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Biomedical subjects

P Kosmidis

Publications and source records attributed to P Kosmidis.

At least 109 records · Page 6Linked to original sources
PubMed1993

Megestrol acetate in cancer patients with anorexia and weight loss. A Hellenic Co-operative Oncology Group (HeCOG) study.

Fifty-two patients with hormone-independent cancer, who complained of anorexia and of weight loss with at least 10%, received megestrol acetate (MA), 480 mg daily, during 1-21 weeks. Of the 41 patients treated during 4 weeks or longer, 38 experienced weight gain. Monthly subjective evaluation of six parameters using a linear analog self-assessment (LASA) form showed a significant improvement in the patient's rating of appetite, mood, nausea and vomiting, and quality of life; the tumor was progressive in 21, stable in 11 and it regressed in only 9 of these patients. No toxicity was observed; one case of death due to a congestive heart failure remains unexplained. MA at the dose used is a powerful appetite stimulant; it contributes to weight increase and might improve the subjective appreciation of quality of life. MA at lower doses should be compared in a prospective trial to the dose used in this study.

Adult↗
PubMed1992

Prevention of tissue necrosis due to accidental extravasation of cytostatic drugs by a conservative approach.

The purpose of the present study was to evaluate comparatively the effectiveness of a conservative approach to treatment, using two therapeutic schedules (with and without sodium thiosulfate (ST), so as to minimize necrosis due to drug extravasation and to avoid the need for reconstructive surgery. The 63 patients entered into this study were separated into two groups; these in group A were treated with hydrocortisone and dexamethasone, and these in group B received the combination plus ST. In both groups, the drugs that had extravasated included doxorubicin, epirubicin, vinblastine, mitomycin C. The healing time varied with the different drugs used and was proportional to the extent of extravasation and to the time at which therapy was begun. The mean healing time for group B, which received ST was about half that for group A, which did not. We conclude that the application of conservative measures during chemotherapy may prevent tissue necrosis due to drug extravasation and the subsequent need for reconstructive surgery. The administration of ST can help in the achievement of this goal.

Adolescent↗
PubMed1992

A randomized prospective study of cisplatin and vinblastine versus cisplatin, vinblastine and mitomycin in advanced non-small cell lung cancer.

From June 1986 to February 1989, 103 patients with advanced non-small cell lung cancer, with no previous chemotherapy, were randomized to receive either a combination of cisplatin and vinblastine (group A) or the same combination with the addition of mitomycin (group B). In group A, 15/48 evaluable patients had objective responses, as did 8/45 in group B. The median survivals were 35 and 32 weeks, respectively. The median survival of patients with response or stable disease was 43 weeks. Response and survival did not differ significantly between treatment groups. The addition of mitomycin to the two-drug combination showed no major therapeutic benefit, while bone marrow toxicity was increased. Three patients in group B died of sepsis. Among the different patient characteristics, disease stage, performance status and response had influence on survival.

Adult↗
PubMed1992

Factors influencing complete response and survival in patients with head and neck cancer treated with platinum-based induction chemotherapy. A Hellenic Co-operative Oncology Group Study.

One hundred fifteen consecutive patients with locally advanced carcinoma of the head and neck were treated between August 1984 and August 1989 with three cycles of either of two platinum-based induction chemotherapies, followed by local treatment. After the completion of chemotherapy 26 (23%) patients had complete responses (CR). Several pre-treatment characteristics were analyzed for a possible correlation to CR to induction chemotherapy and to survival. The following variables were closely interrelated: sex, history of smoking, alcohol abuse, histologic type, tumor site and grade. Tumor stage and negative history of smoking were correlated with CR. The variables which were individually correlated with survival were keratinization, CR to chemotherapy, alcohol abuse, histologic type, site and grade of the primary tumor, serum albumin level and tumor stage. A regression analysis after Cox's model to identify a limited set of predictors selected CR, serum albumin, tumor grade, performance status and nodal status as the most significant; when analyzing the data without the time-dependent variable CR, the factors selected by the model were serum albumin, tumor grade, performance status and tumor stage. In conclusion, serum albumin level, tumor grade, performance status and tumor stage prior to treatment can be used to define risk classes in our patient population.

Adolescent↗
PubMed1992

Subsets of tumors responsive to cisplatin or carboplatin combinations in patients with carcinoma of unknown primary site. A Hellenic Cooperative Oncology Group Study.

In this retrospective analysis 48 patients with metastatic undifferentiated carcinoma, adenocarcinoma and epidermoid carcinoma of unknown origin were studied. The purpose of this analysis was to evaluate both the response rate and the toxicity of combination chemotherapy containing cisplatin or carboplatin, and to attempt to identify certain clinical subsets of patients sensitive to these drugs. Four patients were not evaluable and 13 (29.5%), eight of the 34 treated with regimens containing cisplatin and 5/14 with carboplatin-based chemotherapy, responded to treatment. Six of the 23 with undifferentiated tumours, 4/17 with adenocarcinomas and 3/8 with epidermoid cancers responded to chemotherapy. Four of 6 women with adenocarcinoma of the peritoneal cavity, 5/11 with undifferentiated carcinomas with midline distribution and 3/5 with epidermoid carcinomas of the cervical nodes responded. Seven patients achieved complete and six partial remissions. The mean duration of response was nine months; a number of patients enjoyed prolonged and/or durable remissions. Toxicity was tolerable. We conclude that: (a) both cisplatin and carboplatin are active agents in this syndrome with one-third of the evaluable patients responding, and (b) there may be chemosensitive subgroups, such as patients with peritoneal adenocarcinomatosis, undifferentiated carcinoma with midline distribution and metastatic epidermoid carcinoma of the neck nodes. The effectiveness of carboplatin in these patients and the responsiveness of metastatic epidermoid carcinoma of unknown origin have not been adequately dealt with in the literature.

Adenocarcinoma↗
PubMed1992

Continuous 24-hour infusion of folinic acid does not increase the response rate of 5-fluorouracil but only the toxicity.

Twenty-four patients with advanced colorectal cancer received two cycles of combination chemotherapy consisting of mitomycin 10 mg/m2 for 5 days continuous infusion and allopurinol 300 mg x 3/day p.o. for 21 days. Two patients responded partially following the two cycles of chemotherapy. Additionally, all patients received folinic acid 200 mg/m2 for 5 days as a continuous infusion. None of the nonresponders responded to the addition of folinic acid, on the contrary toxicity was increased and 2 toxic deaths were reported. We conclude that continuous infusion of folinic acid added to the combination of mitomycin and 5-fluorouracil does not improve the response rate but only enhances toxicity.

Adult↗
PubMed1992

Antiemetic efficacy of high-dose metoclopramide and dexamethasone in patients receiving cisplatin chemotherapy: a randomized trial.

In a prospective randomized trial we compared the antiemetic efficacy of metoclopramide (MCP) and dexamethasone (DXM). A total of 172 patients receiving chemotherapy based on cisplatin 100 mg/m2/day were randomly allocated to four groups. CP was administered in 5 doses of 1.5 mg/kg (group A), 2 mg/kg (group C), or combined with 4 doses of DXM 4 mg/6 h (MCP: 1.5 mg/kg in group B; 2 mg/kg in group D). Vomiting was decreased in the DXM groups compared to groups A and C (p < 0.002), and the duration of nausea was greater in group A than in group D (P < 0.004). A greater disturbance in appetite was observed in group A compared to groups B (p < 0.028), D(p < 0.001) and C (p < 0.045). Activity problems were greater in group A than in C (p < 0.003) and D(p < 0.005). We noticed that a small increase in MCP (0.5 mg/kg) did not influence the antiemetic effect. The addition of DXM did not significantly alter the antiemetic results at the lower MCP dose, but improved them when MCP was slightly increased. We conclude that DXM slightly improves the antiemetic effect of MCP and the effects are related to the MCP dose.

Adult↗
PubMed1992

Prognostic value of serum levels of immunoglobulins (IgA, IgM, IgG, IgE) in patients with colorectal cancer.

In the present study, the serum immunoglobulin levels of 100 patients with colorectal cancer who had undergone antitumor therapy, were measured before and during therapy. We received three samples before therapy and further samples every 2 months after initiation of therapy. It was found that the group of patients having increased IgG (P less than 0.05) and perhaps IgM (P less than 0.1) levels showed a longer time to progression of disease and prolonged overall survival time. Based on this finding we conclude that survival can potentially be correlated with immunoglobulin levels. Studies with large numbers of patients, and orientated towards the correlation of immunoglobulin levels with specific clinical parameters may prove that immunoglobulins can play a prognostic role in survival for colorectal cancer patients.

Adult↗
PubMed1991

Carboplatin, continuous infusion fluorouracil and mid-cycle high-dose methotrexate as initial treatment in patients with locally advanced head and neck cancer. Hellenic Co-operative Oncology Group Study.

Forty-nine patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) were treated with 3 cycles of induction chemotherapy prior to definitive local treatment (surgery and/or radiation therapy). Chemotherapy consisted of carboplatin 300 mg/m2 on day 1, fluorouracil 1000 mg/m2 daily as a continuous infusion on days 1 to 5 and high-dose methotrexate 1.2 g/m2 with leucovorin rescue on day 14. After completing the induction chemotherapy, 9 patients (18%) achieved a complete remission (CR), 26 (54%) a partial remission (PR), 7 had stable disease and 7 a progression. The response rates increased to 53% CR and 18% PR following locoregional treatment. Survival at 12 months was 61% and its actuarial probability at 24 months 31%. Median time to progression was 14 months. Toxicity from chemotherapy was generally mild. Nausea was observed in 35%, vomiting in 26%, stomatitis in 57%, anemia in 22%, leukopenia in 36%, thrombocytopenia in 26% and diarrhea in 6% of the patients. In conclusion, the combination of carboplatin, 5-day continuous-infusion fluorouracil and mid-cycle high-dose methotrexate is a moderately effective, well tolerated regimen in patients with SCCHN but does not seem superior to the combination of carboplatin and fluorouracil only.

Aged↗
PubMed1991

High-dose epirubicin as a single agent in the treatment of patients with advanced breast cancer. A Hellenic Co-operative Oncology Group study.

Fifty-two women with advanced breast cancer were treated with 6 cycles of epirubicin. Even though the study was started with a dose schedule of 110 mg/m2 every 3 weeks, the average treatment interval was 26 days and the median weekly dose 78% of the protocol requirement. Forty-eight patients were evaluable for response; 3 achieved a complete remission which lasted for 17, 24 and 65 weeks, respectively, and 14 a partial remission. Median survival was 32 weeks. Toxicity included nausea/vomiting (68%), anemia (24%), leukopenia (37%), thrombocytopenia (8%), alopecia (81%), stomatitis (24%), diarrhea (14%), fever (19%) and fatigue (14%). Also 1 treatment-related death occurred and 2 cases of arrhythmia. Monotherapy with high doses of epirubicin has definite activity in advanced breast cancer and deserves further study in combination with hematopoietic growth factors which might allow a higher dose intensity.

Adult↗
PubMed1991

Diphenhydramine for nausea and vomiting related to cancer chemotherapy with cisplatin.

High dose metoclopramide and adjuvant drugs, such as corticosteroids, benzodiazepines, and drugs with antidopaminergic, anticholinergic, or antihistaminic effects, are the most widely used antiemetics in cancer patients receiving chemotherapy, particularly cis-dichloro-diammine platinum II (cisplatin). The purpose of our prospective randomized study was to investigate the possible antiemetic efficacy of diphenhydramine as an adjuvant antiemetic drug when combined with metoclopramide (MCP). A total of 91 patients were assigned to either group A (N = 44) who received only MCP and group B (N = 47) who received the combination of MCP and diphenhydramine. All patients received cisplatin-based combination chemotherapy for the first time and were evaluated only once in order to exclude the effects of anticipatory nausea and vomiting. There were no statistically significant differences between the two groups except that patients treated with diphenhydramine presented more sedative effects and had more limited activity. Also diphenhydramine did not give absolute protection from the extrapyramidal side effects of MCP. Side effects of diphenhydramine were minimal and well tolerated. We conclude that diphenhydramine is not a useful adjuvant drug in the antiemetic therapy.

Adult↗
PubMed1991

Laryngeal preservation in cases of advanced laryngeal cancer treated with platinum based induction chemotherapy before local treatment.

In this study we analyse our preliminary results after treating 28 patients with locally advanced laryngeal cancer with platinum based induction chemotherapy followed by radiation therapy or surgery. The median age of our patients was 60 (46-75) years and median performance status was 80 (60-100). In 18 of the 28 patients locoregional treatment was radiation therapy with an overall response of 94.4 per cent. After a median follow-up of 26 (15-40) months 39.3 per cent of the whole group of patients are alive and disease-free and six (21.4 per cent) patients are alive and disease-free preserving their larynx. We conclude that although more extensive studies with large groups of patients and longer follow-up is needed to reach definite conclusions, it seems that platinum based induction chemotherapy can be used successfully in locally advanced laryngeal cancer followed by radiotherapy. In those cases who respond well, the patient's larynx is preserved without compromizing the overall survival.

Aged↗
PubMed1991

Platinum-based induction chemotherapy followed by radiation as definitive treatment for patients with locally advanced cancer of the oral cavity, oropharynx and hypopharynx. A retrospective analysis of 32 cases.

Thirty-two patients with locally advanced cancer of oral cavity, oropharynx and hypopharynx were treated with three cycles of platinum-based induction chemotherapy followed by radiation therapy. After completion of the combined treatment 50% of the patients were in complete response (CR) and 28% in partial response (PR). So far, 24 patients have died. Local progression occurred in 20 patients. Survival is 29% at 24 months. Seven (22%) patients remain alive and have been disease-free for 22-59 months. In conclusion, induction chemotherapy followed by radiation therapy may omit radical surgery, without compromising survival, in some patients with locally advanced cancer of the oral cavity, oropharynx and hypopharynx.

Adult↗
PubMed1991

Decreased oral toxicity with the local use of allopurinol in patients who received high dose 5-fluorouracil.

5-Fluorouracil (5FU) is the most effective drug in gastrointestinal cancer. Mucositis and bone marrow toxicity are the two major limiting side effects. In our effort to reduce mucositis we administered Allopurinol mouthwash in 42 patients who had experienced oral mucositis during prior treatment with 5FU. In all patients significant reduction of oral toxicity was noticed as well as prolonged pain relief.

Allopurinol↗
PubMed1991

Antiemetic efficacy of alprazolam in carboplatin-induced emesis.

In order to potentiate the efficacy of antiemetic drugs such as metoclopramide (MCP) and the new drug GR 38032F, adjuvant antiemetic drugs such as benzodiazepines are used in cancer patients receiving chemotherapy. The purpose of our prospective study was to investigate the efficacy of alprazolam (APZ), a newer diazepam, as an adjuvant antiemetic drug, when combined with MCP, in carboplatin (JM8)-based chemotherapy. Thus, 42 patients entered this study. First they received only MCP 1 mg/kg in 15 min infusion (arm A). In the next cycle they received the combination of MCP in the same dose and a tablet of APZ 0.25 mg, 30 min before JM8 infusion and then 3.5, 5.5 and 11.5 h after (arm B). JM8 was administered alone (400 mg/m2) or in combination (300 mg/m2) with vinblastine (6 mg/m2), etoposide (100 mg/m2) or 5-fluorouracil (1,000 mg/m2). In arm A, according to the WHO classification, nausea was intense (p less than 0.003) and the duration of nausea longer (p less than 0.002). In arm B more patients did not present vomiting (p less than 0.018). Secondary effects such as appetite (p less than 0.04), diarrhea (p less than 0.064), diaphoresis (p less than 0.085) and headache (p less than 0.024) were worst in arm A. We conclude that APZ increases the antiemetic effect of MCP on JM8. APZ is a useful adjuvant antiemetic drug, especially against the development of anticipatory anxiety, nausea and vomiting that many cancer patients presented during chemotherapy.

Administration, Oral↗