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Roncato R, Peruzzi E, Gerratana L, Posocco B, Nuzzo S, Montico M, Orleni M, Corsetti S, Bartoletti M, Gagno S, Canil G, De Mattia E, Angelini J, Baraldo M, Puglisi F, Cecchin E, Toffoli G. Clinical impact of body mass index on palbociclib treatment outcomes and effect on exposure. Biomed Pharmacother 2023; 164:114906. [PMID: 37295250 DOI: 10.1016/j.biopha.2023.114906] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
The impact of body mass index (BMI) on treatment outcomes in patients with cancer is gaining increasing attention given the limited data available. The aim of this study was to investigate the contribution of BMI on the safety and efficacy profile of palbociclib in 134 patients with metastatic luminal-like breast cancer treated with palbociclib and endocrine therapy (ET). Normal-weight and underweight patients (BMI<25) were compared with overweight and obese (BMI≥25). Detailed clinical and demographic data were collected. Patients with a BMI<25 had a higher incidence of relevant-hematologic toxicities (p = 0.001), dose reduction events (p = 0.003), and tolerated lower dose intensities (p = 0.023) compared to patients with a BMI≥25. In addition, patients with a BMI<25 had significantly shorter progression-free survival (log-rank p = 0.0332). A significant difference was observed in the subgroup of patients for whom systemic palbociclib concentrations were available: patients with a BMI<25 had a 25% higher median minimum plasma concentrations (Cmin) compared to BMI≥25. This study provides compelling evidence for a clinically relevant contribution of BMI in discriminating a group of patients who experienced multiple toxicities that appeared to affect treatment adherence and lead to poorer survival. BMI could become a valuable tool for personalizing the starting dose of palbociclib to improve its safety and efficacy.
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Affiliation(s)
- Rossana Roncato
- Experimental and Clinical Pharmacology Unit-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy; Department of Medicine (DAME), University of Udine, Udine, Italy.
| | - Elena Peruzzi
- Experimental and Clinical Pharmacology Unit-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Lorenzo Gerratana
- Department of Medical Oncology-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Bianca Posocco
- Experimental and Clinical Pharmacology Unit-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Sofia Nuzzo
- Experimental and Clinical Pharmacology Unit-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Marcella Montico
- Clinical Trial Office, Scientific Direction-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Marco Orleni
- Experimental and Clinical Pharmacology Unit-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Serena Corsetti
- Department of Medical Oncology-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Michele Bartoletti
- Department of Medical Oncology-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Sara Gagno
- Experimental and Clinical Pharmacology Unit-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Giovanni Canil
- Experimental and Clinical Pharmacology Unit-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Elena De Mattia
- Experimental and Clinical Pharmacology Unit-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Jacopo Angelini
- Clinical Pharmacology and Toxicology Institute, University Hospital Friuli Centrale ASU FC, 33100 Udine, Italy.
| | - Massimo Baraldo
- Department of Medicine (DAME), University of Udine, Udine, Italy; Clinical Pharmacology and Toxicology Institute, University Hospital Friuli Centrale ASU FC, 33100 Udine, Italy.
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Erika Cecchin
- Experimental and Clinical Pharmacology Unit-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology Unit-CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
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Chu X, Xue P, Zhu S. Management of chemotherapy dose intensity for metastatic colorectal cancer (Review). Oncol Lett 2022; 23:141. [PMID: 35340557 PMCID: PMC8931773 DOI: 10.3892/ol.2022.13261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/14/2022] [Indexed: 12/24/2022] Open
Abstract
Chemotherapy dose intensity is a momentous parameter of antitumor clinical medication. In certain clinical trials, the actual application dose of the chemotherapeutic drugs is frequently different from the prescribed dose. The chemotherapy dose intensity completed in different trials is also variable, which has an impact on the treatment efficacy, disease prognosis and patient safety. When these agents are tested in the population, chemotherapy reduction and delay or failure to complete the planned cycle constantly occur due to age, performance status, adverse reactions and other reasons, resulting in the modification of the chemotherapy dose intensity. The present review analyzed the correlation between the chemotherapy dose intensity and the incidence of adverse reactions, the treatment efficacy and disease prognosis in clinical trials of metastatic colorectal cancer. Moreover, the clinical applications of chemotherapy dose intensity were discussed. Based on individual differences, the present review analyzed the clinical trials that examined the efficacy of the chemotherapy dose intensity in different patient populations. The conclusions suggested that different populations require a specific dose intensity to reduce treatment toxicity without affecting the curative effect.
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Affiliation(s)
- Xuelei Chu
- Department of Oncology, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing 100102, P.R. China
| | - Peng Xue
- Department of Oncology, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing 100102, P.R. China
| | - Shijie Zhu
- Department of Oncology, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing 100102, P.R. China
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Callahan R, Kieran MW, Baird CW, Colan SD, Gauvreau K, Ireland CM, Marshall AC, Sena LM, Vargas SO, Jenkins KJ. Adjunct Targeted Biologic Inhibition Agents to Treat Aggressive Multivessel Intraluminal Pediatric Pulmonary Vein Stenosis. J Pediatr 2018; 198:29-35.e5. [PMID: 29576325 DOI: 10.1016/j.jpeds.2018.01.029] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/28/2017] [Accepted: 01/10/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the use of imatinib mesylate with or without bevacizumab targeting neoproliferative myofibroblast-like cells with tyrosine kinase receptor expression, as adjuncts to modern interventional therapies for the treatment of multivessel intraluminal pulmonary vein stenosis (PVS). We describe the 48- and 72-week outcomes among patients receiving imatinib mesylate with or without bevacizumab for multivessel intraluminal PVS. STUDY DESIGN This single-arm, prospective, open-label US Food and Drug Administration approved trial enrolled patients with ≥2 affected pulmonary veins after surgical or catheter-based relief of obstruction between March 2009 and December 2014. Drug therapy was discontinued at 48 weeks, or after 24 weeks of stabilization, whichever occurred later. RESULTS Among 48 enrolled patients, 5 had isolated PVS, 26 congenital heart disease, 5 lung disease, and 12 both. After the 72-week follow-up, 16 patients had stabilized, 27 had recurred locally without stabilization, and 5 had progressed. Stabilization was associated with the absence of lung disease (P = .03), a higher percentage of eligible drug doses received (P = .03), and was not associated with age, diagnosis, disease laterality, or number of veins involved. Survival to 72 weeks was 77% (37 of 48). Adverse events were common (n = 1489 total), but only 16 were definitely related to drug treatment, none of which were serious. CONCLUSION Survival to 72 weeks was 77% in a referral population with multivessel intraluminal PVS undergoing multimodal treatment, including antiproliferative tyrosine kinase blockade. Toxicity specific to tyrosine kinase blockade was minimal.
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Affiliation(s)
- Ryan Callahan
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
| | - Mark W Kieran
- Division of Pediatric Medical Neuro-Oncology, Dana-Farber Cancer Institute, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Christina M Ireland
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Audrey C Marshall
- Department of Cardiology, Floating Hospital for Children at Tufts Medical Center, Boston, MA
| | - Laureen M Sena
- Department of Radiology, UMass Memorial Medical Center, Boston, MA
| | - Sara O Vargas
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Kathy J Jenkins
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
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Fountzilas G, Skarlos D, Pavlidis NA, Makrantonakis P, Tsavaris N, Kalogera-Fountzila A, Giannakakis T, Beer M, Kosmidis P. High-Dose Epirubicin as a Single Agent in the Treatment of Patients with Advanced Breast Cancer. TUMORI JOURNAL 2018; 77:232-6. [PMID: 1862551 DOI: 10.1177/030089169107700309] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fifty-two women with advanced breast cancer were treated with 6 cycles of epirubicin. Even though the study was started with a dose schedule of 110 mg/m2 every 3 weeks, the average treatment interval was 26 days and the median weekly dose 78% of the protocol requirement. Forty-eight patients were evaluable for response; 3 achieved a complete remission which lasted for 17, 24 and 65 weeks, respectively, and 14 a partial remission. Median survival was 32 weeks. Toxicity included nausea/vomiting (68%), anemia (24%), leukopenia (37 %), thrombocytopenia (8 %), alopecia (81 %), stomatitis (24%), diarrhea (14%), fever (19%) and fatigue (14%). Also 1 treatment-related death occurred and 2 cases of arrhythmia. Monotherapy with high doses of epirubicin has definite activity in advanced breast cancer and deserves further study in combination with hematopoietic growth factors which might allow a higher dose Intensity.
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Abstract
Objective. Our objective was to review oprelvekin, which is a new thrombopoietic cytokine approved in the United States to prevent severe thrombocytopenia and reduce the number of platelet transfusions after myelosuppressive chemotherapy. This article focuses on oprelvekin’s pharmacology, pharmacokinetics, and place in therapy. Data Sources. A search of the National Cancer Institute-sponsored Cancerlit database from 1963 to 1999 was completed. Subject mesh headings that were searched included interleukin-11, oprelvekin, breast cancer, chemotherapy dose intensity, and cancer pharmacoeconomics. Data were also collected from the package insert and from Genetics Institute (Cambridge, MA) publications. Study Selection. Searches were limited to studies with humans, which included clinical trials, news articles, and review articles. After reading all of the human clinical trials, additional pertinent citations were obtained and read. Data Synthesis. Oprelvekin has been studied in both adults and children, with the bulk of the data coming from the treatment of women with breast cancer. A phase I study in adults evaluated doses of 10, 25, 50, 75, and 100 mg/kg/day and determined the maximum tolerated dose to be 50 mg/kg/day. The toxicity seen with the 75 and 100 mg/kg/day doses includes constitutional symptoms (arthralgias, myalgias, fatigue, nausea, and headache) and a cerebral vascular accident. Phase II and III trials showed that 25-50 mg/kg/day effectively reduced the number of patients requiring platelet transfusions and decreased the number of platelet transfusions after chemotherapy. Pharmacokinetics performed with the 50 mg/kg/day subcutaneous (s.c.) dose resulted in a maximum sera concentration of 17.4 6 5.4 ng/mL, which occurred at 3.2 6 2.4 hours. The terminal half-life was 6.9 6 1.7 hours. Clearance decreases with increasing age, and pediatric patients have a 1.2- to 1.6-fold higher clearance than adults. These pharmacokinetic parameters led to a dosing recommendation of 75- 100 mg/kg/day in pediatric patients. Due to the high cost of oprelvekin and the lack of data demonstrating that it affects mortality, its role in current therapies is unclear. It is currently being promoted to maintain dose intensity in patients with breast cancer, testicular cancer, and lymphoma. Depending upon institutional platelet and oprelvekin costs, it may also be useful in patients receiving a large number of platelet transfusions. Thus far, it has not demonstrated efficacy in bone marrow transplant patients. Conclusion. Oprelvekin can effectively prevent the need for platelet transfusion in nontransplant patients receiving myelosuppressive chemotherapy. Due to its high cost, it will most likely be used to maintain chemotherapy dose intensity, which may translate into a survival advantage.
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Affiliation(s)
- Val R Adams
- Division of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Timothy L Brenner
- Division of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
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Kurihara T, Kogo M, Ishii M, Shimada K, Yoneyama K, Kitamura K, Shimizu S, Yoshida H, Kiuchi Y. Chemotherapy-induced neutropenia as a prognostic factor in patients with unresectable pancreatic cancer. Cancer Chemother Pharmacol 2015; 76:1217-24. [PMID: 26560484 DOI: 10.1007/s00280-015-2887-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 10/15/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE We conducted a retrospective cohort study to examine whether neutropenia could be an indicator of good prognosis in patients treated with gemcitabine (GEM) for unresectable pancreatic cancer. METHODS A total of 178 patients with unresectable pancreatic cancer, who were treated with first-line (n = 121) or second-line (n = 57) GEM, were included in our analyses. A Cox proportional hazard model was used to examine the effect of the grade of GEM-induced neutropenia on prognosis. Furthermore, the difference in survival time for each grade was assessed using a log-rank test. RESULTS In the first-line population, the hazard ratios of patients with grade 2 or grade 3 neutropenia compared with the ratios of those without neutropenia (grade 0) were 0.43 (95% CI 0.27-0.70) and 0.37 (0.21-0.65), respectively (p < 0.05). The median survival time (MST) was 3.8 months for grade 0, 9.4 months for grade 2, and 10.1 for grade 3. Landmark analysis of the second-line population revealed a hazard ratio of 0.52 (0.30-0.82) for grade 1 and 0.49 for grade 2 (0.28-0.72) (p < 0.05). MST was 1.3 months for grade 0, 4.7 months for grade 1, and 4.6 months for grade 2. CONCLUSIONS We found that neutropenia grade was an indicator of good prognosis in patients treated with first-line and second-line GEM for unresectable pancreatic cancer. A prospective study should be performed to examine whether dosage adjustment using neutropenia grade as an indicator would improve prognosis.
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Affiliation(s)
- Tatsuya Kurihara
- Division of Physiology and Pathology, Department of Pharmacology, Toxicology and Therapeutics, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Mari Kogo
- Department of Hospital Pharmaceutics, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Masakazu Ishii
- Division of Physiology and Pathology, Department of Pharmacology, Toxicology and Therapeutics, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Ken Shimada
- Division of Medical Oncology, Department of Medicine, Showa University Koto-Toyosu Hospital, 1-5-8 Hatanodai, Koto-ku, Tokyo, 135-0061, Japan
| | - Keiichiro Yoneyama
- Health Service Center, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Katsuya Kitamura
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Shunichi Shimizu
- Division of Physiology and Pathology, Department of Pharmacology, Toxicology and Therapeutics, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Hitoshi Yoshida
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Yuji Kiuchi
- Center of Pharmaceutical Education, School of Pharmaceutical Sciences, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
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Marconato L, Finotello R, Bonfanti U, Dacasto M, Beatrice L, Pizzoni S, Leone VF, Balestra G, Furlanello T, Rohrer Bley C, Aresu L. An open-label phase 1 dose-escalation clinical trial of a single intravenous administration of gemcitabine in dogs with advanced solid tumors. J Vet Intern Med 2015; 29:620-5. [PMID: 25818216 PMCID: PMC4895507 DOI: 10.1111/jvim.12557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/16/2014] [Accepted: 01/19/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A broad range of gemcitabine dosages have been used in dogs. HYPOTHESIS/OBJECTIVES To determine maximally tolerated dose (MTD), dose-limiting toxicity (DLT), and preliminary antitumor activity of intravenous administration of gemcitabine in dogs with advanced solid tumors. ANIMALS Twenty-two client-owned dogs. METHODS Dogs with advanced cancer were prospectively enrolled in an open-label Phase 1 study of gemcitabine. Gemcitabine was administered as a 30-minute intravenous bolus starting at 800 mg/m(2), using escalation of 50 mg/m(2) increments with 3 dogs per dose level. MTD was established based on the number of dogs experiencing DLT assessed after 1 cycle. Treatment continued until disease progression or unacceptable toxicosis. Additional dogs were enrolled at MTD to better characterize tolerability, and to assess the extent and duration of gemcitabine excretion. RESULTS Twenty-two dogs were treated at 4 dose levels, ranging from 800 to 950 mg/m(2). Neutropenia was identified as DLT. MTD was 900 mg/m(2). DLT consisting of grade 4 febrile neutropenia was observed at 950 mg/m(2) in 2 dogs. There were no nonhematologic DLTs. Twenty dogs received multiple doses, and none had evidence of severe toxicosis from any of their subsequent treatments. At 900 mg/m(2), 2 complete and 5 partial responses were observed in dogs with measurable tumors. The amount of gemcitabine excreted in urine decreased over time, and was undetectable after the first 24 hours. CONCLUSIONS AND CLINICAL IMPORTANCE The recommended dose of gemcitabine for future Phase 2 studies is weekly 900 mg/m(2). In chemotherapy-naïve dogs with advanced solid tumor this dose level merits further evaluation.
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Affiliation(s)
- L Marconato
- Centro Oncologico Veterinario, Sasso Marconi, Italy
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Kobrinsky NL, Sjolander DE, Cheang MS, Levitt R, Steen PD. Granulocyte-macrophage colony-stimulating factor treatment before doxorubicin and cyclophosphamide chemotherapy priming in women with early-stage breast cancer. J Clin Oncol 1999; 17:3426-30. [PMID: 10550137 DOI: 10.1200/jco.1999.17.11.3426] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine if inhibition of stem-cell activity induced by granulocyte-macrophage colony-stimulating factor ([GM-CSF]; Sargramostim; Immunex Corporation, Seattle, WA) withdrawal or priming protects hematopoietic stem cells from the cytotoxic effects of adjuvant chemotherapy for early-stage breast cancer. PATIENTS AND METHODS Serial blood counts were performed in 20 women with early-stage breast cancer receiving four courses of cyclophosphamide and doxorubicin chemotherapy. By a double-blind, placebo-controlled, balanced randomization, subjects received GM-CSF priming on days 5 to 1 for courses 1 and 3 or courses 2 and 4. RESULTS Compared with before priming, after priming the times to neutrophil nadir (12.8 +/- 2.5 days v 14.8 +/- 1.5 days, respectively; P =.0001) and platelet nadir (mean +/- SD, 10.1 +/- 1.9 days v 11.1 +/- 2.2 days, P <.05) were shorter, indicating a shift of cytotoxicity to later progenitors. The neutrophil nadir was similar with and without priming (mean +/- SD, 490 +/- 310/microL v 550 +/- 350/microL, respectively; P =.2); however, on day 16 the mean neutrophil count was higher (mean +/- SD, 1030 +/- 580/microL v 690 +/- 370/microL, P =.004), and the proportion of patients with a neutrophil count less than 500/microL was lower after priming than before (six of 35 or 17. 1% v 12 of 34 or 35.3%, respectively; P =.04). The platelet nadir was higher (mean +/- SD, 166,000 +/- 51,000/microL after priming v 151,000 +/- 45,000/microL before priming, P =.007), and the duration of thrombocytopenia, ie, a platelet count less than 150,000/microL, was shorter (1.5 +/- 2.1 days v 2.8 +/- 2.9 days, P =.0025) after priming. Episodes of fever and neutropenia were not observed. CONCLUSIONS GM-CSF priming from days 5 to 1 before doxorubicin and cyclophosphamide chemotherapy was associated with an earlier neutrophil and platelet nadir. On day 16, a higher mean neutrophil count and a lower proportion of patients with severe (< 500/microL) neutropenia were observed. Beneficial effects on the severity and duration of thrombocytopenia were also noted. These observations support the hypothesis that GM-CSF priming protects hematopoietic progenitors from the cytotoxic effects of chemotherapy.
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Affiliation(s)
- N L Kobrinsky
- MeritCare Roger Maris Cancer Center, Fargo, ND 58122, USA
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9
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Adams VR, Brenner T. Oprelvekin (Neumega), first platelet growth factor for thrombocytopenia. JOURNAL OF THE AMERICAN PHARMACEUTICAL ASSOCIATION (WASHINGTON, D.C. : 1996) 1999; 39:706-7. [PMID: 10533354 DOI: 10.1016/s1086-5802(15)30363-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Oprelvekin decreases the need for platelet transfusion in nontransplant patients receiving myelosuppressive chemotherapy. Until pharmacoeconomics studies determine the most cost-effective strategy for use of oprelvekin, it is likely to be used primarily in patients receiving dose-intensive chemotherapy to maintain the high-dose regimen that may provide a survival advantage for the patient with cancer. Additional product information is available at www.ahp.com/products/neumega.htm.
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Affiliation(s)
- V R Adams
- College of Pharmacy, University of Kentucky, Lexington, USA
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MASTERS JOHNR, POPERT RICHARDJ, THOMPSON PETERM, GIBSON DELLA, COPTCOAT MALCOLMJ, PARMAR MAHESHK. INTRAVESICAL CHEMOTHERAPY WITH EPIRUBICIN: A DOSE RESPONSE STUDY. J Urol 1999. [DOI: 10.1016/s0022-5347(05)68935-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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INTRAVESICAL CHEMOTHERAPY WITH EPIRUBICIN. J Urol 1999. [DOI: 10.1097/00005392-199905000-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Clemons M, Gharif R, Howell A. The value of dose intensification of standard chemotherapy for advanced breast cancer using colony-stimulating factors alone. Cancer Treat Rev 1998; 24:173-84. [PMID: 9767733 DOI: 10.1016/s0305-7372(98)90048-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- M Clemons
- CRC Department of Medical Oncology, Christie Hospital, Manchester, U.K
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13
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Clarke R. Issues in experimental design and endpoint analysis in the study of experimental cytotoxic agents in vivo in breast cancer and other models. Breast Cancer Res Treat 1997; 46:255-78. [PMID: 9478280 DOI: 10.1023/a:1005938428456] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Considerable effort has been placed into the identification of new antineoplastic agents to treat breast cancer and other malignant diseases. The basic approaches, in terms of model selection, endpoints, and data analysis, have changed in the previous few decades. This article deals with many of the issues associated with designing in vivo studies to investigate the activity of experimental and established compounds and their potential interactions. Endpoints for both in situ and excision assays are described, including approaches for determining cell kill, tumor growth delay, survival, and other estimates of activity. Suggestions for approaches that may limit the number of animals also are included, as are possible alternatives for death as an experimental endpoint. Other concerns, such routes for drug administration, drug dosage, and preliminary assessments of toxicity also are addressed. Statistical considerations are only briefly discussed, since these are addressed in detail in the accompanying article by Hanfelt (Hanfelt JJ, Breast Cancer Res Treat 46:279-302, 1997). The approaches suggested within this article are presented to draw attention to many of the key issues in experimental design and are not intended to exclude other approaches.
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Affiliation(s)
- R Clarke
- Vincent T. Lombardi Cancer Center, Georgetown University Medical School, Washington DC 20007, USA.
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14
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Affiliation(s)
- A W Craft
- Department of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
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15
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Planting AS, de Wit R, van der Burg ME, Stoter G, Verweij J. Phase II study of a closely spaced ifosfamide--cisplatin schedule with the addition of G-CSF in advanced non-small-cell lung cancer and malignant melanoma. Ann Oncol 1996; 7:1080-2. [PMID: 9037369 DOI: 10.1093/oxfordjournals.annonc.a010503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Ifosfamide and cisplatin are frequently combined cytotoxic agents. Both have a dose-response relationship. In view of this it appears attractive to study regimens with a higher dose intensity than usual. One way to increase the dose intensity is to shorten intervals between chemotherapy cycles. As bone marrow toxicity is dose limiting in ifosfamide-cisplatin combinations we started a phase II study with both drugs administered every 2 weeks in combination with G-CSF. PATIENTS AND METHODS Patients with advanced non-small-cell lung cancer or malignant melanoma were eligible for the study. The treatment consisted of ifosfamide 2 gram/m2/day days 1-3 combined with mesna, and cisplatin 33 mg/m2/day days 1-3, administered in hypertonic saline (3% NaCl). G-CSF was started on day 4 at a dose of 5 micrograms/kg/day and was continued until day 12. The cycles were to be repeated every 2 weeks for a maximum of 6 cycles. RESULTS Thirty-two patients were entered in the study; 30 patients were evaluable for response and toxicity. Neutropenia (grade 4 in 16 patients) and thrombocytopenia (grade 4 in 15 patients) were the most common toxicities. Thrombocytopenia incidence and -duration increased per cycle and was the main cause of treatment delays especially after the third cycle. Only 4 patients were able to complete the planned treatment without any delay or dose reduction and reached the intended dose intensity of 3 gram/m2/week of ifosfamide and 50 mg/m2/week of cisplatin. Non haematologic toxicities were generally mild. Out of 22 evaluable patients with non-small cell lung cancer 6 responded (27%; 95% CI: 10%-48%) while only one out of 8 patients with melanoma responded. The median response duration was 26 weeks (range 16-36 weeks). CONCLUSION The planned high-dose intensity of ifosfamide and cisplatin could be reached only for the first 2-3 cycles. Haematologic toxicity, especially cumulative thrombocytopenia, necessitated treatment delays jeopardizing the dose intensity. The response rate in non-small-cell lung cancer and melanoma was not superior to what can be expected from more conventional regimens.
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Affiliation(s)
- A S Planting
- Department of Medical Oncology, Rotterdam Cancer Institute, The Netherlands
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Kawai A, Sugihara S, Kunisada T, Hamada M, Inoue H. The importance of doxorubicin and methotrexate dose intensity in the chemotherapy of osteosarcoma. Arch Orthop Trauma Surg 1996; 115:68-70. [PMID: 9063854 DOI: 10.1007/bf00573443] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The relationship between dose intensity of cytotoxic agents and therapeutic results was examined in a retrospective analysis of 32 patients with non-metastatic high-grade osteosarcoma of the extremities. The average dose intensities of individual agents were 9.8 mg/m2/week for doxorubicin, 1.2 g/m2/week for methotrexate, and 10.5 mg/m2/week for cisplatinum. The dose intensities of doxorubicin and methotrexate were significantly correlated with the clinical results, while that of cisplatinum was not. These results indicate that maximal dose intensification of doxorubicin and methotrexate is an important determinant of treatment outcome for patients with osteosarcoma.
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Affiliation(s)
- A Kawai
- Department of Orthopaedic Surgery, Okayama University Medical School, Shikata-cho, Japan
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Thatcher N, Anderson H, Bleehen NM, Girling DJ, Lallemand G, Machin D, Stephens RJ. The feasibility of using glycosylated recombinant human granulocyte colony-stimulating factor (G-CSF) to increase the planned dose intensity of doxorubicin, cyclophosphamide and etoposide (ACE) in the treatment of small cell lung cancer. Medical Research Council Lung Cancer Working Party. Eur J Cancer 1995; 31A:152-6. [PMID: 7536433 DOI: 10.1016/0959-8049(94)00416-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study was conducted to test the feasibility of reducing the interval between cycles of doxorubicin, cyclophosphamide, etoposide (ACE) chemotherapy to 2 weeks, thereby increasing dose intensity, by adding granulocyte colony-stimulating factor (G-CSF) to reduce the duration of neutropenia following a cycle. 20 patients with small cell lung cancer (SCLC) were prescribed six cycles of 2-weekly ACE, with G-CSF on the intermediate days. 3 patients died during the treatment period and a further 5 had ACE terminated, 3 for toxicity and 2 for progressive disease. Of the 71 intervals between cycles, 42 (59%) were of the prescribed 14 days, 9 (13%) of 15-20 days, 15 (21%) of 21 days and five (7%) longer, but during the first four cycles, 36 (77%) of 47 intervals were of 14 days. The main reason for delay was haematological toxicity. All 20 patients experienced WHO grade 3 or 4 neutropenia, but at 2 weeks after a cycle only 3 had grade 4 and 1 grade 3. 17 patients required blood transfusion and 12 platelet transfusion. The only potentially serious adverse reaction to G-CSF was an episode of rash with facial oedema. Adding G-CSF allows ACE chemotherapy to be intensified by reducing the interval between cycles.
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Affiliation(s)
- N Thatcher
- Department of Medical Oncology, Wythenshawe Hospital, Manchester
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Thatcher N. Treatment evaluation of combined modality therapy: 'what can we obtain today from phase II trials?'. Lung Cancer 1994; 10 Suppl 1:S117-33. [PMID: 8087501 DOI: 10.1016/0169-5002(94)91674-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Demonstration of activity is the major goal of Phase II studies. Other end points-duration of response, survival (relapse free in complete responders), progression free interval, changes in performance status and quality of life also provide useful information. From these data a decision to continue or discard a particular therapy can be considered. Various handicaps including variability in response reporting, heterogeneity of patient populations, inadequate reporting of failure patterns, causes of death, performance status changes and quality of life hinder interpretation of Phase II data. Nevertheless, Phase II studies have defined prognostic groups, beneficial changes in performance status and have helped formulate novel management approaches. Targeting particular prognostic groups, investigating dose-intensive regimens with haemopoietic growth-factor support and novel combined-modality approaches have all been generated through Phase II investigations.
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MESH Headings
- Actuarial Analysis
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/therapy
- Carcinoma, Small Cell/drug therapy
- Carcinoma, Small Cell/mortality
- Carcinoma, Small Cell/therapy
- Chemotherapy, Adjuvant
- Clinical Trials, Phase II as Topic/methods
- Clinical Trials, Phase II as Topic/standards
- Combined Modality Therapy
- Female
- Humans
- Lung Neoplasms/drug therapy
- Lung Neoplasms/mortality
- Lung Neoplasms/therapy
- Male
- Multicenter Studies as Topic/methods
- Outcome Assessment, Health Care
- Prognosis
- Proportional Hazards Models
- Quality Control
- Quality of Life
- Reproducibility of Results
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- N Thatcher
- Christie Hospital, CRC Department of Medical Oncology, Manchester, UK
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Paccagnella A, Favaretto A, Riccardi A, Danova M, Ghiotto C, Giordano M, Pappagallo G, Comis S, Panozzo M, Chieco-Bianchi L. Granulocyte-macrophage colony-stimulating factor increases dose intensity of chemotherapy in small cell lung cancer. Relationship between clinical results, peripheral blood cell modifications, and bone marrow kinetics. Cancer 1993; 72:697-706. [PMID: 8392903 DOI: 10.1002/1097-0142(19930801)72:3<697::aid-cncr2820720312>3.0.co;2-u] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Until now, no dose-response correlation has been clearly defined in small cell lung cancer (SCLC). METHODS Forty-one consecutive patients with SCLC entered this study, 21 (limited [L]/extensive [E] = 10/11) patients (group A) received cisplatin 60 mg/m2, etoposide 120 mg/m2 x 3, and escalating epirubicin (5 mg/m2) starting from 45 mg/m2, every 3 weeks for six courses. RESULTS The maximum tolerated dose (MTD) was reached at epirubicin 60 mg/m2. In 15 (L/E = 9/6) patients (group B), who were submitted to the same combination plus granulocyte-macrophage colony-stimulating factor (GM-CSF) 10 micrograms/kg on days 4 to 14, the MTD was reached at the epirubicin dose of 70 mg/m2. In five (L/E = 4/1) patients (group C) treated as in group B, but with a GM-CSF priming from day -17 to -7 before the first cycle, the MTD was again at 70 mg/m2. Group A patients received 73% of the planned cycles; groups B and C, 86% (P < 0.015). Twenty-five percent of group A cycles versus 6% of groups B and C were delayed (P = 0.0018). The chemotherapy dose was reduced in 15% versus 1.5% of cycles (P = 0.0072). A significant difference was observed in the delivered dose intensity (DI) and in the relative DI with an increase of 29% for cisplatin and etoposide (P < 0.0005; P = 0.0017) and of 63% for epirubicin (P < 0.0000). In group A, the response rate was 72% (24% complete response [CR]), and in groups B and C, 95% (40% CR). Bone marrow myeloid precursor (BMMP) proliferative activity was determined in 21 patients after in vivo bromodeoxyuridine infusion. In GM-CSF-treated patients the production rate evaluated before the starting of the second, fourth, and fifth cycle was significantly higher than the corresponding value of the first cycle. CONCLUSIONS GM-CSF induces a significant increase of dose intensity by a long-lasting and cumulative enhancement of BMMP proliferation.
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Affiliation(s)
- A Paccagnella
- Division of Medical Oncology, General Hospital, Padova, Italy
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22
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Mross K, Bohn C, Edler L, Jonat W, Queisser W, Heidemann E, Goebel M, Hossfeld DK. Randomized phase II study of single-agent epirubicin +/- verapamil in patients with advanced metastatic breast cancer. An AIO clinical trial. Arbeitsgemeinschaft Internistische Onkologie of the German Cancer Society. Ann Oncol 1993; 4:45-50. [PMID: 8435362 DOI: 10.1093/oxfordjournals.annonc.a058356] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Anthracyclines are the most active cytostatic agents in patients with metastatic breast cancer. Drug resistance and dose intensity are relevant issues in the treatment of cancer. METHODS A randomized phase II study in 51 patients with advanced progressive metastatic breast cancer was performed. Twenty-six were treated with epirubicin (EPI) 120 mg/m2 i.v. bolus injection divided over three days combined with a daily dose of 480 mg verapamil (VPL) orally administered one day before and during EPI. Twenty-five patients received the same dose and schedule of EPI without VPL. Evaluation of response was carried out after three 21-day cycles. Study endpoints were objective response rate and overall survival. RESULTS Among the 24 evaluable patients treated with EPI+VPL 1 CR (4%), 7 PR (29%), 9 NC (38%) and 7 PD (29%) were observed. Two patients were excluded because of toxicity. Among the 24 evaluable patients treated with EPI alone 8 PR (28%), 6 NC (24%) and 10 PD (40%) were observed, and one patient was excluded because of toxicity. Myelotoxicity was the major side effect followed by alopecia, stomatitis/mucositis and nausea. The patient group treated with VPL had lower blood pressure levels during therapy, with complete normalization after discontinuation of VPL. The median overall survival times were similar: 7.4 month in the EPI group and 8.9 month in the EPI+VPL group. CONCLUSION In both treatment groups the objective response rate was about 30% and the overall survival rates were also the same. No clinical relevance could be demonstrated for the hypothesized resistance modifying action of VPL. Furthermore, VPL did not increase the toxicity of EPI.
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Affiliation(s)
- K Mross
- University Hospital Eppendorf, Dept. Oncology and Hematology, Hamburg
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Dodwell DJ, Rathmell AJ, Ash DV. Assessment of palliative chemotherapy: a step beyond response. Clin Oncol (R Coll Radiol) 1993; 5:114-7. [PMID: 7683201 DOI: 10.1016/s0936-6555(05)80860-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In summary, tumour response is a useful index of cytotoxic activity, but is of limited value in the assessment of benefit to the patient following treatment with cytotoxic drugs. Survival is a similarly inappropriate endpoint to assess the clinical benefits of palliative cytotoxic therapy. The widespread introduction of QL assessment as a primary outcome measure in cancer therapy will enhance our understanding of the value of a wide range of established cancer treatments, not only that of palliative chemotherapy, but also surgery and radiotherapy.
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Affiliation(s)
- D J Dodwell
- Yorkshire Regional Centre for Cancer Treatment, Cookridge Hospital, Leeds, UK
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Radford JA, Ryder WD, Dodwell D, Anderson H, Thatcher N. Predicting septic complications of chemotherapy: an analysis of 382 patients treated for small cell lung cancer without dose reduction after major sepsis. Eur J Cancer 1993; 29A:81-6. [PMID: 1332739 DOI: 10.1016/0959-8049(93)90581-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The incidence and risk of septic complications in 382 patients treated for small cell lung cancer with combination chemotherapy at a single centre have been analysed. Full protocol doses were employed throughout with no dose reduction after episodes of severe or life-threatening sepsis (SLTS). 50 (13%) patients experienced 66 episodes of SLTS associated with 1978 cycles of chemotherapy (3.2% cycles affected). 20 (5.2%) patients died due to sepsis (SD) of whom only 4 had experienced SLTS with a previous cycle of treatment. The others died as a result of their first septic episode. A model comprising four variables, age (< or = 50 or > 50 years), Karnofsky performance status (KP < or = 50 or > 50), treatment (two- or three-drug regimen) and previous sepsis (SLTS or no SLTS with previous cycles) was found to satisfactorily describe the incidence of SLTS and SD in the study population and once validated in another patient groups this model should allow identification of high-risk individuals before treatment starts. If so, we propose that high-risk patients (age > 50 years, KP < or = 50, treatment with three-drug regimen) receive 50% of protocol doses in the first cycle of treatment with escalation to 75% and eventually 100% doses in subsequent cycles if sepsis does not supervene. Those with one or two risk factors present run a relatively low risk of SLTS or SD and we consider that full-dose chemotherapy should be used throughout in these individuals.
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Affiliation(s)
- J A Radford
- CRC Department of Medical Oncology, Christie Hospital, Manchester, U.K
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Yosef H, Slater A, Keen CW, Bunting JS, Hope-Stone H, Parmar H, Roberts JT, Termander B, Nilsson B. Prednimustine (Sterecyt) versus cyclophosphamide both in combination with methotrexate and 5-fluorouracil in the treatment of advanced breast cancer. Eur J Cancer 1993; 29A:1100-5. [PMID: 8518020 DOI: 10.1016/s0959-8049(05)80296-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
153 women with advanced breast cancer were randomly allocated for treatment with SMF [prednimustine (Sterecyt) + methotrexate + 5-fluorouracil, 83 patients] or CMF (cyclophosphamide+methotrexate+5-fluorouracil, 70 patients). Prednimustine was administered orally 100 mg/m2 daily, for 5 days, and cyclophosphamide was administered orally 100 mg/m2, for 14 days, each, every 4 weeks. Methotrexate was given at a dose of 40 mg/m2 and 5-fluorouracil at 600 mg/m2 on day 1 and 8, every 4 weeks. Leucovorin was used in 39 patients to alleviate mucositis. The two treatment groups were balanced in terms of age, performance status, lymph node status, histology, menopausal status and previous therapy. Response was evaluated in 140 patients. Of 76 patients treated with SMF, 4 had a complete and 21 a partial response (CR+PR = 33%), 40 had no change (NC) and 11 had progressive disease (PD). Of 64 patients treated with CMF, 3 had a complete and 18 a partial response (CR+PR = 33%), 30 had no change (NC) and 13 had progressive disease (PD). Time to treatment failure and survival were similar in both groups. A relationship between haematological and gastrointestinal toxicity and therapeutic efficacy was demonstrated with a superior survival and response rate recorded for patients with such toxicity than in patients without. Haematological toxicity was, in general, mild to moderate with no difference between the two groups. Alopecia (P = 0.008), nausea/vomiting (P = 0.02) and euphoria (P = 0.03) were more common in the CMF-treated group. Diarrhoea was more common in the SMF group (P = 0.03). In conclusion, SMF seems to be as efficient as CMF with regard to response rate, time to treatment failure and survival. However, SMF was tolerated better than CMF.
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Affiliation(s)
- H Yosef
- Beatson Oncology Centre, Belvidere Hospital, Glasgow
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26
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Ardizzoni A, Venturini M, Crinò L, Sertoli MR, Bruzzi P, Pennucci MC, Mariani GL, Garrone O, Bracarda S, Rosso R. High dose-intensity chemotherapy, with accelerated cyclophosphamide-doxorubicin-etoposide and granulocyte-macrophage colony stimulating factor, in the treatment of small cell lung cancer. Eur J Cancer 1993; 29A:687-92. [PMID: 8385970 DOI: 10.1016/s0959-8049(05)80347-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
15 patients with small-cell lung cancer were treated with an "accelerated" chemotherapy consisting of standard-dose cyclophosphamide-doxorubicin-etoposide administered every 15 days (as opposed to the usual 21-day intervals) along with granulocyte-macrophage colony stimulating factor (10 micrograms/kg/day) administered prophylactically subcutaneously from day 4 to 13. The primary objective of this study was to examine the possibility of achieving a 50% dose-intensity increase by a shortening of chemotherapy intervals. 9 patients were not able to complete the planned six courses of chemotherapy owing to cumulative haematological toxicity. In fact, while leukopenia was acceptable and constant during treatment, both thrombocytopenia and anaemia progressively worsened with subsequent courses, becoming particularly severe after the 4th cycle when interruption of the treatment was often required. 13 patients who completed four courses of chemotherapy received a median of 96% of the planned dose-intensity. This corresponded with an average relative dose-intensity actually delivered of 1.44 compared with the planned dose-intensity of a standard cyclophosphamide-doxorubicin-etoposide every 21 days. In conclusion, acceleration of cyclophosphamide-doxorubicin-etoposide chemotherapy combined with granulocyte-macrophage colony stimulating factor can lead to a significant increase of dose-intensity but it is feasible only for a limited number of courses.
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Affiliation(s)
- A Ardizzoni
- Department of Medical Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
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Abstract
The haemopoietic growth factors are a diverse group of hormones with effects on different haemopoietic cell lineages and at various points in their developmental differentiation. The biology of many of these factors is now well understood. They have entered clinical trials and have demonstrated benefits in particular clinical situations. The thrust of current phase II and III clinical investigations now is to use these factors, alone or in combinations, to modify various disease states and to ameliorate many of the side-effects of other therapeutic agents, particularly cytotoxic anticancer agents. Many other disease states also lend themselves to therapy with these growth factors. Other haemopoietic growth factors have not been as extensively studied in humans but hold great promise. In this chapter, the current status of the haemopoietic growth factors presently under clinical trial has been reviewed. In addition, several factors which have been recently described but which have not yet entered clinical trials have been discussed.
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Abstract
Chemotherapy offers the potential for cure or substantial palliation of numerous malignancies. However, its effective use requires a carefully developed strategy to overcome the barriers presented by a variety of neoplasms. Curative treatment for those human malignancies that show sensitivity to the available drugs requires combinations of drugs in "dose intense" regimens. Autologous bone marrow transplants and cytokines allow larger doses of drugs and possibly will improve the cure rates. Maximum compliance and prevention of drug toxicity are essential.
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Affiliation(s)
- J R Bertino
- Program of Molecular Pharmacology and Therapeutics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021
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Thatcher N. New perspectives in lung cancer. 4. Haematopoietic growth factors and lung cancer treatment. Thorax 1992; 47:119-26. [PMID: 1372450 PMCID: PMC463590 DOI: 10.1136/thx.47.2.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- N Thatcher
- Department of Medical Oncology, Christie Hospital and Holt Radium Institute, Manchester
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Wampler GL, Fryer JG. Calculation of received dose intensity for combinations of drugs using small-cell lung carcinoma treatment regimens as examples. Cancer Chemother Pharmacol 1992; 30:199-206. [PMID: 1321006 DOI: 10.1007/bf00686312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Programs are presented for the calculation of received dose intensity in combination chemotherapy regimens. These provide methods for determining the final dose intensity, the mean cumulative dose intensity together with its standard error, and other tabular and graphic summaries. Two ways of dividing patients into high and low received-dose-intensity groups are proposed. Methods are illustrated using data from Mid-Atlantic Oncology Program (MAOP) 2183, a phase III evaluation of a six-drug alternating combination vs a three-drug "standard" combination treatment for extensive small-cell lung cancer. Comparisons of received dose intensity with demographic and outcome variables are presented.
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Affiliation(s)
- G L Wampler
- Department of Medicine, Medical College of Virginia, Richmond 23298
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Cullen MH. Dose-response relationships in testicular cancer. Eur J Cancer 1991; 27:817-8. [PMID: 1657076 DOI: 10.1016/0277-5379(91)90122-t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- M H Cullen
- Department of Medical Oncology, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, U.K
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Schmähl D. [Janus-faced character of chemotherapy: a comment on the Abel theses]. KLINISCHE WOCHENSCHRIFT 1991; 69:49-51. [PMID: 2016847 DOI: 10.1007/bf01649059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- D Schmähl
- Institut für Toxikologie und Chemotherapie, Deutsches Krebsforschungszentrum, Heidelberg
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