A phase II trial of the combination of gemcitabine, ifosfamide and cisplatin in the treatment of advanced non-small cell lung cancer.

OBJECTIVE: This phase II trial was designed to assess the efficacy and toxicity profile of the combination of gemcitabine, ifosfamide and cisplatin (GIP) in the treatment of patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Patients included in the study were those with surgically unresectable or metastatic NSCLC, with bidimensionally measurable disease, a Karnofsky performance status > 60, and who had not received previous chemotherapy. Treatment consisted of 1000 mg/m(2) gemcitabine on days 1 and 8, 3 g/m(2) ifosfamide on day 1, and 50 mg/m(2) cisplatin on day 1, administered in 21-day cycles. A maximum of six cycles were administered. RESULTS: Between March 1996 and December 1997, 60 patients were included in the study (37 stage III and 23 stage IV), of which 59 were evaluated for response. An objective response was obtained in 43% of patients (3% complete and 40% partial responses), whereas 22% had stable disease. The median survival time for the whole group was 52 weeks (65 weeks in patients with stage III, and 35 weeks in stage IV). The most frequent toxicity was haematological, 56% of patients presented grade 3 or 4 myelotoxicity in one of the cycles, although only seven episodes of febrile neutropenia were recorded in the 255 cycles administered. CONCLUSIONS: The GIP regimen attains response rates similar to those obtained with the gemcitabine plus cisplatin combination used in advanced NSCLC, and had an acceptable toxicity profile.

[Using Karnofsky's scale to measure the quality of life]. / Indice de Karnofsky para medir la calidad de vida.

Karnofsky's scale is one of the indexes most frequently used to measure cancer patients' quality of life. The main problem encountered when trying to verify it is the degree of subjectivity inherent in it. Due to this, an attempt was made to create a more objective measuring instrument based on Karnofsky's scale. To this end, a retrospective study involving 300 outpatients was carried out. For these patients, their Karnofsky index was determined by two independent agents: the patient's oncologist and the nursing team which complied its measure based on a survey answered by the patient himself/herself. The differences between these two methods proved to be statistically insignificant.

[Yield of diagnostic tests in neoplasms of unknown origin. A retrospective study]. / Rentabilidad de las pruebas diagnósticas en la neoplasia de origen desconocido. Estudio retrospectivo.

A retrospective analysis of 54 patients diagnosed of neoplasia of unknown origin between January 1983 and December 1987 are presented. The patients's characteristics, histologic type, localization of metastasis, diagnostic procedures used and their cost-effectiveness, treatment, survival, and percentage of diagnosis of primary disease, are studied by clinical follow-up o necropsy studies. Our results are compared with those described in the literature. Adenocarcinoma was the predominant histologic type (48%). The cost-effectiveness of diagnostic tests was practically none in those performed without a clear clinical sign of suspicion, and very low in those performed with a clinical suspicion. The over all survival was 13 months with an actuarial survival probability at 24 months of 34%. We highlight the importance of an organized and predetermined clinical approach in this kind of patients, performing complementary tests only under the suspicion of a sign, or if a disease has to be discarded before initiating active oncologic treatment.

[Neuropathy of the chin associated with neoplasms. Presentation of 5 cases and a review of the literature]. / Neuropatía mentoniana asociada a neoplasia. Presentación de cinco casos y revisión de la literatura.

Mental neuropathy is a paraneoplastic syndrome characterized by hypoesthesia or anesthesia in the area of mental nerve inervation. Its ethyology is not well known, and in some cases would be secondary to metastasis in the mandible, meningeal carcinomatosis or infiltration of the ganglion of Gasser. We report five new cases; three of them we have studied the presence of circulating antibodies against nervous tissue of ganglion of Gasser, and it was negative in all of them. Likewise we have reviewed the literature.