Dose-intensive use of cyclophosphamide in ablation of neuroblastoma

Article Abstract:

Neuroblastoma, a malignant tumor that usually affects infants and children, is sensitive to radiation and a number of different chemotherapeutic agents. However, long-term progression-free survival is less than 20 percent for patients who fall into poor risk categories. These patients include those with skeletal metastases and patients over one year of age with metastases and a primary tumor not amenable to surgery. Other poor prognostic indicators include serum ferritin (iron) over 142 nanograms per milliliter and amplification of the N-myc proto-oncogene. The use of high-dose cyclophosphamide was evaluated in 22 children with poor-risk neuroblastoma. Fourteen had newly diagnosed Stage IV neuroblastoma and eight had either progressive disease or disease refractory to previous treatment. The patients received four courses of chemotherapeutic treatment each consisting of 140 milligrams of cyclophosphamide per kilogram of body weight over two days, with doxorubicin and vincristine, followed by three courses of cisplatin and VP16. Fourteen of the patients achieved either a complete response or what the authors term a very good partial response. Five patients achieved a partial response. A total of 12 patients remain progression-free over periods ranging from 8 to 30 months. Bone marrow toxicity from the intensive treatment was expected, and 11 patients required rescue with autologous bone marrow obtained after the cyclophosphamide chemotherapy and prior to subsequent therapy. Toxicity for tissues other than bone marrow was minor. One patient with bone marrow toxicity refused to take antibiotics and died of Pneumocystis carinii pneumonia. This case was the only death related to bone marrow toxicity. The results suggest that high dose cyclophosphamide therapy is effective against metastatic and surgically unresectable neuroblastoma and has acceptable levels of toxicity. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Cancer in children, Childhood cancer, Neuroblastoma

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Recombinant interferon-alpha combined with prednisone in metastatic renal cell carcinoma: reduced toxicity without reduction of the response rate - a phase II study

Article Abstract:

Interferon alpha is the most effective single drug for the treatment of metastatic cancer spread from the kidneys, despite the fact that the nature of its activity is not known. Unfortunately, the overall response rates rarely exceed 20 percent. Side effects are often the limiting factor in treatment with interferon alpha, which include fever and flu-like symptoms, weakness, and muscle pain. Addition of prednisone might reduce these side effects, allowing interferon alpha to be better tolerated, and result in an improved response rate. The combination of interferon alpha and prednisone was used to treat 23 patients with metastatic kidney cell cancer. Responses were seen in five patients, an almost 22 percent response rate. The tolerability of the chemotherapeutic regimen seemed to be improved, but a randomized trial will be necessary to make this interpretation definitive. The results indicate that the addition of prednisone does not detract from the effectiveness of interferon alpha and may well decrease the side effects. Future studies may evaluate whether the apparent decrease in side effects will permit the elevation of the interferon dosage, and perhaps a concomitant elevation in effectiveness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Metastasis, Cancer metastasis, Interferon alpha, Kidney cancer

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A new combination chemotherapy for advanced chronic lymphocytic leukemia (vincristine, cyclophosphamide, melphalan, peptichemio, and prednisone protocol)

Article Abstract:

MiNa protocol (vincristine, cyclophosphamide, melphalan, peptichemio, and prednisone protocol) was administered to 20 patients with advanced chronic lymphocytic leukemia (CLL). Seven patients achieved complete remission and an additional seven patients had partial remission of CLL, yielding a total response rate to the MiNa therapy of 70 percent. Most patients tolerated the protocol well and there were few infections. Furthermore, no other malignancies were observed among the 20 patients in the study. Researchers recommend a longer follow-up period to evaluate the ability of this chemotherapy protocol to treat CLL. A note of caution was advised concerning cyclophosphamide and melphalan since both of these drugs have been reported to be potentially mutagenic (causing genetic mutation).

Methods, Lymphocytic leukemia, Melphalan, Vincristine

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