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Biomedical subjects

R D Rubens

Publications and source records attributed to R D Rubens.

At least 181 records · Page 10Linked to original sources
PubMed1983

Adriamycin alone or combined with vincristine in the treatment of advanced breast cancer.

One hundred and nineteen women with advanced breast cancer treated previously by endocrine therapy but no prior chemotherapy were given adriamycin 70 mg/m2 i.v. on day 1 of a 3-weekly cycle for 8 courses, followed by a regimen of cyclophosphamide, methotrexate and 5-fluorouracil (CMF) until relapse. They were allocated randomly to receive either no treatment (group A) or vincristine 1.4 mg/m2 i.v. on days 1 and 8 during treatment with adriamycin (group AV). In 107 evaluable patients objective responses were seen in 30/53 patients (57%) in group A and in 28/54 patients (52%) in group AV. The projected dose of adriamycin received was 78% in group A and 75% in group AV; and 60% for vincristine in group AV. The subjective and haematological toxicity for adriamycin was similar in both groups, but 65% of patients treated with vincristine developed neurotoxicity. The median duration of objective regressions was the same for both groups (7 months), and the median time to failure was 5 months for group A and 6 months for group AV respectively. The median survival of the responders tended to be longer in group AV (17.5 months) than in group A (13 months), but this difference was not statistically significant (P = 0.112). It is concluded that there is no advantage therapeutically in combining vincristine and adriamycin in patients with advanced breast cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Results of endocrine therapy do not predict response to chemotherapy in advanced breast cancer.

One hundred and four patients with advanced breast cancer treated with adriamycin +/- vincristine had had prior endocrine therapy. Of 28 responders to prior endocrine therapy a response to subsequent chemotherapy occurred in 15 (54%); the response frequency in the 76 non-responders to endocrine therapy was 51% (39 patients). The median time to treatment failure was not significantly different between responders to prior endocrine treatment and non-responders (7 months vs 5 months; P = 0.136). Although the median survival from starting chemotherapy tended to be longer in the endocrine responders (18 months) than in the non-responders (12 months), there was no significant difference between the two groups (chi = 2.749; P = 0.097). In a subgroup of 31 non-responders to endocrine therapy who had had stable disease (greater than or equal to 6 months) the median time to treatment failure was 6 months and median survival 13 months. This lack of differences existed for each subgroup of endocrine therapy. Response to prior endocrine treatment was not shown to be a determinant of response to subsequent chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Steroid receptors and prognosis in operable (stage I and II) breast cancer.

Four hundred and forty-seven women with operable (TNM stage I or II) breast cancer in whom oestrogen receptors (ER), progesterone receptors (PgR) or both receptors had been assayed were studied. Receptor status was independent of axillary nodal status, but infiltrating duct carcinomas that were ER-, PgR- or ER-PgR- were more likely to be anaplastic (P less than 0.001). Four hundred patients with follow-up and uniform treatment were analysed for post-operative disease-free interval (DFI) and survival. No significant difference in DFI existed between patients with ER+ and ER- tumours or PgR+ and PgR- tumours, although there was a trend for longer DFI for ER+ and PgR+. DFI was longer in patients with better-differentiated (grade 1 and 2) tumours than with anaplastic (grade 3) tumours. In patients with ER+ tumours, those with grade 1 and 2 tumours had a longer DFI than those with grade 3 tumours (P less than 0.005). Survival was significantly longer in patients with ER+ tumours compared to those with ER- tumours (P less than 0.001), but there was no such association between tumour PgR and survival. Survival of patients with ER+PgR+ tumours was significantly longer than those with ER-PgR- tumours (P less than 0.025) and, in patients with no evidence of axillary nodal involvement, significantly longer than those with ER+PgR- tumours. Survival in patients with nodal involvement was influenced by histological grade, being longer in those with grade 1 or 2 tumours compared to those with grade 3 tumours. For ER+ tumours, survival was longer in patients with grade 1 or 2 than with grade 3 tumours. These results suggest that steroid receptors significantly affect survival but not DFI. This effect is most closely related to ER content, with relatively little additional information accruing from analysis of PgR. Histological grade influences both DFI and survival, and analysis of both grade and ER content may give a more accurate indication of prognosis in operable breast cancer.

Axilla↗
PubMed1982

The pattern of metastatic disease in patients with pleural effusions secondary to breast cancer.

The pattern of pleural metastases in women with effusions secondary to breast cancer was evaluated by thoracoscopy in a series of 46 patients with previously untreated effusions. Metastases involving the visceral pleural were seen in 59 per cent of patients whereas parietal deposits were found in only 15 per cent. No tumour deposits were seen in 26 per cent of cases. No patients had both visceral and parietal tumour secondaries. Patients within each of these groups showed differences in rates of positive effusion cytology, chest wall recurrence and previous evidence of recurrent breast cancer.

Breast Neoplasms↗
PubMed1982

Duration of complete response to chemotherapy in advanced breast cancer.

Twenty-seven patients with advanced breast cancer with complete response (CR) to chemotherapy have been analysed and observed for up to 8 years. Median time to attainment of CR was 8.1 months (range, 1-19.5) and median duration of CR was 27.5 months (1-97 + months). Most (16) recurrences occurred in the first 2 years. In 12 patients (63%) relapse was at sites initially involved. No clear relationship between the duration of CR and a variety of prognostic factors or the dose of cytotoxic drugs given was found, although there was a tendency to longer duration of CR when fewer sites were involved. The presence of visceral disease did not preclude a prolonged CR. It seems that despite some patients surviving many years, relapse is inevitable and cure of the disease is unlikely with presently available chemotherapy.

Adult↗
PubMed1982

The response to endocrine therapy in patients with advanced breast cancer in Great Britain and Japan.

A prospective study has been carried out to compare the response rates to endocrine therapy of Japanese and British women with breast cancer. Premenopausal women were treated by ovarian ablation, patients who were up to five years postmenopausal were prescribed androgen therapy and patients who were more than five years postmenopausal were treated with oestrogens. No differences in response rate, response time or survival could be detected in the three categories of patients. Significantly more Japanese patients presented with pulmonary metastases in the pre- and postmenopausal groups. In postmenopausal Japanese patients treated with oestrogens, those with pulmonary metastases survived significantly longer.

Adult↗
PubMed1982

Contribution of prednisolone to the primary endocrine treatment of advanced breast cancer.

Two hundred and four patients with progressive locally advanced or metastatic breast cancer not controllable by local therapy alone, and who had had no prior systemic therapy for advanced disease, were treated by primary endocrine therapy according to menopausal status. Premenopausal patients received ovarian irradiation (O) whilst postmenopausal patients received tamoxifen 10 mg b.d. (T). Patients were randomised to receive either no additional treatment or prednisolone 5 mg b.d. (P). In 180 evaluable patients, T + P induced significantly more responses than T alone (26/73 vs 9/72, P less than 0.01) and the addition of P to O in premenopausal patients also induced more responses than O alone (7/16 vs 4/19), but this difference was not significant and accrual of premenopausal patients continues. There was a trend for patients receiving T + P to have a longer survival than those receiving T alone (median 25 vs 16 months). These trends occurred in patients with tumours positive for oestrogen receptors and when receptor status was unknown; patients with receptor-negative tumours had a negligible response to endocrine treatment. P mitigated the occurrence of hypercalcaemia and tumour flare sometimes seen with T alone.

Adult↗
PubMed1982

Oestrogen receptors, clinical features and prognosis in stage III breast cancer.

One hundred and twenty-four patients with stage III breast cancer who had oestrogen receptor analyses (ER) performed on primary tumour were studied. For operable disease (T3a, N0.1, M0), patients with ER-negative (ER less than 5 fmol/mg cytosol protein) tumours had a shorter duration of symptoms, but no other differences were observed at presentation. In patients with inoperable (T3b,4, N0.1, M0 or any T, N2.3, M0) tumours there were no differences in the clinical characteristics that rendered the primary tumour inoperable between those with ER+ or ER- tumours. The median disease-free interval (DFI) in patients with operable tumours and uninvolved axillary nodes was significantly longer in those with ER+ tumours (P less than 0.05). Median survival was significantly longer in patients with ER+ tumours than in those with ER- tumours (50 vs 27.5 months, P less than 0.05), and when survival was analysed according to various methods of initial treatment, it was significantly prolonged in patients with operable (T3a, N0.1, M0) ER+ tumours compared to those with operable ER- tumours. In patients with inoperable tumours no effect of ER status on prognosis was demonstrated. These results suggest that oestrogen receptor content may be a prognostic variable in patients with operable stage III breast cancer, but further studies of patients with similar methods of initial treatment are needed to confirm this. Patients with operable stage III tumours should be considered separately from those with locally advanced inoperable tumours in view of the significant differences in their survival prospects.

Breast Neoplasms↗
PubMed1982

Serum sialyl transferase levels in patients with metastatic breast cancer treated by chemotherapy.

Serum sialyl transferase (SST) was measured in 49 female patients with advanced breast cancer and 60 female controls. The mean SST level was significantly raised in patients with advanced breast cancer. There was no correlation between specific sites, or numbers of sites of metastatic disease and SST levels. The patients with advanced breast cancer were all treated with chemotherapy; in 13/21 responders there was a significant fall in SST and in 2 responders a significant rise in SST. The 6 patients who died after one course of chemotherapy had a significantly higher mean SST than those surviving longer. SST appears to lack sufficient specificity to be of practical value as a marker of response in patients with breast cancer treated by chemotherapy, though constant measurement of changes in SST may be of use in monitoring drug response. Raised SST at the commencement of chemotherapy may signify poor prognosis.

Antineoplastic Agents↗
PubMed1981

Corticosteroids for elderly patients with breast cancer.

Ninety-one assessable elderly women (greater than 65 years) with advanced breast cancer were treated with prednisolone 15 mg (or cortisone 75 mg) daily after primary endocrine treatment (estrogens, androgens or tamoxifen). Thirteen (14%) achieved an objective regression, and 19 (21%) others showed no change for greater than or equal to six months. Hence, 32 patients (35%) had control of disease for about one year. Responses were mainly in soft tissue and skeletal lesions and were independent of response to prior endocrine treatment. Toxicity was low. Low-dose corticosteroid treatment is of value in controlling advanced breast cancer in elderly women.

Aged↗
PubMed1980

Estrogen receptors and response to endocrine therapy and cytotoxic chemotherapy in advanced breast cancer.

In a consecutive series of 191 patients with advanced breast cancer, the response rate to endocrine treatment was 46/136 (34%) in estrogen receptor positive (ER+) patients, compared with 5/55 (9%) in estrogen receptor negative (ER-) patients (P < 0.01). In a retrospective analysis of 47 patients, the response rate to cytotoxic chemotherapy was 20/33 (62%) for ER+ tumors and 8/14 (57%) for ER-. It is concluded that ER+ tumors have a significantly higher chance of responding to endocrine therapy than do ER- tumors, but that receptor status is not a determinant of response to cytotoxic chemotherapy.

Antineoplastic Agents↗