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Biomedical subjects

E Frei

Publications and source records attributed to E Frei.

At least 271 records · Page 15Linked to original sources
PubMed1981

Improved survival for patients with advanced carcinoma of the head and neck treated with methotrexate-leucovorin prior to definitive radiotherapy or surgery.

Patients presenting with Stage III-IV squamous carcinoma of the head and neck often relapse following aggressive surgery and/or radiotherapy. In an attempt to increase survival in this high risk group of patients, HD-MTX, 3 gm./m2/dose, given weekly, was administered to 21 inoperable patients with Stage III/IV squamous carcinoma of head and neck prior to, and for 1 month after, definitive surgery and/or radiotherapy. Six of 11 patients (55%) who showed a significant response (greater than 50% reduction in tumor volume) to HD-MTX are alive and free of tumor greater than 38 months following treatment (p = 0.6) (Fisher Exact Test). Responder median survival is greater than 38 months while non-responder median survival is 15 months (p = .02) (Log Rank Test). For the entire treatment group, at a mean duration of 44.2 months following initiation of therapy, 7 patients (33%) remain alive and free of tumor. Patients responding to induction MTX-LCV more often become eligible for combined modality approach than did the non-responder group. This "downstaging" of the tumor prior to aggressive surgery or radiotherapy may be responsible for the increased survival rate seen in those patients who responded to MTX-LCV.

Carcinoma, Squamous Cell↗
PubMed1981

Methotrexate as a single agent and in combination chemotherapy for the treatment of non-Hodgkin's lymphoma of unfavorable histology.

High-dose methotrexate (HDMTX) with citrovorum factor (CF) was used to treat non-Hodgkin's lymphomas either as a single agent in those patients who had previously failed to respond to conventional chemotherapy or in previously untreated patients in combination with bleomycin, Adriamycin, cytoxan, and vincristine. Twenty-five patients who had been previously treated and were refractory to cytotoxic chemotherapy were treated with HDMTX ranging between 1 and 7.5 g/m2 as an iv infusion over 20 to 40 minutes. CF rescue was begun at 24 hours and was maintained orally every 6 hours at 10 mg/m2 for a total of 72 hours. In instances where the 24-hour serum level of MTX was in excess of 1 X 10(-7) M, the dose of CF was increased to 100 mg/m2 every 3 hours until the serum MTX level fell into the appropriate range. Of the 25 patients, 13 (52%) responded. Response duration was brief, lasting a median of 2 months. Three patients had prolonged control lasting 13, 16, and 21 months respectively. Five of the six patients with central nervous system (CNS) involvement have demonstrated marked clearing of spinal fluid abnormalities and reversion of brain scans toward normal. Fifty-four previously untreated patients with diffuse histiocytic or undifferentiated lymphoma have been treated with combination chemotherapy including MTX given at the level of 3 g/m2 on day 14 of a cycle. Bleomycin, Adriamycin, cyclophosphamide, and vincristine are given on Day 1 of the cycle. Dexamethasone 6 mg/m2 is given orally on Days 1 through 5. The cycle is repeated on Day 21, and patients are treated with 10 such cycles for a total of 30 weeks. Of our 42 patients who are evaluable for response and who have completed chemotherapy, 33 (78%) achieved a complete remission (CR). A total of seven patients have relapsed. Only one patient in the CR group has relapsed in the CNS after the cessation of chemotherapy.

Adult↗
PubMed1981

High-dose methotrexate in osteogenic sarcoma adjuvant chemotherapy and limb salvage results.

This communication provides a description and update of the three adjuvant regimens utilized at the Sidney Farber Cancer Institute. The disease-free survivals are: Study I--42% at 4 years; Study II--58% at 3 years; and Study III--currently 78%. In the limb salvage experience, among the evaluable patients, 6 of 12 treated with preoperative chemotherapy are disease free (median 32 months) and 12 of 14 (86%) treated without preoperative chemotherapy are disease free (median 13 months).

Amputation, Surgical↗
PubMed1981

High-dose methotrexate in osteogenic sarcoma.

From 1972 to 1979, high-dose methotrexate (HDMTX) and 3 adjuvant regimens were used at the Sidney Farber Cancer Institute and Children's Hospital Medical Center. In the first regiment, HDMTX was used alone; the second, HDMTX and adriamycin, and the third, weekly courses of HDMTX and combination. Actuarial disease-free survival achieved with these regimens in patient with local control of the primary lesion varied from 42 to 75% at 3 years. This compared favorably with historical control patients, of whom 50% were free of disease at 6 months and only 20% at 12 months. Among 41 patients with established pulmonary metastases, 14 were alive and free of disease from more than 4 to over 60 months. The most efficacious method of administering HDMTX was a weekly schedule which produced an overall response rate of 48% in the treatment of pulmonary metastases and primary tumor in patients previously not exposed to HDMTX. Urinary alkalinization was not a standard procedure, and investigations failed to demonstrate any significant effect of alkalinization on HDMTX pharmacokinetics.

Antineoplastic Agents↗
PubMed1981

Prolonged disease-free survival in advanced breast cancer treated with "super-CMF" adriamycin: an alternating regimen employing high-dose methotrexate with citrovorum factor rescue.

Sixty-six patients were treated with the combination "super-CMF" as follows: cyclophosphamide 100 mg/m2 po days 2 through 14; methotrexate 3.0 g/m2 iv days 1 and 8; 5-fluorouracil 600 m g/m2 iv days 1 and 8; citrovorum factor rescue 10 mg/m2 iv days 2 and 9 and po days 2 through 4 and 9 through 11; and Adriamycin 70 to 90 mg/m2 iv day 29. This cycle was repeated at 49-day intervals. The single-agent activity of high-dose methotrexate with rescue was first evaluated in breast cancer patients in a truncated phase II study; 3 of 19 had a partial response (greater than 50% regression of measurable lesions) after 2 to 6 weekly courses and another 6 to 19 had some objective evidence of response (greater than 25%, less than 50%). The response rate to the combination "super-CMF" was: complete response (CR) 15 of 55 evaluable patients (27%) and partial response (PR) 28 of 55 (51%). The median duration of response was 24.5 months and the median time to treatment failure was 21.6 months. Nineteen of these patients have completed 12 to 18 months of drug treatment and have been followed in continuing remission for 1 to 28 months without further therapy. The total response rate and the CR rate achieved with this regimen are substantial, and the durability of the responses appears to be considerably greater than that obtained with other drug combinations.

Adult↗
PubMed1980

Successful treatment of metastatic sarcomas with cyclophosphamide, adriamycin, and DTIC (CAD).

Fifty consecutive adults with sarcoma were treated with Adriamycin (45 mg/m2) on day 1, cyclophosphamide (500 mg/m2) on day 2, and DTIC (400 mg/m2) on days 1 and 2 (CAD). Of the 23 patients with measurable metastatic disease, 4 patients (17%) had a complete response, 9 patients (39%) had a partial response, 5 patients (22%) had stabilization, but 5 patients (22%) did not respond. The actuarial survival of complete and partial responders was 31.5 months compared to 5.5 months for non-responders (P < .005). Chemotherapy doses were escalated to a median lowest white count of 700 cells/mm3. Acute gastrointestinal toxicity and alopecia occurred in all patients. CAD differed from previously reported combinations by omission of vincristine, a two-day dose schedule and dose rate intensification. CAD is recommended for patients with metastatic sarcoma.

Adult↗
PubMed1980

Treatment of acute myelogenous leukemia in children and adults.

We designed a protocol to address the problem of relapse from complete remission in acute myelogenous leukemia. Patients in remission were treated for 14 months; early and later intensification of chemotherapy, sequential drug combinations, and high-dose continuous infusions of cytarabine were included. Eighty-three consecutive patients under 50 years of age were entered into this study from February 1976 to October 1979. The rate of complete remission is 70 per cent. A Kaplan-Meier analysis predicts that 49 +/- 17 per cent of patients (mean +/- 2 S.D.) who entered complete remission will remain free of disease at two years. Durations of complete remission for patients in the 0 to 17-year and 18 to 50-year age groups are comparable.

Adolescent↗
PubMed1980

Combination chemotherapy with adriamycin-cyclophosphamide for advanced ovarian carcinoma.

Combination chemotherapy with Adriamycin-cyclophosphamide was employed after surgical treatment in 60 women with Stage III-IV ovarian adenocarcinoma. Of 53 evaluable patients, objective response was noted in 34 of 41 (83%) without prior cytotoxic therapy but in only two of 12 (17%) who had failed a single alkylating agent or radiotherapy (P < .005). Complete response was confirmed by a negative biopsy at the site(s) of prior disease in 12 patients. Eleven of the 12 biopsy-confirmed complete responses were achieved in patients without pretreatment palpable tumor. Twenty-four out of 41 patients with palpable masses responded but only one was confirmed as complete. Confirmed complete responses had a median duration of 24 months, whereas the median duration of all other responses was only seven months. The median survival for patients in whom Adriamycin-cyclophosphamide was the initial chemotherapy was 24 months. The median survival in patients with palpable tumor exceeds that of historical controls matched for age, tumor cell type, and grade (P = .05); the median survival for the confirmed complete responders has not been reached. The toxicity of this regimen was acceptable at doses of Adriamycin and cyclophosphamide of 45 mg and 500 mg/M2 body surface area, respectively. Extensive excision of tumor followed by effective combination chemotherapy offers the best current approach toward improved patient survival in advanced ovarian cancer.

Adenocarcinoma↗
PubMed1980

Comparison of three methods of central-nervous-system prophylaxis in childhood acute lymphoblastic leukaemia.

A retrospective comparison was made of three methods of central-nervous-system prophylaxis in childhood acute lymphoblastic leukaemia; (1) intrathecal methotrexate only; (2) intermediate-dose methotrexate infusion and intrathecal methotrexate and, (3) 2400 rads cranial irradiation and intrathecal methotrexate. The incidence of primary meningeal relapse was statistically significantly lower in both standard-risk patients (age grear than 24 months and less than or equal to 120 months white-cell count less than 20,000) and increased-risk patients (age less than or equal to 24 months or greater than 120 months and/or white-cell count greater than 20,000) whose central-nervous-system prophylaxis included cranial irradiation. The disease-free and overall survival of irradiated increased-risk patients was significantly better than that of unirradiated increased-risk patients. The disease-free survival of standard-risk patients who received intermediate-dose methotrexate was statistically superior to that of the remaining standard-risk patients. There were no significant differences in overall survival between the three groups of standard-risk patients.

Adolescent↗