Combination therapy for advanced breast cancer: cyclophosphamide, doxorubicin, UFT, and tamoxifen.

We evaluated combination therapy for advanced and recurrent breast cancer with cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), UFT (uracil and tegafur), and tamoxifen (Nolvadex) (CAUT), designed as chemoendocrine therapy with a high antitumor effect and less severe adverse reactions. In this therapy, one 3-week cycle consisted of doxorubicin 30 mg/m2 intravenously on day 1, cyclophosphamide 65 mg/m2 orally (po) and UFT 300 mg/m2 po on days 1 to 14, and tamoxifen at 20 mg/day po on days 1 to 21. Twenty patients were registered and 19 were eligible, including seven with advanced breast cancer and 12 with recurrent disease. Six patients had received previous treatment. The comprehensive evaluation for objective response revealed one patient with a complete response and 10 patients with partial responses, producing an overall response rate of 58% (95% confidence interval, 29% to 87%). Three patients experienced no change, and five patients had progressive disease. Adverse events > or = grade 3 were leukopenia in six patients, erythropenia in one patient, alopecia in four, and severe generalized malaise in one. One patient who developed grade 4 leukopenia and one of five patients who developed grade 3 leukopenia recovered after receiving granulocyte colony-stimulating factor. CAUT therapy produced high response rates and relatively mild adverse reactions and is considered useful for the treatment of advanced and recurrent breast cancer.

[A study on the efficacy of combination chemoendocrine therapy consisting of cyclophosphamide, adriamycin, UFT, and tamoxifen for advanced or recurrent breast cancer].

The efficacy of the combination chemoendocrine therapy CAUT against advanced and recurrent breast cancer was examined. One course of this therapy lasted 3 weeks and consisted of adriamycin (i.v.) at 30 mg/m2 on day 1, cyclophosphamide (p.o.) at 65 mg/m2 and UFT (p.o.) at 300 mg/m2 on days 1-14, and tamoxifen (p.o.) at 20 mg/body on days 1-21. Twenty patients were enrolled, of whom 19 were eligible including seven with advanced cancer and 12 with recurrent cancer. One patient achieved CR, ten PR, three NC, and five PD, for a response rate of 58% (95% CI: 29-87%). The response rates according to type of lesion were 73% (8/11) for the soft tissue, 38% (3/8) for the bone, 20% (1/5) for the lungs and pleura, and 50% (2/4) for the liver. Adverse events with a severity of grade 3 or more included a reduction in WBC in six patients (31.6%), a reduction in RBC in one (5.3%), alopecia in four (21.1%), and severe general fatigue in one (5.3%). One patient experiencing a grade 4 reduction in WBC, and one of five patients experiencing a grade 3 reduction with a fever, recovered after treatment with G-CSF. The other four patients recovered following suspension of administration. This therapy is considered useful, exhibiting a high response rate and relatively slight adverse effects.

Night-time hypnopompic visual hallucinations related to REM sleep disorder.

We encountered three patients who had experienced hypnopompic visual night-time hallucinations. Their clinical manifestations resembled Charles Bonnet's syndrome and the content of their experiences were understood as attempts at wish fulfillment. However, abnormal REM findings were recognized on polysomnogram at the occurrence of visual hallucination in two cases. We speculated that dysfunction of REM sleep mechanism might contribute to the night-time occurrence of such kind of visual hallucination and that their visual experiences might be reflected by dream content.

[A case report of far advanced gastric cancer with multiple liver metastasis (H3) treated with transarterial intermittent chemotherapy and intradermal administration of low molecular lipopolysaccharide (LPSp) extracted from Pantoea agglomerans].

A case of far advanced gastric cancer with multiple liver metastasis (H3) was treated with transarterial intermittent chemotherapy (5-FU: 250 mg/week, Farmorubicin: 10 mg/4 weeks, MMC: 4 mg/2 weeks) and intradermal administration of low molecular lipopolysaccharide (LPSp) extracted from Pantoea agglomerans. The CT examination and endoscopy showed regression of the tumor and the patient was discharged from the hospital. LPSp was given at the concentration of 0.1 microgram initially, and the dose was gradually increased. Finally, the dose of LPSp was increased up to 70 micrograms. No serious side effect except fever was observed. The serum TNF-alpha levels were elevated and, histologically, CD 8(+) lymphocyte dominantly infiltrated around the tumor. These findings clearly indicated the immunological anticancer effect of LPSp. Intradermal administration of LPSp is a promising new adjuvant therapy to improve QOL without serious side effect.

[Tissue concentration of 5-FU after intra-operative arterial infusion].

The aim of this study was to measure the tissue concentration of anti-cancer agents administered by arterial infusion. After the abdominal cavity was opened, 250 mg of 5-FU diluted in 20 ml saline was infused into the feeding artery in 16 patients with colonic cancer. After the affected lesion was resected, specimens were obtained at the tumor, at sites 5 and 10 cm from the center of the tumor, and at the adjacent nodes. The concentration of 5-FU was higher in the tumor and the adjacent lymph nodes than in the normal colon near the lesion. This suggests that 5-FU has a more favorable distribution profile in tumor tissue than in normal tissue. Patients with a high concentration of 5-FU in the tumor also demonstrated high levels in the other tissue. Blood flow volume and the length of time between the injection of 5-FU and harvest of the specimen may account for differences in the tissue concentration of the agent after administration of the same dose.

[Experimental study on the effect of injection with anticancer agent-oil suspension].

Local injection of an anticancer agent guided by endoscopy is thought to be effective for cancerous lesion associated with lymph node metastasis, if the anticancer drugs are drained into the lymph nodes. In the experimental study, anticancer drug-oil (nimustine-Lipiodol) (N-L) suspension (5 mg/ml) was injected into the tumor (Lewis lung cancer) that had been implanted sub dorsally in mice (57 black/6 mice) for the purpose of finding out the antitumor effect on the primary lesion. Then it was injected into sarcoma-180 that had been implanted into hind feet of mice (ICR mice) for the purpose of finding out the antitumor effect on metastatic lymph nodes. The results showed that the N-L suspension was effective for the primary cancerous lesion and metastatic lesions.

Antipsychotic and prophylactic effects of acetazolamide (Diamox) on atypical psychosis.

We investigated the antipsychotic and prophylactic effects of acetazolamide (Diamox) on atypical psychosis. Acetazolamide was given to 30 patients: Type I, puberal periodic psychosis, a psychosis whose onset occurs during the period of puberty and which appears repetitively with psychosis-like condition at about the same interval as the menstrual cycle (6 cases); Type II, a) presenile atypical psychosis which initially appears in patients in their 20s or 30s accompanied by manic-depressive cycles and shows acute confusional and dreamy states in the presenile period, incurable cases (7), b) atypical psychosis, in the narrow sense, cases which show acute hallucination, delusion, confusional and dreamy states accompanied by affective symptoms (8 cases); Type III, repetitively the atypical manic and depressive states, and atypical manic-depressive psychosis, and transient changes in consciousness, refractory cases (2); Type IV, atypical schizophrenia, which is considered to be schizophrenia but shows the abnormalities in electroencephalogram and emotional disorders (7 cases). Among these cases, some extent of the therapeutic effects of acetazolamide (500-1,000 mg/day) was obtained in about 70%. The high therapeutic effects were particularly observed in Types I, II and III. It was less effective against atypical schizophrenia. Acetazolamide showed the effectiveness in 10 cases out of 13 cases to which lithium carbonate and carbamazepine were ineffective. The high therapeutic effects of acetazolamide were shown in the cases whose symptoms were aggravated at the interval of the menstrual cycle. No correlation was observed between the electroencephalographic abnormalities and the therapeutic effects. In addition, the prophylactic effects of acetazolamide on the periodic crisis were observed in 9 cases. From these results, acetazolamide was considered to have the antipsychotic and prophylactic effects on atypical psychosis. Since side effects due to acetazolamide were rarely observed, the present drug was considered to have a high safety margin.