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Biomedical subjects

F A Greco

Publications and source records attributed to F A Greco.

At least 199 records · Page 11Linked to original sources
PubMed1986

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in small-cell lung cancer.

Review of clinical data from 350 patients with small-cell lung cancer (SCLC) revealed hyponatremia (sodium less than 130 mEq/L) attributable to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in 40 patients (11%). Although hyponatremia was severe in most instances (median, sodium 117 mEq/L), symptoms attributable to water intoxication were identified in only 27% of hyponatremic episodes. Development of SIADH showed no correlation with clinical stage, distribution of metastatic sites, sex, or histologic subtype of small-cell carcinoma. SIADH occurred most often with initial presentation (33 of 40), and resolved promptly (less than 3 weeks) with initiation of combination chemotherapy in 80% of evaluable patients. The presence of SIADH did not influence response to chemotherapy or overall survival as an independent variable. However, in five patients profound hyponatremia developed immediately following primary cytotoxic therapy (range, one to five days). Despite initial control of SIADH, dilutional hyponatremia recurred in 70% of patients with tumor progression. Our findings suggest that development of clinically demonstrable SIADH in patients with SCLC is dependent on functional properties of the neoplastic cells, rather than tumor burden or metastatic site. The potential for development of clinically significant hyponatremia early in the course of cytotoxic therapy emphasizes the need to closely monitor patients, particularly those receiving chemotherapy regimens requiring substantial intravenous hydration.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Advanced poorly differentiated carcinoma of unknown primary site: recognition of a treatable syndrome.

We describe the clinical characteristics and prognostic features of 71 patients with advanced poorly differentiated carcinoma of unknown primary site. These patients had at least one component of the extragonadal germ cell cancer syndrome that we have previously described. Of 68 patients who received therapy, 62 were given intensive cisplatin-based combination chemotherapy that is used for treatment of germinal neoplasms. Fifteen patients (22%) had complete responses, and 9 patients (13%) have remained free of tumor after a minimum follow-up of 36 months (range, 36 to 67 months). Tumor in the mediastinum, retroperitoneum, and lymph nodes was associated with a favorable outcome of treatment when compared with tumor in other locations (p = 0.0016, Cox regression analysis). Although the histogenesis of tumors in many of these patients remains unclear, we believe the tumors most likely originate from germ cells. Patients with advanced poorly differentiated carcinoma should be considered for treatment with cisplatin-based combination chemotherapy, particularly if tumors occur predominantly in the mediastinum, retroperitoneum, or lymph nodes.

Actuarial Analysis↗
PubMed1986

Acute vascular ischemic events after cisplatin-based combination chemotherapy for germ-cell tumors of the testis.

Four patients with germ-cell tumors of the testis had acute vascular ischemic events after treatment with cisplatin-based combination chemotherapy. Two patients had myocardial infarctions and two others cerebrovascular accidents. All patients were less than 30 years old and had no significant risk factors for atherosclerotic cardiovascular disease. Angiographic studies done in three patients showed no endovascular abnormalities. Raynaud's phenomenon preceded acute myocardial infarction in one patient with angiographic evidence of ergonovine-induced coronary artery spasm. We suggest that major arterial occlusive events may occur as a result of treatment with cisplatin-based combination chemotherapy.

Adult↗
PubMed1986

Rationale for chemotherapy for patients with advanced non-small-cell lung cancer.

Patients with advanced non-small-cell lung cancer (NSCLC) are difficult to treat effectively. There is a strong rationale to continue clinical investigation, since this approach has been useful for other groups of patients with "resistant" tumors. This report reviews the major reasons to consider chemotherapy in these patients, and discusses several other important auxiliary issues.

Carcinoma, Non-Small-Cell Lung↗
PubMed1986

Randomized dose-response evaluation of etoposide in small cell carcinoma of the lung: a Southeastern Cancer Study Group Trial.

To evaluate postulated dose-response relationships of etoposide (VP-16) for patients with recurrent small cell carcinoma of the lung, a prospectively randomized study was undertaken. VP-16 was administered iv at three dose levels: 300, 600, and 900 mg/m2. Based on historical information, a 20% response rate was anticipated in the standard-dose level and the study was designed to be able to detect a response rate of 40% in either of the high-dose levels. The planned number of patients required in each arm was 45, with an alpha-level of 0.1 and a beta-level of 0.2. The total number of patients actually entered was less than the planned number due to a low response rate. Seventy-seven of 79 treated patients were eligible, and 26, 27, and 26 patients were treated at each dose level, respectively. Toxicity was predominantly hematologic, with the higher dose levels substantially more toxic. Response to therapy was infrequent, with only four partial responses achieved and distributed between all dose levels. In this study, using previously treated patients, VP-16 at standard-dose or at moderate-dose increments had minimal activity.

Carcinoma, Small Cell↗
PubMed1986

Effects of Mega-COMLA (cyclophosphamide, cytarabine, vincristine, and methotrexate followed by leucovorin and prednisone) plus CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) in the treatment of lymphoid neoplasms with very poor prognosis.

Treatment results remain very poor for some clinical and histopathologic subsets of patients with aggressive non-Hodgkin's lymphoma. We treated 21 such patients with a high-dose combination chemotherapy regimen [Mega-COMLA (cyclophosphamide, cytarabine, vincristine, and methotrexate followed by leucovorin and prednisone) + CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)] in an attempt to improve disease-free survival. Neoplasms were classified using the Lukes-Collins system. Eight patients had T-cell lymphomas (convoluted lymphocytic lymphoma, four patients; T-cell lymphoma/leukemia, one; and peripheral T-cell lymphoma, three), eight had B-cell lymphomas (immunoblastic sarcoma, five patients; small noncleaved follicular center cell, one; and large noncleaved follicular center cell, two), and five had nontypable large noncleaved cell lymphomas. All patients were previously untreated; 18 of 21 patients had clinical stage III or IV disease. Following induction therapy (4-8 weeks' duration), 16 patients (76%) achieved complete remission, while three had partial remission. Two patients died of sepsis during induction therapy. Eleven of 16 complete responders (69%) remain in complete remission after a median follow-up of 35 months. The actuarial 3-year survival rate is 51% for the entire group. Myelosuppression with this regimen was severe and prolonged, with a median duration of neutropenia (less than 500 cells/microliter) of 14 days. Seven patients (33%) developed severe neuropathy following induction treatment. High-dose induction therapy with this regimen resulted in a high complete remission rate with manageable toxicity. Survival results are encouraging when compared retrospectively to our patients with similar poor-prognosis histologies treated with standard combination chemotherapy. However, the value of this intensive therapy, relative to newer ("third-generation") regimens, can only be established by prospective randomized studies.

Actuarial Analysis↗
PubMed1986

High-dose pilot studies in extensive-stage small-cell lung cancer.

Small-cell lung cancer is rarely cured with standard chemotherapy, despite initial good responses. The concept of high-dose induction therapy for extensive-stage patients has been explained in a series of pilot studies. The rationale of this approach and the most recent preliminary results will be presented.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Cyclophosphamide, doxorubicin, and etoposide as first-line therapy in the treatment of small-cell lung cancer.

The discovery that etoposide is one of the most active drugs in small-cell lung cancer (SCLC) led to its incorporation into a number of first-line combination chemotherapy regimens. The cyclophosphamide/doxorubicin/etoposide (CAE) regimen was shown to be as active or more active than other standard regimens in nonrandomized studies. In a randomized study presented in this report, the CAE regimen was significantly superior to the cyclophosphamide/doxorubicin/vincristine (CAV) regimen for response duration and survival in extensive-stage patients. In limited-stage patients the results were slightly better with CAE. In addition, CAE lacked the neurotoxicity of CAV.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Phase II study of etoposide for carcinoma of the prostate.

The treatment of prostate carcinoma with the epipodophyllotoxin derivative etoposide was studied in a multi-institutional phase II trial. An iv dose schedule of 130 mg/m2 daily for 3 days every 3 weeks was utilized. A total of 36 patients were evaluable; the observed total response was 3%. Moderate toxicity (predominantly myelosuppression) was seen utilizing this treatment schedule. It is concluded that etoposide possesses little single-agent therapeutic activity for prostate carcinoma.

Blood Cell Count↗
PubMed1986

Appetite stimulation with megestrol acetate in cachectic cancer patients.

Cachexia is often a severe problem in the management of cancer and other illnesses because it adds to the morbidity of the underlying disease and complicates its treatment. Megestrol acetate has been observed anecdotally to produce weight gain. A review of our experience, and our ongoing phase I/II study of high-dose megestrol acetate for breast cancer, revealed that weight gain occurred in nearly one third (27%) of patients at conventional doses (160 mg/d), and that a marked weight gain (median, 5.1 kg; range, 0.9 to 20.1 kg) occurred in 27 of 28 patients with breast cancer during treatment with high doses of megestrol acetate. Subjective improvement in appetite occurred in most patients at low doses and in most patients at high doses. Further, nearly one half (48%) of patients at conventional doses and virtually all patients at high doses experienced an increased sense of well-being. Our data suggest that megestrol acetate has a potential role in producing subjective improvement, sense of well-being, and increase in appetite and weight, and that the effect may be dose related. Further research is necessary to understand the mechanism of appetite stimulation and/or anabolic effect.

Adult↗
PubMed1986

Combination chemotherapy with vindesine, etoposide, and cisplatin in non-small cell lung cancer: a pilot study of the Southeastern Cancer Study Group.

Ninety-two patients with advanced non-small cell lung cancer were treated with a combination chemotherapy regimen containing cisplatin, vindesine, and etoposide. Eighteen patients (20%) achieved major responses to therapy (three complete responders and 15 partial responders). Response rates were similar in each histologic subtype. Initial performance status was an important determinant of response; 42% of the patients with a Karnofsky performance status greater than or equal to 70% responded versus 5% of those with a performance status less than 50%. The median duration of partial response was 21 weeks; complete responders had a median response duration of 50 weeks. The median survival for the entire group was 23.5 weeks. Toxicity with this regimen was acceptable; myelosuppression was the major toxic effect and was severe in only 10% of the patients. This regimen produced response rates comparable to those reported with other combinations containing cisplatin. Survival advantage in patients receiving this treatment is not established.

Adenocarcinoma↗
PubMed1985

Human chorionic gonadotropin production by colon carcinoma. Biochemical heterogeneity and identification of a chemotherapy-sensitive cell subpopulation.

Human chorionic gonadotropin (hCG) is produced and secreted by a wide variety of human neoplasms and represents one example of biochemical heterogeneity in tumors. The authors report two patients with advanced hCG-producing colon carcinomas in whom immunohistochemical staining demonstrated a distinct hCG-producing cell subpopulation. Both patients had objective tumor responses when treated with chemotherapy effective against germinal neoplasms. Responses were characterized by prompt and substantial reduction in plasma hCG levels and by improvement in clinical status, radiographic tumor measurements, and other biochemical abnormalities. These epithelial carcinomas responded to chemotherapeutic agents that are usually ineffective, and striking chemosensitivity was observed in the hCG-producing cell subpopulation. These two cases provide initial evidence that hCG-producing cells are sensitive to certain chemotherapeutic agents even when they are a part of common epithelial somatic tumors, and that this sensitivity represents another type of heterogeneity in human tumors. The identification of hCG production in epithelial tumors may be important in determining therapeutic strategy.

Adenocarcinoma↗
PubMed1985

Serum neuron-specific enolase in metastatic Merkel cell tumors.

Three patients with widely disseminated Merkel cell tumors of the skin are presented. In all three cases, neuron-specific enolase (NSE) was demonstrated in neoplastic tissue by immunohistochemical staining, and serum NSE levels were also elevated in all three patients. Serum NSE may prove to be a useful tumor marker in this and other malignancies of neuroendocrine origin.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Inflammatory carcinoma of the breast. Clinical review and summary of the Vanderbilt experience with multi-modality therapy.

Inflammatory breast cancer is a distinct clinicopathologic entity that accounts for 1 percent of all cases of breast cancer. The diagnosis should be strongly suspected on the basis of the distinctive clinical findings, which include edema of the breast, inflammation, wheals, and a typical reddish-purple color of the overlying skin. Pathologic examination usually shows infiltration of the dermal lymphatics with carcinoma. Evidence of distant metastatic spread is more frequent than with other types of breast cancer and is seen in approximately 30 percent of patients. The five-year disease-free survival rate is less than 5 percent when local therapy alone (mastectomy and/or local radiotherapy) is used. The addition of combination chemotherapy to high-dose local radiotherapy has improved the five-year survival rate to approximately 30 percent. The potential for long-term survival is limited to the subgroup of patients with only local-regional disease at the time of diagnosis. Patients with inflammatory breast cancer should be treated with combined-modality therapy using combination chemotherapy and high-dose radiotherapy to the breast, since this approach is potentially curative. The fatalism formerly associated with this diagnosis is no longer warranted, particularly in patients with local-regional disease. Failure to employ intensive combined-modality treatment will deny some patients a chance for long-term survival.

Adult↗