Contrast-enhanced MRI of the breast: technique and indications.

Magnetic Resonance Imaging of the breast is a recent promising technique. Today this technique is still dedicated to problematic cases or has very specific indications and cannot be regarded as a screening technique. However, MRI of the breast has already proved to be very reliable in the differentiation between tumor recurrence and scar formation, in the preoperative evaluation of tumor extension, the detection of a tumor recurrence adjacent to a breast prosthesis, the response of tumors to radiotherapy and/or chemotherapy, and can also be helpful in the differentiation between benign and malignant breast lesions. For these reasons, MR of the breast has already achieved a place in the diagnosis of breast tumors.

Aminoglutethimide and estrogenic stimulation before chemotherapy for treatment of advanced breast cancer. Preliminary results of a phase II study conducted by the E.O.R.T.C. Breast Cancer Cooperative Group.

While both endocrine therapy and chemotherapy are of proven value in the treatment of advanced breast cancer, the effects of combining these two methods or applying them consecutively have been relatively disappointing. This may be due to endocrine therapy suppressing cell division, in hormone-dependent tumors, whereas chemotherapy acts mainly on active-dividing cells. A trial protocol has therefore been devised which seeks to exploit the properties of both types of therapy. Oestrogen suppression is first obtained by aminoglutethimide (Orimeten) plus hydrocortisone; after 2 weeks, ethinyloestradiol is given to induce cell division and followed 24 h later by a combination of 3 cytotoxic agents given intravenously. This pattern of therapy, repeated at regular intervals, appears to be producing favorable clinical results. A phase-III study is being started among patients with hormone-dependent advanced breast cancer.

Cisplatin plus vindesine in advanced breast cancer: a phase II trial of the EORTC Breast Cancer Cooperative Group.

This phase II clinical trial was conducted in a series of patients with advanced breast cancer, refractory to conventional chemotherapy. The therapeutic regimen consisted of a combination of cisplatin 100 mg/m2, given as a 24-hr infusion on day 1 and vindesine (VDS) 2 mg/m2, i.v. bolus on days 1 and 8. VDS injection was omitted on day 8 in patients with poor bone marrow reserves (prior extensive irradiation). Courses were repeated at 4-week intervals until documented disease progression. Among 46 evaluable patients, there were two complete and seven partial remissions for an overall response rate of 20%. These responses lasted for a median of 21 weeks (range 8-89 weeks). Remission rates according to the predominant metastatic site were as follows: soft tissue, 3/8 (38%); bone, 0/6 (0%); viscera, 6/32 (19%). Transient myelosuppression and gastrointestinal intolerance were almost universal. Renal function impairment and neurologic manifestations were frequently encountered but these adverse reactions were generally mild. Significant antineoplastic activity in far-advanced and heavily pretreated patients warrants further evaluation of this regimen at an earlier stage of the disease.

Phase II study of 9-hydroxy-2N-methylellipticinium acetate.

A broad phase II trial of elliptinium was conducted in 105 evaluable patients with advanced solid tumors. The drug was given as a 60-90-min i.v. infusion at a weekly dose of 100 mg/m2. Of 36 breast cancer patients, one achieved complete and six achieved partial response for an overall response rate of 19%. Responses lasted for 12-56 weeks from initiation of therapy. There was also one partial response among 21 patients with squamous cell carcinoma of the lung. No response could be obtained in 17 patients with colon cancer, 13 patients with head and neck cancer and 18 patients with a wide variety of other malignancies. Myelosuppression was minimal. Nausea and vomiting were the most frequent toxic effects. The drug also produced serious xerostomia and acute intravascular hemolysis. Asthenia was common. Other adverse reactions included fever and chills, transient neurologic and cardiovascular manifestations and renal function impairment. Additional work is needed to define optimal modes of drug administration.

Drug dependent red cell antibodies and intravascular haemolysis occurring in patients treated with 9 hydroxy-methyl-ellipticinium.

Eleven patients were treated weekly with a new cytostatic drug, 9-hydroxy-methyl-ellipticinium (9 HME). Eight were treated for longer than 4 weeks and three of these developed a drug dependent antibody reacting with normal red cells. In two of these patients acute intravascular haemolysis occurred, one with oliguric renal failure; in the third patient the drug was stopped as soon as the antibody was detected. In all three patients the antibody developed after 4 weeks of treatment. It was IgM, agglutinated normal red cells and bound complement only in the presence of the drug. No antibodies could be detected in the patient's serum reacting with normal platelets in the presence of the drug. The incidence of haemolysis with this drug is much higher than seen with other drugs causing immune-complex haemolysis. Studies done with closely related substances suggest that the antigenic site of the drug is related to the group attached to carbon atom 9.

Domperidone (R 33812) in the prophylactic treatment of chemotherapy-induced emesis. A multicentre evaluation.

Domperidone (R 33812) was injected i.v. for the prevention of nausea and vomiting in a total of 395 cytostatic treatment courses in 172 patients. The total dose ranged from 1 to 40 mg and was given in one or several doses. Even after the administration of severely emetic substances, vomiting and nausea were largely prevented in hospitalized patients, but the results were rather poor in ambulatory patients. In all of the cytostatic treatment schedules very favourable results were obtained.

Treatment of acute myeloblastic leukemia in adults: remission induction with a combination of cyclophosphamide, cytarabine and vincristine.

A regimen of intravenous cyclophosphamide, cytarabine and vincristine, given over a four-day period and repeated every two to three weeks, was used to treat 33 patients with acute myeloblastic leukemia. Of the 30 evaluable patients 9/18 previously untreated patients achieved complete remission and two others marked improvement, and 4/12 previously treated patients achieved complete remission. Twelve of 16 patients under the median age of 38 responded while only 3/14 patients over this age responded. There was no difference in response between those with elevated muramidase levels and those with normal levels. Three patients developed a previously unrecognized syndorme of fever, malaise, rash and orbital suffusion. Cytarabine was probably responsible.At least four courses of treatment are required before abandoning this regimen of therapy. Patients who achieve a complete remission and live for more than 150 days spend about 25% of their total survival time from diagnosis in hospital.