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Biomedical subjects

G Tancini

Publications and source records attributed to G Tancini.

At least 109 records · Page 6Linked to original sources
PubMed1987

Clinical study of melatonin in untreatable advanced cancer patients.

It is known that the pineal gland has some antitumor activity. Melatonin, its most important hormone, has been shown to inhibit tumor growth in vivo and in vitro. Moreover, some investigations have demonstrated an altered melatonin secretion in cancer patients. Despite these interesting data, clinical trials have never been carried out to evaluate the effects of melatonin on human neoplasms. The aim of this study was to draw some preliminary conclusions on melatonin therapy in advanced human neoplasms. Nineteen patients suffering from advanced solid tumors, which did not respond to standard therapies, entered the study. Performance status (PS) was 20 or less in 9 cases, and more than 20 in the other 10. Melatonin was given intramuscularly at a daily dose of 20 mg at 3.00 p.m., followed by a maintenance period with lower doses in patients who had a remission, a stabilization of disease or an improvement in PS. Among patients with a PS higher than 20, a partial response was achieved in one case with cancer of the pancreas; moreover, 5 of 10 had stable disease, but the other 4 cases had a progression; an evident improvement of PS was obtained in 6 of the 10 cases. In contrast, among patients with a very poor PS, 7 of 9 died within the first 2 months of therapy. This preliminary study would suggest that melatonin may be of some value in treating cancer patients in whom standard antitumor therapies have failed, particularly in improving their PS and quality of life.

Adult↗
PubMed1987

Aminoglutethimide in postmenopausal breast cancer refractory to multiple hormonal and cytostatic treatments.

Eighty-seven consecutive patients with metastatic breast cancer were treated with aminoglutethimide plus hydrocortisone. All patients were postmenopausal and had progressive disease following prior chemotherapy and endocrine therapy. Eighty-five women were evaluable for drug response. One patient showed complete remission and 14 patients partial response, for an overall response rate of 17%. The median duration of response was 11+ months. The response rate was highest in the presence of soft tissue involvement (36%). The most common side effects were transient skin rash, lethargy, and dizziness. Two patients discontinued treatment because of cutaneous allergy. Aminoglutethimide can be considered a moderately active agent when utilized as second- or third-line hormonal therapy.

Adrenalectomy↗
PubMed1987

Correlation between changes in prolactin and melatonin serum levels after radical mastectomy.

Both prolactin (PRL) and melatonin (MLT) (the most important pineal hormone) have been shown to play a role in regulating breast cancer growth. The present study was carried out to investigate the relationship between PRL and MLT secretions in human breast cancer. Twenty-four women with breast cancer, at clinical stage T1-2 N0-2 M0, were evaluated before and after radical mastectomy. As controls, 14 women who underwent surgery for reasons other than neoplastic disease were included in the study. PRL and MLT serum levels were measured by RIA before and 15 days after surgery. There were no significant differences in mean PRL serum levels between patients and controls; mean MLT serum values were significantly higher in patients than in controls. In no control subject was PRL affected by surgery. In contrast, 13/24 breast cancer women showed high PRL levels after mastectomy; the PRL rise induced by surgery was significantly higher in patients without axillary node involvement. MLT was not affected by mastectomy in 13 patients, whereas it was enhanced in 5 women and decreased in the last 6 cases. No significant correlation was seen between PRL and MLT changes induced by mastectomy. The present study shows that radical mastectomy influences PRL and MLT secretions, however, its clinical significance remains to be established.

Adult↗
PubMed1987

Acute effects of various chemotherapeutic combinations on hypophyseal and pineal hormone secretions in cancer patients.

It is known that prolonged therapy with cytotoxic drugs may affect the endocrine system. The present study was carried out to establish whether administration of chemotherapeutic drugs acutely influences hypophyseal and pineal activities. Nineteen patients affected by solid tumors were included in the study, 5 of whom were treated with CMF, 4 with FEC, 4 with CEV, and 6 with CDDP. Cytotoxic drugs were intravenously administered. Venous blood samples were collected at zero time and at 30, 60, 120 and 180 min after drug administration. On a separate occasion, venous blood samples were drawn during a saline infusion only. In each sample FSH, LH, GH, PRL, TSH, cortisol, melatonin and beta-endorphin were determined by the RIA method. The only significant changes observed in this study were a rise in PRL and a decrease in beta-endorphin after CDDP administration. Melatonin was enhanced after CDDP and CMF, and cortisol decreased after CMF and FEC, but their variations were not statistically significant with respect to those seen during saline infusion.

Adult↗
PubMed1987

Evidence for altered opioid activity in patients with cancer.

Endogenous opioid peptides have been shown to be involved in the regulation of tumour growth. At present, however, no data are available about the secretion of opioid peptides in cancer patients. To draw some preliminary conclusions on opioid brain function in human neoplasms, we evaluated hypophyseal hormone responses to the administration of a met-enkephalin analogue, FK 33-824. The study included 14 patients affected by early or advanced neoplastic disease, 12 healthy subjects and 7 patients with a chronic medical illness other than cancer. FK 33-824 was given intravenously at a dose of 0.3 mg. Venous blood samples were collected at zero time, and 30, 60 and 120 min after drug administration. In each sample, PRL, GH, LH, cortisol and beta-endorphin levels were measured by RIA. In all normal subjects and in patients with non-neoplastic chronic illness, FK 33-824 induced a rise in PRL and GH levels, and a decrease in LH, cortisol and beta-endorphin. A normal endocrine response to FK 33-824 was seen in our cancer patient only, while in the other cases with tumour no hormonal changes or a paradoxical response were seen after FK 33-824. Based on the fact that an abnormal endocrine response to FK 33-824 has been described in hypothalamic-pituitary disorders, in which anomalous brain opioid activity has been demonstrated, these results suggest the existence of an altered function of the opioid system in cancer patients, the clinical importance of which remains to be determined.

Adult↗
PubMed1987

Second malignancies after CMF for resectable breast cancer.

From June 1973 to May 1978, a total of 845 women with resectable breast cancer and positive axillary nodes were entered into two consecutive randomized studies evaluating adjuvant chemotherapy. All patients were subjected to radical or modified radical mastectomy, none received postoperative radiation, and 666 were administered adjuvant CMF (cyclophosphamide, methotrexate, and fluorouracil). After a median follow-up in excess of 10 years, no cases of acute nonlymphocytic leukemia were detected, but 21 second solid tumors other than contralateral breast carcinoma were documented. The cumulative frequency was 4% +/- 1.9% after surgery alone, and 4.2% +/- 1.03% following adjuvant CMF. No differences were observed between patients aged up to 50 years (surgery, 3.1% +/- 2.2%; CMF, 3.3% +/- 1.3%) or older than 50 years (surgery, 4.5% +/- 2.6%; CMF, 5.2% +/- 1.8%). During the same period, a total of 29 contralateral breast carcinomas were documented for a cumulative frequency of 3.7% +/- 1.7% after surgery alone and of 5.2% +/- 1.4% following adjuvant CMF, respectively. We conclude that, at present, there is no evidence for an increased risk of second malignancies following adjuvant CMF as given in this series. Our findings would suggest that second tumors documented so far cannot be entirely ascribed to treatment with adjuvant chemotherapy, but they could be due to a chance association.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

[Concomitant therapy with cisplatin and radiotherapy in locally advanced tumors of the cervico-facial area].

Nineteen patients with locally advanced head and neck cancer were treated from November 1983 to January 1986 with standard loco-regional Radiotherapy: 2 Gy for 5 days/week up to a total dose of 70 Gy and simultaneous Cisplatinum 20 mg/m2 weekly. All patients achieved a response: 10 (52%) obtained a complete remission (CR) and 9 (48%) a partial remission (PR). Four of 9 patients in PR after chemoradiotherapy were disease-free after radical resection of the residual masses, while another patient was completely cured after second-line chemotherapy. The overall CR was then 79% (15/19). The results were analyzed according to the nodal status and showed that: 92% (11/12) of patients with initial nodal involvement (N1-2) achieved a CR and 75% of them were disease-free after a median follow-up of 23+ months, while only 57% (4/7) of patients with advanced nodal involvement (N3) obtained a CR (p greater than 0.05; NS) and 28% (2/7) of them were alive without evidence of disease (p less than 0.05) after 4+ and 30+ months. Toxicity was moderate: nausea and vomiting (grade 2-3) occurred in about 50% of patients, mucosal toxicity (grade 1-2) in 58%. Myelosuppression was negligible. No patient developed renal failure. Weekly cisplatinum administration during radiotherapy deserves further study especially in the management of patients with advanced primary tumor and minimal lymph node involvement.

Adult↗
PubMed1986

Salvage treatment of patients suffering relapse after adjuvant CMF chemotherapy.

The efficacy of salvage treatments in 243 patients with operable breast cancer and positive axillary nodes who failed during or after adjuvant chemotherapy with CMF (cyclophosphamide, methotrexate and fluorouracil) was analyzed. Results were compared with those achieved in 100 patients who had relapses after radical mastectomy alone (control group). Salvage treatments consisted primarily of endocrine therapy (castration in premenopausal patients and tamoxifen in postmenopausal women) and chemotherapy (CMF or Adriamycin [doxorubicin] regimens). In 20 patients, however, first salvage treatment consisted of local therapy only (i.e., radiation therapy with or without surgery). In women previously treated with adjuvant CMF, complete plus partial remissions after first salvage treatment were 37% with a median duration of 17 months. In the control group, the response rate was 43% with a median duration of 16 months. The findings also indicated that drug-induced amenorrhea did not lower the objective response to salvage castration. In patients failing with a disease-free interval in excess of 12 months from end of adjuvant CMF, retreatment with the same combination was able to induce remission in 52% of the patients. Current data, derived from prospective controlled studies, confirm that, despite relatively high remission rates, all forms of salvage treatment failed to provide, in unselected cases, long-term control of relapsed breast cancer. Most important, prior adjuvant chemotherapy with CMF did not adversely affect results compared to concomitant controls.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Prolactin response to thyrotropin-releasing hormone in early and advanced human breast cancer.

While prolactin (PRL) has been shown to stimulate the development of mammary carcinoma in several animal species, its role in human breast cancer remains to be established. To further investigate PRL secretion in human breast cancer, its basal levels and response to thyrotropin-releasing hormone (TRH) were evaluated in 16 patients (6 with no metastases and 10 with metastatic locations). The control group consisted of 19 healthy women. High PRL basal concentrations were seen in 2 patients only; no significant differences were found between the other patients and the normal subjects. The PRL increase induced by TRH administration was significantly higher in patients than in controls. Finally a change in the hormonal secretion was found after chemotherapy in 3 of the 5 patients in whom PRL response to TRH was evaluated either before or 10-12 days after a cycle of intravenous CMF adjuvant chemotherapy. These results demonstrate the existence of an exaggerated response of PRL to TRH in patients with breast cancer, even in the presence of normal basal levels. Moreover, they would seem to suggest a possible influence of CMF on PRL response to TRH stimulation.

Adult↗
PubMed1986

Current status of Milan adjuvant chemotherapy trials for node-positive and node-negative breast cancer.

This report summarizes the most important clinical results achieved at the Milan Cancer Institute through various randomized trials with systemic adjuvant chemotherapy. In the study testing surgery versus surgery plus 12 cycles of cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) in node-positive patients, the reduction in failure rate (34%) significantly favored CMF-treated patients (P less than 0.001). Despite a reduction in the death rate of 23%, the overall survival showed only a trend for CMF compared to surgery alone (P = 0.10). In a second study, the 8-year results confirmed the lack of difference in relapse-free survival and total survival rates between patients who received 12 and 6 cycles of CMF. The third study indicated that at 6 years, postmenopausal women who had 1-3 positive lymph nodes and were treated with full-dose sequential non-cross-resistant combinations had rates of relapse-free survival and total survival that were superior to those previously achieved with CMF in the same menopausal subset. In a limited series of patients with negative axillary nodes as well as negative estrogen receptors, there was clear evidence of very poor prognosis in women given only local-regional therapy, compared to women treated with adjuvant CMF. Within the node-negative subset, the proliferative activity (labeling index) of the primary tumor appears to be a more effective prognostic discriminant than estrogen receptor status. The proportion of primary drug-resistant tumor cells as well as the lack of relative dose intensity in the drug programs tested so far probably represent the two most important causes for the failure of adjuvant chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Ten-year experience with CMF-based adjuvant chemotherapy in resectable breast cancer.

The paper reviews all adjuvant studies carried out since 1973 at the Milan Cancer Institute in women with resectable breast cancer and positive axillary nodes. The updated results essentially confirm previous findings, and indicate that CMF-based chemotherapy is able to exert a prolonged therapeutic activity in a fraction of patients bearing micrometastases. In particular, the first randomized study testing no postoperative chemotherapy vs 12 CMF cycles, showed a 10-year relapse free survival (RFS) of 31.4% vs 43.4% (P less than 0.001) and an overall survival (OS) of 47.3% vs 55.2% (P = 0.10), respectively. Findings related to subsets indicated that RFS and OS benefit was significant in premenopausal and not in postmenopausal women, and in both treatment groups the observed findings were always related to the number of histologically positive nodes. On relapse, salvage therapy administered to controls failed to produce superior results compared to those achieved in the CMF group. The 8-year results of the second study testing 12 vs 6 CMF cycles failed to show a significant difference between the two treatment groups. This indicated that the maximum tumor cell kill occurred during initial chemotherapy cycles. In the third study, carried out only in postmenopausal women less than or equal to 65 years, sequential non-cross resistant combinations (CMFP----AV) at full dose achieved superior results compared to CMF in the subset with limited nodal extent. Acute side effects were moderate and no delayed morbidity, including increased incidence of second neoplasms, was observed. We conclude that the tumor cell heterogeneity, and in particular primary drug resistance, represents the major obstacle to adjuvant systemic therapy in high risk breast cancer. Current results suggest that 6 cycles of CMF can be considered a simple, safe, and moderately effective adjuvant therapy. Future trials should contemplate treatments of different intensity related to major prognostic subsets, while in women at very high risk of early relapse more vigorous drug regimens should be concentrated within the first six months from local-regional therapy.

Adult↗
PubMed1983

Adjuvant CMF in breast cancer: comparative 5-year results of 12 versus 6 cycles.

We report the 5-yr results of a prospective randomized study comparing 12 versus 6 cycles of CMF (cyclophosphamide, methotrexate, fluorouracil) with the aim to evaluate the possibility of reducing the duration of adjuvant treatment without compromising the therapeutic effect of the multimodal approach. At 5-yr from mastectomy, both relapse-free survival (CMF 12: 59%; CMF 6: 65.6%) and total survival (CMF 12: 72.7%; CMF 6: 76.9%) were not significantly different in the two treatment groups. Within the two series, no difference was detected between pre- and postmenopausal patients (CMF 12: 59.3% versus 57.6%; CMF 6: 66.5% versus 63.1%), while findings were inversely related to the number of involved axillary nodes. The analysis of relapse-free survival confirmed that in both menopausal groups, relapse-free survival was not significantly affected by estrogen receptor status. Acute toxic manifestations were moderate and reversible. In particular, no drug-induced leukemia nor increased incidence of solid tumors other than breast cancer were documented in this series. Present results after 12 CMF cycles are almost identical to those of our first CMF adjuvant study. Current findings are sufficiently mature to indicate that the maximum tumor cytoreduction with CMF occurs within a relatively short period of time. To improve the results achieved with a single multidrug regimen, more intensive forms of treatment, i.e., utilizing non-cross-resistant combinations, warrant careful evaluation.

Adult↗
PubMed1982

[Association of laparoscopy and bone marrow biopsy in the staging of small-cell undifferentiated carcinoma of the lung. Evaluation of 116 consecutive cases].

116 consecutive patients with small cell anaplastic carcinoma of the lung had laparoscopy with multiple liver biopsies and bone marrow biopsy, performed as a staging procedure. Bone marrow biopsy was positive in 13 patients (11.2%); no significant rise in percent was seen when bilateral specimens were obtained. Laparoscopy was positive in 17 patients (14.6%); one patient had extrahepatic involvement only. Liver scan did not show high correlation with laparoscopy: 6 patients out of 11 had negative liver scan with metastases demonstrated at laparoscopy. Only 6 patients had laparoscopy positive along with bone marrow biopsy (5.1%). At determination of the stage, 12 patients out of 78 (15.3%), with apparently localized disease had diffuse disease after the two procedures. Laparoscopy and bone marrow biopsy were positive in 12 patients out of 38 (31.5%), when the disease was diffuse at diagnosis. 7 patients had liver metastases at diagnosis, which were excluded after laparoscopy. Laparoscopy and bone marrow remain valuable procedures in assessing stage in small cell anaplastic carcinoma of the lung, because of their high rate of stage modifications due to their combined employment at diagnosis.

Adolescent↗