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Biomedical subjects

C G Kardinal

Publications and source records attributed to C G Kardinal.

At least 55 records · Page 3Linked to original sources
PubMed1990

Two months of doxorubicin-cyclophosphamide with and without interval reinduction therapy compared with 6 months of cyclophosphamide, methotrexate, and fluorouracil in positive-node breast cancer patients with tamoxifen-nonresponsive tumors: results from the National Surgical Adjuvant Breast and Bowel Project B-15.

The National Surgical Adjuvant Breast and Bowel Project (NSABP) implemented protocol B-15 to compare 2 months of Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH) and cyclophosphamide (AC) with 6 months of conventional cyclophosphamide, methotrexate, and fluorouracil (CMF) in patients with breast cancer nonresponsive to tamoxifen (TAM, T). A second aim was to determine whether AC followed in 6 months by intravenous (IV) CMF was more effective than AC without reinduction therapy. Through 3 years of follow-up, findings from 2,194 patients indicate no significant difference in disease-free survival (DFS, P = .5), distant disease-free survival (DDFS, P = .5) or survival (S, P = .8) among the three groups. Since the outcome from AC and CMF was almost identical, the issue arises concerning which regimen is more appropriate for the treatment of breast cancer patients. AC seems preferable since, following total mastectomy, AC was completed on day 63 versus day 154 for conventional CMF; patients visited health professionals three times as often for conventional CMF as for AC; women on AC received therapy on each of 4 days versus on each of 84 days for conventional CMF; and nausea-control medication was given for about 84 days to conventional CMF patients versus for about 12 days to patients on AC. The difference in the amount of alopecia between the two treatment groups was less than anticipated. While alopecia was almost universally observed following AC therapy, 71% of the CMF patients also had hair loss and, in 41%, the loss was greater than 50%. This study and NSABP B-16, which evaluates the worth of AC therapy in TAM-responsive patients, indicate the merit of 2 months of AC therapy for all positive-node breast cancer patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Treatment of acute nonlymphocytic leukemia in the elderly with intermediate high-dose cytosine arabinoside.

Effective treatment of the elderly patients (greater than or equal to 65 years) with acute nonlymphocytic leukemia (ANLL) remains elusive and controversial. In the present study, single-agent Cytosine Arabinoside (ARA-C) was administered at an intermediate dose level (500 mg/m2 intravenously [I.V.] 1-hour infusion q12 hours for 12 doses) to 30 newly diagnosed and previously untreated patients. Complete remission was achieved in seven patients after the initial cycle of treatment, in two patients after retreatment, and in one patient after delayed recovery of his peripheral count over a 6-month period. The toxicity of this schedule was primarily hematologic, and the response rate was in keeping with that reported by other groups using aggressive multiagent regimens.

Age Factors↗
PubMed1988

Responses to chemotherapy or chemohormonal therapy in advanced breast cancer patients treated previously with adjuvant chemotherapy. A subset analysis of CALGB Study 8081.

The Cancer and Leukemia Group B (CALGB) evaluated the response to subsequent chemotherapy or chemohormonal therapy in 46 patients with advanced breast cancer treated previously with adjuvant chemotherapy that had been completed 6 months or more before protocol entry. The results were compared with 379 patients in the same study who had not received prior adjuvant chemotherapy. The patients were treated with cyclophosphamide, Adriamycin (Adria Laboratories, Columbus, OH), and 5-fluorouracil (CAF), with or without tamoxifen. There was no difference in response rate, response duration, time to treatment failure, or survival between patients who had received prior adjuvant chemotherapy and those who had not. The addition of tamoxifen to CAF failed to enhance response rates or response durations in all subgroups. Women who relapsed 6 months or more after completion of adjuvant chemotherapy did not have inherently drug-resistant tumors. They responded to standard CAF chemotherapy with the same response rate and survival as patients untreated previously with chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Chemohormonal therapy in advanced carcinoma of the breast: Cancer and Leukemia Group B protocol 8081.

In a prospective, randomized trial Cancer and Leukemia Group B (CALGB) evaluated CAF chemotherapy (cyclophosphamide + doxorubicin + 5-fluorouracil [5-FU]) v CAF plus tamoxifen (TCAF) in advanced breast cancer. Patients were stratified by estrogen receptor (ER) status, dominant site of metastatic disease, menopausal status, and prior adjuvant therapy. Regardless of ER status or menopausal status, the addition of tamoxifen conferred no significant advantage in response rate, response duration, time to treatment failure (TTF) or survival over CAF alone. A secondary objective was to compare the response to CAF of ER positive (ER+) and ER negative (ER-) patients to determine if there was a differential response to cytotoxic chemotherapy. Response rates of ER+ and ER- patients to CAF were identical (56%), but the response duration, time to treatment failure, and survival of ER+ patients were significantly longer than ER- patients. This lack of differential response implies that chemotherapy and hormonal therapy may compete for the same pool of ER+ cells. It also suggests that chemotherapy kills breast cancer cells indiscriminately, regardless of ER status.

Adult↗
PubMed1986

The antiemetic efficacy of secobarbital and chlorpromazine compared to metoclopramide, diphenhydramine, and dexamethasone. A randomized trial.

The efficacy of secobarbital sodium plus chlorpromazine (SC) in the prevention of cisplatin induced emesis was compared to the combination of metoclopramide, diphenhydramine, and dexamethasone (MDD). Twenty-three patients were entered onto protocol. Eighteen were evaluable. Good to excellent antiemetic prophylaxis was obtained in 72% with MDD versus 17% with SC (P less than 0.01). Sedation and anticholinergic side effects were more common with SC. Extrapyramidal reactions were more commonly seen with MDD. Significantly more patients preferred the combination of metoclopramide, diphenhydramine, and dexamethasone (P less than 0.05).

Adult↗
PubMed1985

Cancer chemotherapy. Historical aspects and future considerations.

Effective cancer chemotherapeutic agents were developed rapidly during the 1940s, 1950s, and 1960s. With recognition of the curability with chemotherapy of certain selected advanced cancers the emphasis of treatment has changed from a palliative to a curative mode. Several important biological advances, such as increased understanding of pharmacokinetics and the principles of combination chemotherapy, have strongly influenced the administration of chemotherapeutic agents. Other major conceptual changes, such as the recognition that regional lymph nodes are not effective barriers to tumor spread, have also had a major impact on the course of cancer treatment. The 1980s will be as productive as the preceding decades, but it is difficult at this time to determine if biologic response modifiers, monoclonal antibodies, differentiating agents, or some other as yet unrecognized therapy will be the major advance.

Alkylating Agents↗
PubMed1985

Chemotherapy with cyclophosphamide, adriamycin, and 5-fluorouracil compared to chemotherapy plus hormonal therapy with tamoxifen in the treatment of advanced breast cancer: an interim analysis.

Between February 1980 and August 1982, the Cancer and Leukemia Group B (CALGB) performed a randomized study aimed to compare chemotherapy with CAF (Cyclophosphamide, Adriamycin, 5-Fluorouracil) versus the same chemotherapeutic regimen plus tamoxifen (T-CAF) in stage IV breast cancer patients. Patients were stratified on the basis of menopausal status, estrogen receptors (ER) status, dominant site of metastasis and prior adjuvant treatment. Overall 474 patients were entered into the study of whom 433 were assessable for response. 314 patients were postmenopausal, 85 premenopausal and 34 patients were unknown as far menopausal status was concerned. No difference was evident among postmenopausal patients in overall response rate and duration of responses between T-CAF and CAF (52% vs 50% respectively). Similarly no difference was shown among premenopausal patients, response rates being 63% with T-CAF and 60% with CAF. Lack of benefit from adding T to chemotherapy was seen also according to the different strata, including patients with ER positive tumors. The failure for this combination to be synergistic might reflect an effect of T on tumor kinetics interfering with the activity of chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Chemoendocrine therapy vs chemotherapy alone for advanced breast cancer in postmenopausal women: preliminary report of a randomized study.

From January 1980 to August 1982 the Cancer and Leukemia Group B conducted a prospective randomized trial comparing chemoendocrine therapy with T-CAF (cyclophosphamide, adriamycin, and 5-fluorouracil plus tamoxifen) to CAF alone in postmenopausal women with advanced breast cancer. The patients were stratified by estrogen receptor (ER) status into three groups: ER-negative, ER-positive, ER-unknown. They were also stratified by dominant site of metastatic disease: visceral and other (osseous and/or soft tissue). A total of 246 eligible patients were enrolled in the study; 232 were evaluable and constitute the basis for this report. The study revealed that there was no difference in overall response frequency or response duration between T-CAF and CAF; there was no difference in response between T-CAF and CAF in ER-positive or in ER-negative patients; and there was no difference in response between T-CAF and CAF by dominant site of metastatic disease. The expected advantage of T-CAF over CAF, especially for ER-positive patients, was not observed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Lactic acidosis in lung cancer.

Because the liver is the dominant site of lactate clearance and utilization, extensive liver metastases may predispose the patient to the development of lactic acidosis. We have described two patients with hepatic metastatic disease who had fatal lactic acidosis. Greater awareness and prompt treatment of this frequently fatal complication may improve survival of patients with potentially treatable advanced malignancies.

Acidosis↗
PubMed1981

Pleural effusion in breast carcinoma: analysis of 122 cases.

One-hundred-twenty-two patients with breast carcinoma and pleural effusion were analyzed for the laterality of effusion and survival. Ipsilateral effusion occurred in 83% of the patients. The median survival of these patients was six months after the onset of effusion. Systemic therapy is recommended even in the absence of other evidence of metastases.

Adult↗
PubMed1981

Inflammatory carcinoma of the breast: therapeutic perspective.

The management of inflammatory carcinoma of the breast remains a therapeutic dilemma because of two basic conceptual problems: local control and systemic micrometastatic disease. Appropriate management requires a multidisciplinary approach involving radiation therapy, surgery, and medical oncology.

Antineoplastic Agents↗
PubMed1980

Second cancers after prolonged adjuvant thiotepa for operable carcinoma of the breast.

From 1963--1972, women treated with radical mastectomy for early cancer of the breast were randomly assigned to treatment with thiotepa weekly for one year (N = 90) or no further therapy (N = 77). Fifteen patients subsequently developed second cancers, six in the thiotepa-treated group, and nine in the concurrent control group. These data are compared to the incidence of second primaries in the other prospective randomized trials of adjuvant chemotherapy for breast cancer. To date there is no greater incidence of second primary malignancies in breast cancer patients treated with adjuvant chemotherapy than in those who are treated with surgery alone. The long-term results of the study were reviewed. There was no difference in survival between the thiotepa-treated patients and the control group. However, of 13 negative node patients less than 55 years old who were treated with adjuvant thiotepa, 12 remain alive and free of disease.

Breast Neoplasms↗
PubMed1979

Adriamycin and cis-dichlorodiammineplatinum in nonresectable and metastatic carcinoma of the lung.

The combination of adriamycin and cis-dichlorodiammineplatinum (DDP) was evaluated in 20 patients with nonresectable and metastatic carcinoma of the lung. Both drugs were administered at a dosage of 60 mg/m2 intravenously every 3 weeks. The overall objective response rate was 40% (eight of 20 patients) with two complete responses (CR) and six partial responses (PR). Four of eight patients with small cell carcinoma responded (1 CR and 3 PR) and four of 12 patients with nonsmall cell carcinoma responded (1 CR and 3 PR). The median duration of response was greater than 36 weeks. The median survival of responders was 54 weeks. Nausea and vomiting were major side effects but rarely lasted longer than 2 days. Renal and bone marrow toxicities were generally minimal and controlled by dosage reduction. However, there was one death secondary to severe myelosuppression.

Adenocarcinoma↗
PubMed1979

Cancer of the breast. Endocrine and hormonal therapy.

Additive hormonal therapy remains the treatment of choice for disseminated breast cancer in postmenopausal women. Patients with hormone-dependent tumors receive excellent and long-lasting palliation from alterations in the hormonal milieu. Now that hormone receptor assays are clinically available, responses can be accuratedly predicted in a large percentage of cases. Tables 11--6 is a summary of additive hormonal therapy in postmenopausal patients. Endocrine ablative therapy remains of primary importance in premenopausal women because of the superior results, but androgens or antiestrogens may be helpful when patients are not surgical candidates. Castration continues to be the initial approach, with adrenalectomy or hypophysectomy reserved for promising candidates. In postmenopausal women the initial choice is estrogens. The exceptions are those patients with metastases limited to bone, when androgens excel because of an equivalent objective response and superior subjective and metabolic effects. Patients who respond to estrogens and then progress are observed for a rebound regression following the discontinuation of estrogen therapy. Whereas some who do not respond to androgens will respond to estrogens, the converse does not appear to be true (Kennedy, 1974). Currently progestins are the secondary hormonal agent of choice in postmenopausal women, but they may be displaced by antiestrogens as more data become available. In general, if a patient's tumor lacks estrogen receptors or the patient fails to respond to an adequate trial of endocrine or hormonal therapy, one should proceed directly to cytotoxic chemotherapy. A suggested plan for the integration of endocrine with hormonal therapy and both with other forms of palliation is diagrammed at the end of Chapter 12.

Adrenal Cortex Hormones↗