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Biomedical subjects

J D Bitran

Publications and source records attributed to J D Bitran.

At least 73 records · Page 4Linked to original sources
PubMed1987

Acute nonlymphocytic leukemia following etoposide and cisplatin combination chemotherapy for advanced non-small-cell carcinoma of the lung.

Combination chemotherapy is frequently used in the therapy of advanced non-small-cell lung cancer (NSCLC), but late complications are rarely recognized because of the short survival of most patients. Of 119 patients with advanced NSCLC treated with cisplatin and other drugs, four patients developed acute nonlymphocytic leukemia (ANLL). All four patients received etoposide and cisplatin with or without vindesine. Leukemia was diagnosed at 13, 19, 28, and 35 months after start of treatment. Three patients had morphologic and/or cytogenetic features of acute leukemia with significant monoblastic involvement; the fourth patient had trilineage dysplasia and cytogenetic abnormalities more commonly associated with therapy-related leukemia. Detailed analysis of the subgroup who survived longer than 1 year (24 patients) suggests that high cumulative doses of etoposide are leukemogenic; the median etoposide dose was 6,795 mg/m2 (first year only) in the four leukemic patients compared with 3,025 mg/m2 in the 20 nonleukemic patients (P less than .01). The rate of ANLL was 0.30 per person-year after the first year (95% confidence limits 0.11 to 0.90), with a cumulative risk of 15% +/- 11% at 2 years, and 44% +/- 24% at 2.5 years. We conclude that high doses of etoposide are potentially leukemogenic, and can induce a syndrome with features of acute monoblastic leukemia de novo that is distinct from other secondary leukemias.

Acute Disease↗
PubMed1987

Phase II study of carboplatin in previously untreated patients with metastatic small cell lung carcinoma.

Fourteen previously untreated patients with metastatic small cell lung carcinoma (SCLC) were treated with carboplatin, 400 mg/m2, given as a 1-hour infusion every 28 days. Eleven patients had a partial response to therapy [response rate, 79% (95% confidence limits, 57%-100%)]. The median duration of response was 8 weeks (range, 4-41) and the median survival was 29 weeks (range, 11-68+). Hematologic toxicity was limited to one patient who developed World Health Organization (WHO) grade IV thrombocytopenia; no patient developed infection due to granulocytopenia. Nonhematologic toxicity was limited to WHO grade I and II nausea and vomiting. This study demonstrates that carboplatin is a highly active drug in SCLC with minimal toxicity. Future studies should evaluate its use in combination with other chemotherapeutic drugs in SCLC.

Adult↗
PubMed1986

A 10-year experience with combined modality therapy for stage III small cell lung carcinoma.

During the past 10 years, 240 patients with Stage III small cell lung carcinoma (SCLC) were treated with one of five chemotherapy programs plus thoracic irradiation. In addition, prophylactic cranial irradiation was administered concurrently with thoracic irradiation to 194 patients receiving CAML-HC, VCAM, or MOCA. Seventy-two patients had disease confined to the chest (Stage IIIM0), 30 patients had disease in the chest plus ipsilateral supraclavicular nodal involvement (Stage IIIM0SCN+), and 138 patients had distant metastatic disease (Stage IIIM1); the median survivals were 15.2 months, 12.6 months, and 8.4 months, respectively. The overall complete response rate was 30% and the overall response rate (complete and partial) was 76%. The overall response rates by stage were 86% for Stage IIIM0, 90% for Stage IIIM0SCN+, and 67% for Stage IIIM1. Eight patients (3%) were alive and free of disease at 24 months. Due to continued disease relapse in this group (four of eight patients), long-term survivors should not be identified for a minimum of 3.5 years from the time of initial therapy. Prophylactic cranial irradiation (PCI) effectively reduced the incidence of central nervous system (CNS) relapse in patients with a complete response to therapy (44% relapse without PCI versus 13% relapse with PCI, P less than 0.01). More effective chemotherapy is required for the successful treatment and improved long-term survival of patients with SCLC.

Altretamine↗
PubMed1986

Staging and therapy of orbital lymphomas.

Ten patients with non-Hodgkin's lymphoma primarily affecting the orbital region were evaluated at Michael Reese Hospital and Medical Center, Chicago, between 1976 and 1983. Diagnoses were based on the histopathologic classification systems of the Working Formulation of the Non-Hodgkin's Lymphomas and Rappoport. Sequential staging procedures performed at the time of diagnosis included liver-spleen scans, Technecium-99 bone scans, gallium 67 scans, computerized axial tomograms of the orbit and abdomen, bone marrow examination and cerebral spinal fluid analyses. Adverse prognostic factors included the following: orbital bone erosions, Stage IV disease, and large cell or mixed cell, diffuse histologic features. The type of histopathologic findings combined with the results of sequential staging procedures is useful in identifying those patients who would benefit most from systemic chemotherapy.

Actuarial Analysis↗
PubMed1986

Protochemotherapy in non-small cell lung carcinoma. An attempt to increase surgical resectability and survival. A preliminary report.

Twenty patients with Stage IIIM0 (T3N2) non-small cell lung cancer were treated with vindesine, etoposide, and Platinol (cisplatin) (ELETOP) chemotherapy in an attempt to decrease tumor size and increase resectability and survival. ELETOP chemotherapy induced a 70% response rate (all partial responses) within 6 weeks, and three patients were able to undergo curative resection. Toxicities with ELETOP were moderately severe, with leukocyte and platelet nadirs on day 15. This pilot study demonstrates the feasibility of protochemotherapy in non-small cell lung cancer.

Adult↗
PubMed1986

Pleural involvement in stage IIIM0 non-small-cell bronchogenic carcinoma. A need to differentiate subtypes.

Forty-one patients with two subtypes of stage IIIM0 non-small-cell lung cancer treated over a 7-year period were evaluated. The first group of 20 patients had ipsilateral parietal pleural involvement not contiguous with the primary tumor but no distant metastases. Fifteen had positive pleural fluid cytology, seven with positive pleural biopsy in addition; four had extensive pleural studding or a positive biopsy but no effusion; and one had negative pleural fluid cytology. Treatment consisted of radiation therapy followed by combination chemotherapy in all. Due to symptoms, eight patients first had fluid drainage with or without sclerosis and two patients had a pleurectomy. Nine had progressive pleural disease despite the local treatment. To all modalities of therapy, only two patients had a partial response. One patient who had a pleurectomy lived 25 months. Median survival was 6.9 months. Cause of failure involved local progression in 17 patients. There was no difference in median survival by age, sex, histology, side of effusion, location of nodal disease, or use of local therapy. The second group of 21 patients had localized involvement of the parietal pleura by the primary tumor. There was deeper chest wall invasion in nine. All patients were rendered free of known disease by surgical resection, were stage T3N0-2M0, and received radiation and chemotherapy in addition to resection. The median survival was 13.5 months. There was local recurrence in nine patients but only one developed an effusion. Five patients were alive at 29-82 months. No variable unfavorably influenced survival except a central versus peripheral primary. Thus, the median survival of the patients in the first group with multiple sites of pleural involvement was similar to that of patients with distant metastases but with the cause of failure primarily local progression. In the majority of patients in the second group, parietal pleural and chest wall involvement, even with nodal metastases, did not translate into local failure, and long-term survival was possible.

Age Factors↗
PubMed1985

CAMP chemotherapy for metastatic non-oat cell bronchogenic carcinoma. A 7-year experience (1975-1981) with 160 patients.

Between January 1975 and December 1981, 160 patients with metastatic non-oat cell bronchogenic carcinoma (MNOBC) were treated with cyclophosphamide, doxorubicin, methotrexate, and procarbazine (CAMP), or with a CAMP-like regimen. Forty-two (26%) of these patients demonstrated an objective response to the chemotherapy with a median survival of 61 weeks. Thirty-nine (24%) patients had stable disease (SD) with a median survival of 45 weeks. Seventy-nine patients (49.4%) were nonresponders with a median survival of 15 weeks. There was a significant difference in survival times between the responders and the SD patients, and between the responders and SD patients and the nonresponders. Responses were seen in 11% of the patients with squamous cell carcinoma and in 37% of the patients with adenocarcinoma. There was a significant difference in the response and SD categories in favor of adenocarcinoma over squamous cell carcinoma. Once a response was achieved, the median survival of the patients with adenocarcinoma was not significantly longer than that of the patients with squamous cell carcinoma.

Actuarial Analysis↗
PubMed1985

Intraperitoneal bleomycin. Pharmacokinetics and results of a phase II trial.

Bleomycin was administered in a phase II trial to 10 patients with malignant ascites. Complete responses to intraperitoneal bleomycin were observed in 6/10 patients (60%). Pharmacokinetics of serum and intraperitoneal bleomycin showed peak levels at 15 minutes with a peritoneal fluid half-life of 4.2 +/- 0.1 hours and a serum half-life of 5.0 +/- 1.2 hours. There was a 400-fold difference in concentration when bleomycin was administered intra-abdominally. Toxicities with intraperitoneal bleomycin were minimal. This phase II trial confirms the efficacy of intraperitoneal bleomycin; further trials appear warranted.

Abdominal Neoplasms↗
PubMed1985

A phase II trial of cyclophosphamide and adriamycin in refractory squamous cell carcinoma of the head and neck. An effective salvage regimen.

A phase II trial of cyclophosphamide and adriamycin was carried out in 26 patients with recurrent squamous cell carcinoma of the head and neck, previously treated with cis-diamminedichloroplatinum-based regimens. The overall response rate was 46% (12/26 patients) with the median duration of response being 6.5 months. Cyclophosphamide and adriamycin is an active combination in patients with previously treated squamous cell carcinoma of the head and neck.

Adult↗
PubMed1985

Management of locally advanced and inflammatory carcinoma of the breast.

From the data presented, there seems little doubt that multimodality systemic and local therapy offers the best chance of long term control and survival in patients with locally advanced noninflammatory and inflammatory carcinoma of the breast. However, the best method of sequencing these modalities remains inadequately defined. The rationale for systemic therapy is that systemic micrometastases are present at diagnosis; since almost all patients die from systemic disease, it would seem preferable to use chemotherapy first, while the disseminated tumor burden is low. Furthermore, this would allow an assessment of local response to the agents administered. However, chemotherapy almost never sterilizes bulky local disease, and local control rates are significantly improved by concurrent or sequential use of a local modality. From the information presented, it would appear that combined operation and radiotherapy may give a better outcome than either modality alone. However, in series in which chemotherapy plus one local modality are used, the five year, local failure rates were 20 to 35 per cent; with the use of two local modalities, the local failure rate was not significantly better (16, 20 and 22 per cent). The full effect of using two local modalities with systemic chemotherapy has not been satisfactorily explored to date. Many groups have suggested that the local control rate is proportional to the dose of radiotherapy given. Since iridium192 implantation permits larger doses of radiotherapy to the local tumor without an apparent increase in toxicity, it holds great promise as a means of improving local control in this disease and should be considered in all instances. Randomized studies comparing iridium192 with operation as an adjunct to external beam radiotherapy are needed. Although there is little doubt that combination systemic chemotherapy is mandatory for improved survival in these patients, the appropriate drugs, combination and scheduling are yet to be defined. Data from studies of metastatic carcinoma of the breast indicate that combinations of two to four drugs, including doxorubicin, give the best response rates. Recently, a number of anthracycline analogues have been studied, in particular mitoxantrone, with response rates comparable to doxorubicin but with less toxicity. These agents could be used effectively in future chemotherapy programs for locally advanced and inflammatory carcinoma of the breast. The place of endocrine manipulation also remains undefined. In general, women who present with carcinoma of the breast later in life are more likely to have hormone receptor positive, endocrine responsive tumors.(ABSTRACT TRUNCATED AT 400 WORDS)

Antineoplastic Agents↗
PubMed1985

Cancer and pregnancy.

The most common malignancies occurring in women of child-bearing ages include breast, cervical, genital, and GI malignancies, and melanoma, lymphoma, and leukemia. Pregnancy does not appear to adversely affect the outcome of most tumors but may affect those that are known to be hormonally dependent. The approach in general to malignancy during pregnancy needs to be individualized. Therapy, whether by radiation or with cytotoxic drugs, has the greatest potential for fetal risk during the first trimester but more acceptable risk in the second and third trimesters. There are many unanswered questions concerning long-term effects of malignancy and its therapy upon the surviving child.

Adolescent↗
PubMed1985

Treatment of metastatic colorectal carcinoma with cisplatin and 5-FU.

Twenty patients with measurable metastatic colorectal carcinoma were treated every 3 weeks with cisplatin (100 mg/m2 iv) on Day 1 and 5-FU (1000 mg/m2/day by iv infusion over 24 hours) on Days 1-5. Seven patients were previously treated with chemotherapy. The mean performance status for all of the patients was 1.5 (Eastern Cooperative Oncology Group). None of the patients had an objective response to the chemotherapy; 11 patients had stable disease and nine had no response. This study demonstrates that the combination of cisplatin and 5-FU, administered at this dose and schedule, has minimal activity in patients with metastatic colorectal cancer.

Adenocarcinoma↗
PubMed1984

Combined modality therapy for Stage IIIMO non-small cell lung cancer. A five-year experience.

Between 1975 and 1980, 101 patients with inoperable Stage IIIMO non-small cell lung carcinoma were entered into combined radiotherapy and chemotherapy trials at Michael Reese Hospital and University of Chicago Hospital. Sixty-four percent of the patients responded. Median survival for all patients was 8.8 months. Responders survived 13.7 months and nonresponders 4.6 months (P = 0.002). Patients treated with 4200 rad had a higher response rate than those treated with 3000 rad (74% versus 54%, P = 0.04) but there was no difference in survival. Although all patients with squamous cell carcinoma died by 30 months, 18% of patients with adenocarcinoma and 20% of patients with large cell carcinoma are long-term survivors. Brain metastases occurred more frequently in patients with large cell or adenocarcinoma than in patients with squamous cell carcinoma (P = 0.02). The prognostic effect of age, initial performance status, sex, histology, and tumor extent are examined. Toxicity was substantial with a 13% treatment-related mortality. Combined modality therapy may benefit selected patients with non-squamous cell types, but more effective chemotherapeutic agents are needed. Prophylactic cranial irradiation in patients with large cell carcinoma or adenocarcinoma may decrease the incidence of subsequent brain metastases.

Adenocarcinoma↗
PubMed1984

The management of cardiac tamponade in patients with breast cancer.

Six patients with disseminated breast cancer and cardiac tamponade were treated with a pleuropericardial window and in four patients with systemic chemotherapy. The median survival of these six patients was 17 months (range 1-50 months). These results indicate that aggressive therapy in patients with cardiac tamponade and breast cancer can lead to prolonged survivals.

Aged↗
PubMed1984

The role of gallium-67 in the clinical evaluation of cancer.

This review is based primarily on historic data, and it examines the indications for and limitations of gallium-67 scanning in the evaluation of patients with neoplasms. The use of gallium-67 scans is discussed according to tumor type, and data from the most representative and comprehensive studies are included. The results described, some of which were obtained primarily with older imaging techniques, should be regarded as representing the minimum that can be expected from application of this imaging procedure.

Adult↗
PubMed1984

Trial of vindesine, etoposide, and cisplatin in patients with previously treated, advanced-stage, non-small cell bronchogenic carcinoma.

Twenty-two patients with advanced-stage, non-small cell bronchogenic carcinoma were treated in a pilot study with a combination of vindesine, etoposide, and cisplatin (VEDDP). All patients had been previously treated with a non-cisplatin-containing regimen and had documentation of progressive disease. Median duration of VEDDP therapy was 2.6 months. Only one patient had a minor response. Median survival from start of protocol therapy was 3.7 months; the overall survival from start of primary therapy was 13.5 months. The only significant variable possibly affecting survival was achieving a minor response or stable disease (5.0 months for minor response/stable disease from start of VEDDP vs 3.2 months for progressive disease, P = 0.016). Hematologic toxicity was moderate to severe in 14 patients and prevented completion of two full cycles in seven patients. We conclude that VEDDP is ineffective in inducing a response in patients with refractory, advanced-stage non-small cell bronchogenic carcinoma in the dose and kinetic schema used in this pilot study.

Adolescent↗