ABSTRACT
Thirty-five consecutive patients with small cell bronchogenic carcinoma (SCBC) received chemoimmunotherapy with VP-16-213, Ifosfamide, vincristine, Adriamycin, and Corynebacterium parvum. Of 33 evaluable patients, 26 (79%) responded with complete (55%) or partial (24%) remissions. Complete remissions were more common among patients with limited disease (11/14 patients, 79%) compared with those with extensive disease (7/19 patients, 37%) and among patients (11/14 patients, 79%) compared with those with extensive disease (7/19 patients, 37%) and among patients who were ambulatory prior to therapy (16/25 patients, 64%) compared with those who were nonambulatory (2/8 patients, 25%). Myelosuppression consisted primarily of neutropenia. Eight percent of the treatment courses in 29% of the patients were associated with hematuria and/or documented episodes of infection during neutropenia. There were three deaths possibly related to treatment, in two of which there was no evidence of disease at post-mortem examination. Six patients relapsed in the central nervous system (CNS). In four instances, CNS relapse was the only site of tumor progression. Central nervous system relapse was more common among evaluable patients who did not receive prophylactic brain irradiation (5/17 patients, 29%, vs. 1/15 patients, 7%; P = 0.23). The median survival duration for all patients was 63 weeks, being slightly longer for patients with limited disease than for those with extensive disease (70.9 weeks vs. 56 weeks; P = 0.18). This was also true for patients who achieved complete rather than partial remissions (71 weeks vs. 50 weeks; P = 0.09). Patients receiving prophylactic brain irradiation experienced longer survival (100.8 weeks vs. 48 weeks; P = 0.01).
Subject(s)
Antineoplastic Agents/administration & dosage , Carcinoma, Small Cell/therapy , Lung Neoplasms/therapy , Propionibacterium acnes/immunology , Adult , Aged , Bacterial Vaccines/therapeutic use , Brain/radiation effects , Clinical Trials as Topic , Doxorubicin/administration & dosage , Drug Therapy, Combination , Etoposide/administration & dosage , Female , Humans , Ifosfamide/administration & dosage , Male , Middle Aged , Vincristine/administration & dosageSubject(s)
Antineoplastic Agents/administration & dosage , Hyperthermia, Induced , Neoplasms/therapy , Adult , Antineoplastic Agents/adverse effects , Bone Marrow/drug effects , Burns/etiology , Creatine Kinase/blood , Electroencephalography , Etoposide/administration & dosage , Female , Humans , Hyperthermia, Induced/adverse effects , L-Lactate Dehydrogenase/blood , Male , Melanoma/therapy , Melphalan/administration & dosage , Middle Aged , Neoplasm Metastasis , Peripheral Nervous System Diseases/etiology , Remission, Spontaneous , Tachycardia/etiologySubject(s)
Hodgkin Disease/complications , Lipodystrophy/complications , Scleroderma, Systemic/complications , Adult , Child , Female , Humans , InfantABSTRACT
Ten patients with disseminated adenocarcinoma were treated with combination chemotherapy employing Adriamycin and Baker's Antifolate (BAF). There were seven patients with lung adenocarcinoma, two of whom achieved partial remission while the remaining five had their disease stabilized. Drug toxicity to the bone marrow, gastrointestinal mucosa, and skin was dose-limiting and was greater than the known toxicities of the individual drugs. Pharmacological studies of both drugs were performed on five patients to determine whether abnormal pharmacokinetics could explain this collateral toxicity. Adriamycin plasma concentrations and disappearance seemed to be unaffected by BAF. However, BAF levels were prolonged, apparently due to an Adriamycin effect on the plasma elimination of BAF, resulting in a prolonged exposure of sensitive tissues and organs to BAF. Consequently, when BAF and Adriamycin are used in combination, appropriate dose and schedule changes must be made to avoid any potentially serious side effects.
