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Biomedical subjects

J Klastersky

Publications and source records attributed to J Klastersky.

At least 127 records · Page 7Linked to original sources
PubMed1989

Cisplatin versus cisplatin plus etoposide in the treatment of advanced non-small-cell lung cancer. Lung Cancer Working Party, Belgium.

We conducted a randomized study comparing the survival after treatment with cisplatin (120 mg/m2) or cisplatin plus etoposide (100 mg/m2 on days 1, 2, and 3) in 162 evaluable patients with advanced non-small-cell lung cancer (NSCLC). No statistically significant difference in survival was detected; the median survival was 26 and 22 weeks, respectively, for patients receiving cisplatin and for those receiving cisplatin plus etoposide. The objective response rate was 19% for cisplatin and 26% for the combination; the corresponding response rates were 17% and 43% in patients with limited disease. No significant differences were detected between the two study arms as far as toxicity was concerned, except for alopecia and granulocytopenia, which occurred more frequently in patients treated with cisplatin plus etoposide.

Adenocarcinoma↗
PubMed1989

[Chemotherapy of cancer of the lung].

Based on the present experience, it is suggested that CDDP plus VP16 is associated with a reproducible 30-40% objective response rate in NSCLC (Non-Small Cell Lung Cancer). Although symptomatic relief is not rare in responding patients, serious morbidity from chemotherapy may also occur. Overall, the duration of the response is not very long (the median duration is approximately 6-8 months) and only modestly influences the survival of responding patients (the median survival in non responders is usually 4-5 months). In addition, due to such factors as the relatively low response and the serious morbidity from treatment, the overall survival and quality of life for these patients has not substantially improved. As for as SCLC (Small Cell Lung Cancer) is concerned, the impact of chemotherapy despite the introduction of VP16, carboplatin and ifosfamide, has remained essentially unchanged for more than ten years. Maintenance chemotherapy, alternating non cross resistant combinations and intensive treatments, with presently available drugs, have failed to improve the prognosis of patients with SCLC. Combined radio chemotherapy also fails in this regard. Truly limited disease should definitely be treated with chemotherapy followed by surgery, as the potential for prolonged survival looks realistic. Therapy of more extensive disease still remains a challenge; despite the failure of early and late intensification programs, more aggressive initial multi-drug therapy represents an alternative approach.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Infections in compromised hosts: considerations on prevention.

Compromised patients are predisposed to the acquisition of resistant bacteria from the hospital environment. In compromised hosts, gram-negative bacillary and staphylococcal infection is often nosocomial, being a result of the severity of the underlying disease and frequent and/or prolonged hospitalizations. The level of colonization of these patients by gram-negative bacilli can be reduced by the use of effective antibiotics administered to the oropharyngeal area or administered orally, by careful handwashing by the hospital personnel and the administration of low microbial diets to the patients. Infections caused by Staphylococcus epidermidis can be reduced by careful attention to i.v. devices; for the streptococcal infections, no clearly effective prophylaxis is available, as the mechanisms of acquisition have not been elucidated. Administration of non-absorbable antibiotics has been used for gastro-intestinal decontamination in order to prevent gram-negative infections in granulocytopenic patients. These regimens are poorly tolerated and have been replaced by the quinolones and cotrimoxazole. This latter drug is also effective for the prevention of Pneumocystis carinii infections. There is no consensus about the optimal prevention of fungal infections, especially as far as Aspergillus is concerned. For the prevention of infections caused by Candida spp., systemically absorbed imidazoles such as ketoconazole are probably effective. The infections caused by cytomegalovirus can be prevented by sero-negative blood products. In seropositive patients, ganciclovir or acyclovir might be active to some extent. Immune globulins can prevent Herpes zoster-Varicella infections and acyclovir is effective in preventing Herpes simplex virus infections.

Humans↗
PubMed1988

Cefoperazone in the treatment of infections in cancer patients.

Cefoperazone appears to be one of the cephalosporins with the most promise in granulocytopenic patients, regardless of whether it is used in combination or as monotherapy. It has the broad spectrum of antimicrobial activity necessary to inhibit the organisms commonly encountered in patients with cancer, as well as the ability to achieve high serum levels for sustained periods of time. Administration of cefoperazone should provide effective therapy in the overall management of most infections encountered in patients with neoplastic diseases.

Bacterial Infections↗
PubMed1988

Pneumococcal bacteremia in cancer patients.

Twenty-eight episodes of Streptococcus pneumoniae bacteremia occurring in 27 cancer patients hospitalized in the Institut Jules Bordet between July 1979 and April 1985 were reviewed. Ten patients had hematological malignancies and 17 had solid tumors (in 7 cases, of the lung). Forty-four per cent of the patients were neutropenic (less than 1000/microliters) and 36% of the patients were in septic shock. In 36% of the patients no clinical source of S. pneumoniae bacteremia could be found. Seventy-nine (21% patients) received empirical antibiotic treatment containing a beta-lactam. Two patients who did not receive any empirical treatment died within 12 hours. Overall, 11/27 patients died within the first week, and 8/27 died within the first three days. Mortality in neutropenic patients was not different from that in non-neutropenic patients. In comparison with a similar study performed previously in our institution, there was no difference in incidence, type of patient, source of bacteremia, or mortality.

Adult↗
PubMed1988

Multiple organ failure during interleukin-2 administration and LAK cells infusion.

Adoptive immunotherapy is a new promising treatment for cancer but is associated with severe toxicity mainly related to a capillary leak syndrome. We report the case of a patient with metastatic hypernephroma, who had many complications such as coma, renal failure, pulmonary edema, life-threatening acidosis, cardiac arrhythmias and venous thrombosis. Critical care specialists should be aware of this type of cancer therapy because of multiple side effects requiring ICU supportive care.

Bone Neoplasms↗
PubMed1988

Phase I study of a carboplatin-etoposide combination in advanced thoracic cancer.

We conducted a phase I trial with the combination carboplatin (CBDCA)-etoposide (VP-16) in thoracic cancer. CBDCA, at a starting dose of 300 mg/m2 dl, was associated with a fixed dose of VP-16 (100 mg/m2 dl-3). Escalation of doses was permitted after three patients entered at each dose level without grade IV toxicity. As expected, hematologic toxicity was the limiting factor. Severe myelosuppression (grade IV) occurred in three out of four patients treated at 350 mg/m2. Only three out of 19 patients treated at 325 mg/m2 exhibited a reversible grade IV hematologic toxicity. Other toxicities were mild and acceptable. Among 15 evaluable patients three showed a partial response. Two of the three responders have previously had a progression while receiving cisplatin and etoposide. The recommended dose of carboplatin to be associated with VP-16 (100 mg/m2 dl-3) is thus 325 mg/m2 dl.

Adult↗
PubMed1988

Role of intensive care unit in a medical oncology department.

Over a 4-year period, 912 patients were admitted to the ICU of the medical oncology service at the Institut Jules Bordet: 574 (63%) were admitted for medical emergencies and 338 (37%) for intensive treatment and/or monitoring. In the first group, the main causes of admission were hypercalcemia, thromboembolic disease, cardiac arhythmias, encephalopathies and pneumopathies. Overall mortality during the ICU stay was 23% (133/574). In the second group, patients were admitted primarily in order to receive, under optimal surveillance, anticancer treatment, either because they were at high risk of complications or because the approach was mainly investigational; several investigations, in the fields of supportive care and anticancer treatment, were successfully conducted within the ICU environment.

Arrhythmias, Cardiac↗
PubMed1988

Phase II study of an intensive combination chemotherapy with cisplatin, adriamycin, etoposide and cyclophosphamide (CAVE) in small cell lung cancer.

One hundred and twelve patients with small cell lung cancer (SCLC) were treated with a combination (CAVE) of cisplatin (60 mg/m2 day 1), adriamycin (45 mg/m2 day 1), etoposide (80 mg/m2 days 1-2-3) and cyclophosphamide (1 g/m2 day 1) given every 4 weeks. A total of 10 courses were given. Response evaluation was initially evaluated after the first two courses of CAVE and repeated at least after treatment completion. This regimen was associated with severe hematological toxicity, mainly leucopenia; five toxic deaths related to sepsis were observed. One hundred and one patients were evaluable for response: 63 with limited disease and 49 with extensive disease. Overall complete and partial response rates after the first two courses of chemotherapy were 16% and 63% respectively but 14 late complete responses were documented, leading to a 30% total complete response rate; 38% in patients with limited disease and 19% in those with disseminated disease. Median overall survival was 46 weeks with a 17% 2 year survival. The only significant prognostic factor for survival was the type of response. There was no survival difference between 'early' and 'late' complete responders. Complete responders had a 75 week median survival time with a 34% 2 year survival. CAVE is thus an effective regimen for SCLC, but with a considerable toxicity.

Adult↗
PubMed1988

Pilot study of amphotericin B entrapped in sonicated liposomes in cancer patients with fungal infections.

A pilot study with amphotericin B incorporated in sonicated liposomes (ampholiposomes) made of egg phosphatidylcholine, cholesterol and stearylamine in a molar ratio 4:3:1 was performed in cancer patients with fungal infections. Fifteen patients received a total of 117 intravenous infusions of ampholiposomes. The total dose of amphotericin B administered per patient ranged from 20 to 1004 mg (mean 472 mg). The number of infusions per patient varied from 1 to 20 (mean 8) and the duration of treatment from 1 to 29 days (mean 10 days). Infusion of doses up to 1.8 mg/kg was well tolerated. None of the common side-effects of Fungizone, the colloidal suspension of amphotericin B, occurred; it was noteworthy that patients had no renal function impairment. Serum amphotericin B concentrations given as ampholiposomes were much higher than those obtained with Fungizone. With a daily treatment schedule, peak and trough serum amphotericin B concentrations, as measured by HPLC, were 10 to 20 micrograms/ml and 5 to 10 micrograms/ml respectively; while they did not exceed 2 micrograms/ml and 1 microgram/ml with Fungizone. Amphotericin B given as ampholiposomes had a prolonged serum beta half-life (25.3 +/- 16.0 h). Higher serum antifungal activity was observed with ampholiposomes as compared to Fungizone. We concluded that ampholiposomes have a better therapeutic index than Fungizone.

Adult↗
PubMed1988

Bactericidal activity and killing rate of serum in volunteers receiving pefloxacin alone or in combination with ceftazidime, piperacillin or mezlocillin against Pseudomonas aeruginosa.

The activity of the combination of pefloxacin with ceftazidime, piperacillin, or mezlocillin was compared to the activity of the same antibiotics given alone, by measurement of serum bactericidal titres and the rate of killing of ten strains of Pseudomonas aeruginosa. Three groups of five volunteers each received pefloxacin (12 mg/kg iv) with or without ceftazidime, piperacillin or mezlocillin (25 mg/kg iv). Serum samples were obtained at the end of the infusion. The mean serum concentration of pefloxacin at this time was 13.9 mg/l (3.2, S.D.). The activity of each of the three combinations was identical to the corresponding activity of the beta-lactam alone. However, the emergence of resistance to pefloxacin was prevented by ceftazidime (five out of five strains), and piperacillin (two out of five strains). We conclude that combinations of pefloxacin with beta-lactam antibiotics may not increase efficacy against P. aeruginosa.

Anti-Bacterial Agents↗
PubMed1988

Penetration of ciprofloxacin in bronchial secretions after intravenous administration.

Ciprofloxacin concentrations in serum and in bronchial secretions were studied after single and multiple intravenous administrations for two days in ten patients. The dose given was either 0.75 or 1.5 mg/kg. With the lower dose, the peak concentrations in the bronchial secretions were (mean +/- S.D.) 0.40 +/- 0.29 mg/l after the first injection and 0.35 +/- 0.25 mg/l after the fourth injection. With the higher dose, the corresponding mean peak bronchial concentrations were 0.84 +/- 0.58 and 1.16 +/- 0.86 mg/l respectively. The half-lives of the drug in bronchial secretions ranged from 2.13 to 3.72 h. The penetration of ciprofloxacin into bronchial secretions was excellent as demonstrated by the high ratios of the areas under the concentration curves obtained in the serum and in bronchial secretions which ranged from 0.79 to 1.11.

Adolescent↗