PHASE II TRIAL OF TESMILIFENE PLUS MITOXANTRONE AND PREDNISONE FOR HORMONE REFRACTORY PROSTATE CANCER: HIGH SUBJECTIVE AND OBJECTIVE RESPONSE IN PATIENTS WITH SYMPTOMATIC METASTASES

PURPOSE

Symptomatic, hormone refractory prostate cancer (HRCAP) is a major cause of morbidity with a median survival of less than 12 months and a 2-year survival of only up to 10% in most series. Mitoxantrone has been approved by the Food and Drug Administration for HRCAP. Preliminary data suggest that DPPE (N,N-diethyl-2-[4-(phenylmethyl) phenoxy]-ethanamine) or tesmilifene modulates cytotoxics to enhance the anticancer effect. In this phase II trial we assessed whether there is sufficient evidence of enhanced efficacy of DPPE and mitoxantrone to lead to a phase III clinical trial.

MATERIALS AND METHODS

A total of 29 patients with a median age of 73 years, of whom 10% were older than 80 years, with progressive HRCAP received 5.3 mg/kg DPPE intravenously every 3 weeks, 12 mg/m mitoxantrone intravenously every weeks and 5 mg prednisone orally twice daily. All patients had pain at presentation, while 97% had bone metastases, 10% had liver metastases and 17% had lung metastases. Median prostate specific antigen (PSA) was 210 ng/ml (IQR 77 to 430).

RESULTS

Of the patients 75% had some pain improvement, 66% had decreased analgesia, 59% had a PSA decrease of 50% or greater and 45% had a PSA decrease of 75% or greater. Actual (not actuarial) 2-year survival was 21%.

CONCLUSIONS

Despite major limitations of historical comparison the PSA decrease and decreased symptoms with DPPE-mitoxantrone-prednisone compare favorably to those of mitoxantrone-prednisone and docetaxel-estramustine in the literature. The 2-year survival rate of 21% mandates further assessment. This will be tested in a phase III Southwest Oncology Group trial.

Preocular tear film characteristics of nonwearers and soft contact lens wearers

The aims of the current investigation were to: (1) characterize (structure, volume, and stability) the preocular tear film of contact lens wearers and nonwearers and (2) test for any difference between contact lens wearers and nonwearers and between symptomatic and asymptomatic subjects. The tear film structure and stability were tested using the Tearscope in conjunction with the biomicroscope observation system. The tear prism height, which is indicative of the tear volume, was measured with the slitlamp. The study was carried out on 239 subjects (478 eyes) who attended our clinic for contact lens fitting. Of these, 184 were habitual daily soft contact lens wearers who had not been wearing contact lenses for at least 24 h; the other 55 were noncontact lens wearers. The results obtained showed that: (1) the stability of the tear film was correlated for two eyes of the same subject; (2) the structure, volume, and stability of the preocular tear film were similar for both groups; (3) no difference in tear film stability was found between asymptomatic and symptomatic contact lens wearers, but a significant difference was found between asymptomatic and symptomatic noncontact tact wearers; and (4) the stability of the tear film was influenced by the nature of the lipid layer present at the surface of the aqueous layer; the greatest stability was achieved when the lipid layer was thick and homogeneous (amorphous pattern).

Effect of material ionicity on the performance of daily disposable contact lenses

The surface of hydrophilic contact lenses is intrinsically hydrophobic. Biocompatibility requires the contact lens surface to be coated with a lipoproteinic biofilm produced by the ocular secretion. For daily disposable modality of wear it is essential that biocompatibility, clinically represented by good in vivo wettability and subjective acceptance, is achieved as quickly as possible following insertion, as the process needs to be repeated daily. It has been hypothesised that non-ionic materials will not achieve biocompatibility as rapidly as ionic materials owing to the latter's ability to attract high levels of adsorbed proteins. The current investigation was a double-masked crossover study that evaluated, over 1 week of wear, a new non-ionic material (Nelfilcon A) and a current ionic material (Etafilcon A) under daily disposable modality. The results obtained showed that overall, both contact lens materials achieved good in vivo tear stability over the first 30 min of wear and good subjective acceptance that remained stable over the period of wear. The results obtained demonstrate that a non-ionic material can achieve rapid biocompatibility and subjective acceptance in a similar manner to an ionic material.

Non-convulsive status epilepticus

The clinical, electrographic and reported neuropsychological features of 50 children with non-convulsive status epilepticus (NCSE) were reviewed and the children's progress followed for one to five years. NCSE occurred in a variety of epilepsies, especially the Lennox-Gastaut syndrome. Clinical manifestations ranged from obvious mental deterioration to subtle changes. The condition had often been overlooked or misinterpreted and many children had experienced repeated episodes over long periods. Following diagnosis, immediate treatment was often not attempted or was not successful. Further episodes of NCSE occurred in the majority of children during the follow up period. Failure to recognise NCSE and to treat episodes promptly, and the high rate of recurrence, is of particular concern in view of fears that repeated exposure to this condition might be brain damaging. At least 28 children in the present series showed evidence of intellectual or educational deterioration over the period during which NCSE had occurred, although the exact cause was difficult to determine.

Psychological effects of sodium valproate and carbamazepine in epilepsy

Information from standardised tests of intelligence, school attainments, attention, memory and visuomotor function, together with parent and teacher questionnaire information about various aspects of behaviour, was obtained for 63 schoolchildren with newly diagnosed epilepsy before treatment with sodium valproate or carbamazepine, and again at intervals for a total period of 12 months. The same information was collected on 47 matched controls. The children with epilepsy represented those under non-specialised paediatric care. The result showed that both drugs were effective in most cases at modest dosage without causing notable psychological effects 12 months into treatment. Modest and temporary adverse cognitive effects seen earlier in treatment could have been the result of uncontrolled seizure discharge. Improved function was the same in children with epilepsy and controls. Some psychological abnormalities in the children with epilepsy were evident before treatment suggesting early unwanted effects of the epileptic process itself.