Association between human immunodeficiency virus type 1 infection and cancer in the black population of Johannesburg and Soweto, South Africa.

A case-control study of 913 black cancer patients (aged 15-50 years) was undertaken to measure the association between human immunodeficiency (HIV) infection and cancers believed to have an infective aetiology. Controls were patients with cancers believed not to be infective in origin. The prevalence of HIV in the controls of 7.3% (24 of 325) was similar to the background HIV seropositivity in this population. Odds ratios (ORs) and 95% confidence intervals (CI) adjusted for age, year of diagnosis, marital status and sex were calculated. There was a strong association between HIV infection and Kaposi's sarcoma (KS), with 27 of 33 cases being HIV seropositive, OR = 61.8 (95% CI 19.7-194.2) and an elevated association with non-Hodgkin's lymphoma (NHL), with 27 of 40 cases being HIV seropositive [OR = 4.8 (95% CI 1.5-14.8)]. The elevated odds ratio for KS associated with HIV infection accords with the observed increases in the incidence of KS in several sub-Saharan African countries where the prevalence of HIV is high. The odds ratio for NHL associated with HIV infection was lower than that reported in developed countries, and the reason for this is not clear. No other cancers, including cervical and liver cancers, showed significantly elevated odds ratios associated with HIV infection.

A phase II study of cisplatin/ifosfamide in recurrent/metastatic undifferentiated nasopharyngeal carcinoma among young blacks in southern Africa.

Recurrent/metastatic, undifferentiated nasopharyngeal carcinoma (UDNPC) is known to be chemosensitive but has rarely been studied in Phase II methodology. No studies concerning its chemoresponsiveness among southern Africans have been demonstrated to date. From 1990 through 1994, 18 African patients from the Johannesburg metropolitan area with recurrent (following radiotherapy failure) or primarily metastatic (bone) UDNPC were treated with ifosfamide (3 g/m), mesna, and cisplatin (50 mg/m) for 2 days. Three patients (15%) attained complete remission and eight (44%) partial remission, yielding an overall response rate of 59%. Median response duration was 28 weeks. Two patients (11%) had stable disease with symptomatic improvement and five (30%) progressed on therapy. Treatment was generally well tolerated but there was one treatment-related death (neutropenic sepsis). The combination of ifosfamide/cisplatin appears to be promising in UDNPC commonly seen in young patients in southern Africa. However, the duration of response still tends to be brief.

Patterns of clonal evolution in transformed chronic myelogenous leukemia.

Chronic myelogenous leukemia (CML) is an initially indolent disease which transforms into an acute leukemia about 2-5 years after diagnosis. We report a series of 75 patients, from a total of 125 patients with CML, who underwent acute blastic transformation. These included four unclassified, 10 lymphoid, and 61 non-lymphoid acute leukemias, including 54 myeloblastic, three promyelocytic, one myelomonocytic, one erythroblastic, and two megakaryoblastic leukemias. Fifty-two patients developed new cytogenetic abnormalities in addition to being Ph positive. These included trisomies of chromosomes 8, 19, and 21, isochromosome of the long arm of chromosome 17 (i(17q)), double and triple Ph, as well as other translocations, deletions, and additions. The overall median survival once the diagnosis of acute blast crisis was made was 61 days.

Vincristine, Adriamycin and Dexamethasone (VAD) as Primary Therapy in Advanced Multiple Myeloma: A Single Centre Experience.

Vincristine, adriamycin and dexamethasone (VAD) combination chemotherapy was used as first line therapy in eleven patients with severe myeloma. Eight patients (73%) responded to VAD, six of them achieved complete remission (55%) with paraprotein concentrations falling to zero after a median of three treatment cycles. Median duration of response was 18.5 months with three patients remaining in CR for > 40 months. Median survival for all patients is greater than 62 months. Both infection (two deaths, both non-responders) and a significant decline in cardiac ejection fraction were encountered although only two patients required treatment for cardiac failure. The VAD regimen appears to be an effective first line treatment for severe myeloma producing prolonged survival and rapid response. Further trials with VAD induction followed by maintenance therapy appear to be justified.

Sequential hormonal therapy and sequential hormonal and chemotherapy for advanced prostatic cancer.

Ninety-two patients with D2 prostatic cancer were studied. Initial treatment was with either diethylstilboestrol (DES) or orchidectomy. Response to DES (5/63, 81%) was significantly higher than for orchidectomy (18/29, 62%; p less than 0.01). However, duration of response and duration of survival were not significantly different for the 2 forms of hormonal therapy. Fifty-seven patients were randomised to receive second-line treatment with either medroxyprogesterone acetate (MPA), oral chlorambucil or combination chemotherapy (adriamycin + cyclophosphamide + 5-fluoro-uracil). Response to second-line treatment was similar for all 3 regimens (46% overall response). Most of the responses were disease stabilisation and, although there was symptomatic benefit, response to second-line therapy did not significantly improve survival compared to the survival experience of the group as a whole. It is concluded that palliative second-line treatment for advanced prostatic cancer should consist of the least toxic form of treatment which in this study was second-line hormone administration (MPA).

Combination chemotherapy of hepatocellular cancer. Comparison of adriamycin + VM 26 + 5-fluorouracil with mAMSA + VM 26 + 5-fluorouracil.

Forty-seven patients with hepatocellular cancer were treated in a randomised trial comparing adriamycin + VM 26 + 5-Fluorouracil (5-FU) to mAMSA + VM 26 + 5-FU. Thirteen patients had a partial response to treatment (28%) and another 6 (13%) showed disease stabilisation. There were no significant differences in the response rates between the two treatment regimens. Patients who responded to treatment showed significant prolongation of survival (48 weeks) when compared to non-responders (5 weeks).

Acute promyelocytic transformation of chronic myeloid leukaemia with an isochromosome 17q.

Transformation to an acute promyelocytic leukaemia occurred in a patient approximately 2 years after having been diagnosed as suffering from chronic myeloid leukaemia (CML). At this time, in addition to the Ph1 chromosomal aberration, an isochromosome 17q [i(17q)] was noted. The t(15:17) was absent. The implications of this are discussed.

Treatment of esophageal cancer with vindesine: an open trial.

Fifty-two patients with advanced esophageal cancer have been entered in an open study with vindesine. The regimen consisted of vindesine at a dose of 3 mg/m2 as a continuous infusion over 48 hours followed by 3 mg/m2 iv weekly for 4 weeks and then by monthly maintenance therapy using the same dose. Objective response was seen in 14 (27%) patients. Patients who responded to treatment had significant prolongation of survival. Major pretreatment prognostic factors included performance status and serum albumin concentration. It is concluded that vindesine has definite, although limited, activity against esophageal cancer.