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Biomedical subjects

B J Kennedy

Publications and source records attributed to B J Kennedy.

At least 37 records · Page 2Linked to original sources

Serial in vivo passage of HIV-1 infection in Macaca nemestrina.

In an earlier study we found that pigtailed macaques (Macaca nemestrina) that were experimentally infected with human immunodeficiency virus type 1 (HIV-1) initially became viremic and seroconverted, but HIV-1 replication diminished markedly over time. In an attempt to develop a longer term pathogenic model, blood from HIV-1-infected macaques was serially transfused into three groups of naive macaques. Transfer was successful through two transfusions as shown by repeated virus isolations and confirmed by the development of cell-free plasma viremia and by seroconversion. Three to five weeks after transfusion, plasma levels of HIV-1 RNA from several macaques in the first two groups exceeded those of the initially inoculated macaques. However, animals in the third group had diminished RNA levels, were virus culture negative, and did not seroconvert. Sequence analyses of env-region clones from infected animals revealed only minimal changes over the course of the passages. These results confirm HIV-1 replication in M. nemestrina during the acute phase of infection. However, adaptation of HIV-1 to a macaque-pathogenic variant did not occur during serial passage, possibly because the animals were able to restrict HIV-1 replication below a level required for a pathogenic variant to emerge. Whether such containment is a function of the host's immune response or a virus cell incompatibility remains to be determined.

Adaptation, Physiological↗

Integrating geriatrics and oncology.

BACKGROUND: A geriatric education retreat in oncology was held in February 1997 to develop a plan to integrate geriatrics into oncology. METHODS: A group of 42 geriatricians and medical oncologists convened to assess the means of incorporating the contents of geriatrics into oncology training. The basic science and clinical aspects of the pathogenesis, diagnosis, and treatment of cancers in older persons and the geriatric aspects of aging were presented. RESULTS AND CONCLUSIONS: This comprehensive review of the problems of aging and cancer provided encouragement to representatives of both disciplines to stimulate further research and clinical training relating to the problems of aging and cancer. The overall conclusions considered means to reach this goal.

Age Factors↗

Use of Truquant BR radioimmunoassay for early detection of breast cancer recurrence in patients with stage II and stage III disease.

PURPOSE: The Truquant BR radioimmunoassay (RIA) (Biomira Diagnostics Inc, Rexdale, Canada) uses the monoclonal antibody B27.29 to quantitate the MUC-1 gene product (CA 27.29 antigen) in serum. We evaluated CA 27.29 antigen in a controlled, prospective clinical trial for its ability to predict relapse in stage II and stage III breast cancer patients. PATIENTS AND METHODS: Over a 2-year period, 166 patients who had completed therapy for stage II (80.1%) or III (19.9%) breast cancer and were clinically free of disease were serially tested for CA 27.29 antigen levels. The study was double-masked and cancer recurrence was documented based on clinical findings. Patients with two consecutive CA 27.29 antigen test results above the upper limit of normal were considered positive. RESULTS: The Truquant BR RIA had a sensitivity of 57.7%, specificity of 97.9%, positive predictive value of 83.3%, and negative predictive value of 92.6%. The recurrence rate was 15.7%. A Cox regression analysis showed that the only variable to correlate with recurrent disease was the CA 27.29 antigen test result. Patients with a positive test result had increased odds of having a recurrence (odds ratio, 6.8; P < .00001). The test was effective in predicting recurrence in patients with both distant and locoregional disease. In a subgroup of patients with bone pain, CA 27.29 antigen level was found to identify reliably patients who would subsequently develop recurrent disease. CONCLUSION: These data demonstrate that the Truquant BR RIA can be used as an aid to predict recurrent breast cancer in patients with stage II and III disease.

Adult↗

Role of splenectomy in gastric cancer surgery: adverse effect of elective splenectomy on longterm survival.

BACKGROUND: Splenectomy, and in some cases pancreatico splenectomy, has been advocated by surgeons in an effort to improve clearance of metastatic nodes to splenic hilum (node 10) and splenic artery (node 11). Although splenectomy has known effects on increasing morbidity and even mortality after a variety of surgical maneuvers including gastrectomy, the longterm effect on survival is controversial. The purpose of this study is to review and analyze the effect of splenectomy on survival in patients having curative gastrectomy for stomach cancer. METHODS: We reviewed the role of splenectomy in patients having curative gastrectomy in a data base of stomach cancer patients that had been collected in 1987 as part of an American College of Surgeons Patterns of Care Study. This analysis had involved 18,344 patients, of whom 11,252 were first diagnosed in 1982 as part of a longterm study, and 7,092 were first diagnosed in 1987 as part of a shortterm study. From the two data collection periods information was available on 12,439 patients who received cancer directed abdominal surgery; 21.2% of these patients received a splenectomy. Among the 3,477 patients reported as having a curative gastrectomy (pathologically clear margins), 26.2% received a splenectomy. RESULTS: The operative mortality was 9.8% with splenectomy and 8.6% without splenectomy. In patients having a curative gastrectomy, the 5-year observed survival rate was 20.9% in patients having splenectomy versus 31% in patients who did not receive splenectomy (p < 0.0001). Examination of differences in survival by stage of diagnosis showed significantly reduced survival outcomes among patients with stage II and III, but not for those diagnosed with stage I or IV disease. The pattern of recurrence was moderately different with a larger proportion of patients having distant metastases among the group of patients who had undergone splenectomy compared with the patients who had not, 29% and 15.5%, respectively. Whether these differences are inherent in the splenectomy or in the associated cofactors was not determined in this study. CONCLUSIONS: The data suggest elective splenectomy should generally be avoided in patients with stage II and III gastric cancer. In patients with resectable proximal advanced (stage IV) cancer or who have extension to spleen and pancreas or macroscopic nodal metastases to splenic hilum, splenectomy might be necessary to facilitate complete removal of the tumor in an effort to achieve longterm tumor control. The importance of surgical judgment is emphasized as the major deciding factor in determining the need for splenectomy in the individual cancer patient.

Elective Surgical Procedures↗

Adequacy of chemotherapy prior to cytoreductive surgery in testicular carcinoma.

Removal of residual masses after cisplatin-based chemotherapy (cytoreductive surgery) for inoperable or metastatic testicular carcinoma has demonstrated that many partial regressions are defects without malignant cells. Such negative results allow a clarification of complete regression. Failure to achieve complete regression requires intensive salvage chemotherapy or bone marrow transplant. Extended initial chemotherapy could reduce these failures. Cytoreductive surgery was performed on 44 patients with inoperable stage II or stage III testicular cancer with residual defects following chemotherapy. The patients were evaluated according to whether (a) adequate treatment was given based on attaining normal markers followed by two additional courses of therapy, (b) normal markers were achieved but two additional courses were not administered, or (c) normal markers were never attained. These were subdivided into those receiving five or more courses of chemotherapy or fewer than five courses. Patients receiving two additional courses of chemotherapy after markers became normal had a low death rate (15.4%) and highest median follow-up. Fewer patients died if they had five or more courses of chemotherapy (11.8%). Of all those who attained normal markers with at least five or more courses of therapy, 10% are dead. The presence of residual malignant cells in those receiving five or more courses of therapy was 18.2% in contrast to 50% in those receiving fewer courses. Adequate chemotherapy and attainment of normal markers followed by two more courses of therapy results in fewer patients with residual malignant cells, a greater potential of cure, and less need for intensive salvage regimens.

Adolescent↗

Gastric carcinoma: does lymph node dissection alter survival?

BACKGROUND: Extragastric lymphadenectomy (D2 node dissection) is strongly supported by Japanese data to have survival benefit. Randomized trial data are either inconclusive or nonsupportive of this view. We have reviewed a prospectively gathered database of 18,346 cases of gastric carcinoma from a gastric cancer patient care evaluation study conducted by the American College of Surgeons to assess whether the performance of extragastric node dissection was associated with improved survival in patients who had resection with curative intent (all margins microscopically clear). STUDY DESIGN: We reviewed a subgroup of patients with curatively resected gastric carcinoma and compared the outcome in patients having extragastric lymph node dissection with the outcome in patients who did not have dissection of N2 nodes. RESULTS: Among the 3,804 patients having curative resection in the long-term study with more than a five-year follow-up, 695 had dissection of the nodes along the celiac axis, hepatic artery, or splenic artery (N2 nodes); 1,529 patients had removal of the adjacent nodes (N1 nodes) along the gastric tube or the gastric or perigastric nodes (N1 nodes); and 903 patients who had no nodes identified in the resection specimen (essentially N0 nodes removed). For patients having a dissection of N2 nodes, the median survival time was 19.7 months with a five-year survival rate of 26.3 percent; for patients having a dissection of N1 nodes, the median survival time was 24.8 months with a five-year survival rate of 30 percent; among patients having no nodes removed, the median survival time was 29.5 months with a five-year survival rate of 35.6 percent. CONCLUSIONS: Lymph node dissection (D2) of N2 nodes did not augment survival compared with gastrectomy without node dissection or that included perigastric nodes in the resection. Subgroup analysis of patients with gastric carcinoma having a curative resection did not show benefit of the extragastric node dissection (D2). Continued study is warranted and the data from ongoing clinical trials may yield more conclusive information.

Aged↗

Alternating chemotherapy regimens for patients with metastatic breast cancer. A pilot study based on tumor marker kinetics. Cancer and Leukemia Group B.

BACKGROUND: Chemotherapy is most effective when applied during the biologically active stage of tumor cells. According to the authors' previous tumor marker kinetic study, methotrexate plus 5-fluorouracil (MF) was found to yield either a cytolytic effect in an MF-sensitive tumor cell population or a cytostatic effect in an MF-resistant population. In the latter, the suppressive effect was transient and the biologic activity resumed in one week after MF administration. METHODS: Based on this marker kinetic study, an alternating chemotherapy program was designed to study its antitumor and side effects. Methotrexate (M) (200 mg/m2) and 5-fluorouracil (F) (500 mg/m2) were administered intravenously on day 1 followed 24 hours later by leucovorin (L) (10 mg/m2 orally every 6 hours for 6 doses). Cyclophosphamide (C) 300 (mg/m2), doxorubicin (A) (50 mg/m2), and vincristine (V) (1 mg/m2) were given on day 8. The MFL/CAV was given every 4 weeks. RESULTS: Forty-nine patients with metastatic breast cancer were enrolled; 41 were eligible. There were 5 complete and 23 partial remissions, producing a total response rate of 68%. In 15 patients with liver metastases, the response rate was 73% and the median survival 13.7 months, results superior to those previously reported for this subgroup of patients. Side effects were manageable. CONCLUSIONS: This regimen, which can be given safely in an outpatient setting, yielded encouraging response and survival rates in patients with visceral-dominant disease with poor prognoses.

Adult↗

Long-term follow-up of stage III testicular carcinoma treated with mithramycin (plicamycin).

In 1965 we reported mithramycin (plicamycin) to produce objective regression in 7 of 12 patients with advanced testicular carcinoma. Between 1963 and 1975 mithramycin was administered to 62 patients with advanced testicular carcinoma as the initial chemotherapy and to 30 patients who failed to respond to prior chemotherapies. There were 13 complete regressions (23%) in 56 patients who as initial chemotherapy received more than one course of mithramycin. The median follow-up is 23 years with 10 patients still alive. A partial regression occurred in 11 (18%), all of whom are dead. Of 30 patients receiving mithramycin after prior chemotherapies, none had a complete regression, 5 had a partial regression, and all are dead. Of 13 patients undergoing complete regression, 85% never had a recurrence of testicular carcinoma. The median follow-up of 23 years implies that these patients are cured.

Follow-Up Studies↗

Optimal number of chemotherapy courses in advanced nonseminomatous testicular carcinoma.

BACKGROUND: Nonseminomatous germ cell tumors (NSGCT) (testicular carcinoma) are a curable disease. Stages I and II are nearly 100% curable. Stage III has had remarkable progress in attaining complete regression, but a substantial number fail to be cured. Using platinum-based regimens such as vinblastine, bleomycin, and cisplatin (VBP), or using etoposide instead of vinblastine (BEP), or without bleomycin (EP), four courses of chemotherapy have become a national standard. Based on our prior experience with mithramycin (plicamycin), which used six courses, six courses of VBP chemotherapy were utilized as our treatment goal. This report challenges the concept that "standard therapy" for stage III testicular carcinoma is four courses. METHOD: From 1976 to 1990, 74 patients with advanced NSGCT were treated with standard doses of plantinum-based chemotherapies. Five or more courses were delivered to 41 patients and fewer than five courses to 33 patients. The intent of therapy was to attain as close to six courses as possible. Because of physician preference, patient adherence, or toxicity, some patients did not reach that goal. RESULTS: Of 33 patients receiving less than five courses, there were 28 (85%) complete responders, and 26 (78.8%) are alive. Of 41 patients receiving five or more courses, 38 (92.7%) had complete responses, and 34 (83%) are alive. One person in each group is living with nonresectable teratoma present. In the group receiving 5+ courses, two died from causes unrelated to testis cancer and had no testis cancer present. As a result of the initial treatment, there was no evidence of cancer in 24 (72.8%) in the group receiving less than five courses and 35 (85.4%) had no cancer after five or more courses. In considering only patients with advanced level of stage III disease in contrast to minimal or moderate stage III disease, there were fewer complete regressions with less than five courses (64.3%) than with five or more courses (88.0%). CONCLUSIONS: For minimal stage III disease, four courses of chemotherapy may be adequate. For advanced stage III disease, more chemotherapy provides fewer treatment failures. Once a complete response is achieved without restriction to an arbitrary number of courses, two additional courses may constitute a more curative regimen.

Antibiotics, Antineoplastic↗

Adjuvant chemotherapy for stage II nonseminomatous germ cell cancer of the testis.

BACKGROUND: The success of chemotherapy for Stage III testicular carcinoma warranted its use as an adjuvant therapy for Stage II cancer. The current report reflects the adjuvant program begun at the University of Minnesota using four courses of vinblastine, bleomycin, and cisplatin (VBP) before the onset of the Testicular Cancer Intergroup Study using two courses of chemotherapies. METHODS: A review of 78 patients with Stage II nonseminomatous germ cell tumors treated between 1972 and 1986 defined three groups: 19 patients treated between 1972 and 1979 with various adjuvant chemotherapies (termed "other"), 37 patients treated from 1975 to 1986 with VBP adjuvant chemotherapy, and 21 patients who received no therapy during the same era of VBP. The latter group was not offered adjuvant chemotherapy at other institutions or declined therapy. RESULTS: Nineteen patients received adjuvant chemotherapy before the cisplatin era. Their survival rate was 42%, including two patients treated with cisplatin-based chemotherapy for recurrence. In the group of 21 patients who did not receive adjuvant therapy, 14 (66.7%) survived. Of these, five had no recurrence and nine were treated for recurrence. In a third group, adjuvant VBP therapy was given to 37 patients, 32 of whom received four full courses. There have been no recurrences, and 36 (97.3%) remain alive; one obese patient with hypertension died of a ruptured aortic aneurysm 12.9 years after the retroperitoneal lymph node dissection. Nodal involvement was more extensive in the VBP group. CONCLUSION: Four courses of VBP adjuvant chemotherapy for pathologic Stage II testicular cancer resulted in a 100% cure rate, all patients having been followed up for more than 6 years. Whether two courses are as adequate remains to be determined when long-term follow-up is reported.

Adolescent↗

Minnesota population cancer risk.

BACKGROUND: The Minnesota Cancer Surveillance System (MCSS) provides information on the occurrence of newly diagnosed cancers among Minnesota residents. Cancer is a major cause of death and morbidity in older persons. Population cancer risk (PCR) was assessed as a measure of the number of cancers that will occur in the lifetime of 1000 persons. METHODS: Approximately 98.6% of all cancers diagnosed in residents of Minnesota are reported by pathologists to the MCSS. By statistical methodology an estimate was made of the total number of cancers that will occur in the lifetime of 1000 people (PCR). The calculation assumes people born today will have the 1988-1990 Minnesota cancer incidence and life expectancy rates. RESULTS: Incidence rates for all cancers in Minnesota have been increasing. Life expectancy in Minnesota is greater than in most areas of the United States. Approximately 50% of all cancers occurred in Minnesotans older than 70 years. The overall PCR is 459 cancers per 1000 lifetimes. It is estimated that by the year 2020 more than 100,000 living Minnesotans will have had cancer diagnosed during their lifetime. CONCLUSION: During the next 20 years, as the Baby Boomer generation in Minnesota moves into the high-risk years for cancer, the number of newly diagnosed cancers will increase disproportionately more than the increase in size of the older population. In view of the projected number of patients with cancer by the year 2020, cancer care will be different from what it is today. Geriatric cancer care will become a significant medical, public health, economic, bioethical, and social issue.

Adolescent↗