A study of cyproheptadine in the treatment of metastatic carcinoid tumor and the malignant carcinoid syndrome

Article Abstract:

For many neuroendocrine tumors, the active hormones which may be secreted by the tumors exert a greater effect upon the patient's health than the actual presence of a tumor mass. One example of this phenomenon is malignant carcinoid syndrome, in which flushing and diarrhea are the major symptoms. Although the physiological mechanisms responsible for the syndrome are not entirely understood, they are thought to involve the secretion of large amounts of serotonin by the tumor, and perhaps other active substances such as histamine and bradykinin. The drug cyproheptadine, which blocks both serotonin 1 and serotonin 2 receptors, as well as histamine H1 receptors, is commonly used in the treatment of patients with malignant carcinoid syndrome. Unfortunately, data on the effectiveness of this treatment are fairly sparse, and many reports consist only of single case histories in which the patient responded either completely or not at all. This paucity of data is underscored by more recent reports that cyproheptadine may not only block the effects of the hormonal excess, but may also exert direct antitumor effects as well. The authors report the data on 16 cases of patients with neuroendocrine tumors and malignant carcinoid syndrome. Seven of 12 evaluable patients experienced relief from diarrhea upon treatment with cyproheptadine. However, the symptom of flushing was more resistant to treatment, and only two of 12 experienced relief from this symptom. The levels of 5-hydroxyindoleacetic acid in the urine were measured, and no reduction greater than 50 percent was observed, indicating that the observed improvements were the result of effects of the drugs on the target tissues of the hormones, and not the result of direct effects on the tumors themselves. While some previous reports have suggested a direct antitumor role for cyproheptadine, this could not be confirmed in any of the 16 patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Carcinoid, Carcinoid tumor, Cyproheptadine, Nervous system cancer

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A prospective, randomized evaluation of intensive-course 5-fluorouracil plus doxorubicin as surgical adjuvant chemotherapy for resected gastric cancer

Article Abstract:

The incidence of gastric (stomach) cancer has been declining in the United States. However, there are still over 23,000 new cases in the US each year. Despite much research, the only treatment for stomach cancer which has the potential to cure the patient is the complete surgical removal of the cancer. Even in the earlier stages when complete surgical resection is possible, only a third of the patients achieve long-term survival. One potential method for improving the survival of patients after surgery for stomach cancer might be to employ adjuvant chemotherapy. The rationale behind the chemotherapy would be to eliminate any small colonies of cancer cells which had already spread at the time of surgery. This hypothesis was tested in a randomized clinical study of the treatment of 125 patients with stomach cancer. The patients were stratified according to the features of their disease, and then the patients within each stratum were randomly assigned to receive or not receive adjuvant chemotherapy consisting of 5-fluorouracil and doxorubicin. There were no significant differences in the time to recurrence or in the five-year survival rate by group. A total of 33 percent of the patients who only had surgery were alive at five years, while 32 percent of the patients who received adjuvant chemotherapy were alive at the end of the same period. Two patients in the group receiving adjuvant chemotherapy died from infections as a direct result of the chemotherapeutic treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Chemotherapy, Stomach cancer, Fluorouracil, Doxorubicin

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