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Biomedical subjects

E Quoix

Publications and source records attributed to E Quoix.

At least 91 records · Page 5Linked to original sources
PubMed1994

An ongoing randomized study of neoadjuvant chemotherapy in resectable non-small cell lung cancer.

The purpose of this trial is to assess the possible benefit of neoadjuvant chemotherapy before surgery in patients with operable non-small cell lung cancer. Patients with operable stages I (except T 1N0), II, or IIIA disease are eligible for this ongoing trial. Patients are randomized into two arms. Surgery is performed first in group I; patients found to have T3 tumors or N2 lymph nodes are given postoperative radiotherapy. Group 2 patients start with two cycles of chemotherapy; following surgery, two more cycles are administered in responder patients and, as in group I, patients with T3 tumors or N2 lymph nodes are given radiotherapy. Chemotherapy is the MIP protocol: mitomycin 6 mg/m2 day I, ifosfamide 1.5 g/m2 days 1 to 3, cisplatin 30 mg/m2 days I to 3, and mesna 1,200 mg/m2 days 1 to 3. One hundred fifty patients were enrolled between June 1991 and September 1993. By the time this report was prepared, 117 patients had completed all assigned treatment, 63 in group I and 54 in group 2. There were two ineligible patients, one in each group. Forty-nine patients underwent thoracotomy in the chemotherapy-surgery group and 62 in the surgery-only group. There was only one progression after two cycles of chemotherapy. Rates of exploratory and incomplete surgery were 17% in group I and 12% in group 2. The trial is ongoing.

Adult↗
PubMed1993

Polychemotherapy in advanced non small cell lung cancer: a meta-analysis.

We did a meta-analysis of all published polychemotherapy vs supportive care clinical trials in patients with non-resectable non small cell lung cancer. 7 studies with more than 700 patients were selected. We used the number of deaths at 3, 6, 9, 12, and 18 months as the endpoints because we were unable to obtain all the individual data. Our analysis showed a reduction in mortality during the first 6 months with polychemotherapy. Although small, this increase in survival, together with an improved quality of life, suggests that polychemotherapy should be recommended for patients with non-resectable non small cell lung cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Pulmonary distribution of vinorelbine in patients with non-small-cell lung cancer.

Vinorelbine (Navelbine, NVB) is a new semi-synthetic vinca alkaloid that is currently used in the treatment of advanced breast cancer and advanced non-small-cell lung cancer (NSCLC). In this study we investigated the tumoral and healthy pulmonary tissue concentrations of NVB in previously untreated NSCLC patients undergoing surgery. A total of 13 patients (mean age, 60 years; range, 42-70 years) were included and received NVB (20 mg/m2) at 1 h (mean, 1.1 h; SD, 0.2 h; n = 6 patients) and 3 h (mean, 3.0 h; SD, 0.6 h; n = 7 patients) before tumor resection. A tumoral and adjacent healthy lung-tissue specimen as well as simultaneously sampled serum were analyzed for NVB by high-performance liquid chromatography (HPLC). NVB levels were much higher in tissue than in serum (up to 300-fold). The tissue/serum ratio increased between the 1-h sampling time (range, 0.1-100) and the 3-h time point (range, 10-300). In all patients but two, NVB concentrations were lower in tumors than in healthy lung tissue. The tumor/healthy tissue ratio ranged from 0.06 to 1.3 (median, 0.09) at 1 h and from 0.18 to 1.1 (median, 0.55) at 3 h. This ratio increased between the 1-h sampling time and the 3-h time point as a consequence of increasing tumor levels (median, 50.4 ng/g at 1 h and 278 ng/g at 3 h). In four patients, concentrations could be measured in necrotic and peripheral tumor zones, showing lower values in necrotic areas. Thus, these data indicate that NVB is highly distributed in lung tissue, with the disposition rate being slower in tumor tissue than in healthy parenchyma during the first 3 h.

Adult↗
PubMed1993

Can we predict very short term survival in small cell lung cancer?

We retrospectively reviewed the charts of 151 consecutive patients diagnosed as small cell lung cancer in our department and who had at least one course of chemotherapy. Nineteen patients died during the first 2 months, of the probability were reported to construct a receiver operating characteristic curve i.e. 13% of the population. The probability of dying within 2 months was investigated through a stepwise logistic regression. A performance status < or = 70 (Karnofsky index), an age > 60, a platelet count < or = 150,000/mm3, elevated alkaline phosphatase and a sodium < or = 135 mmol/l were independent predictors of a very short term survival and contributed to the equation for the probability of dying within a 2-month period. Sensitivity and specificity for various cutoff points characteristic curve allowing one to determine for a given patient his risk of being a very short term survivor. Such an approach could prevent inclusion of patients with high risk of early death in clinical trials and help to choose appropriate treatments for such poor risk patients.

Aged↗
PubMed1993

Inability of serum neuron-specific enolase to predict disease extent in small cell lung cancer.

Serum neuron-specific enolase (NSE) levels were measured before treatment in 112 patients diagnosed as having small cell lung cancer in our department. All these patients underwent exhaustive staging procedures: 53 had limited disease (LD) and 59 extensive disease (ED). Serum NSE was elevated in 83% of the patients (i.e. 71% of the patients with LD and 93% of the patients with ED). Mean values of NSE differed significantly according to disease extent. A receiver-operating characteristic curve was constructed with different cut-off levels of serum NSE in order to determine the accuracy of NSE for identifying ED. There was no level of NSE capable of predicting with sufficient accuracy the presence of ED. The best compromise was given by a threshold of 35 micrograms/l: 60% of the ED patients had a serum NSE above 35 micrograms/l but 30% of the LD patients also had a serum NSE above 35 micrograms/l.

Adult↗
PubMed1993

Mite allergen content in mattress dust of Dermatophagoides-allergic asthmatics/rhinitics and matched controls.

It has been suggested that the mites Dermatophagoides pteronyssinus and D. farinae are important indoor environmental factors facilitating both the sensitization of atopic subjects and asthmatic attacks of house dust-sensitive patients. Contradictory results have been reported about the current exposure to mites or their allergens among patients and control groups of atopic or non-atopic subjects. In order to determine whether there is a difference in mite exposure levels between D. pteronyssinus-sensitized asthmatics and/or rhinitis and control subjects we considered a case-control study of 70 patients with asthma and/or rhinitis and positive skin test reactions to D. pteronyssinus and twice as many control subjects who were matched as to age and sex. The first control subject for each patient was an immediate neighbour of the patient and the second was patient arbitrarily chosen among hospitalized patients. Mite allergen exposure was measured in mattress dust collected under standardized conditions, by measuring Der p I+Der fI content and by performing a semiquantitative guanine determination (Acarex-test). The content of Der p I and Der fI was very high both in the homes of patients and those of healthy individuals: 69% of the total samples contained more than 10 micrograms Der pI+Der fI/g of dust. There was no significant difference between cases and controls with respect to Der p I, Der fI, Der p I+Der fI content and Acare class distributions. The calculated odds-ratios associated with the Acarex test and the mite allergens did not differ significantly from the level 1.0.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Prediction of mite allergen levels by guanine measurements in house-dust samples.

We studied the sensitivity and specificity of guanine environmental tests in the evaluation of the two mite allergen levels, i.e. 2 micrograms/g and 10 micrograms/g of Der p I and Der f I, considered to be risk factors for sensitization or for the development of acute asthma. We examined 239 house-dust samples for Der p I and Der f I levels (ELISA) and guanine contents (semiquantitative guanine test and quantitative assays). All house-dust samples with class 2 or 3 guanine tests contained more than 2 micrograms/g of Der p I and Der f I. The probability that house-dust samples of class 2 contained more than 10 micrograms/g of mite allergens was 88%; it was 100% for house-dust samples of class 3. The probability that a house-dust sample of class 0 contained less than 2 micrograms/g of mite allergen was 87%. For each level of mite allergen, a ROC curve was constructed with the true positive rates and the false positive rates calculated by different cutoffs of guanine concentration. The cutoff point which gave the best compromise between sensitivity (76%) and specificity (89%) was 2100 micrograms/g for the threshold of 2 micrograms/g of Der p I and Der f I. For detection of a mite allergen > 10 micrograms, a guanine content of 3000 micrograms/g gave the best compromise between sensitivity (86%) and specificity (93%). In conclusion, the guanine test represents a satisfactory environmental test, inexpensive and simple, for predicting mite allergen levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Pharmacokinetic profile of vinorelbine, a new semi-synthetic vinca alkaloid, determined by high-performance liquid chromatography.

1. Vinorelbine (NVB), a new semi-synthetic vinca alkaloid, is currently used in the treatment of advanced non-small-cell lung cancer (NSCLC) and advanced breast cancer. The pharmacokinetic profile of NVB has been redefined with a specific h.p.l.c. method which measures NVB and desacetyl-NVB. 2. In man, the pharmacokinetics of NVB are best characterized by a three-compartment model with a terminal half-life of 42 h and a large volume of distribution (75 l/kg). The total clearance was 1.26 lh-1 kg-1 and about 11% of the dose was eliminated by the kidneys. Desacetyl-NVB was a minor urinary metabolite. 3. Human pulmonary distribution study showed higher levels of NVB in lung tissue than in serum during the first 3 h after NVB injection; the tumour concentrations were lower than those determined in healthy parenchyma. 4. In the micropig, the 0-48 h biliary excretion of unchanged drug accounted for 25% dose with 21.5% being eliminated during the first 8 h. Desacetyl-NVB concentrations were low and inconsistent. 5. Preliminary results show a better response rate with the combination of cisplatin and NVB than that obtained with NVB alone in the treatment of advanced NSCLC. This increased activity is not the result of a pharmacokinetic interaction since it was shown that cisplatin did not alter the kinetic profile of NVB. 6. This is the first pharmacokinetic investigation of unlabelled vinca alkaloids by a h.p.l.c. procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

[Multiple complications of a mycoplasma pneumoniae infection].

We report the case of a patient who was admitted to hospital for a pneumonia in association with a Stevens-Johnson syndrome. The association of these conditions suggested a Mycoplasma pneumoniae infection, which was confirmed on serology. There were three other extra-respiratory complications discovered: cold agglutinins, a disturbance of liver function tests, and circulating anticoagulant; both the two latter and the Stevens-Johnson syndrome are rare complications.

Anemia, Hemolytic, Autoimmune↗
PubMed1993

[Pre-therapeutic prognostic factors of survival in small cell bronchial cancer. Retrospective study in a series of 112 patients].

Pretherapeutic prognostic factors were studied retrospectively in 112 consecutive patients diagnosed as small cell lung cancer between January 1st 1986 and December 30th 1990 in our department. Mean age of the population was 59.3, 89.3% were males. Median survival time of the whole population is 11.66 months. It is 15.3 months for the 48 patients with limited disease stage and 9.74 months for 64 patients with extensive disease stage. Among the patients with limited disease stage, those with supraclavicular lymph nodes had a significantly shorter survival (p < 0.001). Univariate analysis of survival identified age, performances status, weight loss, T, N, bone and liver involvement, serum sodium, albumin and sedimentation rate as prognostic factors. The final model in multivariate analysis of survival includes for the patients with performance status < or = 70, extent of disease as an independent prognostic factor and for the patients with performance status < 70, extent of disease, serum sodium and albumin.

Adult↗
PubMed1992

Comparison of two carboplatin-containing regimens with standard chemotherapy for small cell lung cancer in a randomised phase II study. The EORTC Lung Cancer Cooperative group.

The EORTC Lung Cancer Cooperative group performed a randomised phase II study in patients with small cell lung cancer comparing the standard cyclophosphamide/doxorubicin/etoposide (CDE) regimen with two regimens containing the new and active cisplatin derivative, carboplatin, 400 mg/m2 in combination with ifosfamide, a drug without important myelotoxicity, at a dose of 5 g/m2 (IMP) or the non-myelotoxic drug vincristine twice 2 mg (VP). Of 178 evaluable patients, 63 received CDE [30 limited disease (LD), 33 extensive disease (ED)], 55 received IMP (22 LD, 33 ED) and 60 (26 LD, 34 ED) were treated with VP. The response duration was not statistically different: CDE 31 weeks, IMP 29 weeks and VP 21 weeks. The time to progression after CEE was 28 weeks, IMP 24 weeks and VP 17 weeks. This was significantly shorter after VP than after CDE (P = 0.017). The 60% response rate of the VP combination was low compared with CDE (83%) and IMP (77%). Toxicity of all three regimens was acceptable, and dose reduction for myelosuppression was necessary in only a minority of the patients. We conclude from this study that the combination of carboplatin, at the maximally tolerated dose of 400 mg/m2, in combination with ifosfamide 5 g/m2, is an active regimen with efficacy comparable with the standard CDE regimen.

Adult↗
PubMed1992

Extensive small-cell lung cancer. A randomized comparison of two chemotherapy programs with early crossover in instances of failure. Association pour le Traitement des Tumeurs Intra-Thoraciques (ATTIT).

Two chemotherapy regimens for patients with extensive small-cell lung cancer were prospectively compared in a randomized multicentric trial with crossover. Every four weeks, 60 consecutive previously untreated patients received either DPE (doxorubicin, cisplatin and etoposide), or CIV (carboplatin, ifosfamide and vincristine) with crossover as soon as progression or end of response were observed. Pretreatment characteristics were similar in the two groups. Fifty-seven patients were evaluated for response. The response rate was higher with the DPE regimen both in first-line (for DPE: response rate 62% (18/29), including 17% (5/29) of complete response (CR), and for CIV: response rate 29% (8/28) with no CR, p < 0.02) and in second-line after crossover (for DPE: response rate 45% (9/20) including 5% (1/20) of CR, and for CIV response rate 0%, p < 0.02). Major toxicities were equally frequent in both groups. No significant difference was found between median survival times (9.7 months for the DPE group and 10.4 months for the CIV group). We conclude that: 1) DPE is a more active regimen than CIV, both in first- and second-line; 2) no alternating scheme may be considered with these two combinations. Of particular note is the similar median survival times in the two groups, contrasting with the different activities of the two regimens.

Adult↗
PubMed1992

Clinical pharmacokinetics of vinorelbine alone and combined with cisplatin.

Vinorelbine (NVB) is a new anticancer drug belonging to the vinca alkaloid family that shows activity as a single-agent treatment in advanced non-small cell lung cancer (NSCLC). Preliminary results show a better response rate with a combination of cisplatin (CDDP) and NVB than with NVB alone. To assess whether this increased activity is secondary to a pharmacokinetic interaction, the authors compared the pharmacokinetic profiles of NVB alone and combined with CDDP in previously untreated inoperable NSCLC patients. Five patients received NVB (30 mg/m2) by short intravenous infusion, and four patients received CDDP (80 mg/m2) 1 hour after the NVB infusion (30 mg/m2). Serum NVB was assayed using a specific high-performance liquid chromatography method. The mean serum concentrations in both groups were similar. In addition, the areas under the curve calculated from 1 hour (beginning of CDDP administration) to 72 hours were 414 ng.hour/mL (standard deviation [SD]: 94) (group NVB alone) and 407.1 ng.hour/mL (SD: 32.9) (group NVB + CDDP). In conclusion, the increased activity observed with the combination NVB + CDDP is not the result of a pharmacokinetic interaction.

Adult↗
PubMed1991

Pharmacokinetic and preliminary metabolic fate of navelbine in humans as determined by high performance liquid chromatography.

The pharmacokinetics and metabolism of Navelbine (NVB) were investigated in 20 patients by a specific high performance liquid chromatographic methodology allowing the monitoring of NVB, deacetyl-NVB, and N-oxide NVB. After the i.v. (15 min) administration of 30 mg/m2 of drug, blood and urine samples were collected for, respectively, 144 and 48 h. NVB is characterized by a three compartmental kinetics, with a Cmax of 1130 +/- 139 (SEM) ng/ml. The total body clearance and apparent volume of distribution, as defined by high performance liquid chromatography, are 1.26 +/- 0.09 liter/h/kg (48.6 +/- 4.1 liters/h/m2) and 75.6 +/- 9.2 liters/kg (2918.4 +/- 307.2 liters/m2). No metabolite could be detected in serum; the urinary excretion of NVB represented 11% of the administered dose. Deacetyl-NVB could be identified as a minor urinary metabolite when no N-oxide NVB appeared in the urine samples. Two additional peaks appeared in most of urinary chromatograms as trace amounts. Thus, the major pathway of NVB, as for other Vinca alkaloids, should be hepatic clearance, as biliary elimination and/or hepatic biotransformation.

Adult↗