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Ezzo JM, Richardson MA, Vickers A, Allen C, Dibble SL, Issell BF, Lao L, Pearl M, Ramirez G, Roscoe J, Shen J, Shivnan JC, Streitberger K, Treish I, Zhang G. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database Syst Rev 2006:CD002285. [PMID: 16625560 DOI: 10.1002/14651858.cd002285.pub2] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There have been recent advances in chemotherapy-induced nausea and vomiting using 5-HT(3) inhibitors and dexamethasone. However, many still experience these symptoms, and expert panels encourage additional methods to reduce these symptoms. OBJECTIVES The objective was to assess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting in cancer patients. SEARCH STRATEGY We searched MEDLINE, EMBASE, PsycLIT, MANTIS, Science Citation Index, CCTR (Cochrane Controlled Trials Registry), Cochrane Complementary Medicine Field Trials Register, Cochrane Pain, Palliative Care and Supportive Care Specialized Register, Cochrane Cancer Specialized Register, and conference abstracts. SELECTION CRITERIA Randomized trials of acupuncture-point stimulation by any method (needles, electrical stimulation, magnets, or acupressure) and assessing chemotherapy-induced nausea or vomiting, or both. DATA COLLECTION AND ANALYSIS Data were provided by investigators of the original trials and pooled using a fixed effect model. Relative risks were calculated on dichotomous data. Standardized mean differences were calculated for nausea severity. Weighted mean differences were calculated for number of emetic episodes. MAIN RESULTS Eleven trials (N = 1247) were pooled. Overall, acupuncture-point stimulation of all methods combined reduced the incidence of acute vomiting (RR = 0.82; 95% confidence interval 0.69 to 0.99; P = 0.04), but not acute or delayed nausea severity compared to control. By modality, stimulation with needles reduced proportion of acute vomiting (RR = 0.74; 95% confidence interval 0.58 to 0.94; P = 0.01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% confidence interval 0.60 to 0.97; P = 0.02), but manual acupuncture did not; delayed symptoms for acupuncture were not reported. Acupressure reduced mean acute nausea severity (SMD = -0.19; 95% confidence interval -0.37 to -0.01; P = 0.04) but not acute vomiting or delayed symptoms. Noninvasive electrostimulation showed no benefit for any outcome. All trials used concomitant pharmacologic antiemetics, and all, except electroacupuncture trials, used state-of-the-art antiemetics. AUTHORS' CONCLUSIONS This review complements data on post-operative nausea and vomiting suggesting a biologic effect of acupuncture-point stimulation. Electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies combining electroacupuncture with state-of-the-art antiemetics and in patients with refractory symptoms are needed to determine clinical relevance. Self-administered acupressure appears to have a protective effect for acute nausea and can readily be taught to patients though studies did not involve placebo control. Noninvasive electrostimulation appears unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy.
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Affiliation(s)
- J M Ezzo
- James P. Swyers Enterprises, 1905 West Rogers Ave, Baltimore, Maryland 21209, USA.
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Affiliation(s)
| | - C. Gotay
- Cancer Rrsch Ctr of Hawaii, Honolulu, HI
| | - I. Pagano
- Cancer Rrsch Ctr of Hawaii, Honolulu, HI
| | - A. Franke
- Cancer Rrsch Ctr of Hawaii, Honolulu, HI
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Issell BF. Availability of clinical trials for Hawaii cancer patients. Hawaii Med J 2001; 60:161. [PMID: 11467012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Gotay CC, Banner RO, Matsunaga DS, Hedlund N, Enos R, Issell BF, DeCambra H. Impact of a culturally appropriate intervention on breast and cervical screening among native Hawaiian women. Prev Med 2000; 31:529-37. [PMID: 11071833 DOI: 10.1006/pmed.2000.0732] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Native Hawaiian women have the highest breast and cervical cancer mortality rates and lowest screening rates in Hawai'i. This paper summarizes impacts of a breast and cervical cancer screening intervention spearheaded by a Native Hawaiian community. METHODS Six hundred seventy-eight randomly selected Native Hawaiian women completed two telephone surveys assessing their cancer screening behaviors: 318 women from a community that implemented an intervention, known as a Kokua Group, to provide culturally tailored education and support in a group setting and 360 women from communities without this intervention. The surveys were conducted before intervention implementation and 3 years later, 4 to 5 months after the last intervention session. RESULTS At posttest, intervention community women reported positive changes in 4 of 12 screening activities (P < or = 0.05), while no changes were found among controls. Some women in both communities had heard about and/or participated in Kokua Groups. Hierarchical logistic regression showed that controlling for community, demographics, and pretest scores, Kokua Group knowledge or participation was a significant predictor (P < 0.05) of 9 of 12 screening-related behaviors. CONCLUSIONS Positive changes in screening activities among women aware of the intervention support the importance of information diffusion by community consumers. Diffusion may occur beyond the boundaries of the community as defined.
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Affiliation(s)
- C C Gotay
- University of Hawai'i Cancer Research Center, Honolulu, Hawai'i 96813, USA.
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Gotay CC, Hara W, Issell BF, Maskarinec G. Use of complementary and alternative medicine in Hawaii cancer patients. Hawaii Med J 1999; 58:94-8. [PMID: 10363431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
This research investigated complementary and alternative medicine (CAM) use by Hawaii cancer patients. Thirty-six percent of patients used CAM, most commonly religious/spiritual therapy and herbal treatments. CAM use was linked with younger age, female gender, Catholic religion, and more education. More research is needed to inform decision-making.
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Affiliation(s)
- C C Gotay
- Cancer Research Center of Hawaii, University of Hawaii, Honolulu 96813, USA
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Matsunaga DS, Enos R, Gotay CC, Banner RO, DeCambra H, Hammond OW, Hedlund N, Ilaban EK, Issell BF, Tsark JA. Participatory research in a Native Hawaiian community. The Wai'anae Cancer Research Project. Cancer 1996; 78:1582-6. [PMID: 8839575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Community participation was a key component of a cancer control research project in a Native Hawaiian community. This project tested the effectiveness of a culturally appropriate intervention as a means of increasing breast and cervical cancer screening practices among Native Hawaiian women on the Wai'anae Coast of the island of O'ahu. METHODS The Wai'anae Cancer Research project was community driven, with Native Hawaiian community representatives involved in all phases of the project, from grant proposal development to data interpretation. A community health center administered the grant award from the National Cancer Institute. The policymaking steering committee included community representatives, health professionals, and researchers to balance community and scientific quality standards. A factor in the project's success was continuous involvement over 7 years by a core of community representatives and professional staff. RESULTS More than 500 women participated in the intervention, and outcome measures indicated that there was a community wide impact on cancer-related knowledge, attitudes, and behaviors. Important contributions of the project also included direct economic benefits, improvements in health services and systems, increased research capabilities, and dissemination of findings to other communities and researchers. CONCLUSION Community participation in all phases of the research was essential in generating community acceptance and resulted in an innovative and effective intervention. This participatory research project has left the community richer in knowledge, skills, experience, confidence, and resources. These qualities provide a strong foundation for building future programs and research.
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Gotay CC, Issell BF, Hernandez BY, Serxner S. Barriers to mammography in a low income, multiethnic clinic population. Hawaii Med J 1996; 55:136-40. [PMID: 8823997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Breast cancer-related knowledge, attitudes, behaviors and barriers to obtaining a mammogram were assessed in women attending a primary care clinic serving a low-income minority population. Although most women believed in the value of mammograms, fewer than one in six was compliant with guidelines, and there were considerable deficits in knowledge about breast cancer risk. Ethnic and age differences in responses have implications for health program planning.
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Affiliation(s)
- C C Gotay
- Cancer Research Center of Hawaii, Honolulu 96813, USA
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Banner RO, DeCambra H, Enos R, Gotay C, Hammond OW, Hedlung N, Issell BF, Matsunaga DS, Tsark JA. A breast and cervical cancer project in a native Hawaiian community: Wai'anae cancer research project. Prev Med 1995; 24:447-53. [PMID: 8524718 DOI: 10.1006/pmed.1995.1072] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND This article describes a breast and cervical cancer control project in a Native Hawaiian community and presents preliminary findings from its first year. The project is community driven, with Native Hawaiian community investigators and advisors involved in all phases of the research project. Its purpose is to test the effectiveness of a culturally appropriate intervention as a means of increasing breast and cervical cancer screening practices among Native Hawaiian women. METHODS This article discusses the process of community participation in the development of a baseline survey as well as selected findings from that survey. A baseline telephone survey was conducted to obtain an initial assessment of community knowledge, attitudes, and behavior related to cancer. Community representatives were an integral part of the research team that planned and implemented the survey. RESULTS A total of 1,260 women drawn equally from the study and the control communities participated in the survey. A majority of those surveyed in both communities indicated adherence to cancer screening recommendations. Seventy-three percent of the women reported having obtained a Pap test during the past 2 years. Fifty-nine percent of women over 40 years of age reported having had a mammogram during the past 2 years. Twenty-eight percent reported having used Hawaiian remedies within the past year. Thirty-six percent of the women reported encouraging others to obtain cancer screening services. DISCUSSION Though a majority of the target population are following cancer screening guidelines, a significant minority are not. While the project intervention aims to change the screening behavior of women not currently getting cancer screening, it plans to do so by enlisting the women already in compliance to reach others in their social networks who are currently not getting cancer screening. The involvement of community representatives, working alongside researchers, in baseline survey planning helped assure the survey was acceptable to the participants and the community as a whole. This process is illustrative of a participatory research commitment which underlies success in the early phase of this Native Hawaiian research project.
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Affiliation(s)
- R O Banner
- Wai'anae Coast Comprehensive Health Center, Hawaii, USA
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Bukowski RM, Young J, Goodman G, Meyers F, Issell BF, Sergi JS, McLain D, Fyfe G, Finke J. Polyethylene glycol conjugated interleukin-2: clinical and immunologic effects in patients with advanced renal cell carcinoma. Invest New Drugs 1993; 11:211-7. [PMID: 8262734 DOI: 10.1007/bf00874158] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Recombinant interleukin-2 (rIL-2) modified with monomethoxypolyethylene glycol (PEG IL-2) was utilized in patients with metastatic renal cell carcinoma in two separate multi-institutional trials. PEG IL-2 was administered as an I.V. bolus days 1, 8, 15, and 22 with cycles repeated every six weeks. The two trials employed different dose levels: A) 20 x 10(6) I.U./m2 day 1 followed by 12 x 10(6) I.U./m2 days 8, 15, 22; and B) 12 x 10(6) I.U./m2 days 1, 8, 15, 22. Thirty-five patients were entered and 31 were evaluable for response (A-15/18, B-16/17). Two of 31 patients had partial responses. Median therapy duration was four weeks (range 1-15), and dose reduction for grade III or IV toxicity was required in 14/35 patients (A-6/18, B-8/17). Toxicity (> or = grade III) seen included: hypotension 51%, dyspnea 17%, seizures 6%, and mental status changes 11%. No differences in response or toxicity between the two schedules were noted. Hematologic changes included lymphocytosis and eosinophilia in the majority of patients. PEG IL-2 given once weekly has significant toxicity, and may produce tumor regression in patients with renal cell carcinoma.
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Abstract
Immunotoxins are formed by chemically linking antibodies to "toxic" polypeptides that inactivate protein synthesis. These hybrid protein molecules are guided to tumor cells by the antibody moiety, and once bound to the tumor cells, the toxic polypeptide moiety penetrates the cell membrane and enzymatically inactivates protein synthesis. A stepwise approach to identifying the potential clinical uses of immunotoxins in cancer therapy is examined in this chapter.
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Abstract
A radioimmunoassay for VP-16 or VM-26 was developed by using tritiated ligand and antisera produced from rabbits immunized with succinyl-VP-16 bovine serum albumin conjugates. Separate determinations of VP-16 and its hydroxy acid, a metabolite which cross-reacted with the VP-16 antisera, could be accomplished by extracting samples with chloroform in which the metabolite was insoluble. The assay was reproducible and sensitive. Extracted standard curves were linear from 0.025 to 5 micrograms for VP-16 and 0.1 to 10 micrograms for the hydroxy acid per 0.5 ml assay mixture. Fifty percent inhibition of binding was achieved at 0.066 and 0.55 microgram for VP-16 or VM-26 and the metabolite, respectively. Preliminary disposition studies in mice and dog, and human urinary excretion support the application of the assay in pharmacologic studies.
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Bradley EC, Catino JJ, Issell BF, Poiesz B, Hustad JM, Dalton T, Allegretta M, Mier J. Cell-mediated inhibition of tumor colony formation in agarose by resting and interleukin 2-stimulated human lymphocytes. Cancer Res 1985; 45:1464-8. [PMID: 3872166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Human nonadherent peripheral blood mononuclear cells (PBMC) isolated from nonimmunized donors were preincubated for 18 h in medium alone or medium containing the lymphokine interleukin 2 and subsequently cocultured with tumor cells derived from malignant tumor cell lines or from fresh human tumors. The cell suspensions were subsequently inoculated into agarose; 14 days later, new tumor colony formation was determined. Although the different tumor cells displayed a wide range of sensitivity to the PBMC, in each instance, the number of colonies formed by the tumor cells exposed to the PBMC was consistently reduced relative to that of control cells. The inhibitory effect on the colony-forming cells was especially pronounced with PBMC preincubated with interleukin-2 and was dependent on the ratio of tumor cells to PBMC in the culture. This assay system provides an alternative to the standard 51Cr release assays in assessing the immunomodulatory effects of lymphokines and in quantitating the cytolytic or cytostatic activity of various effector cells against neoplastic stem cells from established cell lines and from heterogeneous cell preparations derived from fresh human tumors.
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Abstract
Mitomycin was approved for marketing by the Food and Drug Administration in 1974 for use in gastric and pancreatic carcinomas when combined with other chemotherapeutic agents. Since then, mitomycin has been used extensively in combination chemotherapy for a variety of tumors, particularly in the past seven years. However, the contribution of this agent to the various drug regimens has not been adequately defined. Clear evidence of the drug's activity as a single agent has been seen in the intravesical treatment of superficial bladder carcinoma. Common toxicities include anorexia, vomiting, and myelosuppression. Less common, but potentially lethal, toxicities in the form of fibrosing alveolitis and microangiopathic hemolytic anemia with renal failure are being reported with increasing frequency. These potentially severe adverse effects, coupled with the still undefined role of mitomycin in systemic cancer chemotherapy, suggest that selection of this drug for other than investigational use should be made with care.
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Abstract
The clinical pharmacology of cisplatin was determined in six patients with malignant ascites secondary to ovarian cancer, and in one patient with peritoneal mesothelioma, following intraperitoneal administration of cisplatin (25-60 mg/m2). The drug was administered in 1 liter of normal saline as a 15- to 30-min infusion. Total, and in some patients free (ultrafilterable), platinum concentrations were determined in plasma, urine, and ascitic fluid by flameless atomic absorption spectrometry. The peak total platinum concentrations in ascitic fluid at the end of infusion were related to dose, a 50 mg/m2 dose producing a 20 to 80 micrograms cisplatin/ml concentration. Filterable platinum represented between 3 and 59% of total platinum in the peritoneum at 4 to 6.5 hr following its administration. Plasma platinum concentrations ranged between 0.2 to 1.6 micrograms/ml 4 hr following administration, and reached a plateau for the next 24 to 48 hr largely in the form of protein-bound platinum. The urinary excretion of cisplatin was consistent with variation in absorption from the peritoneum. Minimal gastrointestinal, bone marrow, and renal toxicities during therapy suggest that sustained free platinum concentrations in ascites may be obtained without significant toxicity and support the intraperitoneal route of administration as an effective strategy for cisplatin therapy of intra-abdominal malignancies.
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Dhingra HM, Valdivieso M, Booser DJ, Umsawasdi T, Carr DT, Chiuten DF, Murphy WK, Issell BF, Spitzer G, Farha P. Chemotherapy for advanced adenocarcinoma and squamous cell carcinoma of the lung with etoposide and cisplatin. Cancer Treat Rep 1984; 68:671-3. [PMID: 6538811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Forty-one patients with unselected advanced non-small cell lung cancer were treated with a combination of etoposide and cisplatin. A response rate of 19%, a 78-week median survival of responders, and a 36-week overall median survival were observed.
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Issell BF, Prout GR, Soloway MS, Cummings KB, Brannen G, Veenema R, Flanagan M, Block NL, Summers JL, Levin EA. Mitomycin C intravesical therapy in noninvasive bladder cancer after failure on thiotepa. Cancer 1984; 53:1025-8. [PMID: 6420039 DOI: 10.1002/1097-0142(19840301)53:5<1025::aid-cncr2820530502>3.0.co;2-d] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Mitomycin C 40 mg in 40 ml water was administered intravesically every week for 8 consecutive weeks to 60 patients with superficial bladder cancer. All patients had failed treatment with intravesical thiotepa and had evaluable disease. An objective response of 50% or greater reduction in measured tumor mucosal involvement was obtained in 68% of patients. Forty-two percent of the patients achieved a complete response, and this included 50% of patients with Grade III disease and 70% of patients with a T1 tumor. Median response duration in complete responders was 12.2 months with a range of 3.5 to 24.3 + months. Fifty-five percent of patients are still responding. Therapy was generally well tolerated, and in contrast to thiotepa, myelosuppression was not the dose-limiting effect. One third of all patients experienced symptoms of local irritation, and skin reactions were seen in 12% of patients.
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Abstract
Over forty papers describing correlations between in vitro human tumor sensitivity to a variety of chemotherapeutic agents and the in vivo response of patients to those agents have been published since the publication in 1978 by Salmon and Hamburger of their results of a human tumor colony-forming chemosensitivity assay (CFCA). The true positive rate in over 1600 correlations is 71% and the true negative rate is 94%. The biological elements of the assay, its developmental history, its place in the spectrum of in vitro chemosensitivity assays, and its theoretical and practical limitations are discussed. The scope, design, and limitations of key clinical trials are presented and an analysis of the potential errors of statistical interpretation of the trials as well as the results of the trials is given.
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Gaver RC, Deeb G, Pittman KA, Issell BF, Mittelman A, Smyth RD. Disposition of orally administered 14C-prednimustine in cancer patients. Cancer Chemother Pharmacol 1983; 11:139-43. [PMID: 6640823 DOI: 10.1007/bf00254192] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A single oral solution dose (40 mg/m2) of 14C-prednimustine was administered to each of four cancer patients. Plasma, urine, and feces were collected at appropriate times and analyzed for total radioactivity. Plasma samples were analyzed for prednimustine. Peak plasma levels of radioactivity (1-3 micrograms 14C-prednimustine equivalents) occurred at 1.5-3 h in three patients and at 5-6 h in one patient. No intact prednimustine was detected in the plasma; this means that if present, it would be at a concentration of 0.02 micrograms/ml or less and would account for less than 1% of the total drug-related material at the time of peak plasma levels. Solvent-extractable metabolites had a plasma half-life of about 8 h or less. By 24 h essentially all the plasma radioactivity appeared to be covalently bound, and it was eliminated slowly with an estimated terminal elimination half-life of about 10 days. Rapid urinary excretion occurred in the first 24 h, and 40%-60% of the dose was recovered in the urine in 72 h. Although prednimustine was well absorbed, the ester was subject to extensive presystemic metabolism and was not present in the systemic circulation after oral administration.
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Comis RL, Issell BF, Pittman K, Ginsberg SJ, Rudolph A, Aust JC, DiFino SM, Tinsley RW, Poiesz BJ, Crooke ST. A phase I and clinical pharmacology study of intravenously administered carminomycin in cancer patients in the United States. Cancer Res 1982; 42:2944-8. [PMID: 7083181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Carminomycin (CMN) was administered i.v. to 44 patients with a variety of nonhematological cancers every 4 weeks at doses of 15, 20, 22.5, and 25 mg/sq m. Granulocytopenia was the dose-limiting toxicity. The median granulocyte count for previously untreated patients receiving 22.5 mg/sq m was 0.962 cells/microliters, and for previously treated patients receiving 20 mg/sq m it was 0.420 cell/microliters. Moderate to severe phlebitis was associated with drug administration in 50% of cases. Nausea, vomiting, and alopecia were mild. Three of nine patients who received a total CMN dose of greater than or equal to 100 mg/sq m (mean, 132 mg/sq m) developed unexplained decreases in radionuclide cardiac ejection fraction, with one patient developing decreased QRS amplitude and congestive heart failure at a total dose of 160 mg/sq m. CMN is rapidly metabolized to carminomycinol. The elimination half-lives of CMN and carminomycinol are 6 to 10 and 50 hr, respectively. CMN was found to be a more potent inhibitor of human granulocyte-macrophage colony-forming units than was carminomycinol. Objective partial responses were seen in two of seven previously untreated patients with non-small cell lung cancer and one of three patients with squamous cell carcinoma of the head and neck previously untreated with chemotherapy.
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Issell BF, Borsos G, D'Aoust JC, Banhidy F, Crooke ST, Eckhardt S. Dibromodulcitol plus bleomycin compared with bleomycin alone in head and neck cancer. Cancer Chemother Pharmacol 1982; 8:171-3. [PMID: 6179650 DOI: 10.1007/bf00255478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Advanced recurrent squamous cell head and neck cancer patients were prospectively randomized to receive or not receive dibromodulcitol 10 mg/kg PO weekly for 8 consecutive weeks in addition to bleomycin chemotherapy. Patients initially entered in the study received bleomycin 15 mu/m2 three times weekly for 8 weeks. This was later changed to 15 mu/m2 twice weekly for 8 weeks because of unacceptable stomatitis. Most patients had relapsed following surgery and/or radiotherapy, but none had received prior chemotherapy. A2 : 1 randomization in favor of the dibromodulcitol-containing therapy was used. There were 12 partial responses in the 44 evaluable patients receiving the combination (27%), and 4 partial responses in the 18 patients receiving single-agent bleomycin chemotherapy (22%). This difference was not statistically significant. Response durations were also relatively short for both therapies. Within the limitations of this study, we were unable to demonstrate that patient benefit resulted from the addition of dibromodulcitol to bleomycin chemotherapy for this patient population.
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Issell BF, Tihon C, Curry ME. Etoposide (VP16-213) and teniposide (VM26) comparative in vitro activities in human tumors. Cancer Chemother Pharmacol 1982; 7:113-5. [PMID: 7083450 DOI: 10.1007/bf00254531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In order to determine if any inherent sensitivity differences may exist between VP16-213 and VM26 individual human tumors were grown in vitro and drug sensitivities were determined using the soft agar clonogenic assay method. Only nine of the 34 tumors tested so far showed a differing sensitivity to VP16-213 and VM26 as measured by a 25% or greater colony number reduction. However in none of these tumors did this added reduction result in a 70% decrease over control plate colony numbers. As yet we have been unable to demonstrate any clinically meaningful inherent in vitro sensitivity difference between VP16-213 and VM26 in any tumor type tested.
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Abstract
VP16-213 and VM26 are compounds with definite anticancer activity in specific tumor types. Despite 10 years of clinical development the full impact of these compounds in current cancer therapy requires further study. There is no conclusive evidence that one compound is superior to the other in any specific tumor type. The composite activities suggest possible differences in certain cancers such as small cell anaplastic lung cancer, lymphoma, leukemia, bladder and ovarian cancer, but sufficiently adequate studies to determine this have not been reported for any tumor. Understanding the basic pharmacology of these compounds should also be considered of high priority since it is obvious that there is much to learn in this area and further clarification should allow improved clinical utilization. It is hoped that the presentations and discussions of the First International Symposium will generate a new wave of interest in future podophyllotoxin research and development.
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Abstract
Serum zinc concentrations were determined in 26 extensive squamous cell lung cancer patients and were tested for correlations with survival, response to therapy, nutritional status indices, and various host defense characteristics. Subnormal serum zinc levels were found in 24 of the 26 patients. The mean serum zinc concentration was 43.2/micrograms 100 ml +/- 3.6 S.E.M. (normal = 80-100 micrograms/100 ml). A significant (P = 0.007) survival advantage was demonstrated for those patients with pretreatment zinc concentrations greater than 45 micrograms%, but serum zinc levels did not correlate with response to chemotherapy (also significantly affecting survival). Decreased serum zinc concentrations were significantly associated with decreased neutrophil migration measured by the skin window technique and with decreased triceps skin fold thickness but not with any of the other host defense and nutritional induces measured. These data suggest that further studies are indicated to examine the role of serum zinc concentration as a possible sensitive prognostic characteristic and to determine if zinc administration may be of therapeutic benefit in cancer patients.
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Jordan WM, Valdivieso M, Frankmann C, Gillespie M, Issell BF, Bodey GP, Freireich EJ. Treatment of advanced adenocarcinoma of the lung with ftorafur, doxorubicin, cyclophosphamide, and cisplatin (FACP) and intensive iv hyperalimentation. Cancer Treat Rep 1981; 65:197-205. [PMID: 6786737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
Mezlocillin, at a dose of 3 g intravenously over a 2-h period every 4 h, was used for the treatment of 92 episodes of documented infections in 75 myelosuppressed cancer patients. The response rate in 59 evaluable bacterial infections was 46%. Eight of 23 patients with septicemia (35%) responded. The response rates for Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli, the three most common gram-negative infections, were 42, 64, and 70%, respectively. Mezlocillin was well tolerated; the only toxicity attributable to this antibiotic was a skin rash in one patient. The formation of a false-positive urine protein reaction by mezlocillin was noted. This study demonstrated that mezlocillin administered as a single agent was effective against some infections in myelosuppressed cancer patients. The response rate for Klebsiella sp. infections was especially encouraging. However, because it had limited or little activity against many infections, especially those caused by P. aeruginosa and Staphylococcus aureus, the general use of mezlocillin as a single agent for treatment of infections in immunocompromised cancer patients cannot be recommended.
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Strong JE, Schurig JE, Issell BF, Kramer WG, Tavel AF, Florczyk AP, Crooke ST. Pharmacokinetics of tallysomycin and bleomycin in the beagle dog. Cancer Treat Rep 1979; 63:1821-7. [PMID: 93509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The pharmacokinetics of tallysomycin, a third-generation bleomycin analog, and bleomycin have been determined and compared in the beagle dog. Both compounds exhibited biphasic plasma elimination characteristics and were extensively absorbed after in injection. The elimination half-lives of tallysomycin after iv and im administration were 1.51 +/- 0.41 hours and 2.40 +/- 0.667 hours respectively. These values were longer than the comparable iv (1.01 +/- 0.19 hours) and im (1.12 +/- 0.39 hours) elimination half-lives for bleomycin. The volume of distribution in the central compartment after iv administration was 0.111 +/- 0.039 liter/kg for tallysomycin and 0.125 +/- 0.0723 liter/kg for bleomycin. The total apparent volumes of distribution were 0.706 +/- 0.255 liter/kg and 0.388 +/- 0.245 liter/kg for tallysomycin and bleomycin respectively after iv injection. These values were significantly different (P less than 0.05). Total urinary recovery in 24 hours for tallysomycin was significantly (P less than 0.05) less than that for bleomycin after both iv and im injections. These observed differences in pharmacokinetic behavior may, in part, account for differences in in vivo antitumor activities and toxic effects which have been reported for these drugs.
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Abstract
The cure rate of infections in cancer patients is adversely affected by neutropenia (less than 1,000/mm3). In particular, patients with severe neutropenia (less than 100/mm3) have shown a poor response to antibiotics. To overcome the adverse effects of neutropenia, tobramycin was given by continuous infusion and combined with intermittent carbenicillin. Tobramycin was given to a total daily dose of 300 mg/m2 and carbenicillin was given at a dose of 5 gm every four hours. There were 125 infectious episodes in 116 cancer patients receiving myelosuppressive chemotherapy. The overall cure rate was 70%. Pneumonia was the most common infection and 61% of 59 episodes were cured. Gram-negative bacilli were the most common causative organisms and 69% of these infections were cured. The most common pathogen was Klebsiella pneumoniae and this, together with Escherichia coli and Pseudomonas aeruginosa, accounted for 74% of all gram-negative bacillary infections. Response was not influenced by the initial neutrophil count, with a 62% cure rate for 39 episodes associated with severe neutropenia. However, failure of the neutrophil count to increase during therapy adversely affected response. Azotemia was the major side effect recognized, and it occurred in 11% of episodes. Major azotemia (serum creatinine greater than 2.5 mg/dl or BUN greater than 50 mg/dl) occurred in only 2%. Azotemia was not related to duration of therapy or serum tobramycin concentration. This antibiotic regimen showed both therapeutic efficacy and acceptable renal toxicity for these patients.
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Issell BF, Valdivieso M, Hersh EM, Richman S, Gutterman JU, Bodey GP. Combination chemoimmunotherapy for extensive non-oat cell lung cancer. Cancer Treat Rep 1978; 62:1059-63. [PMID: 356968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In a prospective randomized trial, sc Corynebacterium parvum (C. parvum) immunotherapy did not significantly affect the responses and survival of 49 non-oat cell lung cancer patients receiving isophosphamide and adriamycin chemotherapy. Remissions (tumor regression greater than 50%) were seen in five of 23 patients receiving an intensive C. parvum schedule and in three of 26 patients receiving a nonintensive C. parvum schedule (22% versus 12%). Median survival was 20 weeks for patients given intensive C. parvum and 23 weeks for patients given nonintensive C. parvum. This study did demonstrate the importance of pretherapy immunocompetence, performance status, and weight loss as predictors for survival. Weight loss was the most significant prognostic factor. Performance status was closely associated with weight loss but skin reactivity to dermatophytin predicted independently and was the second most important prognostic characteristic.
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Issell BF, Valdivieso M, Bodey GP. Chemotherapy for adenocarcinoma and large cell anaplastic carcinoma of the lung with ftorafur, adriamycin, and cis-dichlorodiammineplatinum(II). Cancer Treat Rep 1978; 62:1089-91. [PMID: 210943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Mezlocillin is a new broad-spectrum semisynthetic penicillin that has shown encouraging in vitro activity against the infecting organisms most likely to cause mortality and morbidity in cancer patients receiving chemotherapy. The serum clearances and urine recoveries of mezlocillin, ampicillin, and carbenicillin were compared after the intravenous administration of single 3-g doses. The peak mean serum concentrations of mezlocillin and carbenicillin were 269 and 278 mug/ml, respectively, whereas the peak ampicillin level was lower at 167 mug/ml. The terminal half-life of mezlocillin, 66 min, was not significantly different from those of ampicillin and carbencillin (63 and 77 min, respectively). Recoveries of mezlocillin, ampicillin, and carbenicillin from urine over 6-h periods after drug dosage were 45, 61, and 80%, respectively. A further study in 11 cancer patients examined serum maintenance levels of mezlocillin when 3-g doses were given intravenously every 4 h for at least 7 consecutive days. After 3 days of therapy, the mean serum concentrations were maintained above 50 mug/ml. Although therapeutic efficacy was not an objective of this study, all of three documented bacterial infections were cured, and no serious toxicity was encountered.
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