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Biomedical subjects

J Klastersky

Publications and source records attributed to J Klastersky.

At least 73 records · Page 4Linked to original sources
PubMed1996

Randomized trial comparing induction chemotherapy versus induction chemotherapy followed by maintenance chemotherapy in small-cell lung cancer. European Lung Cancer Working Party.

PURPOSE AND METHODS: The European Lung Cancer Working Party (ELCWP) performed a randomized trial with the primary end point to determine if maintenance chemotherapy with 12 courses of etoposide (120 mg/m2 on days 1 and 3) and vindesine (3 mg/m2 on day 3) could improve progression-free survival in small-cell lung cancer (SCLC) patients who responded to six courses of induction chemotherapy with ifosfamide, etoposide, and an anthracycline (doxorubicin or epirubicin). RESULTS: Among 235 eligible patients initially registered, 91 were randomized to receive maintenance therapy, including seven patients who were no longer responding. Among 84 randomized responders, progression-free survival was significantly improved (P = .003) by maintenance therapy, with median durations (maintenance v follow-up) of 25 versus 12 weeks after the second randomization, but survival was not significantly increased (P = .10), with median durations of 48 and 38 weeks. However, in a multi-variate analysis that took into account disease extent, maintenance therapy, Karnofsky performance status (PS), and absolute dose-intensity (ADI) of anthracycline given during induction, limited disease (LD) and maintenance were found to be independent positive predictors of survival. CONCLUSION: We conclude that maintenance chemotherapy in responding patients is beneficial in SCLC.

Adult↗
PubMed1995

Prevention and therapy of fungal infections in cancer patients. A review of recently published information.

This review of recent publications in the field of fungal infections in cancer patients clearly confirms that protracted severe granulocytopenia is a major risk factor for their development. Because severe and prolonged granulocytopenia plays such a major predisposing role for fungal infections, it is likely that the use of the colony-stimulating factors, which are able to reduce the duration and the severity of granulocytopenia, might prove effective in decreasing the frequency and the severity of these infections. Another conclusion is that certain categories of patients with granulocytopenia might benefit from antifungal prophylaxis and empiric therapy. Conversely, there are other populations who will benefit only marginally from such strategies. Imidazoles, namely fluconazole, for the prevention of local and systemic Candida infections have been shown to be effective in granulocytopenic patients. So far, the development of resistance has not been a major problem. In patients at the greatest risk of developing severe fungal infections, such as those receiving high-dose corticosteroid therapy for GVHD after allogeneic bone marrow transplantation, early administration of low doses of amphotericin B seems to be effective in reducing the development of systemic fungal infection. In terms of therapy, amphotericin B is still the standard approach, especially for empiric treatment, prior to the recognition of a specific pathogen.

Agranulocytosis↗
PubMed1995

Therapy of non-small cell lung cancer.

A few regimens can give clinical responses and more prolonged survival to the patients with NSCLC who respond. In addition, there is often a suppression of morbid symptoms in those patients. This is the situation that can be obtained in about 30% of the treated patients and, in addition, the treatment corresponds, from the psychological point of view, to what the patient expects. The toxicity of chemotherapy and the resulting morbidity and mortality can, to a large extent, be controlled by a close clinical follow-up and the use of various techniques of supportive care. Such a surveillance of patients probably explains why administration of planned therapy can be less expensive than palliative care.

Antineoplastic Agents↗
PubMed1995

Piperacillin-tazobactam plus amikacin versus ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer. The International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer.

Gram-positive bacteria have become the predominant infecting organisms in granulocytopenic cancer patients. Empiric antibiotic regimens used in febrile neutropenic patients often include an extended-spectrum cephalosporin, but the response to therapy in gram-positive coccal bacteremia has been unsatisfactory. Thus, new antibiotics with better activity against gram-positive bacteria should be tested. The objective of this prospective randomized controlled study was to evaluate and compare the efficacy and tolerance of piperacillintazobactam plus amikacin with that of ceftazidime plus amikacin, the standard regimen of the International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer, in the empiric treatment of febrile granulocytopenic cancer patients. A total of 858 episodes were eligible for this study, and 706 episodes were assessable for efficacy. The antibiotic treatment was successful in 210 (61%) of 342 episodes in the piperacillin-tazobactam-amikacin group compared with 196 (54%) of 364 episodes treated with ceftazidime plus amikacin (P = 0.05). The time to defervescence was significantly shorter (P = 0.01) and the time to failure was significantly longer (P = 0.02) in the piperacillin-tazobactam-amikacin group. A significant difference in response to bacteremic infections between the two patient groups was found: piperacillin-tazobactam plus amikacin was successful in 40 of 80 episodes (50%), and ceftazidime plus amikacin was successful in 35 of 101 episodes (35%) (P = 0.05). A multivariate analysis showed that the probability of failure was significantly greater with ceftazidime plus amikacin than with piperacillin-tazobactam plus amikacin (P = 0.02). This trial suggests that piperacillin-tazobactam plus amikacin is more effective than ceftazidime plus amikacin for the empiric treatment of fever and bacteremia in granulocytopenic cancer patients. Although cutaneous reaction was more frequently associated with piperacillin-tazobactam plus amikacin than with ceftazidime-amikacin, this unwanted effect was relatively mild and its incidence was comparable to that of other penicillin compounds.

Adolescent↗
PubMed1995

History of brain and epidural metastases from breast cancer in relation with the disease evolution outside the central nervous system.

We reviewed 89 breast cancer patients with brain or epidural metastases in order to see whether a parallelism could be found between disease evolution inside and outside the central nervous system. One-fifth of the patients with brain metastases did not have any other site of relapse before neurological complication. Among the 38 patients who developed brain metastases and had a prior history of relapse outside the brain, 12 had control of constant extracranial sites while disease was progressing at these sites in 26 of them. In the epidural metastases group, all patients but 4 had progressive disease elsewhere when neurological complication appeared.

Adult↗
PubMed1995

Dose-finding study of paclitaxel (Taxol) plus cisplatin in patients with non-small cell lung cancer. European Lung Cancer Working Party.

We conducted a phase I trial in advanced NSCLC to determine the optimal dosage of the new active drug paclitaxel (Taxol), in combination with high-dose ciplastin (CDDP). Taxol was infused over 3 h, followed by CDDP given over 30 min with hyperhydration. Main criteria of selection were the presence of metastatic or locally relapsing pathologically proven NSCLC, stage IIIB or IV and no prior therapy. Out of 17 treated patients, eight objective responses (47%) were documented. Significant but transient neutropenia was observed in steps III and IV. In seven patients, who received more than three courses, treatment was discontinued for severe polyneuropathy in five, cancer progression in one and unrelated disease in one. In conclusion, paclitaxel plus cisplatin, although active, was associated with severe late neurological toxicity prohibiting the administration of multiples courses.

Adult↗
PubMed1995

[Definitive results of a phase I study of a chemotherapy regimen using cisplatin and paclitaxel for non-small cell bronchial cancer].

A phase I trial has been performed in patients with advanced non-small lung cancer without prior chemotherapy in order to determine the optimal administration schedule of a combination of high dose cisplatin and paclitaxel (Taxol). Those drugs have been evaluated at respective dosages of 100-120 mg/m2 and of 135-170-200 mg/m2, the later being given over a 3-hour infusion. Seventeen patients have been treated in 4 different steps, without occurrence of an acute limiting toxicity, neither hematological, neither of another type. No major acute hypersensitivity reaction has been observed but three cases of potential cardiac toxicity including one death were documented. The regime appeared to be active with an objective response rate of 47% (8/17) but a severe polyneuropathy occurred lately, avoiding further treatment administration in the majority of responders (5/7). In conclusion, the combination can only be recommended for short treatment.

Adult↗
PubMed1994

Empirical therapy for bacterial infections in neutropenic patients.

Infection in neutropenic patients remains a continuing challenge as the modalities of cancer treatment evolve and new pathogens appear. Although the concept of empirical therapy remains valid, there is a need for adaptation of our therapeutic approaches to new clinical and microbiological evidence.

Anti-Bacterial Agents↗
PubMed1994

A four-drug combination chemotherapy with cisplatin, mitomycin, vindesine and 5 fluorouracile: a regimen associated with major toxicity in patients with advanced non-small cell lung cancer.

The purpose of this study was to determine the activity of a 4-drug combination chemotherapy: cisplatin, mitomycin C, vindesine and 5-fluorouracil (5-FU) in patients with advanced non-small cell lung cancer (NSCLC). Chemotherapy consisted of the administration of cisplatin (30 mg/m2 d 1-4), mitomycin C (10 mg/m2 d 1), vindesine (3 mg/m2 d 1) and 5-FU (1 g/m2 d 1-4 by continuous intravenous infusion). In patients older than 70 years, and in those who received prior irradiation or chemotherapy, cisplatin and 5-FU were omitted on day 4. Courses were repeated every 4 weeks and evaluation of response was performed after the first 2 courses. In case of response, treatment was continued until best response or untolerable toxicity. Among 182 eligible patients, 75% had received no prior therapy; 41% had locoregional disease and 59% metastatic disease; 41% lost more than 5% of their pretherapy body weight. A 34% objective response rate was observed in the 164 evaluable patients (31% in all the eligible patients) including 4 complete and 52 partial responses. Patients with locoregional disease had a significantly better response rate than those with metastases (44% vs 27%). The overall median survival was 26 weeks. Significant hematological toxicity was documented but the most serious adverse event was the occurrence of 18 (10%) cardiac or sudden deaths. These toxic deaths were significantly associated with a 5% loss of body weight prior to therapy. The addition of 5-FU to combination of cisplatin, mitomycin C and vindesine does not improve antitumoral effect but results in very significant cardiac toxicity.

Adult↗