Diagnostic value of CYFRA 21-1 tumor marker and CEA in pleural effusion due to mesothelioma.

STUDY OBJECTIVE: The aim of our study was to assess the clinical value of CYFRA 21-1 tumor marker and carcinoembryonic antigen (CEA) as diagnostic tools that are complementary to cytology in the diagnosis of malignant mesotheliomas. PATIENTS: We measured CEA and CYFRA 21-1 in the pleural effusions (PEs) and serum of 106 patients (benign lung disease, 34 patients; bronchogenic and metastatic carcinoma, 40 patients; mesothelioma, 32 patients). METHODS: CEA and CYFRA 21--1 levels were determined by means of two commercial enzyme immunoassays. RESULTS: The cutoff levels of CYFRA 21--1 and CEA in malignant PEs, selected on the basis of the best diagnostic efficacy, were 41.9 ng/mL and 5.0 ng/mL, respectively. In all neoplastic PEs, CYFRA 21--1 and CEA sensitivity was 78% and 30.6%, respectively, with a specificity of 80% and 91%, respectively. The sensitivity of CYFRA 21--1 and CEA in patients with mesothelioma was 87.5% and 3.1%, respectively. The results of the CYFRA 21--1 assay were positive in 17 of 19 cases of mesothelioma (89.5%) with a negative or uncertain cytology. The association of the tumor marker assay and the cytology allowed a correct diagnosis in 30 of 32 cases of mesothelioma (93.7%). CONCLUSION: This study suggests that CYFRA 21--1 would provide a useful parameter for the differential diagnosis between benign and malignant PE from mesothelioma when the result of cytology is negative or uncertain and the clinical context does not allow a more aggressive approach. Moreover, the association of CYFRA 21--1 with CEA could provide details for a differential diagnosis between mesotheliomas and carcinomas. In fact, an elevated CYFRA 21--1 level with a low CEA level is highly suggestive of mesothelioma, whereas high levels of CEA alone or high levels of both the markers suggest a diagnosis of malignant PE, excluding mesothelioma.

Gemcitabine plus vinorelbine in advanced non-small cell lung cancer: a phase II study of three different doses. Gem Vin Investigators.

Our aim was to study the activity and toxicity of the gemcitabine plus vinorelbine (Gem Vin) combination and to identify the optimal dose. Previously untreated patients aged < 70 years, with stage IV or IIIb (not candidates for radiotherapy) non-small cell lung cancer were eligible. Studied dose-levels of Gem Vin, administered on days 1 and 8 every 3 weeks, were (mg m(-2)): level I = 1000/25; level II = 1200/25; level III = 1000/30; level IV = 1200/30. A feasibility study was performed at each dose-level, followed by a single-stage phase II study. Dose-level IV was unfeasible because of grade 4 neutropenia. Overall, out of 126 patients enrolled in phase II studies, there were one complete and 32 partial responses (response rate 26%: 95% CI 18-34%). Response rates were 27.9%, 21.4% and 29.3% at levels I, II and III, respectively. The treatment was well tolerated. Toxicity was less frequent and severe at level I. Overall median survival was 33 weeks (95% CI 28-40). Descriptive quality of life analysis showed that patients with a worse baseline global health status score tended to drop out of the study earlier than those with a better score. Gem Vin is feasible at different doses. It is sufficiently active and well tolerated. A phase III study to compare the effect on quality of life of Gem Vin (level I) vs cisplatin-based chemotherapy is ongoing.

Symptomatic treatment of recurrent malignant pleural effusions with intrapleurally administered Corynebacterium parvum. Clinical response is not associated with evidence of enhancement of local cellular-mediated immunity.

Intrapleural injection of Corynebacterium parvum (CBP) has been recently proposed as a useful symptomatic treatment of recurrent malignant effusions. Although the result is often a fibrotic thickening of the pleura, CBP is thought to stimulate the effector cells present in the effusion and, possibly, to activate the antitumor cytotoxic activity of the pleural fluid mononuclear cells. To test this hypothesis, we studied 7 patients with recurrent malignant pleural effusions caused by lung cancer and evaluated the cellular composition, the proportions of lymphocyte subpopulations, and the cytotoxic activity of mononuclear cells in the pleural fluid before and 7 days after injection of CBP in the pleural space. The CBP treatment induced a marked decrease in the rate of accumulation of pleural fluid (p less than 0.01) and in the concentration of immune effector cells in the pleural exudate (p less than 0.001). These changes were associated with a decrease in the percentages of pleural fluid monocytes and lymphocytes present (p less than 0.01, each comparison) and to a marked increase in the percentages of pleural fluid neutrophils (p less than 0.001). No significant changes in the proportions of T- and B-lymphocytes or in the proportions of helper/inducer and suppressor/cytotoxic T-cells or of natural killer cells were observed in the pleural exudate after CBP treatment (p greater than 0.2, each comparison). In addition, the cytotoxic activity of pleural fluid mononuclear cells was similar before and after CBP treatment (p greater than 0.2), and the levels of interferon, as a marker of immunoactivation of mononuclear cells, were not changed after treatment (p greater than 0.2).(ABSTRACT TRUNCATED AT 250 WORDS)

Social consequences of brain or liver relapse in small cell carcinoma of the bronchus.

The time spent in hospital when cerebral metastases occur as the first site of relapse in patients with small cell carcinoma of the lung (SCCL) has been analysed and compared to the consequences of relapse in the liver. In the course of a clinical trial with 370 patients, 50 patients relapsed initially in the brain and 20 in the liver. The 2 groups were comparable with respect to performance status at diagnosis and the amount of home support available. Patients who relapsed in the brain suffered a greater deterioration in performance status, and spent a greater proportion of their remaining life in hospital than did patients whose initial relapse was in the liver. This difference was most marked in patients who died soon after relapse. Radiotherapy (20 Gy in 5 fractions over one week or 30 Gy in 10 fractions over 2 weeks) and dexamethasone were not very effective treatments for brain relapse though subjective responses were common. The substantial morbidity and lengthy hospitalisation resulting from brain relapse compared with relapse at another site is a important factor to be considered in assessing whether prophylactic cranial irradiation should routinely be offered to patients with SCCL.

Low-dose cisplatin and etoposide in advanced non-small cell lung carcinoma.

Twenty-seven consecutive patients with locally advanced or metastatic non-small cell lung carcinoma were treated with low-dose cisplatin and etoposide. Out of 25 evaluable patients, 8% had a partial response, 56% had stable disease and 36% had disease progression. The overall median survival was 4 months. The survival of the two responding patients was 5 and 6.5 months. The patients showing stable disease or progression had a median survival of 6 and 3 months, respectively. Toxicity including myelosuppression, nephrotoxicity and gastrointestinal side effects was generally mild. In this trial the combination of low-dose cisplatin and etoposide did not yield the same positive results observed by other authors. The different selection of patients and criteria of response evaluation could represent the main reason for this disagreement in results.

Intrapleural Corynebacterium parvum for malignant pleural effusions.

A pilot study of topical (intrapleural) treatment with Corynebacterium parvum was carried out in 10 patients with malignant pleural effusions complicating primary or secondary neoplasms and necessitating frequent thoracocentesis for symptomatic relief. The method was aspiration of all intrapleural fluid except a small portion left for dilution, and then injection of 7 mg of a preparation of Corynebacterium parvum suspended in 20 ml of normal saline solution. The treatment was repeated in each case as clinical conditions called for further thoracocentesis. In eight of these 10 patients the treatment resulted in prompt reduction of the rate of accumulation of pleural fluid and a striking change of cell sediment composition, with appreciable reduction in or complete disappearance of malignant cells and a rise in lymphocyte and neutrophil polymorph counts. The best responders were patients with primary pleural mesothelioma. Clinical improvement was evident in all responders.