is an electival improvement and 188 days in the opposite difference which is significant. Scan ications are not conclusive because of peri tumoral edema evolution and hift of medical structures can be shown by echography.

[A study of the use of sequential chemotherapy in 176 cases of glioblastoma (author's transl)]

Sequential administration of VM 26 and CCNU has been used in France for the treatment of glioblastoma since 1973. Results have shown that this association can cause a remission lasting, on average, from seven to eight months after starting chemotherapy. It seems that, adding Adriamycin to this sequential therapy does not increase its efficiency. On the other side, dosage and the interval between cycles of chemotherapy appear to be a determining factor in the activity, but the limits are very narrow. Therapy is either ineffective or has doubtful efficiency in about one third of patients, and even when prolonged clinical remission is obtained, cessation of therapy, usually due to a persistent thrombopenia is followed by progression of the tumour in the following months. The large amount of research being made in the field of cellular kinetics and pharcacology will, hopefully, lead to improvement in results.

[Induction chemotherapy of non-Hodgkin malignant lymphomas. Results of a controlled trial comparing two quadruple associations (author's transl)]

Two types of chemotherapy have been compared in a randomized trial to treat non-Hodgkin malignant lymphomas. 66 patients were included in this study, but only 40 were evaluable after a histologic review of all cases. Treatment were an association of cyclophosphamide, vincristine, prednisone and doxorubicine or VM 26. Patients received only one induction chemotherapy course during 15--20 days. Results were evaluated immediately at the end of the course. Side-effects were mild. Efficacy was about the same with the two protocols: 35 patients out of 40 experienced a remission of more than 50% (among them 8 experienced a complete remission). These results are better than previous one obtained with cyclophosphamide, vincristine and prednisone only. It is concluded that this type of treatment is well tolerated, quickly efficient and useful before treating patients with radiotherapy or long-term chemotherapy.

A comprehensive protocol for management of cancer of the bilharzial bladder

A randomized clinical trial for the management of bilharzial bladder cancer is presented. A multidisciplinary approach is adopted. The objective of the study is to evaluate the role of adjuvant radiotherapy in improving the results of surgery in deeply infiltrating tumours, and to screen a number of chemotherapeutic agents for their effectiveness in bladder cancer. A large number of cases will be admitted into the study and the results will hopefully help to achieve better results in the management of this disease.

[The toxicity of massive dosis of VM26 (4-demethyl-epipodophyllotoxin-beta-D-thenylidene glucoside). A contribution to the therapy of advanced ovarian cancer (author's transl)]

19 patients with advanced ovarian cancer (FIGO-stages IIb-IV) were treated by ultra-high doses of VM26 partly according to positive oncobiograms during Multiple-drug-stoss-therapy. The toxic reactions and the cytostatic effect were investigated. The range of 57,9% remissions and the moderate toxicity suggest a specific application of VM26 in advanced ovarian cancer.

Epipodophyllotoxin VM-26 in the treatment of childhood neuroblastoma

Thirteen children with disseminated neuroblastoma that had become refractory to conventional chemotherapy were treated with the epipodophyllotoxin VM-26. Three patients developed partial responses (greater than 50% reductions in tumors and in the proportion of tumor cells in bone marrow). Acute nonhematologic toxicity after treatment was minimal. Hematologic toxicity was observed but could not be assessed accurately since most patients had abnormal hematopoiesis due to extensive tumor involvement of bone marrow. These results demonstrate that VM-26, as a single agent, can produce measurable tumor responses in children with neuroblastoma.

Cerebral pseudocysts following chemotherapy of glioblastomas

Three cases of pseudocysts following surgery and chemotherapy for glioblastomas are reported. Their clinical picture was similar, consisting of intracranial hypertension without primary modification of focal signs. CT scanning has been able to detect the cystic aspect and to eliminate a true tumour recurrence. Medical treatment (steroids or Mannitol) seems inefficient. Evacuation of the cyst is the only efficient method of treatment.