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Biomedical subjects

J Klastersky

Publications and source records attributed to J Klastersky.

At least 253 records · Page 14Linked to original sources
PubMed1983

The role of the new penicillins and cephalosporins in the management of infection in granulocytopenic patients.

Overall, the use of the new cephalosporins has not so far been a major breakthrough in the empire therapy of febrile episodes and infections in granulocytopenic patients. In the only controlled large study available so far (EORTC), the cefotaxime-containing regimen was definitely not the best among the combinations tested. It remains to be seen whether other cephalosporins such as cefoperazone or ceftazidime would perform better in the future; especially with ceftazidime alone or in combination with aminoglycosides, the early results appear to be very promising. Whether single drug therapy with one of these new cephalosporins, which usually results in a high serum bactericidal activity, will eventually prove to be as good as combination therapy will await evaluation of more patients over extended periods of time, with a special attention to the possible emergence of resistant pathogens.

Agranulocytosis↗
PubMed1982

Combination chemotherapy with cisplatin and etoposide in bronchogenic squamous cell carcinoma and adenocarcinoma. A study by the EORTC lung cancer working party (Belgium).

Cisplatin and etoposide combination was used in 94 patients with measurable or evaluable bronchogenic squamous cell carcinoma or adenocarcinoma. The overall response rate was 38% with four complete remission (CR). In patients with locoregional disease who did not receive any prior anticancer therapy the response rate was 56% (19/34) with three CR, significantly (P = 0.02) higher than that observed in the other patients (28%). The overall median duration of response was 36.7 weeks. Patients with locoregional disease who did not receive any prior anticancer therapy had a median duration of response of 43.6 weeks; longer than that (27.5 weeks) in the other patients. Overall, responding patients survived significantly longer (P less than 0.0001) than non responders (median survival 60.0 weeks versus 23.0). Toxicity was tolerable; gastrointestinal side effects were occasionally responsible for discontinuation of therapy and sepsis was the cause of death in two neutropenic patients. No serious nephrotoxicity was observed. The combination of cisplatin and etoposide should probably be tested in combination with surgery of radiotherapy.

Adenocarcinoma↗
PubMed1982

Treatment of severe infections in patients with cancer. The role of new acyl-penicillins.

At the present time, gram-negative bacillary bacteremia in patients with neutropenia will respond favorably in 60% to 70% of the patients when carbenicillin-ticarcillin or cephalothin-cefazolin combined with aminoglycosides (gentamicin, tobramycin, sisomicin, netilmicin, or amikacin) are given. Piperacillin alone will cure 20/34 (59%) of bacteremic episodes in patients without granulocytopenia who have a severe underlying disease. In patients with neutropenia, the combination of piperacillin with amikacin was found to be associated with a favorable response in 76/121 patients (63%). These results are thus as good as those obtained with other broad-spectrum, beta-lactam antibiotics whether used alone in patients without granulocytopenia or in combination with aminoglycosides in patients with neutropenia. It seems likely that in patients with severe underlying disease and/or granulocytopenia, antibiotic combinations have reached an optimal efficacy. More attention should be paid to the correction of the basic predisposing factors to infection (granulocytopenia and immunodepression) and to infections caused by nonbacterial pathogens.

Amikacin↗
PubMed1982

Cisplatin, adriamycin, and etoposide (CAV) for remission induction of small-cell bronchogenic carcinoma.

Chemotherapy with a combination of cisplatin (60 mg/m2), Adriamycin (45 mg/m2), and etoposide (120 mg/m2 X 3) (CAV) has been evaluated in 36 patients with small-cell bronchogenic carcinoma (SCBC) after two full courses. The complete response (CR) rate was 23% in patients with extensive disease and 64% in patients with limited disease; the partial remission (PR) rate was 59% in patients with extensive disease and 22% in those with limited disease after two cycles (six weeks) of therapy. Patients with CR survived significantly longer than patients with PR (P = 0.02). Side effects were acceptable and consisted mostly of nausea, vomiting, alopecia, and myelosuppression. Thirteen patients were included into a "late intensification" program that was performed with increased doses of CAV regimen used for remission induction. This intensification of chemotherapy was carried out in a protective environment and with autologous bone marrow transfusion. In two patients with PR, CR could be obtained after late intensification and in one patient whose disease was progressing, PR had been achieved. However, excessive extramedullary toxicity of the late intensification regimen, consisting of mucositis, suggested that CAV does not appear to be the optimal therapy for further intensification.

Adult↗
PubMed1982

[Clonogenic cultures of human tumours. Experience and prospects in cancer chemotherapy (author's transl)].

Malignant cells grow selectively in semi-solid media. Cultures of single cell suspensions in these media result in the formation of colonies which are believed to represent clones of stem cells. Cells freshly sampled in cancer patients are assayed in such a system to quantitate the in vitro effect of various anticancer agents vs untreated controls. Partially retrospective comparisons between in vitro and in vivo data are very encouraging and suggest that observations in this assay correlate very favorably with clinical findings. This clonogenic assay should provide an experimental model of special relevance to clinical cancer chemotherapy and should greatly help define optimal treatments in individual patients. Although many technical problems remain to be settled, prospective studies are ongoing to determine to what extent the assay is actually predictive of the response to chemotherapy in cancer patients.

Antineoplastic Agents↗
PubMed1982

Anaerobic infections in cancer patients--a retrospective analysis of clindamycin, tinidazole, doxycycline, cefoxitin and lamoxactam.

The results of three consecutive clinical trials on the therapy of anaerobic infections in cancer patients have been compared. The success rate with lamoxactam (94%) (6000mg/d i.v.) was statistically different from that of doxycycline (63%) (300 mg/d per os). Clindamycin (1200 mg/d per os), clindamycin (2700 mg/d i.v.) and cefoxitin (6000 mg/d i.v.) resulted in a favourable outcome in approximately 80% of the patients. Mixed anaerobic infections had a similar response rate (80%). Even when the anaerobic pathogen was resistant to therapy, six of ten patients were cured. Surgical drainage played an important role, but was difficult to assess precisely.

Anti-Bacterial Agents↗
PubMed1982

Synergism of trimethoprim combined with aminoglycosides in vitro and in serum of volunteers.

In vitro synergism of trimethoprim plus amikacin and trimethoprim plus sisomicin against 66 gram-negative bacilli was studied by microtiter checkerboard dilution. Synergism was defined as an FIC or FBC index equal to or less than 0.5. Fifty-two percent of strains were inhibited and 65% killed synergistically by the former combination, and 27% and 36% respectively by the latter combination (p less than 0.01). Serum bactericidal activity against 16 strains resistant to ampicillin and/or cephalothin was studied using serum from five volunteers one and six hours after intravenous administration of trimethoprim (160 mg), amikacin (250 mg) or the combination, and from six volunteers after administration of trimethoprim, tobramycin (1 mg/kg) or the combination. With trimethoprim and amikacin serum bactericidal titers greater than or equal to 1:8 were found more frequently with the combination (77 of 80 samples) than with either drug alone (trimethoprim 19 of 80 samples, amikacin 60 of 80 samples, p less than 0.01). Trimethoprim plus amikacin may be useful in the treatment of infections with gram-negative rods resistant to cephalothin and ampicillin.

Aminoglycosides↗