Repeated adjuvant chemotherapy with phenylalanine mustard or 5-fluorouracil, cyclophosphamide, and prednisone with or without radiation, after mastectomy for breast cancer

172 patients who had had mastectomy for breast cancer were treated by repeated adjuvant chemotherapy, either with phenylalanine mustard (P.A.M.) or a combination of cyclophosphamide, 5-fluorouracil, and prednisone (C.F.P.) with and without radiotherapy. Tumours recurred significantly more frequently and mortality tended to be higher in P.A.M.-treated patients than in patients on other treatment. The interval between surgery and disease recurrence was significantly shorter for P.A.M.-treated premenopausal but not postmenopausal patients than for patients of equivalent menstrual status treated with C.F.P. with or without radiation. The associations in premenopausal patients between the mode of treatment and both survival and the disease-free interval were significant before and after adjustment for variations between the treatment groups in the number of involved lymph nodes and the size of the primary tumour.

The bone marrow examination in breast cancer: diagnostic considerations and clinical usefulness

Bone marrow examinations were performed on 116 women with primary and metastatic breast cancer and were correlated with the clinical status of the patient and other specific diagnostic modalities. The relative diagnostic efficacy of the marrow biopsy, aspirate smear and clot section was examined, as was the value of serial marrow examinations. A marrow positive for tumor was found in 40% of those with metastatic disease, 55% with positive x-rays, 56% with positive bone scans, but only 4% (1/24) with both scan and x-ray normal. Routine hematologic parameters were of limited usefulness in predicting the finding of a positive marrow. The biopsy was superior to the smear and clot section but aspirated material also had to be analyzed to maximize diagnostic yield. When analyzed qualitatively, i.e., positive or negative for tumor, serial marrow examinations were not useful in assessing the efficacy of antitumor treatment. The potential usefulness of bone marrow examination in patients with breast cancer is discussed.

Early clinical study of an intermittent schedule for maytansine (NSC-153858): brief communication

Maytansine, an ansa macrolide, was evaluated in an early clinical trial in 40 adult patients with various solid tumors. Severe nausea and vomiting, sometimes associated with watery diarrhea and abdominal cramps, and liver function abnormalities, mainly elevation of serum glutamic--oxaloacetic transaminase levels, together constituted what we considered dose-limiting toxicity. Mild hematologic toxicity (mainly thrombocytopenia), neurotoxicity, and possibly cardiac toxicity were also noted. No antitumor effect was seen. An iv dose of 0.750 mg/m2 on days 1, 3, and 5 (total dose, 2.25 mg/m2) repeated every 4 weeks is recommended for Phase II trials.

Bone marrow involvement in breast cancer: effect on response and tolerance to combination chemotherapy

Forty-three patients with metastatic breast cancer who had not received prior chemotherapy were divided into two groups on the basis of whether or not a bone marrow examination revealed tumor. Both groups were treated with combination chemotherapy regimens and were analyzed with regard to response and toxicity parameters. The positive marrow group had a response rate similar to that of the negative marrow group (67% vs 71%), and a slightly shorter median time to progressive disease (240 vs 258 days) and median duration of remission (213 vs 243 days). The positive marrow group had higher requirements for hematologic support and tended to have more infectious complications. The data suggest that metastatic breast cancer patients with a bone marrow examination revealing tumor, although requiring more supportive care, may be treated as effectively with combination chemotherapy as those patients in whom the marrow examination does not reveal tumor.

Mediastinoscopy: a diagnostic aid in metastatic carcinoma of the breast

Six patients with metastatic carcinoma of the breast underwent mediastinoscopy to obtain tissue for estrogen receptor analysis and pathologic confirmation of metastatic tumor. The indication for mediastioxcopy was an abnormal mediastinal accumulation of gallium in five patients, only two of whom had an abnormality noted on tomography. All six patients had tumor recovered by mediastinoscopy as demonstrated by pathologic examination and/or estrogen receptor assay, Therefore, the diagnosis of mediastinal metastases in breast cancer may be suggested by either chest roentgenograms, mediastinal tomography, or gallium scintigraphy. Mediastinoscopy is a safe, effective procedure capable of establishing the diagnosis of metastatic carcinoma of the breast and of procuring sufficient tissue for estrogen receptor analysis in patients without more readily accessible sites of metastases.

Usefulness of gallium scintigraphy in primary and metastatic breast carcinoma

Gallium-67-citrate whole-body scintigraphy was incorporated into the evaluation of 125 patients with primary and metastatic breast carcinoma. A prospective analysis of these patients demonstrated gallium scanning to be limited in its corroborative value and of practical use only in detecting metastatic breast carcinoma in the mediastinum. Since the extent of tumor involvement is a significant prognostic factor, the gallium scan merits consideration for the detection of mediastinal metastases.