RESUMEN
OBJECTIVE: To determine, in stage IV non-small-cell lung cancer (NSCLC), if the combination of gemcitabine-a new active drug-with ifosfamide (IG) or with the cisplatin-carboplatin association (CCG) will improve survival (primary end point) in comparison with a first-generation regimen, cisplatin-carboplatin-ifosfamide (CCI). PATIENTS AND METHODS: A total of 284 chemotherapy-naïve patients with metastatic NSCLC were randomised. Four were ineligible and 16 were not assessable for responses. Cisplatin was given at 60 mg/m2 on day 1, carboplatin AUC 3 mg.min/ml on day 1, ifosfamide 4.5 g/m2 on day 1 and gemcitabine 1 g/m2 on days 1, 8 and 15. Courses were repeated every 4 weeks. Response was assessed after three courses and chemotherapy was continued in responding patients until best response. There were 94 eligible patients in the CCI arm, 92 in CCG and 94 in the IG arm. RESULTS: The objective response rates for CCI, CCG and IG were 23% [95% confidence interval (CI) 15% to 32%], 29% (95% CI 20% to 39%) and 25% (95% CI 16% to 33%), respectively ( P = 0.61). Median survival time was 24, 34 and 30 weeks, respectively (P = 0.20). One-year survival was 23, 33 and 35%, and 2-year survival was 11, 14 and 17%, respectively. In some subgroups (older patients, women), there was a significant survival advantage for CCG and IG compared with CCI. Toxicity was tolerable: severe alopecia was less frequent in the CCG arm, and IG was associated with significantly more thrombopenia while CCG was associated with more leucopenia. CONCLUSION: In stage IV NSCLC, treatment with regimens including the new drug gemcitabine were associated with a better but not statistically significant observed survival compared with a classical first-generation cisplatin-containing regimen. The non-platinum combination of gemcitabine was as effective as its combination with platinum.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Desoxicitidina/análogos & derivados , Neoplasias Pulmonares/tratamiento farmacológico , Adulto , Anciano , Antineoplásicos Alquilantes/administración & dosificación , Antineoplásicos Alquilantes/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Bélgica , Biopsia con Aguja , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Desoxicitidina/administración & dosificación , Desoxicitidina/efectos adversos , Supervivencia sin Enfermedad , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Ifosfamida/administración & dosificación , Ifosfamida/efectos adversos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Probabilidad , Valores de Referencia , Inducción de Remisión , Análisis de Supervivencia , Resultado del Tratamiento , GemcitabinaRESUMEN
The purpose of this study was to determine the activity of paclitaxel as a second-line chemotherapy for non-small cell lung cancer (NSCLC). This multicentric trial included patients who had failed to a first-line chemotherapy with platinum derivatives and/or ifosfamide. After registration, patients were treated by paclitaxel i.v. at a dose of 225 mg/m(2) given over 3 h administered every 3 weeks. Response was assessed after three courses of therapy. Sixty-seven patients were registered, one was ineligible and 64 were assessable for response. Two partial responses were observed (3% of the eligible patients; 95% confidence interval: 0-7%). No change was documented in 16 cases (24%). Tolerance was acceptable, the main toxicity being cumulative polyneuropathy. Median survival duration was 4.5 months with a 1-year rate at 19%. We concluded that paclitaxel is not active in terms of response as second-line chemotherapy for NSCLC.
Asunto(s)
Antineoplásicos Fitogénicos/farmacología , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Paclitaxel/farmacología , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/patología , Resistencia a Antineoplásicos , Femenino , Humanos , Infusiones Intravenosas , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Polineuropatías/inducido químicamente , Sobrevida , Resultado del TratamientoRESUMEN
PURPOSE: A phase III randomised trial was conducted in patients with non-metastatic unresectable non-small-cell lung cancer in order to compare, in responders to induction chemotherapy, consolidation treatment by further chemotherapy to chest irradiation. PATIENTS AND METHODS: A total of 462 untreated NSCLC patients were eligible for three courses of induction chemotherapy (MIP) consisting of cisplatin (50 mg/m2), ifosfamide (3 g/m2) and mitomycin C (6 mg/m2). It was proposed that objective responders be randomised to either three further courses of MIP or to chest irradiation (60 Gy; 2 Gy per fraction given over six weeks). RESULTS: An objective response rate of 35% was achieved; 115 patients (including 52% with initial stage IIIA and 44% with initial stage IIIB) were randomised to consolidation treatment, 60 of them to further chemotherapy and 55 to chest radiotherapy. There was no significant difference in survival between the two arms, with a respective median and two-year survival of 42 weeks (95% confidence intervals (95% CI: 35-51) and 18% (95% CI: 8-28) for chemotherapy and 54 weeks (95% CI: 43-73) and 22% (95% CI: 11-33) for irradiation. There was also no statistical difference for response duration between the two arms but chest irradiation was associated with a significantly greater duration of local control than chemotherapy (median duration times: 158 vs. 31 weeks, P = 0.0007). CONCLUSIONS: For non-metastatic unresectable NSCLC treated by an induction chemotherapy regimen containing cisplatin and ifosfamide, if an objective response is obtained, consolidation treatments by further chemotherapy or by chest irradiation result in non-statistically different survival distributions, although a better local control duration is observed with radiotherapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Adulto , Anciano , Antibióticos Antineoplásicos/administración & dosificación , Antineoplásicos Alquilantes/administración & dosificación , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Cisplatino/administración & dosificación , Intervalos de Confianza , Supervivencia sin Enfermedad , Femenino , Humanos , Ifosfamida/administración & dosificación , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Mitomicinas/administración & dosificación , Estadificación de Neoplasias , Pronóstico , Radioterapia Adyuvante , Inducción de Remisión , Terapia Recuperativa , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
PURPOSE: This study attempted to investigate, in a cohort of patients with clinical stage III initially unresectable non-small cell lung cancer (NSCLC) treated by the same induction chemotherapy regimen, the prognostic value of clinical T and N sub-groupings in order to validate the current International Staging System (ISS). PATIENTS AND METHODS: All the eligible patients with stage III NSCLC (428 patients) registered in a clinical trial were included in the study investigating, after three courses of induction chemotherapy, the role, in responders, of chest irradiation in comparison to further chemotherapy. The chemotherapy regimen consisted of mitomycin C, ifosfamide and cisplatin. RESULTS: Patients with ISS 1986 stage IIIA had a significantly better survival than those with stage IIIB (median survival 47 vs 36 weeks; P = 0.01). A RECPAM analysis showed that patients with T1-T2 N3 and T4 N0-1-2 stage had a more similar prognosis to those with stage IIIA. That result leads to define two new sub-groups: stage IIIlalpha (T3-T4 N0-N1; any T N2; T1-T2 N3) and IIIbeta (T3-T4 N3), with a highly significant difference in survival between them (median survival: 45 vs 29 weeks; P < 0.0001). The superiority of that new classification on the ISS documented in our series of stage III patients for discriminating survival and tumour response has to be confirmed on another series in a multivariate context. CONCLUSION: For unresectable NSCLC treated by induction chemotherapy, stage III sub-classification by moving T4 N0-1 and T1-2 N3 tumours from stage IIIB to stage IIIA appeared to better correlate with prognosis. The usefulness of this new sub-division has to be tested in validation studies.
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Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/patología , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/clasificación , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Cisplatino/administración & dosificación , Estudios de Cohortes , Femenino , Humanos , Ifosfamida/administración & dosificación , Estado de Ejecución de Karnofsky , Neoplasias Pulmonares/clasificación , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Mitomicina/administración & dosificación , Estadificación de Neoplasias , Pronóstico , Análisis de SupervivenciaRESUMEN
Until recently, tumours involving the pelvis were usually treated by hemipelvectomy, otherwise called "hindquarter amputation". A more recent approach of treating these tumours is the 'conservative hemipelvectomy', which consists of removing the tumour and sparing the lower extremity. A patient with Ewing's sarcoma of the pelvis underwent such a procedure. The femoral head was fixed temporarily to the remaining parts of the acetabulum and the iliac wing by a Steinman pin. The Steinman pin was removed 6 weeks after the operation and the patient was then put into traction for another 6 weeks. Weight-bearing was gradually allowed after 3 to 6 months. The patient remodelled a neoacetabulum, which gave sufficient stability to the hip joint. Walking without external help was possible. The patient presented with a 2 cm limb-shortening. No local recurrence was observed during a follow-up of 30 months. This experience with internal hemipelvectomy shows an encouraging result in terms of tumour control and gait function.
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Neoplasias Óseas/cirugía , Huesos Pélvicos/cirugía , Sarcoma de Ewing/cirugía , Adulto , Clavos Ortopédicos , Neoplasias Óseas/fisiopatología , Humanos , Masculino , Huesos Pélvicos/fisiopatología , Sarcoma de Ewing/fisiopatología , Procedimientos Quirúrgicos Operativos/métodos , Caminata , Soporte de PesoRESUMEN
We describe a peritoneal mesothelioma. There are many aspecific symptoms. Professional exposure is found in only fifty percent of cases. The histological diagnosis is often difficult. The survival period is short because of the absence of curative treatment.
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Amianto/efectos adversos , Mesotelioma/etiología , Neoplasias Peritoneales/etiología , Humanos , Masculino , Mesotelioma/diagnóstico , Mesotelioma/patología , Persona de Mediana Edad , Exposición Profesional , Neoplasias Peritoneales/diagnóstico , Neoplasias Peritoneales/patologíaRESUMEN
The European Lung Cancer Working Party conducted a phase II trial to determine the activity of a salvage regimen with high dose epirubicin (120 mg/m(2) on day 1) and vindesine (3 mg/m(2) on day 1) in patients with advanced non-small cell lung cancer failing to respond to first-line chemotherapy containing cisplatin and/or carboplatin. Courses were repeated every 3 weeks and evaluation of antitumoral response was performed after the 2 first courses. A total of 53 patients were registered, 4 were not eligible and 42 were evaluable for response. Two (5%) objective responses were documented. Although the regimen was very well tolerated, based oh the results it has to be considered inactive.
RESUMEN
A phase II trial was conducted to determine the effectiveness of weekly administration of cisplatin (25 mg/m(2) on day 1) and carboplatin (100 mg/m(2) on day 1) as salvage chemotherapy for patients with small cell lung cancer after first-line chemotherapy without platinum derivatives. Of 40 eligible patients, 38 were evaluable for response. Interval between last course of first-line chemotherapy and first course of salvage therapy was less than 3 months in 34 and greater in 4. Five partial responses (13%; confidence interval at 95%:0.01-0.25) were documented (including 4 in patients with a treatment-free interval <3 months) as well as 8 no change, 21 progressions and 4 early deaths due to malignant disease. Toxicity consisted mainly of moderate thrombopenia and leucopenia. Grade I nephrotoxicity was observed in 6 patients. In conclusion, weekly administration of moderate doses of cisplatin and carboplatin as salvage chemotherapy for small cell lung cancer appeared feasible and was associated with a moderate but definitive anticancer activity.
RESUMEN
Acquired hemophilia is a very rare disease characterized by the presence of an autoantibody (mainly IgG) to factor VIII, with a clinical presentation resembling hemophilia A. It is associated with various autoimmune or dermatologic diseases, pregnancy, cancer, or drug ingestion, but in almost 50% of patients no underlying disorder is found. The treatment of acquired hemophilia is particularly complex because response to therapy is unpredictable. If an acute hemorrhage occurs despite preventive measures, two complementary strategies must be employed: stopping the bleeding and decreasing the factor VIII inhibitor with human or porcine factor VIII, DDAVP, prothrombin complex concentrates, intravenous immunoglobulin, immunosuppression, or by extracorporeal removal of the inhibitor. Autoantibody titer, previous response to a given treatment, and severity of clinical presentation must be taken into account when choosing between these different therapeutic options, which must often be associated.
Asunto(s)
Autoanticuerpos/inmunología , Factor VIII/inmunología , Hemofilia A/etiología , Adulto , Anciano , Factores de Coagulación Sanguínea/uso terapéutico , Terapia Combinada , Desamino Arginina Vasopresina/uso terapéutico , Factor VIII/uso terapéutico , Femenino , Hemofilia A/inmunología , Hemofilia A/terapia , Hemorragia/etiología , Hemorragia/terapia , Humanos , Inmunoglobulina G/inmunología , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , PlasmaféresisRESUMEN
Digestive metastases of breast cancer are well documented (1-4). We report a patient with metastatic breast cancer presenting as a 5 mm polypoid benign looking lesion. The diagnosis was confirmed by histopathology and immunostaining.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma/secundario , Pólipos del Colon/secundario , Anciano , Pólipos del Colon/patología , Pólipos del Colon/cirugía , Femenino , HumanosRESUMEN
Forty-six patients with Stage III-IV previously untreated squamous cell carcinoma of the head and neck were treated with neoadjuvant chemotherapy with cisplatin, methotrexate, bleomycin and vincristine. The overall response rate was 70%, with a 9% complete response rate. The most frequent side effects were myelosuppression, nausea and vomiting, alopecia, neurotoxicity and stomatitis. Definitive local therapy consisted of surgery alone in 13 cases, surgery plus radiation in another 13, and radiotherapy alone in 14. Six patients, four of whom died, received no definitive local therapy and two were lost to follow-up. The median disease-free survival time was 10.5 months, and the most frequent cause of failure was local regional relapse (85%). Median survival time was 13 months and there were eight long-term survivals (median 48 months). Response to chemotherapy was independent of all analysed prognostic factors. Disease-free survival and survival were significantly influenced by the presence or absence of lymph nodes. Our results do not support the routine use of neoadjuvant chemotherapy with cisplatin, methotrexate, bleomycin, and vincristine in patients with advanced cell carcinoma of the head and neck.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Bleomicina/administración & dosificación , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Cisplatino/administración & dosificación , Terapia Combinada , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/patología , Humanos , Metástasis Linfática , Metotrexato/administración & dosificación , Estadificación de Neoplasias , Pronóstico , Vincristina/administración & dosificaciónRESUMEN
Six breast cancer patients were treated recently for renal insufficiency secondary to neoplasic involvement of the ureters. This complication usually occurs in long standing hormonal-dependent breast cancer with bone metastases. Diagnosis was performed by abdominal echography. Ureteral catheterization or percutaneous nephrostomy with or without irradiation always resulted in rapid recovery of renal function. Systemic chemotherapy could then be given, sometimes with antitumoral responses, allowing the removal of the endoureteral catheters.