Cisplatin-vinorelbine combination chemotherapy in locally advanced non-small cell lung cancer.

AIM: The North Milan Group presents the results of a phase II study on a cisplatin-vinorelbine combination schedule in the treatment of locally advanced non-small cell lung cancer to evaluate its activity and tolerability. METHODS: Seventy-six consecutive patients entered the study. Patients' characteristics were the following: males/females 69/7; median age, 61.4 years (range, 40-73); ECOG performance status, 0-1; 17 stage IIIa and 59 stage IIIb. There were 49 squamous cell carcinomas, 20 adenocarcinomas, and 7 large cell carcinomas. All patients had not been previously treated and showed measureable disease. Treatment consisted of vinorelbine, 25 mg/m2 on days 1 and 8, plus cisplatin, 80 mg/m2 on day 1, administered intravenously every 21 days for three standard courses. RESULTS: Seventy-four patients were evaluable for response. Objective responses were documented in 42/74 patients with an overall response rate (CR+PR) of 56.7%; 18/74 patients (24.3%) showed stable disease and the remaining 14/74 (18.9%) went into progression. Twelve patients (16.2%) were suitable for a subsequent surgery. The median duration of response was 13.3 months. Survival time ranged from 4 to 36 months; it was 14.6 months for PR patients, 8.6 months for NC and 5 months for PD. Mean survival time is presently 12.85 months (SE, 1.2 months). Toxicity evaluated on 222 cycles administered was acceptable, and it was necessary to use G-CSF or delay the treatment because of severe leukopenia in only a few cases. CONCLUSIONS: The regimen is active and safe: the slight survival increase is likely due to the small amenability to surgery achieved (16.2%). However, our results are fully comparable to others obtained with vinorelbine in two/three drug combination chemotherapy regimens.

Cisplatin plus epirubicin and etoposide followed by irradiation plus lonidamine in stage III nonsmall cell lung cancer.

Forty-seven patients with stage III nonsmall cell lung cancer (NSCLC) were treated with the sequential administration of combination chemotherapy consisting of cisplatin, epirubicin and etoposide and of irradiation plus lonidamine. The response rate was 49% after chemotherapy with an improvement of 14% after radiation therapy and lonidamine. The median survival was around 15 months for responders and 9 months for nonresponders. Toxicity was moderate and acceptable. It is concluded that this schedule is active in the treatment of NSCLC.

Distribution of FMRFamide-like immunoreactivity in the brain of the elasmobranch fish Scyliorhinus canicula.

The distribution of FMRFamide-like-immunoreactive peptides was investigated in the brain and pituitary of the elasmobranch fish Scyliorhinus canicula using the indirect immunofluorescence technique. FMRFamide-immunoreactive cells and fibers were mainly observed in the telencephalon and the diencephalon, while other brain structures were almost unstained. In the telencephalon, FMRFamide-like-containing neurons were seen in the caudal part of the area periventricularis pallialis, in the posterior area of the nucleus septi medialis and in the nucleus septi caudoventralis. In the diencephalon, numerous FMRFamide-positive cell bodies were observed in the hypothalamus, ventral thalamus and posterior tuberculum. The highest density of immunofluorescent perikarya was found in the nucleus lobi lateralis hypothalami and in the nucleus periventricularis hypothalami. More caudally, the mesencephalon and the caudal brainstem only contained scattered varicose FMRFamide-immunoreactive fibers. Stained fibers were also identified in the median eminence and several FMRFamide-like-positive cells were detected in the dorsal and rostral parts of the neurointermediate lobe of the pituitary. These data indicate that substances related to the molluscan cardioexcitatory peptide FMRFamide are widely distributed in the brain of S. canicula, suggesting their implication in neuroendocrine and/or neuromodulatory functions.

Six-drug sequential chemotherapy in non small cell lung cancer. A North Milan Group Study.

Forty-five patients with inoperable non small cell lung carcinoma were treated according to a sequential polychemotherapeutic regimen with cisplatin-vinblastine (A), cyclophosphamide-etoposide (B), and adriamycin-vincristine (C). Patients were evaluated every two cycles. Ten patients (22.2%) showed a partial response with a mean duration of 20 weeks, and mean survival of 50.8 weeks. It is remarkable that, among them, 6 patients (13.3%) lived over 12 months and three (6.6%) over 18 months. The mean survival for all patients was 35.7 weeks. Toxicity was acceptable and reversible.

Transient blindness and seizure associated with cisplatin therapy.

A 38-year-old woman with adenocarcinoma of unknown origin was treated with cisplatin and etoposide. After the 4th course of chemotherapy she complained of blindness and had a seizure with spontaneous recovery in 4 days. The relationship between these events and the known neurotoxicity of other heavy metals indicate cisplatin as a possible etiologic factor.

Enzymuria in carboplatin nephrotoxicity.

Urinary excretion of N-acetyl-beta-glucosaminidase (NAG) is an early marker of nephrotoxicity. NAG activity was assayed by the fluorimetric method of Leaback and Walker in 17 patients treated (22 courses) with carboplatin (CBDCA, 220-550 mg/m2) before infusion and 24, 48, 72 and 96 h after. Increased excretion of NAG, a sensitive index of renal tubular damage, was observed following 10 of the 22 courses. A transient increase in plasma creatinine and/or abnormal proteinuria was observed in 6 cases. Impaired renal function prior to therapy seems to be a predisposing factor to the nephrotoxicity.

Pharmacokinetics of nitrosoureas: levels of 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) in organs of normal and Walker 256/B carcinoma bearing rats after i.v. bolus.

The disappearance of 1,3-bis(2-chlorethyl)-1-nitrosourea (BCNU) from plasma, liver, kidney, lung, brain, spleen, tumor tissue and epididymal adipose tissue of Walker 256/B carcinoma-bearing rats and healthy animals was measured by differential pulse polarography after i.v. bolus of the drug. Only BCNU, not its decomposition products, was detected by the polarographic assay. Levels of BCNU in liver of tumor-bearing animals were significantly lower (about 10 times) than those on healthy rats. A bi-exponential fit was used to calculate the kinetics of BCNU in plasma, kidney, lung and brain, but no difference could be found between healthy and Walker tumor-bearing rats. BCNU disappeared faster from adipose tissue of tumor-bearing animals than from normals.

Pharmacokinetics of nitrosoureas: comparison of 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) and 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) after oral and intravenous administration to rats.

Differential pulse polarographic assay of intact nitrosoureas revealed the lower bioavailability of CCNU (1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea) in stomach and liver after oral administration to rats in comparison to BCNU (1,3-bis-(2-chloroethyl)-1-nitrosourea); blood levels of CCNU were below the detection limit of the method (20 ng). After i.v. bolus the CCNU concentration in plasma fell faster than that of BCNU. The rate of CCNU decomposition during incubation with blood at 37 degrees C was 3 times lower than that of BCNU.

Pharmacokinetic studies in lung cancer patients.

Pharmacokinetic measurements to monitor and design cytotoxic treatments in cancer patients are being used more and more in order to optimize dosage and administration schedules. Ideally, information on drug concentrations over time should help reveal dose-response correlations. The cytotoxic drugs carmustine, etoposide, cyclophosphamide, iphosphamide, cis-diammineplatinum, Adriamycin (doxorubicin), and 4'-epi-Adriamycin have been monitored on different treatment programs of patients with advanced lung cancers. The collected experience emphasizes the many individual variables encountered in clinical practice complicating the effort of correlating pharmacokinetic data with clinical results. The examples, presented on the basis of the authors' experiences, pertain to drug instability, gastrointestinal absorption, enzymatic induction in the liver, drug interaction, and drug tissue concentrations.

Polarographic assay of submicrogram quantities of cis-dichlorodiamineplatinum (II) in biological samples.

Differential pulse polarographic assay of the antineoplastic agent cis-dichlorodiamineplatinum II and its analogues was performed after acid oxidative hydrolysis (HClO4, HNO3, HCl) of biological samples (plasma, tissue homogenates, urine) and reaction with ethylenediamine. Platinum levels and kinetics were determined in blood and urine of patients with non-oat-cell lung carcinoma. Detection limit of the polarographic assay was 0.5 ng platinum; analytical error was +/- 3%. Levels of free cis-dichlorodiamineplatinum (II) in plasma fell in samples stored at -20 degrees C; the half-life of free drug was 38 h.