[Adjuvant chemotherapy of breast cancer].
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Antineoplastic Agents↗
Biomedical subjects
C Blomqvist
Publications and source records attributed to C Blomqvist.
The combination of radiotherapy, adjuvant chemotherapy (cyclophosphamide-doxorubicin-ftorafur) and tamoxifen in stage II breast cancer. Long-term follow-up results of a randomised trial.
Two hundred patients with node positive stage II breast cancer were randomised to four groups after radical mastectomy and axillary evacuation: (1) Postoperative radiotherapy, (2) Adjuvant chemotherapy with eight courses of CAFt (cyclophosphamide 500 mg m-2 + doxorubicin 40 mg/m-2 + ftorafur 20 mg kg-1 orally day 1-14) every fourth week, (3) Postoperative radiotherapy and adjuvant chemotherapy and (4) postoperative radiation, adjuvant chemotherapy and tamoxifen 40 mg daily for 2 years. Thirty-two per cent of the patients discontinued treatment due to GI-toxicity, while 26% required dose reductions due to leukopenia. Radiation pneumonitis was more frequent after the combination of postoperative radiotherapy with chemotherapy. There was a better relapse-free survival in the groups receiving chemotherapy compared to radiotherapy alone (P = 0.05), which was highly significant in a multivariate Cox analysis (P = 0.004). No significant survival differences were seen. Tamoxifen had no clear overall effect but there were better relapse-free (P = 0.04) and overall (P = 0.004) survival with tamoxifen in estrogen receptor positive patients, while estrogen receptor negative patients had a somewhat poorer survival (P = 0.07) after tamoxifen. Local control was better (NS) after the combination (93%) radiotherapy and chemotherapy compared to either treatment alone (76% with radiotherapy and 74% with chemotherapy at 5 years).
Administration, Oral↗
FEC (5-fluorouracil-epirubicin-cyclophosphamide) monthly versus FEC weekly in metastatic breast cancer. First results of a randomized trial.
Patients (n = 174) with metastatic breast cancer previously untreated with anthracycline cytotoxic agents were randomized into two groups: Group 1 received FEC (5-fluorouracil 500 mg/m2, epirubicin 60 mg/m2 and cyclophosphamide 500 mg/m2) once every fourth week and group 2 received the treatment once weekly in the same monthly dosage. Treatment was recommended to continue until disease progression or to a cumulative epirubicin dose of 1,000 mg/m2, but could be discontinued at any time at the patient's request or at the treating physician's judgement. An interim analysis was made when 131 patients were evaluable for response, and 128 patients for toxicity. Hematological toxicity was significantly more severe in the monthly group, as was nausea and vomiting. Of the monthly treated patients 76% had total alopecia compared to 14% in the weekly group. There were no statistically significant differences in the occurrence of mucositis. Monthly FEC gave significantly higher response rate than weekly treatment (52 vs 34%, p = 0.01). Time to progression was significantly (p = 0.004) longer with monthly FEC. Patients in the monthly treated group lived significantly (p = 0.02) longer than patients in the weekly group. These results indicate that both toxicity and efficacy of epirubicin-containing combination therapy in breast cancer is dependent on the treatment schedule, not merely on dosage. Both efficacy and toxicity increased when the treatment was given once monthly compared to the weekly schedule.
Antineoplastic Combined Chemotherapy Protocols↗
Ten years' experience in patients with osteogenic sarcoma in Finland.
Ten years' results of 56 patients with high grade osteogenic sarcoma are reported. Fifty-two patients had M0 disease. Immediately after open biopsy the patients were treated with chemotherapy using modified Rosen's protocols T4, T7 and T10. The primary tumor was adequately removed in most patients. Six children were treated with limb saving. The actuarial and disease-free survival was 80% after 1 year, and 73% to 8 years. Two patients died because of toxic side effects of chemotherapy, one of septicemia, the other of late cardiac failure secondary to doxorubicin.
Actuarial Analysis↗
Experiences of clodronate treatment of multifocal eosinophilic granuloma of bone.
Clodronate, an inhibitor of osteoclast function, reduces bone resorption in osteolytic metastases and in multiple myeloma. We have evaluated its ability to decrease bone destruction in patients with multifocal eosinophilic granuloma of the skeleton. Two patients, whose multifocal bone granulomas appeared with a frequency of about 6 months, received 1.6 g day-1 oral clodronate for 6 months. Both patients had a reduction in serum calcium level which was accompanied by a decline in the fasting urinary hydroxyproline/creatinine and calcium/creatinine ratios and a slight increase in parathyroid hormone (PTH) level. Pain relief was observed in both patients. No new bone lesions were seen during the treatment and the old lesions healed. After discontinuing the therapy, however, new painful lesions appeared after 5 years in patient 1 and after 3, 4 and 5 years in patient 2. We suppose that clodronate delayed the appearance of new granulomas.
Adult↗
Adjuvant chemotherapy with doxorubicin in high-grade soft tissue sarcoma: a randomized trial of the Scandinavian Sarcoma Group.
From January 1981 to February 1986, a total of 240 patients with primary, malignancy-grade III or IV soft tissue sarcoma were entered into an adjuvant chemotherapy multicenter trial conducted by the Scandinavian Sarcoma Group (SSG). Of these patients, 181 were evaluable. The tumor was located in the extremities in 155 patients. After radical surgery (wide and compartmental) the patients were randomized to treatment with single-agent doxorubicin 60 mg/m2 administered as an intravenous (IV) bolus once a month for 9 months (group 1, n = 77) or to control (group 2, n = 77). If the surgical procedure was marginal, the patients initially received postoperative radiotherapy, followed by doxorubicin (group 3, n = 16) or control (group 4, n = 11). The control groups did not receive any adjuvant chemotherapy. Adjuvant therapy was initiated within 6 weeks of surgery (group 1) or within 10 weeks of surgery for patients receiving postoperative radiotherapy (group 3). With a median follow-up of 40 months, there was no significant difference between the four treatment groups in overall survival (group 1, 75%; group 2, 70%; group 3, 69%; group 4, 73%), disease-free survival (group 1, 62%; group 2, 56%; group 3, 62%; group 4, 64%), or local tumor control (group 1, 92%; group 2, 92%; group 3, 87%; group 4, 90%). The conclusions were the same whether the total group or evaluable patients only were included in the analysis. The local recurrence rate for patients undergoing radical surgery was 8% and for patients undergoing marginal surgery followed by radiotherapy was 12%. This study indicates that the use of single-agent doxorubicin as postoperative adjuvant chemotherapy has no significant clinical benefit in patients with high-grade soft tissue sarcoma.
Adolescent↗
Campylobacter pylori: Swedish experiences.
All patients referred for gastroscopy were investigated by Campylobacter pylori culture and antibody titration. An enzyme immunoassay was developed and found to have a negative predictive value of 0.997, which indicates that serologic tests could be used for screening of patients before gastroscopy. A close correlation was found between active and inactive duodenal and gastric ulcer and positive C. pylori culture. Small open treatment trials with the antibiotics doxycycline, tinidazole, amoxycillin, and norfloxacin were ineffective for the eradication of C. pylori. Treatment with the new anti-ulcer agents enprostil, rioprostil, and omeprazole had no effect on the presence of C. pylori.
Adult↗
Evaluation of salmon calcitonin treatment in bone metastases from breast cancer--a controlled trial.
Salmon calcitonin 100 MRCU/day or a saline placebo were given in daily injections for at least three months to 49 patients with bone metastases from breast cancer in a randomized double-blind trial. All patients were normocalcemic, and most patients had stable or regressing disease at start of trial. No improvement in general performance or bone pain was detected as measured by a visual analogue scale, the daily duration of pain or consumption of analgetic drugs. Calcitonin had no effect on disease progression as judged by bone scans and radiographs. Calcitonin therapy did not affect serum calcium, alkaline phosphatase, bone gla-protein, or the urinary excretion of calcium and hydroxyproline. Serum phosphate and magnesium decreased significantly during calcitonin treatment (p = 0.01, and 0.00005, respectively). It was concluded that salmon calcitonin in this dosage has no discernible effect on skeletal pain, general performance, bone metabolism or disease progression in patients with breast cancer metastatic to bone. A significant decrease in serum phosphate and magnesium probably indicated an effect of calcitonin on the renal excretion of these ions.
Bone Neoplasms↗
Aminoglutethimide for advanced prostatic cancer resistant to conventional hormonal therapy.
Aminoglutethimide (AG) and hydrocortisone (HC) were given to 20 patients with advanced prostatic cancer resistant to conventional hormonal therapy. Most patients had painful bone metastases and were heavily pretreated. 12 of 16 patients required narcotic analgetics. 8 of 20 were bedridden. AG + HC produced relief of bone pain in 12 patients (75%) and only 4 required narcotics after treatment. The performance status improved in 8 of 20 patients (40%). However, the number of bone metastases seen in bone scans decreased in only 4 patients (22%). The level of serum alkaline phosphatase decreased in 11 of 18 patients and that of acid phosphatase in 8 of 16 patients. The reduction of bone pain lasted approximately 4 months (range 1-15 months). The median lifespan between the start of AG treatment and death was 8 months (range 2-22 months). There was no difference in survival between responders and nonresponders. 3 patients had skin rash, 1 lethargy and 1 thrombocytopenia.
Aged↗
Weekly low-dose doxorubicin with or without high-dose medroxyprogesterone acetate as secondary treatment in metastatic breast cancer--a randomized trial.
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Adult↗
Weekly low-dose doxorubicin as second line therapy in advanced breast cancer.
This is a retrospective analysis of women whose advanced breast cancer was treated with weekly low-dose doxorubicin (12 mg/m2) as second line therapy. The patients received doxorubicin as single agent therapy (group D, n = 47) or combined with various cytotoxic (group D+CT, n = 52) or with hormonal drugs (group D+ET, n = 37). Objective responses were found in 23% in group D, in 33% in group D+CT and in 30% in group D+ET. Mean response duration was 11 months in group D+CT and group D+ET and 6 months in group D (p = 0.007, Student's t-test). Median survival was 17 months in group D+CT and 9 months both in group D and group D+ET (p = 0.01, Mantel-Cox). The toxicity was mild. However, nausea occurred more often in group D+CT than in group D (p = 0.009, chi-square-test).
Adult↗
Campylobacter pylori in Swedish patients referred for gastroscopy.
Campylobacter pylori was isolated more often from patient with peptic ulcers and in an age-related manner in a material of 395 consecutive patients referred for gastroscopy. Direct microscopy was done with Gram and Acridine Orange stain and found too insensitive for practical use. All patients were investigated serologically with an enzyme immunoassay which showed excellent correlation with positive cultures for C. pylori. The findings were discussed, and the enzyme immunoassay, with a negative predictive value of 0.99, was found to be a valuable tool for primary screening of patients suspected of being carriers of C. pylori.
Adolescent↗
Clodronate for osteolytic metastases due to breast cancer.
Breast-cancer patients with multiple osteolytic bone metastases were treated with clodronate (Cl2MDP) 1.6 g/day (17 patients) or placebo (17 patients) for 12 months. Bone pain, extension of bone metastases and formation of new osteolytic foci were reduced by Cl2MDP, and development of severe hypercalcaemia was prevented. After withdrawal of treatment, the patients were followed up for at least 12 months. New bone metastases developed in both groups. There were, however, less fractures and less hypercalcaemia in the Cl2MDP than in the placebo group. The survival rate was higher in the Cl2MDP group than in the placebo group. No side-effects were observed in the Cl2MDP group.
Aged↗
The response evaluation of bone metastases in mammary carcinoma. The value of radiology, scintigraphy, and biochemical markers of bone metabolism.
The correlation between response of metastatic bone lysis and bone pain, various biochemical markers of bone metabolism, and radiological and scintigraphic findings was investigated in 49 women with breast cancer included in a calcitonin supportive therapy trial. All patients had dominant skeletal disease and were on stable systemic treatment (cytotoxic or hormonal) for a least 6 months before the first response evaluation. Bone pain correlated poorly with treatment response. Changes in sclerotic metastases did not show any apparent relation to changes in lytic lesions. A correlation between bone scans and lytic activity on radiographs was found. The absolute level of biochemical bone markers did not correlate with treatment response, but seemed instead to reflect the rate of bone turnover. The relative level of bone markers with respect to baseline showed better correlation to treatment response. The best conventional marker of disease activity was urinary hydroxyproline/creatinine. Propeptide of Type III procollagen (PIIINP), a novel marker reflecting collagen turnover, promises to be at least as sensitive as hydroxyproline. Stable and regressing patients had the same prognosis and significantly longer survival than progressors.
Biomarkers, Tumor↗
Multicentre evaluation of a direct coagglutination test for group A streptococci.
A coagglutination test for detection of group A streptococci in throat samples was evaluated in a multicentre study and found to be about 95% sensitive when applied to swabs taken from symptomatic patients which yielded more than 100 colonies per plate on culture. The sensitivity of the test dropped significantly when it was applied to swabs giving fewer than 100 colonies on culture. The specificity of the test was high regardless of colony count on conventional media.
Acute Disease↗
Cytogenetic investigations of patients on clodronate therapy for Paget's disease of bone.
In order to judge whether or not clodronate used for treatment of patients with Paget's disease of bone had an effect on the haematopoetic tissue, the frequency of chromosome/chromatid breaks in bone marrows and blood cells was evaluated. Seven patients were studied before treatment, after a few days of treatment and after greater than or equal to 2 months of treatment. Three additional patients were studied after exposure to clodronate for greater than or equal to 6 months. There was no significant increase in the occurrence of chromosomal aberrations induced by treatment. Thus no negative effect of clodronate on the haematopoetic tissue could be noted.
Aged↗
Treatment of skeletal disease in breast cancer: a controlled clodronate trial.
Normocalcaemic breast cancer patients with progressive osteolytic bone metastases were treated with clodronate 1.6 g/day (17) or placebo (17) for 12 months. Bone pain, extension of bone metastases and formation of new osteolytic foci were reduced by clodronate, and development of severe hypercalcaemia was prevented. After withdrawal of treatment the patients were followed-up for at at least 12 months. New bone metastases developed in both groups. There were, however, less fractures and less hypercalcaemia in the clodronate than in the placebo group. The survival rate was higher in the clodronate group than in the placebo group. No haematological toxicity was observed in the clodronate group.
Bone Neoplasms↗
Aminoglutethimide as second line therapy in advanced breast cancer.
Seventy-two women with advanced breast cancer were treated with aminoglutethimide and hydrocortisone (AG). All patients were previously treated with hormones and 59 patients had also received cytotoxic agents. A partial response to AG with a mean duration of 9 months (range: 4-26 months) was achieved in 24 patients (33%), 10 patients (14%) had stable disease, and 32 patients (44%) were progressing during AG therapy. Response to previous treatment seemed to be correlated to response to AG, as 47% of patients having responded to the first hormonal treatment also responded to AG, while only 16% of the progressors responded to AG. The number of previous treatments influenced neither the frequency nor duration of response to AG. The median survival after start of AG was 13 months, and 31% of the patients lived more than 2 years. Side-effects led to discontinuation of therapy in 9 patients (13%). Three patients developed reversible agranulocytosis.
Adult↗