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Biomedical subjects

L A Price

Publications and source records attributed to L A Price.

At least 37 records · Page 2Linked to original sources
PubMed1987

The promising role of safe initial non-cisplatin-containing combination chemotherapy in nasopharyngeal tumors.

Twenty patients with previously untreated nasopharyngeal tumors received, as initial treatment, two courses of Schedule A chemotherapy including vincristine, 5-fluorouracil, bleomycin, hydrocortisone, methotrexate, and a folinic acid rescue, prior to definitive radiotherapy. Thirteen patients had Stage IV and seven had Stage III tumors, with nodal involvement in 18 patients (90%). Response to two courses of Schedule A chemotherapy was assessed on day 28, and overall, 18 patients responded. Side effects were minimal. Following radiotherapy 17 patients achieved a clinical complete remission. Durations of response ranged from 6 to 95+ months (median 40 months) and of survival from 8 to 95+ months (median 53 months). This chemotherapy protocol should be more widely evaluated as initial treatment in nasopharyngeal carcinomas since the 90% chemotherapy response rate and, after radiotherapy, 85% clinical complete remission rate was accomplished with minimal toxicity and interference with patients' quality of life and resulted in median overall survival figures of approximately four years.

Adult↗
PubMed1986

Importance of primary site in assessing chemotherapy response and 7-year survival data in advanced squamous-cell carcinomas of the head and neck treated with initial combination chemotherapy without cisplatin.

Two hundred eight patients with advanced head and neck squamous-cell carcinomas were treated between 1975 and 1982 with schedule A chemotherapy containing vincristine, bleomycin, methotrexate, 5-fluorouracil, and hydrocortisone administered over 24 hours followed by a folinic acid rescue. Chemotherapy was administered as initial treatment on days 1 and 14 before "curative" local therapy. Toxicity was minimal and patient compliance was 100%. Chemotherapy response was assessed on day 28 in 200 patients: 132 (66%) had an objective response and 68 (34%) were judged to be nonresponders. The complete remission (CR) rate following local therapy was significantly greater in chemotherapy responders (78%) than nonresponders (49%) (P less than .001). Overall median survival figures were 32 months for all patients, 37 months for all chemotherapy responders, and 69 months for all patients achieving CR. Analysis by tumor site showed that oral cavity or nasopharyngeal tumors responded well to initial chemotherapy (P less than .05 and P less than .01) compared with all other sites. This high response rate was not necessarily associated with increased survival, since the median survival of chemotherapy responders for oral cavity lesions was only 22 months, although in nasopharyngeal tumors, median survival figures were 64 months. Furthermore, the longest median survival duration of 69 months was observed in patients with laryngeal tumors, although these had a lower response rate (61%) to initial chemotherapy. Therefore, response to initial chemotherapy is not automatically a favorable prognostic sign. Survival figures appear markedly influenced by tumor site.

Actuarial Analysis↗
PubMed1984

Treatment of advanced squamous cell carcinomas of the head and neck with initial combination chemotherapy prior to surgery and/or radiotherapy: five-year survival data.

One hundred and thirty-nine patients with advanced head and neck cancer were treated with a combination of vincristine, bleomycin, methotrexate with a folinic acid rescue, 5-fluorouracil and hydrocortisone given over 24 hours, as initial therapy on days one and 14 prior to conventional local therapy on day 28. One hundred and thirty-six patients were assessed for chemotherapy response on day 28. Ninety-one patients (67 per cent) had an objective response and 45 (33 per cent) were classed as non-responders, although 13 had a minimal (20-30 per cent) response. The complete remission rate following local therapy was significantly greater in chemotherapy responders (76 per cent) than in nonresponders (54 per cent) p less than 0.05. Toxicity was minimal, provided standard medical precautions were observed, and 87 patients (63 per cent) reported no side-effects. There was 100 per cent patient compliance. Sex or histological grade did not significantly influence response to chemotherapy. Oral cavity or nasopharyngeal tumours responded better than other sites (p less than 0.05). Patients under 49 were more likely to respond to chemotherapy than older patients (p less than 0.01). Survival data are available for a mean follow-up time of 48 months (range 12-78 months). Chemotherapy responders have a longer median survival than non-responders, 33 versus 20 months (p less than 0.05). Patients who achieve a complete remission after local therapy live significantly longer than those with residual disease, median durations of survival being 52.4 and 7.8 months respectively (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

24-hour combination chemotherapy without cisplatin in patients with recurrent or metastatic head and neck cancer.

Sixty-three patients with advanced histologically proven squamous cell carcinomas of the head and neck, considered untreatable other than by chemotherapy, received a combination of vincristine, bleomycin, methotrexate, 5-fluorouracil, and hydrocortisone administered over 24 hours, followed by a folinic acid rescue, every 3 weeks. Fifty-seven patients had received prior radiotherapy and 78% of recurrences were within the radiation field. Sixty-one patients were assessable for response to chemotherapy and 25 (41%) achieved objective responses. Side effects from 167 courses of chemotherapy were minimal and were present only in 38% of patients. There were no cases of bone marrow depression and no drug-induced deaths. Patient compliance was 98%. Chemotherapy responders had a longer median duration of survival of 11.9 months (with four patients still alive at 10, 22, 30, and 90 months) compared with 4.96 months for nonresponders (with two patients alive at 7 and 15 months), p less than 0.001. Ten of 24 chemotherapy responders went on to surgery and eight achieved a complete remission (CR), while only 6/36 nonresponders underwent salvage surgery and all became disease-free. Patients achieving a complete remission had improved survival (median 24.5 months). The presence of metastatic disease was a poor prognostic sign; only 8/30 (27%) responded to chemotherapy and none subsequently achieved complete remission. This safe drug protocol appears to benefit only a small subset of patients, namely those who respond to chemotherapy rendering their tumors operable, but is of no general value in this group of previously irradiated patients since 92% of all patients treated were dead at 2 years.

Actuarial Analysis↗
PubMed1983

An experimentally based safe method of administering intensive cancer chemotherapy. Prospects for increased survival in patients with 'solid' tumours during the next decade.

A clinically proven experimentally based method of administering intensive combination chemotherapy, which is much safer than methods used in the past, has been developed over the past 13 years. Clinical studies of several different tumour types over several thousand treatment cycles have confirmed the validity of this approach. The implications of this new method of administering chemotherapy to patients with advanced disease are discussed and its potential for improving the 'cure' rates for certain common 'solid' tumours such as breast, small-cell lung, bladder, prostate and ovarian carcinomas and squamous cell carcinomas of the head and neck is outlined.

Antineoplastic Agents↗
PubMed1983

Twenty-four hour combination chemotherapy: a feasibility study with implications for improved adjuvant treatment of breast cancer.

Forty-three patients with metastatic breast cancer were treated with a total of 385 cycles of combination chemotherapy consisting of adriamycin, cyclophosphamide, 5-fluorouracil, methotrexate and vincristine sulphate given over 24 hr and followed by a leucovorin 'rescue'. Thirty patients (70%) responded with three complete remissions. Thirteen patients did not respond, including six in whom the progression of disease was apparently arrested. Duration of response ranged from 2 to 24 months. At 20 months, 10 of 30 responding patients were alive compared with 1 of 13 non-responders. Toxicity was minimal apart from nausea and vomiting. This study confirms previous reports that intensive chemotherapy can be given safely over 24 hr without loss of therapeutic effect. This regimen is now being tested as an adjuvant to mastectomy in node-positive operable breast surgery.

Adult↗
PubMed1983

Integration of safe initial combination chemotherapy (without cisplatin) with a high response rate and local therapy for untreated stage III and IV epidermoid cancer of the head and neck: 5-year survival data.

This prospective study has established the effectiveness and safety of two courses of a combination of vincristine, bleomycin, methotrexate, 5-FU, and hydrocortisone with a folinic acid "rescue" given over 24 hours on Days 1 and 14 prior to surgery and/or radiotherapy in 93 patients with advanced (stage III and IV) untreated epidermoid cancer of the head and neck. Of 91 patients evaluated on Day 28 for chemotherapy response, 58 (64%) had a partial remission and 33 (36%) were classified as nonresponders, although 12 had a minimal response of 20%-30%. After completion of local therapy, 73% of the chemotherapy responders achieved complete remission compared with only 48% of the nonresponders (P = 0.005). Forty-seven percent of the patients achieving complete remission were alive at 5 years compared with only 4% of those with residual disease after local therapy. Response to chemotherapy is a good prognostic sign. Side effects were minimal and there was 100% patient compliance.

Adult↗