A phase I trial of alpha-interferon in combination with pentostatin in hematologic malignancies

Pentostatin, a novel inhibitor of adenosine deaminase, has shown activity in various lymphoid malignancies of both the T and B cell lineage. This agent has unique side effects and in general myelosuppression has been mild. Interferon has both antiviral and antineoplastic properties. This agent has shown activity in hairy cell leukemia, chronic granulocytic leukemia, low grade lymphoma, and myeloma. Side effects from interferon are in general dissimilar to those that have been seen with pentostatin and in particular myelosuppression has not been a major toxicity with low doses of interferon. This current trial explored the combination of pentostatin and interferon in hematologic malignancies. Fifteen patients were enrolled in this phase I trial at a fixed dose of pentostatin of 4 mg/m2 biweekly and interferon at doses of 0.5, 1, 2, or 4 million units/m2 of interferon. At the first three dose levels of interferon nausea and vomiting were the predominant toxicity and appeared to worsen with time on study. Fatigue also was seen at the lowest level of interferon and was severe enough to cause two individuals to discontinue the study medications. At higher dose levels of interferon, myelosuppression, nausea and vomiting, and fatigue were the predominant toxicities. One patient with hairy cell leukemia had a complete response and a second patient with T cell cutaneous lymphoma had a partial response which lasted for 6 to 7 weeks. The maximum tolerated dose of interferon with pentostatin in this patient population was four million units/m2.

[Evaluation of the second line of treatment of patients with small cell carcinoma of the lung]

Efficacy of second line therapy which included vepesid and adriamycin or vepesid, adriamycin and cis-platin, in small cell lung cancer was studied. Objective remission was seen in 35% of the once more treated patients. Analysis of survival time showed significant prolongation of it in cases treated once more in comparison with a group of patients with progression of the neoplastic process during primary therapy or patients not treated due to relapses of the process. The observed difference was bigger in patients that reacted with a remission to the second line therapy.