Combination chemotherapy and high-dose cyclophosphamide intensification for poor prognosis breast cancer: a Southwest Oncology Group Study

Article Abstract:

Research has provided insights into factors associated with a poor prognosis in breast cancer. One such factor is the absence of the estrogen receptor on breast cancer cells (estrogen-receptor-negative); not only does this factor carry a poor prognosis, but it also correlates with other more traditional negative prognostic factors, such as liver metastases (spread of cancer to the liver). Recurrent or disseminated breast cancers are generally treated with a combination of agents, which usually includes doxorubicin, sometimes referred to by its brand name Adriamycin. Although some response may be achieved in 70 to 80 percent of the patients with estrogen-receptor-negative breast cancer, survival is generally poor with less than 5 percent of patients surviving five years after diagnosis. Roughly 20 percent of patients with estrogen-receptor-positive cancer survive five years after diagnosis. To try to improve treatment success for these poor-prognosis patients, high-dose cyclophosphamide was added to intensify chemotherapy; previous studies established that doses of cyclophosphamide as high as 200 milligrams per kilogram (mg per kg) can be tolerated without necessitating bone marrow infusion. Of 45 patients enrolled in the study, 35 were fully evaluable for results. Patients who continued to have progressive disease after initial chemotherapy with 5-fluorouracil, vinblastine, and doxorubicin were removed from the study. Twenty-six patients were treated with high-dose cyclophosphamide (120 mg per kg) and 16 of these patients relapsed, usually at sites of previous metastases. A median survival time of 15 months and an overall response rate of 69 percent indicates that a single cycle of high-dose cyclophosphamide does not provide a significant benefit. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Breast cancer, Cyclophosphamide

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A weekly cisplatin-based induction regimen for extensive non- small cell lung cancer: a Southwest Oncology Group study

Article Abstract:

Much of the current research in chemotherapy for cancer is focused on improving the results obtained with already established chemotherapeutic agents. Cisplatin is one of the more effective chemotherapeutic drugs for the treatment of lung cancer. As is often the case, the effectiveness of the drug is limited by its toxicity. Greater anti-cancer activity could be achieved at higher doses, but the toxic effects of the higher doses would be unacceptable. Researchers have tried to improve upon the success of cisplatin-containing chemotherapeutic regimens in the treatment of non-small cell lung cancer. One approach is that each round of chemotherapy contains cisplatin, but another agent is combined with cisplatin and the identity of this second agent is rotated from round to round. In the present study, cisplatin was administered for eight weeks; the drug was given in combination with mitomycin C on weeks one and six, with vinblastine on weeks two and seven, and in combination with 5-fluorouracil on weeks three and eight. Patients who responded to this treatment regimen were given cisplatin and etoposide for three monthly cycles. Eighty patients were eligible for participation in the study, and 77 were evaluable for their response to treatment. One patient achieved a complete response, and 17 patients achieved partial responses, for an overall response rate of 23 percent. The median survival was 4.6 months. Neither the overall survival rate nor the toxicity of this treatment protocol were significantly different from the standard dose regimens. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration

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Cisplatin and novobiocin in the treatment of non-small cell lung cancer: a Southwest Oncology Group study

Article Abstract:

Novobiocin is an antibiotic that works by inhibiting (stopping the action of) a bacterial enzyme involved in the maintenance of DNA (genetic material). Novobiocin also inhibits an enzyme in human cells as well. Experiments in tissue culture have indicated that the inhibition of this enzyme, called DNA topoisomerase II, actually potentiates the action of some anticancer drugs, including cisplatin. In some preliminary studies, it seemed that the addition of novobiocin to chemotherapeutic regimens containing cisplatin might improve the response of lung cancer patients to treatment. As the study involved only a small number of patients, it is important to test this drug combination in a larger and more reliable study. However, the completion of such a study provides no reason to believe that this drug combination provides any useful benefit. A total of 36 patients with non-small cell lung cancer were treated. No complete responses were achieved and only three partial responses were observed. The midpoint survival time of the patients was less than seven months, which is no better than could be achieved using cisplatin alone. At present, novobiocin is available as capsules which are taken orally. Better results might be achieved if it were possible to administer novobiocin to the patients intravenously. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Antibiotics

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