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Biomedical subjects

M Markman

Publications and source records attributed to M Markman.

At least 325 records · Page 18Linked to original sources
PubMed1985

Intracavitary chemotherapy for malignant disease confined to body cavities.

The direct administration of cytotoxic chemotherapeutic agents into the peritoneal or pleural cavities to treat malignant disease principally involving these regions is based on modeling studies suggesting a major pharmacokinetic advantage for the exposed cavity compared with the plasma. The safety and clinical efficacy of several agents administered directly into body cavities either singly or in combination have now been shown. Additional studies are needed to define optimal drugs, dosages and treatment schedules for the various tumors confined to body cavities. Whether this form of therapy will prove to be superior to standard systemic drug administration will require controlled clinical trials comparing the two treatment methods.

Animals↗
PubMed1985

Intracavitary cisplatin chemotherapy for mesothelioma.

A feasibility study of intracavitary cisplatin was conducted in eight patients with mesothelioma. Cisplatin, 90 mg/m2, was instilled weekly for 3 weeks, followed by a 3-week rest; thiosulfate was given iv to reduce nephrotoxicity. In 50 courses there was no chemical serositis; the major toxic effect was myelosuppression. One patient with measurable disease had a complete response; three others had objective responses.

Adult↗
PubMed1985

Melphalan and cytarabine administered intraperitoneally as single agents and combination intraperitoneal chemotherapy with cisplatin and cytarabine.

At the UCSD Cancer Center several chemotherapeutic agents have been evaluated for safety and clinical utility when delivered by the intraperitoneal route. Both melphalan and cytarabine have demonstrated a major pharmacokinetic advantage for peritoneal cavity exposure to drug compared to that of the plasma when these agents are administered directly into the abdominal cavity. In addition, limited clinical efficacy for both agents has been demonstrated. In one experimental system cisplatin and cytarabine have shown significant concentration-dependent synergy. As intraperitoneal drug delivery allows one to administer extremely high concentrations of chemotherapeutic agents to tumors localized to the abdominal cavity, this therapeutic approach is perhaps the optimal method for producing clinically relevant concentration-dependent drug synergy. Patients with refractory ovarian carcinoma and other tumors principally confined to the peritoneal cavity have demonstrated subjective and objective improvement following intraperitoneal therapy with a cisplatin-cytarabine-based chemotherapeutic regimen.

Adult↗
PubMed1985

Intraperitoneal chemotherapy: technical experience at five institutions.

With the rapid expansion of research programs examining intraperitoneal chemotherapy for ovarian cancer and other intraabdominal malignancies, there is a need for a reliable and safe access to the peritoneal cavity. The technical experience accumulated with either the Tenckhoff catheter or the Port-A-Cath in 288 patients treated at five institutions showed a low incidence of catheter-related peritonitis (5% and 8%, respectively), skin infection (6.6% and 0%), and bowel perforation following surgical implantation (3.5% and 1.3%). Postoperative leakage of intraabdominal fluid, bleeding, or ileus were uncommon and easily controlled. Drainage failure was the major problem with both systems; occurring in 45% of patients. Although both systems are workable, improved catheters for the administration of intraperitoneal chemotherapy are warranted.

Antineoplastic Agents↗
PubMed1984

Histocompatibility antigens in small cell carcinoma of the lung.

Fifty white patients with small cell carcinoma of the lung (SCCL) were typed for histocompatibility antigens (HLA) to assist in providing platelet support for intensive induction therapy. An analysis of the HLA types in this population was undertaken to determine if there was an influence of HLA type on this disease. Patients with the HLA-Bw44 (HLA-B12) allele were found to be significantly over-represented in our patient population compared to a control population (52% versus 26%, P less than 0.001). In addition, patients possessing the HLA-A1 phenotype were found to have a significantly poorer 1-year survival rate (15%) than individuals who did not possess this allele (60% 1-year survival rate) (P less than 0.025). These findings will need to be confirmed by other groups working with large numbers of patients with SCCL.

Carcinoma, Small Cell↗
PubMed1984

Antiemetic efficacy of dexamethasone. Randomized, double-blind, crossover study with prochlorperazine in patients receiving cancer chemotherapy.

We conducted a randomized, double-blind, crossover study comparing the antiemetic efficacy of dexamethasone and prochlorperazine in 42 patients with cancer who were receiving outpatient chemotherapy, mainly without cisplatin. Patients experienced significantly less nausea and vomiting with dexamethasone than with prochlorperazine (P less than 0.02 and less than 0.03, respectively). Twenty-five patients experienced no nausea with dexamethasone, as compared with 14 patients taking prochlorperazine (P less than 0.001). Similarly, 29 patients receiving dexamethasone did not vomit, as compared with 18 receiving prochlorperazine (P less than 0.001). Somnolence was the most frequent side effect, occurring in 60 per cent of patients receiving prochlorperazine and in 12 per cent of those receiving dexamethasone (P less than 0.001). Patients also experienced less suppression of appetite while receiving dexamethasone (P less than 0.02). We conclude that dexamethasone is an effective and safe antiemetic in patients receiving cancer chemotherapy without cisplatin.

Adult↗
PubMed1984

Human histocompatibility antigens and survival in acute myelocytic leukemia.

Several previous reports have suggested an association between human histocompatibility antigens (HLA) and survival in acute myelocytic leukemia (AML). The authors have retrospectively analyzed the records of 104 consecutive newly diagnosed patients with AML treated on the Leukemia Service of the Johns Hopkins Oncology Center from March 1978 through May 1982 who had HLA typing performed to further evaluate this point. The authors have been unable to demonstrate a statistically significant association of HLA phenotype with the ability to achieve a complete response (CR), length of CR, survival of the total group of treated patients, or survival of only those patients achieving a CR (P less than 0.05). The available evidence does not strongly support a significant influence of HLA on survival in AML.

Acute Disease↗
PubMed1984

Anaphylactic reaction to cytarabine: in vitro evidence that the response is immunoglobulin E mediated.

A 48-year-old female developed significant bronchospasm on two occasions after being treated with cytarabine (Ara-C) by the intraperitoneal route. In this report we present the first in vitro evidence that such a reaction to cytarabine can be associated with the release of histamine and therefore might be immunoglobulin E (IgE) mediated. In addition, this report emphasizes the fact that, while uncommon, severe allergic reactions to this useful chemotherapeutic agent do occur and must be considered in the differential diagnosis of anaphylaxis and related symptoms in patients receiving this drug.

Anaphylaxis↗
PubMed1984

Combination intracavitary chemotherapy for malignant pleural disease.

Seven previously heavily pretreated patients with malignant pleural disease and effusions were treated with 12 courses of combination intrapleural chemotherapy with cisplatin, cytarabine, and doxorubicin. Two patients with ovarian cancer metastatic to the pleura demonstrated dramatic clinical improvement following therapy. Local pain, nephrotoxicity, or bone marrow suppression were not observed during this trial. Further investigation of intrapleural therapy utilizing an escalated dose of cytarabine is warranted.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Totally implantable system for peritoneal access.

A totally implantable system for providing access to the peritoneal cavity was evaluated. Fifty-six Port-A-Cath (Pharmacia Nu Tech, Piscataway, NJ) peritoneal access systems were implanted in 54 cancer patients receiving intraperitoneal chemotherapy. The catheters are accessed by transcutaneous placement of a Huber point needle through a silicone septum at the top of the portal. A total of 32 patient years of experience are reported. The Port-A-Caths have been in place for a median of 22 weeks (range, one to 85). A total of 401 entries have been made for paracentesis, chemotherapy administration, antibiotic administration, peritoneal lavage for cytology, and catheter flushing. There have been six episodes of peritonitis (five Staphylococcus epidermidis, one S aureus) in three patients. There have been no mechanical failures of the Port-A-Caths. Loss of bidirectional flow through the catheter due to fibrin deposition about the catheter has been the major cause of catheter failure. Patient acceptance of the Port-A-Cath has been excellent.

Antineoplastic Agents↗
PubMed1984

Combination intraperitoneal chemotherapy with cisplatin, cytarabine, and doxorubicin for refractory ovarian carcinoma and other malignancies principally confined to the peritoneal cavity.

Thirty-one patients with refractory ovarian cancer and other malignancies principally confined to the abdominal cavity were treated with an intraperitoneal combination-chemotherapy regimen consisting of cisplatin (100 to 200 mg/m2), cytosine arabinoside (10(-4) to 10(-3) mol/L) and doxorubicin (2 to 18 mumol/L). Sodium thiosulfate was simultaneously administered intravenously to prevent cisplatin-induced nephrotoxicity. Eight of 26 evaluable patients demonstrated clinical response including seven of 17 (41%) with ovarian cancer refractory to frontline chemotherapy. Systemic toxicity was mild except for nausea and vomiting. Abdominal pain secondary to doxorubicin was the major complication of therapy. We conclude that combination intraperitoneal therapy with cisplatin, cytosine arabinoside, and doxorubicin can be safely administered with objective tumor responses observed in patients with ovarian cancer heavily pretreated and in individuals with other malignancies involving the peritoneal cavity. Doxorubicin-induced local pain limits the ability to administer multiple courses of this treatment regimen.

Adult↗
PubMed1984

The role of computed tomography of the chest in the management of small-cell lung cancer.

Despite the wide application of computed tomography (CT) in the diagnosis and management of lung cancer, the role of this diagnostic modality in the management of small-cell lung cancer (SCC) has not yet been defined. We therefore compared information gained from routine chest radiography (CXR) and CT scans performed on 32 patients with SCC who were treated on an intensive chemotherapy-radiotherapy protocol. Seventy-nine pairs of CXRs and CT scans were retrospectively reviewed. We found that although CT delineates a greater extent of intrathoracic disease in each of nine anatomic areas evaluated than does CXR, agreement between CT and CXR was significant for all areas except the pericardium. Pericardial thickening was seen only on CT scan and is more frequent in SCC patients than has previously been appreciated, but both its etiology and prognostic significance are unclear at this time. CT also allowed interpretation of disease status in cases where radiation-induced fibrosis made interpretation of the CXR impossible. We do not recommend routine use of chest CT at time of diagnosis of SCC, but we recommend that its use be reserved for evaluation of new symptoms or suspected relapse, or when radiation fibrosis on CXR is severe.

Carcinoma, Small Cell↗