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Biomedical subjects

J M Bennett

Publications and source records attributed to J M Bennett.

At least 235 records · Page 13Linked to original sources
PubMed1983

Sequential cyclophosphamide-prednisone and vincristine-bleomycin (CPOB). An effective, schedule-dependent treatment for advanced diffuse histiocytic lymphoma.

In an Eastern Cooperative Oncology Group non-Hodgkin's lymphoma clinical trial, 90 patients with Stage III or IV diffuse histiocytic lymphoma (DHL) were treated with one of four chemotherapy regimens. All patients were previously untreated with chemotherapy, and careful restaging was required to document responses. Each treatment included cyclophosphamide, vincristine and prednisone (COP) plus Adriamycin (COPA), BCNU (BCVP) or bleomycin (COPB and CPOB). The two bleomycin-containing regimens differed only in the schedule of drug administration. CPOB-treated patients received cyclophosphamide on day 1, prednisone on days 1 to 5 and vincristine and bleomycin on day 15 of each 21-day cycle. COPB-treated patients received the same four drugs in the same dosage; however, the schedule was changed so that vincristine and bleomycin were given on day 1. Treatment of responders was continued for 8 cycles. Those with a complete response (CR) were randomized to maintenance therapy with BCVP or no treatment. Treatment with CPOB yielded a CR rate of 55% compared to 25% for COPB (P = 0.07). In contrast to COPB, treatment with CPOB was associated with a significantly longer median duration of CR (26.5 versus 5.7 months; P less than 0.05) and median survival (27.7 versus 11.2 months; P less than 0.02). The CR rate was 31% for BCVP and 45% for COPA, and the median survivals were 10.7 months and 14.4 months, respectively. One half of the CPOB-treated patients who achieved CR remained alive in continuous CR after 30 to 72 months. No advantage for maintenance therapy was observed. Myelotoxicity was greater with CPOB than COPB, but comparable to COPA. This trial demonstrated that the results of treatment of DHL with COP plus bleomycin were strikingly dependent upon the schedule of administration of bleomycin and vincristine. Bleomycin effectively combined with COP, as in CPOB, yielded results comparable to those obtained when Adriamycin was added to COP. CPOB appears to be an effective treatment for DHL that should be considered as an alternative to other regimens, particularly for patients who cannot receive Adriamycin.

Antineoplastic Agents↗
PubMed1983

Adriamycin and Cytoxan in the treatment of inoperable lung cancer.

The results of a clinical trial involving 599 patients with inoperable squamous cell, large cell anaplastic, and adenocarcinoma of the lung are summarized. Patients were randomized to initial therapy with Cytoxan (CTX) (cyclophosphamide), or to one of two schedules of Adriamycin (doxorubicin) 50, or 75 mg/m2 IV every three weeks, or to a combined regimen of ADR and CTX. Upon disease progression, CTX patients were randomized to one of the two ADR schedules, while ADR patients were randomly assigned to CTX alone, or in combination with Cisdiamminedichloroplatinum (Cis-Platinum) 15 mg/m2 IV every three weeks. No statistically significant response or survival differences were observed between the two dose schedules of Adriamycin for any of the cell types studied. The two dose levels did, however, differ with respect to toxicity. There were some response and survival differences among the various cell types in the comparison of low-dose Adriamycin and Cytoxan: (1) patients with adenocarcinoma treated with low-dose Adriamycin tended to survive longer (P = 0.04) than those treated with Cytoxan; and (2) patients with large cell carcinoma receiving Cytoxan experienced a greater tumor response rate than those receiving low dose Adriamycin (P = 0.03). Because of the difficulties involved in distinguishing these two cell types on pathologic examination, the evidence of apparent treatment differences should not be regarded as definitive. During the period when Adriamycin plus Cytoxan was open to patient entry 61 evaluable patients received that regimen, 21 received low-dose Adriamycin and 22 received Cytoxan. Because relatively few patients received the latter two regimens, comparisons of these treatments with Adriamycin plus Cytoxan lack statistical power. However, there is no suggestion in the available data that Adriamycin plus Cytoxan increased survival either in the overall population or in the subset of patients with squamous histology. Initial performance status, metastatic disease symptoms, primary disease symptoms, and weight loss were significantly correlated to survival time, and are recommended as stratification factors in future studies.

Adenocarcinoma↗
PubMed1983

Oncologists' views of cancer patient noncompliance.

Cancer patient compliance with medical advice and procedures is crucial to successful treatment. This study assessed the views of 246 randomly selected oncologists about the extent of, and reasons for, cancer patient noncompliance. A questionnaire was designed to assess aspects of a) appointment-keeping, b) adherence to outpatient and inpatient treatments, and c) adherence to self-medication instructions. Difficulties with cancer patients' adherence to either inpatient or outpatient treatments were reported as the most difficult problems. Oncologists who reported greater problems with noncompliance had significantly more patients on randomized clinical trials. Oncologists cited psychological problems as a prime determinant for noncompliance. Treatment-related side effects were also seen as contributing to patient noncompliance. The results suggest that mental health and educational disciplines could play a significant role in the reduction of cancer patient noncompliance.

Appointments and Schedules↗
PubMed1983

Informed consent to treatment in clinical trials.

Special characteristics of clinical trials place unique demands on the concept and practice of informed consent to treatment. We focus on the practical problem that consent to treatment forms are not typically able to be understood by patients in clinical trials research. Informed consent forms are significantly less comprehensible than popular press written material and may be as difficult to read as medical journals. Several guidelines for improving informed consent to treatment documents such as the use of non-professionals and patients to critique drafts of consent to treatment forms are proposed and discussed. The use of these guidelines can insure that patients have the opportunity to understand more clearly what their treatment will involve within a clinical trial before they give an informed consent.

Clinical Trials as Topic↗
PubMed1982

Clinical and chemotherapeutic study of hepatocellular carcinoma in Malaysia: a comparison with African and American patients.

Twenty Malaysian patients with unresectable primary liver cell cancer were prospectively studied at the General Hospital, Kuala Lampur, and were compared for clinical features with an equal number each of African and American patients being studied by the Eastern Cooperative Oncology Group. The patients received intravenous 5-FU and oral MeCCNU which was used for the first time in an Asian country. Most of the Malaysian patients were Chinese, belonged to younger age groups, and presented with massive hepatomegaly, jaundice, and fever. Toxicity to MeCCNU invariably occurred in the form of leukopenia or thrombocytopenia, but none life threatening. Partial response was seen in 20% of Malaysians as compared to 16% in Americans and none in Africans. Malaysians achieved a median survival of 16 weeks compared to 28 weeks in Americans and only eight weeks in Africans. Malaysian Chinese patients were all HBc Ab + ve. Other factors which may have played an etiologic role in the induction of primary liver cancer included alcohol, Chinese herbal medicines, aflatoxin and habitual use of medicated rubbing oils.

Adult↗
PubMed1982

[Intracoronary thrombolysis. A case report].

Restoration of blood flow in an occluded right coronary artery of a patient with an acute myocardial infarction was achieved with intracoronary administration of streptokinase. Patency of the vessel was restored within 15 minutes after starting the infusion. The dose of streptokinase used was 3000 U/min. The patient's pain was relieved and the raised ST segments returned to normal after patency was achieved. Cardiac output and stroke volume increased fro 3,6 to 6,3 1/min and from 61 to 70 ml respectively. No complications occurred during the infusion of streptokinase. Intracoronary thrombolysis might well establish itself as the treatment of choice for acute myocardial infarction in selected patients.

Coronary Disease↗
PubMed1982

Nodular histiocytic lymphoma: factors influencing prognosis and implications for aggressive chemotherapy.

Twenty-five patients with Stage III and IV nodular histiocytic lymphoma (NH), entered on three different Eastern Cooperative Oncology Group protocols from 1972-78, were analyzed for response and survival. A complete response (CR) rate of 44% was observed, with 40% partial responders (PR). Four of the 11 CRs are continuing in their original remission. Median survival for CRs was 52 months; for PRs it was 30 months. The six patients treated with cyclophosphamide-prednisone had a median survival of 18 months versus 51 months for the 19 patients treated with more aggressive combination chemotherapy programs. No significant difference in survival was noted between those patients with both nodular and diffuse histology and those with a pure nodular pattern. The median survival of the 25 NH patients was 47 months and is similar to a group of 101 patients with nodular mixed lymphoma (NM) entered on the same ECOG protocols during this time. This survival is intermediate between the nodular lymphocytic poorly differentiated subtype and diffuse histiocytic lymphoma. It suggests that patients with NH histologies be treated with aggressive combination chemotherapy programs designed to achieve complete remission and prolonged disease-free survival.

Antineoplastic Agents↗
PubMed1982

Burkitt cell leukemia following therapy for Hodgkin disease.

Two adults with advanced Hodgkin disease-one treated with combination chemotherapy, and one with chemotherapy and radiation therapy-developed Burkitt cell leukemia four and seven years after diagnosis, proved by cytochemical and ultrastructural study. Acute lymphocytic leukemia must be considered in the evaluation of therapy-related leukemias.

Burkitt Lymphoma↗
PubMed1982

High-dose radiation therapy with low-dose (pulsed) BCNU in malignant gliomas: an Eastern Cooperative Oncology Group (ECOG) report.

Based on preliminary favorable results with the use of postoperative high-dose radiation therapy for malignant gliomas and encouraging experimental studies which indicated that fractionated does of BCNU given 16 hours before irradiation significantly enhanced the effect of radiation both in vitro and in vivo, the Eastern Cooperative Oncology Group (ECOG) decided to explore the use of high-dose radiation therapy in combination with pulsed low doses of Group (ECOG) decided to explore the use of high-dose radiation therapy in combination with pulsed low doses of BCNU in a high-risk Phase I-II pilot study. The radiation therapy consisted of delivering 6000 rad to the whole brain plus a boost of 1000 rad to the tumor. BCNU was given i.v. 16 hours before the next radiation fraction with doses of 20 mg/M2 twice weekly for six weeks beginning on the second day of irradiation. Twelve patients were treated (5 with Grade III and 7 with Grade IV Astrocytomas). The median survival for the entire group was 80 weeks (30 weeks for Grade IV and 210 weeks for Grade III tumors). These results are not difficult from what was achieved by high-dose radiation alone. Subsequent experimental data seem to indicate that probably the smallest dose of BCNU that should be used in pulsed BCNU combined modality therapy is 80 mg/M2. In general, the treatment as offered in this study was well tolerated. There were no fatal or life-threatening hematologic toxicities and only one patient exhibited a transitory leukopenia of 1600.

Adult↗
PubMed1982

Cancer patient accessions into clinical trials: a pilot investigation into some patient and physician determinants of entry.

This study investigated the external validity (or generalizability of results) of randomized clinical trials in cancer. Tao ECOG lung cancer chemotherapy protocols active in the early 1970s were studied using a case-control design. All lung cancer patients of the four specified cell types resident in Monroe County during the ECOG study period were identified from the Rochester Regional Tumor Registry. All of the patients entered into either protocol ("ECOG cases") and a random sample of the nonprotocol cases were examined by medical records review. Thirty-seven percent of the nonprotocol cases were determined to have been eligible for either of the two ECOG protocols, but not entered ("eligible controls"). A comparison of the ECOG cases (n = 65) and the eligible controls (n = 109) revealed that (1) ECOG cases were more likely than eligible controls to have been diagnosed at a hospital which participated in the University of Rochester Cancer Center's medical oncology program; (2) ECOG cases were of higher occupational status than eligible controls; (3) duration from diagnosis to protocol entry for ECOG cases was longer than duration from diagnosis to earliest date of eligibility for eligible controls. The implications of these findings for the conduct of cancer clinical trials are discussed.

Aged↗