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Biomedical subjects

Maurie Markman

Publications and source records attributed to Maurie Markman.

At least 37 records · Page 2Linked to original sources
PubMed2006

Sequential prolonged oral topotecan and prolonged oral etoposide as second-line therapy in ovarian or peritoneal carcinoma: a phase I Gynecologic Oncology Group study.

OBJECTIVE: Preclinical models suggest synergy when topoisomerase I and II inhibitors are given sequentially, but not simultaneously. A phase I study was conducted in previously treated ovarian or peritoneal carcinoma to determine the tolerability (maximum number of days) of sequential oral topotecan and oral etoposide. METHODS: Topotecan (0.8 mg/m(2)) was administered daily (days 1-5) followed by etoposide (50 mg/m(2)) administered daily for up to 5 days (days 8-12). Patients on dose levels 3 and 4 repeated topotecan for up to 5 days starting on day 15 after the initial topotecan and etoposide sequence. Cycles were repeated every 28 days. Dose-limiting toxicities (DLT) were defined as: neutrophils <1000/microl or platelets <50,000/microl before completing administration of etoposide or topotecan; neutropenic fever; platelets <20,000/microl; or a delay greater than 2 weeks in starting cycle 2 due to hematologic toxicity (ANC <1500/microl or platelets <100,000/microl on scheduled day of treatment). RESULTS: Nineteen patients were entered into this trial, and a total of 54 cycles (range 1-10) of therapy were administered. Dose-limiting toxicities, principally neutropenia, occurred when therapy was administered for 3 of 4 weeks. CONCLUSION: Oral topotecan and oral etoposide administered at these doses daily for 5 days sequentially for a maximum of three (out of every four) weeks of therapy are tolerable. In some cases, it may be necessary to hold therapy the third week. Based on the activity seen in this patient population, it is planned to take this regimen into a phase II setting.

Administration, Oral↗
PubMed2006

Chemotherapy-induced peripheral neuropathy: underreported and underappreciated.

Chemotherapy-induced neuropathy is one of the most serious non-life-threatening side effects experienced by patients receiving this group of pharmaceutical agents. Although frequently reversible, some patients may remain with symptoms for the remainder of their lives. Early recognition that "numbness and tingling" in the hands and feet of a patient receiving chemotherapy is due to the antineoplastic drug, with subsequent dose reduction or discontinuation of the offending agent, may prevent the development of serious neurologic dysfunction.

Antineoplastic Agents↗
PubMed2006

Unresolved issues in the chemotherapeutic management of gynecologic malignancies.

Despite substantial documented progress in the chemotherapeutic management of women with gynecologic malignancies, a number of highly clinically relevant issues remain unresolved. In ovarian cancer, questions asked by practicing oncologists, patients, and their families include the role of maintenance chemotherapy in routine management of the disease, determining which patients with early stage disease do not require cytotoxic therapy, defining the most appropriate management paradigm for both recurrent and resistant cancer, determining which taxane to combine with carboplatin in the first-line regimen, and developing an optimal intraperitoneal primary chemotherapy regimen for small-volume residual advanced disease. In endometrial cancer, important issues include defining first-line chemotherapy for metastatic or recurrent disease and mixed mesodermal endometrial cancer, and determining whether there is a role for adjuvant cytotoxic chemotherapy in the setting of high-risk early stage cancer. Finally, in cervical cancer, there is a critical need to determine the most appropriate treatment strategy for metastatic cancer, as well as to find an effective second-line treatment option for platinum-resistant disease. It is reasonable to anticipate that future clinical trials will answer these and other unresolved issues, just as past well-designed studies have resulted in major improvements in both the survival and quality of life of women with this group of malignancies.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

Clinical efficacy supporting the role of intraperitoneal drug delivery in the primary chemotherapeutic management of small-volume residual advanced ovarian cancer.

Delivery of chemotherapeutic agents directly into the peritoneum to treat tumors localized to the abdominal cavity is a concept tested initially in clinical practice in the early 1950s. However, thorough investigation of the drawbacks and potential of intraperitoneal (IP) drug administration was not explored until the late 1970s. After fading in popularity, three major phase III randomized trials (SWOG 8501/GOG 104, GOG 114, and GOG 172) have helped IP therapy to resurface as an acceptable alternative for selected stage III ovarian cancer patients with optimally debulked tumors. These trials have provided overwhelming evidence supporting the value of IP strategy in prolonging progression-free and overall survival rates. GOG 172 showed a remarkable 15.9 month increase in median overall survival for the IP arm in comparison to the intravenous arm. This review article discusses the clinical data available from these three Gynecologic Oncology Group (GOG) studies (SWOG 8501/GOG 104, GOG 114, and GOG 172), supporting the use of a combination of IP and intravenous chemotherapy in patients with stage III ovarian cancer after surgical debulking.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

Profile of ovarian cancer patients seeking information from a web-based decision support program.

BACKGROUND: There is limited information available regarding the characteristics of patients who elect to gather and share information about their malignancy on the Internet. METHODS: Using a proprietary decision support program embedded into a number of established websites, individuals entered personal clinical data into disease site profilers designed to provide information about evidence-based treatment options, based on specific characteristics (e.g., stage of disease, prior therapy) provided by the patients. The aggregate data were evaluated to examine the characteristics of patients with gynecological cancer (with a focus on newly diagnosed and recurrent ovarian cancer) using such a tool. RESULTS: From early 2000 through November 2004, >15,000 patients with gynecological cancer have entered data into one of four profilers: newly diagnosed (n = 5604)/recurrent (n = 2803) ovarian, endometrial, and cervical cancers. Internal data consistency includes similar ages and general health histories of the ovarian and endometrial cancer populations and younger age of the cervical cancer patients. Whereas 90% of the women with ovarian cancer considered themselves to be in "good health," 64% of newly diagnosed vs. only 50% of recurrent disease patients declared their activity level was "normal." Of the recurrent patients, 32% stated they had undergone a secondary surgery. The overall aggressive management philosophy of the recurrent patients in this series is supported by the observation that 33% had received > or =4 prior chemotherapy regimens, 97% desired additional treatment, and 81% were interested in clinical trials. CONCLUSIONS: Women with ovarian cancer seeking assistance from web-based decision support programs may represent a subgroup with unique clinical features compared with the general patient population.

Adult↗
PubMed2006

Pegylated liposomal doxorubicin in the treatment of cancers of the breast and ovary.

Peglyated liposomal doxorubicin was developed to maintain or enhance the demonstrated antineoplastic effects of doxorubicin, while improving the toxicity profile associated with this important cytotoxic agent. Accumulating clinical data have confirmed the activity of pegylated liposomal doxorubicin in cancers of the breast and ovary. Furthermore, Phase II and III trial experience has revealed that the drug produces objective responses comparable in rate and duration to doxorubicin and other single agents employed in metastatic breast cancer. In recurrent and platinum-resistant ovarian cancer, single-agent pegylated liposomal doxorubicin has assumed an important role in routine patient management.

Antineoplastic Agents↗
PubMed2006

Management of ovarian cancer. An impressive history of improvement in survival and quality of life.

Over the past 2 decades, we have seen major progress in the management of women with ovarian cancer, with improvements in both overall survival and quality of life. To truly appreciate this progress, it is important to understand the state of affairs regarding the treatment of ovarian cancer in the early 1980s. This paper will discuss that historical background, describe the increasingly favorable impact of evolving treatment paradigms in ovarian cancer, and note future directions for clinical research in this complex disease process.

Antineoplastic Agents↗
PubMed2005

Phase II trial of weekly paclitaxel (80 mg/m2) in platinum and paclitaxel-resistant ovarian and primary peritoneal cancers: a Gynecologic Oncology Group study.

OBJECTIVE: To evaluate the activity of single agent weekly paclitaxel in patients with both platinum and paclitaxel (delivered every 3 weeks)-resistant ovarian cancer. METHODS: Forty-eight patients with platinum and paclitaxel-resistant ovarian cancer (defined as progression during, or recurrence < 6 months following, their prior treatment with both agents) received single agent weekly paclitaxel (80 mg/m2/week) until disease progression (assuming acceptable toxicity). Following the initial 12 weekly doses, treatment could be given for 3 weeks, with a 1 week break. RESULTS: In this chemoresistant population, the objective response rate was 20.9%. Serious adverse events were relatively uncommon (neuropathy-grade 2: 21%; grade 3: 4%; and grade 3 fatigue: 8%). CONCLUSION: The weekly administration of paclitaxel can be a useful management approach in women with both platinum and paclitaxel (given every 3 weeks)-resistant ovarian cancer. It would be appropriate to directly compare weekly to every 3-week paclitaxel delivery in the setting of primary chemotherapy of advanced ovarian cancer.

Adult↗