Report on the International Workshop on Staging and Treatment of Testicular Cancer.
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Biomedical subjects
Publications and source records attributed to F Cavalli.
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A 34% response was obtained in 202 evaluable patients in the terminal phase of chronic granulocytic leukemia using combinations of hydroxyurea, 6-mercaptopurine, and corticosteroids. Twelve percent of responses were complete and 22% partial. Overall median survival was 12 wk. A 30 wk median survival for responding patients was statistically superior to the 7-wk survival for nonresponders (p less than 0.001). Response was inversely correlated with toxicity. No responses were obtained in patients sustaining both severe infectious and bleeding complications. No benefit could be demonstrated from the addition of vincristine in induction and daunorubicin for consolidation. Although the response frequency and duration of survival with this combination chemotherapy were generally superior to those previously reported by our group, the terminal phase of chronic granulocytic leukemia still remains a formidable and generally refractory disease.
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Eleven patients with measurable, previously treated oat-cell carcinoma of the lung received DDP 80 mg/m2 once every three weeks. The drug was given as a 6-hour infusion. In 4 patients a partial remission was achieved: 2 others showed a minor tumor regression. The main toxicity was vomiting, whereas generally myelosuppression and nephrotoxicity were manageable. Based on these preliminary data, a further investigation of DDP in the treatment of oat-cell carcinoma of the lung is definitely warranted.
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The preliminary results of a still ongoing phase III study in patients with previously untreated metastatic breast cancer are reported. 210 cases are already evaluable. In this study patients are randomized to hormonotherapy either concurrently with combination chemotherapy or alone, chemotherapy being delayed until the occurrence of tumor progression. In both groups patients are further randomly allocated to 3 chemotherapy programs. So far there appear to be differences between remission rates, but not with regard to survival course.
The detection of specific hormone receptors in normal and tumor tissue has brought new insight into the mechanisms of action of hormones and anti-hormones. The Swiss Cooperative Cancer Study Group (SAKK) has evaluated the antitumor effect of the new antiestrogenic substance tamoxifen in metastatic breast cancer. 158 postmenopausal patients treated with 20 mg/d tamoxifen by mouth are evaluable at present time. Complete and good partial remissions were achieved in 39 patients (25%) largely with soft tissue but also lung and bone metastases. Tamoxifen was well tolerated and caused few serious complications such as thrombosis/pulmonary embolism and hypercalcemia. These results confirm already published experience with tamoxifen, which may replace the estrogens as the primary endocrine treatment in postmenopausal mammary carcinoma metastasizing to soft tissues, lung and bone.
After presentation of several important methodological problems in the development of new cytostatic agents, the newer substances adriamycin, the nitroso-urea derivatives, ICDT, diaminodichloro-cisplatinum, VP 16-213 and tamoxifen are briefly discussed with regard to their pharmacology and activity spectra. In this context adriamycin, diaminochloro-cisplatinum and VP 16-213 may be considered break-throughs in the field of therapeutic oncology. Finally, several newer drugs still in phase I studies are mentioned.
The most important advances achieved during the past 5 years in the diagnosis and treatment of acute leukemia are presented. It is now possible to achieve complete remission in about 60% of all patients with acute myelocytic leukemia (AML) using optimal polychemotherapy. This significant advance is in part due to improved supportive measures such as transfusions and isolation etc., which are frequently necessary during the induction phase of treatment. Unfortunately, such remissions are still of relatively short duration and seldom exceed 1 year. The treatment of relapses remains less successful. The first attempts to include immunotherapy in the treatment of AML have also been rather disappointing. Today remissions are obtained in 70% of patients with acute lymphocytic leukemia (ALL) which last, on the average, almost 1 1/2 years. These results, however, do not approach those in childhood ALL. Finally, the therapeutic possibilities for the treatment of blastic crisis in chronic myelocytic leukemia (CML) are discussed.
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Adriamycin (doxorubicin, Adriblastin) and cis-diammine-dichloro-platinum (II) (DDP, NSC 119 875) were used in the treatment of 18 patients with ovarian carcinoma, usually after intensive pre-treatment, both in a dosage of 50 mg/m2 once every 4 weeks. Forced diuresis was initiated at the same time. On average three such treatments were given. Six patients showed partial remission defined as decrease of tumour mass by more than 50% or as almost complete disappearance of ascites during more than two months without concomitant diuretic treatment. The remission time was 2+, 3, 3+, 3.5, 7+, and 9+ months. In all patients severe gastrointestinal toxicity occurred, however the myelosuppressive action was only moderate. Nephrotoxicity was negligible. Combined chemotherapy with Adriblastin and DDP thus seems effective even in intensively pretreated patients with ovarian carcinoma.
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The number of patients with non-Hodgkin's lymphoma who develop acute myelogenous leukemia is relatively small. The case of a patient with histologically proven diffuse histiocytic lymphoma who died with unequivocal acute myelogenous leukemia 5 years after the lymphoma diagnosis is presented. The difficulties in differential diagnosis are cited with a review of the literature.
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The authors have compared the activity of Terbutaline with that of Salbutamol in 14 subjects with partially reversible airways obstruction. In this within patients trial FEV1 resulted significantly increased with both compounds and was still significant 240 minutes after Terbutaline. After Terbutaline there was in addition a better situation in regard to blood gases. Tolerability with both compounds was very good.
The newest aspects for the use of cytostatic agents in the treatment of bladder, prostatic and testicular carcinomas are presented. Especially the two new drugs diaminodichlor cisplatinum and adriamycin are discussed as to their potential use in these diseases.