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Biomedical subjects

K W Brunner

Publications and source records attributed to K W Brunner.

At least 55 records · Page 3Linked to original sources
PubMed1986

The antiemetic activity of high-dose alizapride and high-dose metoclopramide in patients receiving cancer chemotherapy: a prospective, randomized, double-blind trial.

Alizapride is a new substituted benzamide with suggested superior antiemetic efficacy to and fewer side effects than metoclopramide. High-dose alizapride (4 mg/kg X five doses) was compared with high-dose metoclopramide (2 mg/kg X five doses) in a prospective, randomized, double-blind trial in 62 evaluable patients undergoing strongly emetic cancer chemotherapy. Patients receiving metoclopramide experienced significantly fewer vomiting episodes than patients receiving alizapride (median of three episodes vs. eight episodes; P less than 0.001). Metoclopramide was more effective in decreasing the volume of emesis than was alizapride (median of 100 ml vs. 360 ml; P less than 0.02). Seventy-two percent of the patients receiving alizapride and 57% of those receiving metoclopramide experienced side effects. High-dose metoclopramide is an effective antiemetic in patients receiving cancer chemotherapy. Alizapride is less effective and has more side effects than metoclopramide. We do not recommend the further use of alizapride.

Adult↗
PubMed1986

[Acceptable risks in adjuvant therapy].

The definition of acceptable risks in adjuvant therapies has to be based on the evaluation of the cost-benefit relationship. The possible benefit can only be determined by prospective clinical trials for each tumor category. Individually, the possible benefit cannot be weighed as long as no method for the detection of micrometastases is available. Statistically, successful or promising adjuvant treatments, treatments in the experimental phase, treatments with controversial or with clearly negative results can be defined for the various malignant tumors. The risks consist in short-, medium- and long-term side-effects of adjuvant therapies, especially of adjuvant chemotherapy. Of special importance for the cost-benefit evaluation are long-term organ toxicities and the induction of second neoplastic diseases. The definition of acceptable risks involves not only medical, but also ethical considerations. But all these considerations should be based as far as possible on objective facts and not on prejudice.

Antineoplastic Agents↗
PubMed1985

[Follow-up of potentially cured cancer patients. Object, method and duration?].

The follow-up of potentially cured cancer patients is discussed. After outlining the goals, requirements and problems of posttreatment follow-up, practical guidelines for gastrointestinal, breast and lung cancer, the malignant lymphomas and testicular cancer are suggested for the benefit of the medical practitioner, who often directs the follow-up care of a patient after completion of primary treatment for cancer.

Breast Neoplasms↗
PubMed1985

Postoperative adjuvant 5-fluorouracil plus methyl-CCNU therapy for gastric cancer patients. Eastern Cooperative Oncology Group study (EST 3275).

After en bloc resection of gastric adenocarcinoma, 180 patients were randomized to 2 years of 5-fluorouracil (5-FU) + semustine (MeCCNU) chemotherapy or to observation only. After a median follow-up time of 64 months, 48 of 89 control patients and 51/91 treated patients recurred (P less than 0.71). The sites of recurrent cancer were similar for both groups: liver, 32%; local esophagus or stomach, 51%; abdominal nodes and peritoneum, 38%; and extra-abdominal nodes, 14%. The survival curves overlap; 51/89 controls and 57/91 treated patients died with a median survival of 32.7 and 36.6 months, respectively (P less than 0.73). Treated patients experienced clinically important hematologic toxicity and two treated patients died of marrow failure with leukemia. Because of the toxicity and the lack of effectiveness, adjuvant 5-FU + MeCCNU is not recommended for patients with resectable gastric cancer.

Adenocarcinoma↗
PubMed1985

Alizapride, a new substituted benzamide, as an antiemetic during cancer chemotherapy.

In early clinical trials alizapride showed a better antiemetic activity with fewer side effects than metoclopramide. Alizapride has now been evaluated in an open dose-ranging study in 24 patients receiving strongly emetic chemotherapy. Alizapride 4-8 mg/kg was given as a 15 min infusion 0.5 h before and 1.5, 3.5, 5.5 and 8.5 h after the chemotherapy. At the dose levels of 6 and 8 mg/kg x 5, respectively 6 out-of 9 and 4 of 4 patients experienced side effects (hypotension, dizziness, profuse sweating, general malaise and diarrhoea). At 4 mg/kg x 54 of 15 patients experienced side effects due to alizapride (dyspnoea 1, diarrhoea 2, extrapyramidal syndrome 1 patient). Overall, 9 of 24 patients were partially or completely protected from nausea and vomiting. Based on this experience alizapride has antiemetic activity and few side effects in the dose of 4 mg/kg x 5.

Adult↗
PubMed1985

Hormono-chemotherapy in the treatment of advanced breast cancer.

The current situation in the treatment of metastatic breast cancer is reviewed. Overall the concurrent use of endocrine treatment and chemotherapy does not improve the therapeutic results as compared to a treatment encompassing only one modality. However, results diverge widely in different subgroups. Data emerging from various randomized trials are beginning to define subgroups of patients, who should be treated differently. Such data are discussed and their importance for future trials in the field of advanced breast cancer reviewed.

Adult↗
PubMed1985

[Chemotherapy as primary therapy in non-radically operated ovarian cancer].

Forthwith the results of chemotherapy on advanced ovarian carcinoma are summarized. The following conclusions can be drawn: stages Ia and Ib of low malignancy degrees should receive follow-up treatment. Stages II and I of high malignancy degrees should receive radiotherapy to the whole abdomen. The value of intensive chemotherapy is examined. Stage II with residual tumor should undergo combined cis-platin treatment for 4 to 6 months. Stage III with residual tumor should receive intensive chemotherapy followed by a second-look operation and radiotherapy to the whole abdomen. The prognosis of cases with large residual tumors is very unfavorable so that the value of radical therapy must be further investigated.

Antineoplastic Agents↗
PubMed1985

The treatment of ovarian cancer by a multimodality approach: remission induction with chemotherapy--hexa PAMP and PAMP regimens--followed by whole-abdominal radiation.

Seventy-six evaluable patients with ovarian carcinoma stages FIGO IIb, IIc, III, and IV, either received cis-platin (P) (80 mg/m2 iv. day 1), melphalan (PAM) (12 mg/m2 i.v. day 2) and hexamethylmelamine (HEXAPAMP) (135 mg/m2 orally days 8 to 21) or the same dose of cis-platin and melphalan but no hexamethylmelamine (PAMP) every four weeks. In 24 patients (32%) a surgically ascertained CR was achieved. 16 of these received follow-up radiation treatment to the whole abdomen. At present 19 patients are without relapse (average time 24 months). The trial has not been concluded. Particularly no predictions can be made on the value of follow-up radiation therapy in obtaining long-term remission rates.

Adult↗
PubMed1984

[Adenocarcinoma of the kidney (hypernephroma)].

Adenocarcinomas of the kidney are rare tumors. This malignancy has been called the "internist's tumor" because of its often unusual presentation and systemic symptoms. The diagnosis is largely based on urography, sonography and CT-scan. Radical tumornephrectomy is the only treatment with curative potential. Interventional angiography with tumor embolization has become an important tool for palliation. On the other hand, the results of systemic treatment, such as hormone therapy, chemotherapy or immunotherapy, remain disappointing.

Androgens↗
PubMed1984

A phase I trial of cis-diammine-1,1-cyclobutane dicarboxylate platinum II (Carboplatin, CBDCA, JM-8) with a single dose every five week-schedule.

Carboplatin, a new platinum analogue, was administered intravenously on a schedule of a single dose every five weeks to 23 patients with advanced malignant solid tumors. Patients were treated at six dosage levels ranging from 200-550 mg/m2 every five weeks. Thrombocytopenia was dose-limiting. At 550 mg/m2 Carboplatin, the median platelet nadir was 65 000/mm3. Leukopenia was common, but usually of mild to moderate degree. Gastrointestinal upset was commonly seen at all dose levels, but 35% of the patients experienced no vomiting. No significant increase of the serum creatinine following Carboplatin was seen. In 16 patients serial determinations of the creatinine clearance were performed. The median base line creatinine clearance was 87 (50-155) ml/min and dropped to a median lowest creatinine clearance of 69 (23-171) ml/min on day four (p less than 0.05). The median creatinine clearance before the next Carboplatin treatment was 89 (42-155) ml/min. No significant proteinuria or electrolyte disturbances were noted. Carboplatin exhibited antitumor activity in ovarian, endometrial, thyroid and gastric carcinomas. The maximally tolerated dose appears to be 550 mg/m2 every five weeks. A starting dose of 450 mg/m2 seems to be appropriate for Phase II studies. In patients with impaired renal function and/or prior cis-Platin chemotherapy, Carboplatin at doses of 200-500 mg/m2 induced renal and severe hematological toxicity.

Adult↗
PubMed1984

Pathologic data of prognostic significance for remission induction in advanced ovarian carcinoma.

Sixty-eight patients with "advanced ovarian carcinoma" were entered into an ongoing phase-II trial for remission induction with cis-platinum (DDP) 80 mg/m2 i.v. on day 1 followed by forced saline diuresis, melphalan (L-PAM) 12 mg/m2 i.v. on day 2 and hexamethylmelamine (HMM) 130 mg/m2 p.o. X 14 days from days 8-21 in six monthly cycles following operative resection and/or staging. Fifty-one patients were evaluable for response, ten had not completed six courses and could not be assessed, two patients died early (one probably of toxicity), and five patients refused treatment and follow-up. Thirty-Two patients had serous, endometrioid or undifferentiated carcinomas of the ovary. Of these, 11 (35%) achieved a pathologically proven complete remission (CR), five (16%) were NED after second-look (residual disease in ovary or removed omentum with all other biopsies and cytology washings negative), eight (32%) achieved a partial remission (PR), and three (12%) had progressive disease. None of the seven patients with clear-cell carcinoma and none of the three patients with Mullerian tumor of the ovary responded. Six of nine patients with tumors of uncertain origin or proven metastasis to ovary did not respond to treatment. These preliminary results indicate that advanced ovarian carcinomas form a heterogeneous group of recognizable neoplastic diseases with striking variation in response to treatment.

Adenocarcinoma↗
PubMed1984

Adjuvant chemotherapy after retroperitoneal lymph node dissection.

At present there are no firm data for the routine use of adjuvant chemotherapy in stage II testicular cancer after retroperitoneal lymph node dissection. The possible advantage of adjuvant chemotherapy in terms of reduced relapse rate and continuously disease free survival have to be weighed against the increasing cure rates with modern chemotherapy regimen, applied at the time of advanced and recurrent disease. About 10-15% of stage I and 40-50% of stage II patients relapse after RPLND. Depending on risk factors such as total tumor burden, histology and disease sites and symptoms at the time of presentation, 30-90% of these patients are brought into complete remission with modern chemotherapy (overall between 50 and 70%). Based on these results, a subgroup of patients with a low risk of relapse and a more than 90% chance of cure with salvage chemotherapy may be defined. They do not need adjuvant chemotherapy with its associated toxicity. On the other hand, in a high risk group, which demonstrates poor results with salvage chemotherapy, adjuvant chemotherapy seems to have the potential to significantly improve the cure rate. A third group of patients, presenting with bulky abdominal disease may need immediate postdiagnostic intensive chemotherapy, with surgical exploration only at the time of maximum response. The question of definition of optimal treatment strategies in the various subgroups of patients with testicular cancer can only be solved by ongoing and future randomized clinical trials.

Abdominal Neoplasms↗