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Objective:To investigate the incidence of interstitial pneumonia (IP) and its risk factors in newly-diagnosed diffuse large B-cell lymphoma (DLBCL) after treatment of R-CHOP regimen (rituximab combined with cyclophosphamide + doxorubicin + vincristine + prednisone) and R-CDOP regimen (rituximab combined with cyclophosphamide + vincristine + liposomal doxorubicin + prednisone).Methods:The clinical data of 54 newly-diagnosed DLBCL patients who were admitted to the Central Hospital Affiliated to Shandong First Medical University from January 2015 to August 2020 were retrospectively analyzed, of which 25 cases were treated with R-CDOP regimen, and 29 cases were treated with R-CHOP regimen. The incidence of IP was compared in patients stratified according to different clinically factors, and the risk factors of IP were analyzed by multivariate logistic regression.Results:The patients with R-CDOP regimen [compared with R-CHOP regimen: 32.0% (8/25) vs. 3.4% (1/29)], normal lactate dehydrogenase level before treatment [compared with high level: 29.0% (9/31) vs. 0 (0/23)], eosinophilic count>0.1×10 9/L [compared with ≤0.1×10 9/L: 28.0% (7/25) vs. 6.9% (2/29)] and Ki-67 positive index<80% [compared with ≥80%: 23.1% (9/39) vs. 0 (0/15)] had a higher incidence of IP (all P<0.05), there were no statistical differences in the incidence of IP among patients stratified with age, gender, smoking history, underlying disease, stage, international prognostic index score, Eastern Cooperative Oncology Group score, type, B symptoms, β 2-microglobulin, and lymphocyte count (all P>0.05). Multivariate logistic regression analysis showed that the application of R-CDOP regimen was the independent risk factor for the incidence of IP (compared with R-CHOP regimen: OR = 2.898, 95% CI 1.358-6.176, P = 0.008). Conclusions:The application of chemotherapy with R-CDOP regimen in DLBCL patients increases the incidence risk of IP, which needs to be closely monitored and prevented during treatment.
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Objective:To compare the efficacy and safety of pegylated liposomal Doxorubicin(PLD)and Epirubicin(EPI)as first-line chemotherapy for diffuse large B-cell lymphoma(DLBCL).Methods:Clinical data of DLBCL patients treated at Zhejiang Cancer Hospital from March 2013 to April 2018 were retrospectively collected.A total of 411 patients who had received first-line chemotherapy were included.Based on age, sex, Ann Arbor staging and other parameters and using the PSM method for 1∶1 matching, 151 patients were assigned into each of the PLD group and the EPI group.Efficacy and adverse events were compared between the PLD group and the EPI group.All patients were followed up for 3 years after treatment to monitor survival.Results:The complete response(CR)rate in the PLD group was 81.5%, and the CR rate in the EPI group was 72.2%.The objective response rate(ORR)of the PLD group was 98%, and the ORR of the EPI group was 96.7%.There was no significant difference in CR rate( χ2=0.478, P=0.489)or ORR between the two groups( χ2=0.007, P=0.934). In the PLD group, myelosuppression occurred in 25 cases(16.6%)and cardiotoxicity-related events in 21 cases(13.9%); in the EPI group, there were 24 cases(15.9%)of myelosuppression and the same number of cases of cardiotoxicity-related events, and there were no significant differences in myelosuppression( χ2=0.018, P=0.895)or cardiotoxicity( χ2=0.174, P=0.677)between the two groups.During the 3-year follow-up, the progression free survival(PFS)rates of the PLD group and the EPI group were 79.1% and 69.6%, respectively, with a statistically significant difference between the two groups( χ2=3.930, P=0.047). Both the PLD group and the EPI group had a 3-year OS rate of 85.2%, with no statistically significant difference between the two groups( χ2=0.402, P=0.538). Conclusions:The 3-year progression-free survival of DLBCL patients with PLD as first-line chemotherapy is significantly better than with EPI, and the 3-year overall survival, short-term efficacy and myelosuppression are comparable to those with EPI.
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Objective: To examine the efficacy and safety of anlotinib as firstline therapy to treat locally advanced or metastatic soft-tissue sarcoma. Methods: This is a single-arm trial. Treatment-naive patients (≥14 years) with locally advanced or metastatic soft tissue sarcoma were eligible. Each treatment cycle lasted for 3 weeks, and included liposomal doxorubicin (40-50 mg/m2) on day 1 and anlotinib (12 mg) on days 8-21. Starting from the 9th cycle, treatment consisted of only anlotinib. Treatment continued until disease progression or intolerable toxicities. The primary efficacy end point was progression-free survival (PFS). Results: Eight patients were enrolled between July 25, 2019 and January 8, 2020. The median number of treatment cycles was 5.5. Within 5.9 months median follow-up, PFS events occurred in 4 (4/8, 50%) patients. The median PFS was 11.3 months and the 6-month PFS rate was 56%. No patients attained complete response and 2 patients (fibrosarcoma, 1 patient and undifferentiated pleomorphic sarcoma, 1 patient) achieved partial response. Three patients (fibrosarcoma, 2 patients and synovial sarcoma, 1 patient) had stable disease. The objective response rate was 25% (2/8) for the study population, and the disease control rate was 75% (6/8). No new safety concerns emerged. Conclusions: Anlotinib plus liposomal doxorubicin demonstrated antitumor activities in previously untreated locally advanced or metastatic soft tissue sarcomas. Due to the small sample size, further investigations with a larger population should be undertaken to confirm the study findings.
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OBJECTIVE: To evaluate the efficacy and safety profile of first-line R-CDOP(rituximab, cyclophosphamide, pegylated liposomal doxorubicin, vincristine, and prednisone) like regimen in diffuse large B-cell lymphoma (DLBCL) with cardiovascular diseases or risk factors. METHODS: DLBCL Patients who were diagnosed with at least one cardiovascular disease/risk factor and received first-line R-CDOPlike chemotherapy in our institute between January 2010 and November 2016 were collected. Cardiovascular diseases/risk factors were referred as:coronary heart disease, hypertension, age ≥60, hyperlipidemia, diabetes mellitus, obesity, history of smoking, and hypothyroidism/hyperthyroidism. Chemotherapy in our institute were retrospectively reviewed. RESULTS: A total of 94 DLBCL patients were recruited. All enrolled patients had history of a cardiovascular disease or presented a high-risk group of developing cardiovascular diseases:coronary heart disease 10 cases, hypertension 33 cases, hyperlipidemia 44 cases, diabetes mellitus 23 cases, obesity 15 cases, history of smoking 25 cases, hypothyroidism/hyperthyroidism 3 cases. A total of 74 patients had more than one cardiovascular disease or risk factors. A total of 34 patients were germinal center B-cell subtype(GCB) and 60 were non-germinal center B-cell subtype(non-GCB). First-line R-CDOP like chemotherapy was given at a median cycle of 4.5 (range, 2-8). Overall response rate(ORR) and complete response rate (CRR) were 92.6%(87/94) and 70.2%(66/94) for the whole group. 5-Year progression-free survival (PFS) and overall survival(OS) rates were 71.3% and 76.9% for overall. For GCB subtype and non-GCB subtype, 5-year PFS rates were 84.6% and 63.9% respectively(P<0.05), and 5-year OS rates were 80.6% and 74.6%, respectively(P=0.407). Grade III/ neutropenia and thrombocytopenia were documented in 53.2%(50/94) and 3.2% (3/94) of patients. 19 (20.2%) patients developed grade /Ⅱ cardiotoxicity. There was no grade III/ cardiac event causing chemotherapy delay or break off. No further cardiotoxicity occurred neither during follow-up. CONCLUSION: PLD-containing first-line R-CDOP like regimen is demonstrated as a highly effective and much tolerable alternative for DLBCL patients with cardiovascular diseases/risk factors.
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As a new type of anthracyclines, pegylated liposomal doxorubicin (PLD) is widely used in the treatment of a variety of malignant tumors, including soft tissue sarcoma, ovarian cancer, breast cancer, multiple myeloma, and so on. Compared with traditional anthracyclines, PLD can significantly decrease the incidences of adverse events such as cardiac toxicity and alopecia. However, the use of PLD will be accompanied with toxic side effects such as hand-foot syndrome, oral mucositis, and infusion reaction. This consensus will mainly focus on the mechanism, prevention and treatment of adverse events of PLD, in order to improve the therapeutic efficacy of PLD and life quality of patients.
Subject(s)
Female , Humans , Antibiotics, Antineoplastic , Therapeutic Uses , Consensus , Doxorubicin , Therapeutic Uses , Drug-Related Side Effects and Adverse Reactions , Hand-Foot Syndrome , Neoplasms , Drug Therapy , Polyethylene Glycols , Therapeutic Uses , Practice Guidelines as Topic , StomatitisABSTRACT
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Humans , Arm , Asian People , Bias , Carboplatin , Disease-Free Survival , Doxorubicin , Drug Therapy , Follow-Up Studies , Maintenance Chemotherapy , Ovarian Neoplasms , Prognosis , Quality of Life , Recombination, Genetic , Sample SizeABSTRACT
Context: In platinum-resistant ovarian cancer, single-agent chemotherapy is recommended for the reduction of adverse events. However, in clinical practice, some patients can tolerate drug-specific adverse events. Aims: We assessed the safety of pegylated liposomal doxorubicin (PEG-LD) and docetaxel regimen in the first cycle of ovarian cancer. Settings and Design: We performed a phase I study to evaluate the combination therapy of PEG-LD and docetaxel. Materials and Methods: We recruited five patients with recurrent ovarian cancer within 12 months of first-line platinum-based chemotherapy. All patients had measurable disease severity. PEG-LD and docetaxel were intravenously administered on day 1 and every 21 days using three dose levels: 25 mg/m2 PEG-LD and 50 mg/m2 docetaxel; 30 mg/m2 PEG-LD and 50 mg/m2 docetaxel; and 30 mg/m2 PEG-LD and 60 mg/m2 docetaxel. Statistical Analysis Used: We defined the maximum tolerated dose of the combination therapy based on the modified Fibonacci method. Results: Five patients were enrolled in this study. The median treatment-free interval was 5.5 months. Two dose-limiting toxicities (Grade 4 neutropenia) were observed in two patients. One complete response, one partial response, one stable disease, and two progressive disease cases were observed. The overall response rate was 2/5, and the disease control rate was 3/5. The median overall survival was 7.4 months. Conclusions: We determined that 25 mg/m2 of PEG-LD and 50 mg/m2 of docetaxel were safe and effective doses. This preliminary efficacy and safety data should be further investigated in a Phase II trial.
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Objective To explore the efficacy and feasibility of additional liposome doxorubicin with DVD regimen in the treatment of multiple myeloma (MM). Methods Thirty patients with MM in Chinese PLA General Hospital from January 2012 to January 2015 were selected and divided into treatment group (DVD group,liposomal doxorubicin+vincristine+dexamethasone),control group A(VTD group,bortezomib+thalidomide+dexamethasone) and control group B (VAD group, pirarubicin+vindesine+dexamethasone) with 10 cases in each,including 18 males and 12 females,aged from 36 to 72 years old,and the mean age was 55.8 years. The treatment effect and adverse reactions among the three groups were compared. Survival analysis was evaluated through Kaplan-Meier and Log-rank tests. Results Followed up to January 31st 2016, the therapy related mortality rates in three groups were 10%(1/10), 20%(2/10) and 10%(1/10), the total efficiency rates were 80%(8/10), 100%(10/10) and 60%(6/10), the median survival time was 25.5, 25.2 and 21.6 months, the disease free survival rates were 70%(7/10), 80%(8/10) and 50%(5/10). Survival analysis showed that the difference between DVD and VTD group was not significant (P=0.098) and there were significant differences between DVD and VAD group(P=0.027),VTD and VAD group(P=0.012). The incidence of peripheral neurotoxicity in VTD group(70%,7/10)was higher than that in other two group(χ2=14.7,P=0.007), and there was no significant difference in the other adverse reactions among the three group (all P>0.05). Conclusions In the treatment of MM, the efficacy of liposomal doxorubicin enhanced DVD regimen is similar to the VTD regimen and more effective than the traditional VAD regimen. It is a safe and effective method for MM.
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Objective To explore the efficacy and feasibility of additional liposome doxorubicin with DVD regimen in the treatment of multiple myeloma (MM). Methods Thirty patients with MM in Chinese PLA General Hospital from January 2012 to January 2015 were selected and divided into treatment group (DVD group,liposomal doxorubicin+vincristine+dexamethasone),control group A(VTD group,bortezomib+thalidomide+dexamethasone) and control group B (VAD group, pirarubicin+vindesine+dexamethasone) with 10 cases in each,including 18 males and 12 females,aged from 36 to 72 years old,and the mean age was 55.8 years. The treatment effect and adverse reactions among the three groups were compared. Survival analysis was evaluated through Kaplan-Meier and Log-rank tests. Results Followed up to January 31st 2016, the therapy related mortality rates in three groups were 10%(1/10), 20%(2/10) and 10%(1/10), the total efficiency rates were 80%(8/10), 100%(10/10) and 60%(6/10), the median survival time was 25.5, 25.2 and 21.6 months, the disease free survival rates were 70%(7/10), 80%(8/10) and 50%(5/10). Survival analysis showed that the difference between DVD and VTD group was not significant (P=0.098) and there were significant differences between DVD and VAD group(P=0.027),VTD and VAD group(P=0.012). The incidence of peripheral neurotoxicity in VTD group(70%,7/10)was higher than that in other two group(χ2=14.7,P=0.007), and there was no significant difference in the other adverse reactions among the three group (all P>0.05). Conclusions In the treatment of MM, the efficacy of liposomal doxorubicin enhanced DVD regimen is similar to the VTD regimen and more effective than the traditional VAD regimen. It is a safe and effective method for MM.
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Objective To evaluate the clinical efficacy and safety of liposomal doxorubicin in the treatment of cancer.Methods The randomized controlled trials of liposomal doxorubicin in treatment of cancer were searched from Chinese academic literature database (CNKI),Wanfang digital joumals,Chinese biomedical literature database (CBM),Chinese scientific journal database (VIP),PubMed database,Embase database and The Cochrane Library database.Data were collected from establishment of the database to January 2017 and the each index was analyzed by Meta-analysis with RevMan 5.3 software.Results A total of 5546 patients with malignant tumors were included in the RCT literature of the 23 articles.The Meta analysis results showed that the analysis on clinical curative effect before and after treatment:I2 =63％,OR =1.14[1.02,1.27],P =0.002;the analysis on safety evaluation of Meta of two groups of cardiac toxicity adverse events:I2=0％,OR =0.18[0.10,0.33],P ＜ 0.00001;I2=77％,OR =0.24[0.17,0.35];the analysis on alopecia adverse events:P ＜ 0.000 01;I2=46％ OR=0.65[0.42,0.99],the ananlysis on neurotoxic adverse events:P =0.05.Conclusion The clinical efficacy of liposomal doxorubicin in the treatment of malignant tumors is better than other chemotherapy regimens,with low side effects,and is especially significantly better than other chemotherapy regimens in the improvement of cardiac toxicity,neurotoxicity,alopecia and other adverse events.
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OBJECTIVE: This study aimed to evaluate the efficacy and safety of pegylated liposomal doxorubicin (PLD) with or without carboplatin in Korean patients with recurrent ovarian cancer (ROC), fallopian tube, or primary peritoneal cancer. METHODS: This retrospective study included 52 patients with ROC, fallopian tube, or primary peritoneal cancer who received PLD (50 mg/m²) between 1(st) December 2014 and 31(th) July 2016. RESULTS: The mean number of chemotherapy cycles was 3.8 (range, 2 to 9) in the PLD monotherapy group and 7 (range, 2 to 13) in the PLD combined with carboplatin (PLD-C) group. In overall response rates and clinical beneficial rates, PLD monotherapy group shows 5.0% and 17.5%, and PLD-C group shows 33.3% and 75.0%. The mean progression-free survival (PFS) was 5 and 13 months in the PLD monotherapy and PLD-C groups, respectively. At 6 months after treatment initiation, absence of disease progression was confirmed in 6 (15%) and 10 (83.3%) patients in the PLD monotherapy and PLD-C groups. Hematological adverse events (e.g., neutropenia and thrombocytopenia) were more common in the PLD-C group (P<0.001, P=0.004). The incidence of anemia and non-hematological adverse events, including mucositis, hand-foot syndrome, and allergic reactions, was similar in both groups. CONCLUSION: This study demonstrated the efficacy and safety of PLD monotherapy and PLD-C combination in Korean patients with ROC. This study would be helpful to consider the degree of worry about side effects and treatment expectations after treatment. Further retrospective studies with larger samples are required to confirm the efficacy of PLD monotherapy in Asian patients with platinum-resistant ROC.
Subject(s)
Female , Humans , Anemia , Asian People , Carboplatin , Disease Progression , Disease-Free Survival , Doxorubicin , Drug Therapy , Fallopian Tubes , Hand-Foot Syndrome , Hypersensitivity , Incidence , Mucositis , Neutropenia , Ovarian Neoplasms , Retrospective StudiesABSTRACT
Objective:To evaluate the efficacy and safety of pegylated liposomal doxorubicin (PLD) in CHOP regimen for un-treated elderly patients with advanced diffuse large B-cell lymphoma (DLBCL). Methods:In a prospective phase II study, we analyzed the feasibility of PLD-modified CHOP regimen in elderly patients with advanced stages of DLBCL. PLD was administered at 30 mg/m2 in combination with cyclophosphamide, vincristine, and prednisone at standard doses every 21 d for six cycles. CD20 positive patients were given option for rituximab treatment. Results:From November 2011 to March 2014, 30 patients with a median age of 70 years (range:63 to 80) were enrolled in this study. Up to 24 cases (80.0%) obtained an International Prognostic Index of≥3. The overall re-sponse rate was 86.7%, and the complete remission rate was 66.7%. With a median follow-up of 20.1 months, the 18-month overall and progression-free survival rates were 82.4%and 70.1%, respectively. The main toxicity was neutropenia, reaching grades 3 to 4 in the 24 cases (80.0%). No significant changes existed in patients' left ventricular ejection fraction and serum troponin-T during the study. Four patients (13.3%) showed asymptomatic abnormal changes in electrocardiogram after PLD infusion. Conclusion:CHOP regimen with PLD is an effective alternative for the treatment of DLBCL in elderly patients, exhibiting an acceptable toxicity.
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Aim: The aim of this Phase II study was to evaluate the activity and safety of biweekly pegylated liposomal doxorubicin (PLD) and oxaliplatin (L-OHP) in patients with platinum-taxane resistant ovarian cancer. Materials and Methods : Treatment consisted of PLD (20 mg/m 2 ) on Day 1; and L-OHP (50 mg/m 2 ) administered on Days 1 and 2, every two weeks. Response to therapy was assessed using the Response Evaluation Criteria in Solid Tumors RECIST ; toxicity was evaluated by the National Cancer Institute Common Toxicity Criteria. Results: Forty patients pretreated with platinum/taxane chemotherapy, with a median age of 61 years, were recruited for the study. Thirty-eight patients were available for response evaluation: three complete responses and nine partial responses were registered; resulting in an overall response rate of 31.5%. Twenty-eight patients gained clinical benefit (73.7%) from this chemotherapy regimen. Median time to progression (TTP) and overall survival (OS) were 5.5 and 10 months respectively. The hematological and non-hematological toxicity profile was favorable. No Grade 4 toxicity was observed. Major toxicities included Grade 3 neutropenia (13.2%), Grade 2 palmar-plantar erythrodysesthesia (7.9%), and Grade 1-2 neuropathy in 15.8% of patients. Conclusion: Biweekly PLD and L-OHP combination has high activity, with less than anticipated adverse toxicity, for treatment of platinum-resistant ovarian cancer. A comparison of the doublet PLD/L-OHP with single-agent treatment is warranted.
Subject(s)
Adult , Aged , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/adverse effects , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Bridged-Ring Compounds/administration & dosage , Doxorubicin/administration & dosage , Doxorubicin/adverse effects , Drug Resistance, Neoplasm/genetics , Female , Humans , Middle Aged , Organoplatinum Compounds/administration & dosage , Organoplatinum Compounds/adverse effects , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/pathology , Survival Analysis , Taxoids/administration & dosageABSTRACT
OBJECTIVE: To investigate the pharmacokinetics of pegylated liposomal doxorubicin (PLD) in Chinese tumor patients. METHODS: Ten patients with malignant tumors were given PLD (20-35 mg · m-2) combined chemotherapy. Serial plasma samples were obtained after completion of the infusion. The doxorubicin concentrations in plasma were measured using high-performance liquid chromatography (HPLC). The pharmacokinetic parameters were estimated by DAS software. The correlations between those parameters and gender were analyzed. RESULTS: The doxorubicin plasma concentration in the 10 patients ranged from 1.68 to 10.10 mg · L-1 during 0 - 168 h after administration. The AUC0-∞, CL, t1/2 and Vd were (918.6 ± 447.4) mg · L · h-1, (0.037 ± 0.02) L · h · m-2, (64.9 ± 28.4) h and (2.95 ± 0.88) L · m-2, respectively. The differences of the pharmacokinetic parameters, ie AUC0-∞, CL, t1/2 and Vd, between genders were not statistically significant. CONCLUSION: The pharmacokinetics of PLD fits one-compartment model, with long retention time, low clearance and small volume of distribution. Copyright 2012 by the Chinese Pharmaceutical Association.
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No existen criterios definidos para el tratamiento del sarcoma de Kaposi asociado a infección por VIH en la era de terapia antirretroviral de alta eficacia. Hay evidencias de regresión de lesiones cutáneas solamente con terapia antirretroviral sin quimioterapia; es muy poco probable que lesiones viscerales y mucosas respondan sin administración simultánea de quimioterapia. Estudio prospectivo en pacientes Kaposi de bajo riesgo y alto riesgo, tratando de definir el momento oportuno de quimioterapia simultáneamente con administración de terapia antirretroviral. 66 pacientes 28 (42 por ciento) T0I0S0, 6 (9 por ciento) T0I0S1, 8 (12 por ciento) T0I1S1, 5 (8 por ciento) T1I1S0 y 19 (29 por ciento) T1I1S1. Todos los pacientes T1, T0I1S1 y un tercio de T0I0S1 fueron tratados con quimioterapia (4 a 8 ciclos con doxorrubicina liposomal) ninguno de los pacientes T0I0S0 recibió quimioterapia. Total de 34 respuestas clínicas, 6 (18 por ciento) completas (3 T1I1S1, 2 T1I1S0, y 1 T0I0S1), 23 (68 por ciento) parciales (16 T1I1S1, 3 T1I1S0, 3 T0I1S1 y 1 T0I0S1) y 5 (14 por ciento) estabilizaron enfermedad (T0I1S1). Pacientes con tumor extenso (T1) requieren quimioterapia desde el diagnóstico, y administración de antirretrovirales. Pacientes con tumores localizados, con nivel células CD4 ≤200/μL (II), síntomas sistémicos requieren quimioterapia aproximadamente 2 a 3 meses después del inicio terapia antirretrovitral, ninguno de los pacientes con tumores localizados, sin síntomas sistémicos, y nivel células CD4 > 200/μL (I0) van a requerir quimioterapia, al menos durante un promedio de 20 meses.
At present there are no defined criteria for treating Kaposi´s sarcoma associated with HIV in the era of highly active antiretroviral therapy. Evidence of regression of cutaneous lesions with only retroviral high efficacy therapy without need of chemotherapy; nevertheless, it is very unlikely that visceral or mucous lesions respond to retroviral without simultaneous initiation chemotherapy. Prospective study in low risk and high risk Kaposi patients, trying to define the adequate moment for initiating the chemotherapy simultaneously with retroviral. 66 male Kaposi patients, 28(42 percent) T0I0S0, 6 (9 percent) T0I0S1, 8 (12 percent) T0I1S1, 5 (8 percent) T1I1S0 y 19 (29 percent) T1I1S1. All T1, T0I1S1 and a third of T0I0S1 patients were treated with chemotherapy (4 to 8 cycles with liposomal doxorubicin) but none of the T0I0S0 patients. 34 clinical responses, 6 (18) complete (3 T1I1S1, 2 T1I1S0, and 1 T0I1S1), 23 (68 percent) partial (16 T1I1S1, 3 T1I1S0, 3 T0I1S1, and 1 T0I0S1) and 5 (14 percent) stable disease (T0I1S1). All patients with extensive tumors require chemotherapy administration since the moment of diagnosis, together with retroviral high efficacy agents. Patients with localized tumors, CD4 cell levels ≤ 200/μL), and systemic symptoms will require chemotherapy in approximately 2 to 3 months period after initiation of retroviral, while none of patients with localized tumors, without systemic symptoms, and CD4 cell levels > 200/μL will require chemotherapy, at least in a mean 20 months follow-up period.
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Humans , Male , Adult , HIV , Doxorubicin/administration & dosage , AIDS-Related Opportunistic Infections/physiopathology , Sarcoma, Kaposi/pathology , Sarcoma, Kaposi/therapy , Antiretroviral Therapy, Highly Active/methods , Doxorubicin , Neoplasm Staging/methodsABSTRACT
Objective To observe the efficacy of liposomal doxorubicin combined with cyclophosphamide, vincristine and prednisone in the treatment of refractory Non-Hodgkin’s lymphoma.Methods Liposomal doxorubicin (40mg/m2) was given by intravenous drip in the 1st day. Cyclophosphamide (750mg/m2) was given by intravenous injection in the 1st day. Vincristine (2mg) was given by intravenous injection in the 1st day. Prednisone (100mg/m2) was given orally from the 1st to the 5th day. A cycle was repeated every 3 to 4 weeks. Every patient took at least 2 cycles of the regimen.Results A total of 13 patients were assessed in the group. Among them, 7 were completely release (53.8), 4 were partially release (30.67) and 2 remained the same (15.35). The B symptom of 7 patients in the 9 with that disappeared, and that of the other 2 patients was improved obviously. The most common adverse effects were slight gastrointestinal reactions and the grade Ⅲ bone marrow suppression in a few patients. Conclusion The regimen of liposomal doxorubicin combined with cyclophosphamide, vincristine and prednisone is effective in the treatment of refractory Non-Hodgkin’s lymphoma with tolerable toxicity. It may be a salvage chemotherapeutic regimen deserving further study.
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PURPOSE: Doxorubicin has an effect of permanently removing muscle after direct injection into the eyelid for treatment of blepharospasm. However, the major dilemma of this attractive treatment is the necrosis of skin overlying the orbicularis oculi muscle. This study was to evaluate whether liposome-encapsulated doxorubicin (Doxil R ) and dimethyl sulfoxide (DMSO) could decrease the incidence and severity of the skin necrosis. METHODS: 0.5, 1, 2 mg of doxorubicin, Doxil and a combination of doxorubicin with DMSO were injected into eyelids of rabbits, respectively. Animals were examined daily on onset, duration, and the size of skin necrosis after each injection. For the evaluation of functional change of muscle after doxorubicin injection, EMG study was conducted and the eyelids were examined histologically and the amount of muscle loss were measured by means of a NIH image analysis program. Electronmicroscopic morphology was also assessed. RESULTS: Doxil decreased the duration and size of skin necrosis, incidence of ectropion, and delayed the onset of skin necrosis markedly. Doxil was more effective in the protection of skin from necrosis than a combination of doxorubicin and DMSO. Compared with free doxorubicin, doxil had 79.2% of myectomy effect. Although doxil was less effective in myectomy than free doxorubicin, excellent myectomy effect was functionally proved on EMG study. A combination of DMSO and doxorubicin had 84.1% of myectomy effect compared with doxorubicin alone but the difference was not significant. In electronmicroscopic study, loss of Z-disc and I-band and segmental disorganization of myofibrills were observed in all three groups. CONCLUSIONS: Both Doxil and a combination of doxorubicin and DMSO improved safety of doxorubicin chemomyectomy by prevention of skin necrosis. Doxil 1.0 mg was most effective in protection of skin from necrosis.