ABSTRACT
PURPOSE: The prognosis for advanced pancreatic cancer remains poor. Gastrin acts as a growth factor for pancreatic cancer. We describe the first study of the antigastrin immunogen G17DT in pancreatic cancer. Our aims were to determine the antibody response, safety, tolerability, and preliminary evidence of efficacy of G17DT in advanced pancreatic cancer. PATIENTS AND METHODS: Thirty patients with advanced pancreatic cancer were immunized with three doses of either 100 micro g or 250 micro g of G17DT. RESULTS: In the whole group, 20 (67%) of 30 patients produced an antibody response. The 250- micro g dose resulted in a significantly greater response rate of 82% compared with 46% for the 100- micro g group (P =.018). The most significant side effects, seen in three patients, were local abscess and/or fever. The median survival for the whole group from the date of the first immunization was 187 days; median survival was 217 days for the antibody responders and 121 days for the antibody nonresponders. The difference in survival between the antibody responders and nonresponders was significant (P =.0023). CONCLUSION: Patients with advanced pancreatic cancer are able to mount an adequate antibody response to G17DT. The 250- micro g dose is superior to the 100- micro g dose, and it appears to be generally well tolerated. Antibody responders demonstrate significantly greater survival than antibody nonresponders. Phase III studies are currently underway in order to determine efficacy.
Subject(s)
Antineoplastic Agents/therapeutic use , Cancer Vaccines , Diphtheria Toxoid/immunology , Diphtheria Toxoid/therapeutic use , Gastrins/immunology , Gastrins/therapeutic use , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/immunology , Adult , Aged , Antibody Formation , Antineoplastic Agents/immunology , Female , Humans , Immunization , Male , Middle Aged , Pancreatic Neoplasms/metabolism , Quality of Life , Survival AnalysisSubject(s)
Cholestasis, Extrahepatic/diagnosis , Common Bile Duct Diseases/diagnosis , Sphincterotomy, Endoscopic , Thrombosis/diagnosis , Adult , Cholangiopancreatography, Endoscopic Retrograde , Cholelithiasis/diagnosis , Cholelithiasis/therapy , Cholestasis, Extrahepatic/etiology , Gallstones/diagnosis , Gallstones/therapy , Humans , Male , RecurrenceSubject(s)
Cholangiopancreatography, Endoscopic Retrograde/instrumentation , Cholestasis/therapy , Palliative Care/methods , Stents , Cholangiopancreatography, Endoscopic Retrograde/methods , Cholestasis/pathology , Dilatation/instrumentation , Dilatation/methods , Humans , Sensitivity and SpecificityABSTRACT
Ten patients with ampullary carcinoma, not suitable for surgery, were treated with endoscopic photodynamic therapy (PDT) to evaluate the feasibility and safety of treatment. Patients received 4 mg kg-1 of haematoporphyrin derivative intravenously. Two days later, a duodenoscopy was performed and red (630 nm) light delivered to the tumour at fixed energy densities of 50 J or 200 J cm-1 per application, depending on the type of optical fibre used. The tumours were treated by three or four light applications at each session. Treatment was repeated up to five times at intervals of three to six months. The sole complication of PDT was moderate skin photosensitivity, which occurred in three patients. Tumour size was assessed at four to eight weekly intervals. In the absence of macroscopic tumour, biopsy specimens were taken. In three patients with small tumours confined to the ampulla, remission was obtained for periods ranging from eight to 12 months. In a further four patients with small tumours bulk was greatly reduced. There was little response in three patients with extensive duodenal involvement. Therefore PDT for ampullary carcinoma is both feasible and safe, and with refinement may prove curative for small tumours.
Subject(s)
Ampulla of Vater , Common Bile Duct Neoplasms/drug therapy , Photochemotherapy , Aged , Common Bile Duct Neoplasms/pathology , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Photochemotherapy/adverse effects , Photochemotherapy/methods , Photosensitivity Disorders/etiology , Pilot ProjectsABSTRACT
Gilbert's syndrome is a benign, often familial condition characterized by recurrent but asymptomatic jaundice. We report two cases of recurrent jaundice due to unconjugated hyperbilirubinemia in Muslim subjects during the fast of Ramadan. As the diagnosis of Gilbert's syndrome was not suspected, both patients were extensively investigated before the relationship to fasting was recognized and the correct diagnosis made. We conclude that the possible exacerbation of Gilbert's by fasting should be borne in mind in the evaluation of Muslim patients with jaundice.
Subject(s)
Fasting/adverse effects , Gilbert Disease/complications , Holidays , Islam , Adult , Fasting/blood , Female , Gilbert Disease/blood , Humans , MaleABSTRACT
The possibility that peripheral hypothermia may impair muscular performance in various sports led us to assess the usefulness of the Wingate anaerobic power test in subjects with normal and cooled leg muscles. Using this test without modification, peak power, average power output, and cumulated work to the point of fatigue were all decreased by cooling, although the fatigue index (the declining rate of change of power output) was less. It is concluded that this test could usefully be employed in field studies to assess the possibility that muscle chilling may influence a person's potential for producing maximal bursts of muscular work.
