A phase II trial of gemcitabine in combination with 5-fluorouracil (24-hour) and folinic acid in patients with chemonaive advanced pancreatic cancer.

BACKGROUND: Gemcitabine (Gemzar) and 5-fluorouracil (5-FU) plus folinic acid (FA) both have proven activity in the treatment of patients with advanced pancreatic cancer. The present study was initiated to investigate the efficacy of gemcitabine in combination with 5-FU-FA. PATIENTS AND METHODS: Thirty-eight patients, median age 60 years (range 34-70) with inoperable, stage IV, pancreatic cancer were enrolled into the study and treated on an outpatient basis. All except one patient received at least one cycle of treatment with gemcitabine (1000 mg/m2), followed by FA (200 mg/m2) and 5-FU (750 mg/m2) administered as a 24-hour continuous infusion on days 1, 8, 15 and 22 of a 42-day schedule. No patient had received prior chemotherapy or radiotherapy. All 38 patients were assessed for efficacy, toxicity and time to progressive disease. RESULTS: Two patients (5%), achieved a partial response and thirty-four patients (89%) achieved stable disease. There were two early deaths (< or = 4 weeks). The median time to progression was 7.1 months (range 0.4-18.1+; 95% confidence interval (95% CI): 5.3-7.9 months). Three patients had a progression-free interval of greater than 12 months and 12 of 38 patients (32%) survived longer than 12 months. The median overall survival was 9.3 months (range 0.5-26.5; 95% CI: 7.3-13.0 months). The incidence of grade 3 and 4 toxicities was low. CONCLUSIONS: The combination of gemcitabine and 5-FU-FA is active and well tolerated and seems to offer an improvement in progression-free interval over both gemcitabine monotherapy and 5-FU-FA therapy.

[Secondary malignant neoplasms in patients with breast cancer]. / Sekundäre maligne Neoplasien bei Patientinnen mit Mammakarzinom.

OBJECTIVE: This report analyzes the occurrence of secondary malignancies among patients with breast cancer. MATERIAL AND METHODS: We evaluated all women diagnosed with breast cancer who were reported to the National Cancer Institute of the former GDR in 1976. There was a follow up of 5,485 patients from 1976 to 1988 (38,231 person-years at risk). Cancer incidence rates of the whole female population specific for age and calendar year were used for calculation of the standardized incidence ratio (SIR). RESULTS: Significantly increased risks were observed for neoplasms of the bilateral breast (SIR 2.44; 95% CI 2.04-2.93), colon (SIR 1.53; 95% CI 1.06-2.12), rectum (SIR 1.65; 95% CI 1.10-2.40), endometrium (SIR 1.55; 95% CI 1.02-2.27), and ovary (SIR 1.71; 95% CI 1.09-2.57). Neoplasms of the lung (SIR 1.65; 95% CI 0.93-2.73), kidney (SIR 1.51; 95% CI 0.69-2.87), bladder (SIR 1.32; 95% CI 0.48-2.87), connective tissue (SIR 3.54; 95% CI 0.73-10.34), and multiple myeloma (SIR 1.98; 95% CI 0.54-5.06) were also increased, not reaching statistical significance. Risk reduction was observed for malignant tumors of the gallbladder (SIR 0.36; 95% CI 0.12-0.83). CONCLUSION: In proposing recommendations for the follow-up and management of women with breast cancer, it is important to recognize their long-term predisposition to an array of secondary cancers.

[Intensification of chemotherapy dosage in metastatic breast carcinoma?]. / Chemotherapie-Dosisintensivierung beim metastasierten Mammakarzinom?

During the last decades, improvements in the median survival time in patients with metastasized carcinoma of the mamma were hardly achieved. There ist still a lack of evidence that the increase in the rate of remissions due to conventional chemotherapy leads to an improvement in survival time. In 450 female patients with metastasized carcinoma of the mamma, the survival time was analyzed with the begin of the metastatic spread in relation to the treatment success of the first palliative chemotherapy. The survival time of the responder group was not significantly different to the group with a stationary tumor (p = 0.5). As patients with primary hormone therapy were included, this result changed if patients only with prognostically unfavorable characteristics (high-risk group) were selected, which received primarily and exclusively a cytostatic chemotherapy. The responder only (partial and complete responder) are profitting from the chemotherapy with a significant increase in survival time in comparison to the group with a stationary tumor (p = 0.02 and p = 0.006). Therefore, a stationary tumor in the high risk group is a result as bad as tumor progression.

[Atrophic corpus gastritis and autoimmune gastritis]. / Atrophische Korpusgastritis und Autoimmungastritis.

The authors tried to clarify relations between autoimmune gastritis and isolated atrophic corpus gastritis by bioptic corporal and antral examinations from 150 probands as well as examinations of gastrin in serum and parietal cell antibody tests. Only 30% of all patients examined with isolated atrophic gastritis of the corpus part revealed criteria of an autoimmune gastritis. Therefore investigations of antibodies against parietal cells are necessary to mark off both clinical pictures. This differentiation seems to be necessary regarding the high risk of gastric cancer following an autoimmune gastritis.

[Ultrasound-guided fine needle biopsy in tumor diagnosis]. / Ultraschall-geleitete Feinnadelbiopsie in der Tumordiagnostik.

Ultrasound guided fine needle biopsy led in 92 of 100 patients with suspected tumours to correct diagnostic results which determined the diagnostic and therapeutic management. Ultrasound-tomography may thus in connection with fine needle biopsy enlarge and simplify tumour diagnosis.

A comparative study of early gastric cancer.

Authors provided a comparative study of early gastric cancers (EGC) which were found in the Cancer Research Centre of the Academy of Medical Sciences of USSR (Group A) and in the Central Institute of Cancer Research of the Academy of Sciences of GDR (Group B). The most frequent EGC-type in group B was type II, while types I and III were more frequent in group A. The rate of lymph node metastases in group A was 4,54% versus 16,2% in group B. Multicentric cancers were more often found in group A. These findings strengthen the opinion that early gastric cancer is not a uniform biological entity. Accuracy of x-ray and gastroscopic diagnoses was higher in group A. This fact surely contributes to the better prognosis of early gastric cancer in this group.

[Parietal cell antibodies and stomach cancer]. / Belegzellantikörper und Magenkarzinom.

Sera of 101 patients with histologically confirmed gastric cancers were investigated for parietal cell antibodies, which are the serological markers of chronic atrophic gastritis type A. These autoantibodies were more often found in patients with early than with advanced gastric cancers. They were more frequent in intestinal than in diffuse gastric cancers. It is discussed that in advanced cancers the frequency of parietal cell antibody is diminishing because of loss of antigene or binding of antibodies in immune complexes. Early gastric cancers therefore seem to be more suitable than advanced cancers to study the relation between gastric cancer and gastritis type.

[Early detection of gastrointestinal tumors (author's transl)]. / Früherkennung gastrointestinaler Tumoren.

"Early cancers" of stomach and colon have a favourable prognosis, but mass screenings for these tumors with endoscopic or radiographic methods are ineffective and expensive. The simple nonspecific test for occult blood as a suitable method for early detection of stomach and colorectal cancer in high-risk patients seems to be more useful. Some suggestions are given to detect and to control risk groups.

[Errors in endoscopic diagnosis of early stomach cancer]. / Endoskopische Fehldiagnosen beim Magenfrühkarzinom.

Authors deal with gastroscopic findings in 60 patients with early gastric cancers. With respect of macroscopic findings exclusively, one third early gastric cancers was thought by the endoscopist to be a benign lesion. The differentiation between benign and malignant ulcer was especially difficult. Authors therefore underline the well-known demand to control each ulcer endoscopically and histologically until complete healing. In so-called discrete lesions (scars, erosions, thick folds) biopsies are performed. Indication for further control depends on the safety of endoscopic and bioptic findings.

[Endoscopy of the esophagus, stomach and duodenal bulb]. / Endoskopie von Osophagus, Magen und Bulbus duodeni.

The authors report on the position of the endoscopy of oesophagus, stomach and duodenal bulb within the diagnostic endoscopy. The therapeutic endoscopy including polypectomy remains widely not taken into consideration. They particularly deal with the endoscopic-bioptic diagnosis of the stenoses of the oesophagus, the gastric ulcers and the early carcinoma of the stomach. It is referred to the importance of the endoscopy for the diagnostics of varicose veins of the oesophagus and of duodenal ulcers. For the clinician references to the clinical elaboration of the endoscopic and bioptic findings are given.

[Diagnostic problems in early gastric cancer]. / Diagnostische Probleme beim Magenfrühkarzinom.

It is reported on 48 early carcinomas in 47 patients who were diagnosed and treated in the Robert-Rössle-Institute Berlin-Buch between 1965 and 1977. In these cases the authors above all deal with the difficulties in the endoscopic and bioptic diagnostics which prove supreme in comparison to the X-ray diagnostics. In the patients who underwent a follow-up observation of more than 5 years the survival rate corresponds to the results reported by Japanese authors.

[Electrogastrographic studies in patients with gastric and duodenal ulcer]. / Elektrogastrographische Untersuchungen bei Patienten mit Ulcus ventriculi und Ulcus duodeni

The establishment of the motor activity of the gastrointestinal tract is difficult to be performed. The method of electrogastroenterography gives an evidence through an indirect registration of the summation vectors of the action potential. In patients with ventricular ulcer a statistically certain retardation of the changes of the potential/min. in comparison to a control group is to be proved. In patients with duodenal ulcer in the same way a trend is to be observed. It is especially referred to the importance of these examination methods in the sense of examinations of the course of the disease.