Phase II study of vinorelbine and ifosfamide in anthracycline resistant metastatic breast cancer.

The new combination of ifosfamide and vinorelbine was evaluated in a phase II study of patients with metastatic breast cancer. All the patients had evaluable or measurable lesions resistant to the combination of cyclophosphamide, epidoxorubicin and 5-fluorouracil. Out of 25 patients entered the trial, 7 achieved an objective response (28%) (95% C.I. 12-49.3). Ten patients (40%) experienced stable disease and the remaining patients (30%) progressive disease. The median time to progression was 4 months (range 2-12+). The activity of the ifosfamide-vinorelbine combination has been demonstrated and the toxicity was acceptable.

Carboplatin and vinorelbine in advanced non-small-cell lung cancer.

A total of 32 patients with advanced non-small-cell lung cancer were treated with carboplatin (350 mg/m2, day 1) and vinorelbine (days 1 and 8) every 28 days. A response rate of 28% (95% confidence limits 12.5 - 43.7%) was observed. The activity of this combination was demonstrated in an outpatient setting with acceptable toxicity.

Granisetron-dexamethasone combination for multiple day cisplatin.

Thirty-four, patients being given polychemotherapy schedules including cisplatin at the dose of 20 mg/sm for 5 days entered an antiemetic protocol with granisetron and dexamethasone at the doses of 3 mg and 8 mg respectively, both administered i.v. before cisplatin. A complete response (no episodes of vomiting) and a major response (< or = 2 episodes of vomiting) were observed in 14 and 12 patients respectively; the toxicity of the antiemetics was mild. It is concluded that the granisetron dexamethasone combination is able to achieve a high rate of antiemetic control in the special set of multiple day cisplatin treated patients.

Carboplatin, methotrexate, and vinblastine in outpatients with advanced transitional cell carcinoma of the bladder.

Twenty outpatients with locally advanced (inoperable) or metastatic transitional cell carcinomas of the bladder were treated with carboplatin (300 mg/m2 i.v., day 1) + methotrexate (40 mg/m2 days 1 and 8) + vinblastine (6 mg/m2 days 1 and 8) (CaMV), every 4 weeks. One patient died of disease progression before completing at least 2 cycles of chemotherapy. Seven patients (35%) obtained a partial response; 8 had disease stabilization (40%) and 4 progressed (20%). Median duration of response was 3 months (range: 3-9), and median overall survival was 12+ months (range: 1-18+). None of the patients suffered grade IV toxicities, and no nephro-, neuro-, or ototoxicity was observed.

What do advanced cancer patients know of their disease? A report from Italy.

The aim of this work was to investigate the awareness of diagnosis, prognosis and meaning of palliative treatment in Italian patients with advanced, incurable cancers. A group of 100 patients, referred to a Medical Oncology facility, were interviewed. Only 38 patients were aware of the malignant neoplastic nature of their disease. The remaining patients believed they had a benign neoplasia, non-neoplastic disease, or were unable to define their illness. No patient had a correct idea of the poor prognosis of the disease. Only 11.5% of 87 patients receiving chemotherapy had a correct perception of the palliative intent of the treatment, while most believed that the chemotherapy was "preventive". Dissatisfaction with the information received was expressed by a minority of patients. The awareness of diagnosis was better among women and patients with a higher educational background. Withholding the truth from cancer patients still seems very common in Italy.

Failure of vinorelbine to produce responses in pretreated non-small cell lung cancer patients.

Fifteen patients with advanced non-small cell lung cancer, already treated with first-line chemotherapy, entered a protocol of palliative second-line treatment with the hemysynthetic vinca alkaloid vinorelbine (25 mg/sm weekly for two months). No patient obtained an objective response and the trial was stopped. Toxicity was not as mild as expected, with one treatment-related death due to leukopenia. It is concluded that single-agent vinorelbine, although effective as front-line chemotherapy for non-small cell lung cancer patients, is probably not suitable for palliative treatment of pretreated patients.

Carboplatin and etoposide as outpatient treatment of advanced non-small-cell lung cancer.

Twenty-four outpatients with locally advanced (inoperable or unsuitable for radical radiotherapy) or metastatic non-small-cell lung cancer were treated with carboplatin (300 mg/m2 day 1)+etoposide (120 mg/2 day 1-3), every 3 weeks. Two patients died of disease progression before completing at least 2 cycles of chemotherapy. Four patients (16.7%) obtained a partial response, 10 had disease stabilization (41.7%) and 8 progressed (33.3%). Median overall survival was 8 months (range 1-22). Toxicity was moderate, with no nephro-, neuro- or ototoxicity.

Hodgkin's disease in adults: association with social factors and age at tonsillectomy. A case-control study.

The relationship between socio-economic characteristics, previous tonsillectomy, family history of cancer and risk of Hodgkin's disease (HD) was investigated in a case-control study. One hundred and sixty patients, aged 15-78, with histologically confirmed HD, and 185 hospital controls were interviewed. A statistically significant decrease in risk of HD was observed among subjects with large sibship size (RR = 0.63, C.I. 0.46-0.86) and among those who underwent tonsillectomy prior to the age of 10 (RR = 0.46, C.I. 0.22-0.94). High educational level was associated with an increased risk of HD (RR = 6.68, C.I. I.94-23.08). Analysis by age-group (15-39 yrs and 40 yrs or more) confirmed the role of high educational level as a risk factor in both young and old subjects, while the protective effect of tonsillectomy at an early age seems to be confined to young subjects. Analysis by histological subtype showed a statistically significant decrease in risk of HD in large sibship size for both nodular sclerosis (NS) and mixed-cell subtypes; the role of education and tonsillectomy was observed only for NS. These data confirm the role of social factors in HD risk and suggest a protective effect of tonsillectomy performed early in life that needs to be confirmed in larger population-based studies.

Role of blood groups as prognostic factors in primary breast cancer.

The role of blood groups as risk factors for breast cancer and their predictive value after radical surgery have been retrospectively evaluated in 315 breast cancer patients. The AB0 group distribution in these breast cancer patients was not significantly different from that of control women. Patients with blood group 0 showed a significantly lower risk of death than those with groups A, B and AB. Moreover, by using Cox's multivariate analysis, blood groups were shown to possess a predictive value independent of other known prognostic factors. These results suggest that also genetic factors could be involved in the pathophysiology of breast cancer growth and need to be further investigated.

Parental age and the origin of trisomy 21. A study of 302 families.

Several studies have attempted to define the role of parental age in determining the prevalence of 47, +21 according to the origin of nondisjunction. This report analyzes the original data of 197 informative families from Italy and reviews the available literature (96 families from Denmark and 201 from other countries). Mothers whose gametes showed nondisjunction are treated as cases, and those with normal meiosis as controls within each study. To utilize the data fully, maternal age at birth of a 47, +21 individual is treated as a continuous variable in a nonparametric comparison. The combined evidence indicates that nondisjunction in the female is associated with a significant age difference between cases and controls which is mostly due to errors in the second meiotic division. It may be inferred that in the general population, aging enhances nondisjunction at both first and second division in the female, while aging in the male is presumably associated mostly (or only) with first division errors. Implications and alternative models are discussed.