Biomedical subjects

R J Motzer

Publications and source records attributed to R J Motzer.

115 records · Page 7Linked to original sources

PubMed1988

Advanced seminoma: the role of chemotherapy and adjunctive surgery.

STUDY OBJECTIVE: To determine the effectiveness of chemotherapy and adjunctive surgery in managing patients with advanced seminoma. DESIGN: Nonrandomized prospective clinical trial of chemotherapy in a cohort of patients with advanced seminoma. SETTING: Referral cancer hospital. PATIENTS: Consecutive sample of 62 patients with primary extragonadal, stage IIC (greater than 5-cm retroperitoneal adenopathy) and stage III seminoma; 45 patients were previously untreated, 13 had received radiotherapy, and 4 had previously received radiotherapy and chemotherapy. INTERVENTION: Cisplatin-based chemotherapy (100 to 120 mg/m2 body surface area per cycle of treatment); 45 patients received vinblastine, bleomycin, cisplatin, dactinomycin, and cyclophosphamide; 15, etoposide and cisplatin; and 2, both regimens. MEASUREMENTS AND MAIN RESULTS: Fifty-three of the sixty (88%) evaluable patients achieved a complete remission, and only 6 patients had relapses. Fifty-three of the sixty-two patients (85%) remain alive and disease-free. The regimen of etoposide and cisplatin was equivalent to regimens using more drugs. An elevated level of human chorionic gonadotropin at the initiation of treatment was associated with a worse prognosis. CONCLUSIONS: Cisplatin-based chemotherapy is effective treatment for patients with extragonadal, stage IIC, and stage III seminoma and should be considered as initial therapy.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1987

Hemorrhage: a complication of metastatic testicular choriocarcinoma.

Patients with choriocarcinoma are at risk for hemorrhage. The majority of reported cases have occurred in patients with gestational trophoblastic disease. Although choriocarcinoma in the male is a less common entity, a similar tendency exists. In 3 male patients at Memorial Sloan-Kettering Cancer Center hemorrhage developed as a direct consequence of metastatic choriocarcinoma. The blood loss was massive and resulted in the death of 2 patients. Hemorrhage occurred in two distinct settings: immediately after chemotherapy and in patients with rapidly progressive advanced disease. Early recognition and vigorous support were critical in patient management. Surgical excision of bleeding metastases may be beneficial in selected instances.

Adolescent↗

PubMed1987

Chemotherapy for germ cell tumors.

With the advent of cisplatin-based chemotherapy and the incorporation of adjunctive surgery, 70 to 80 per cent of patients with advanced germ cell tumors are cured. Serum tumor markers are important diagnostically and prognostically and are necessary for monitoring response to therapy. Patients with germ cell tumors may be divided into "good risk" (high likelihood of complete response) and "poor risk" (low likelihood of complete response) based on pretreatment serum tumor markers, extent of disease, histology, and primary site. For "good-risk" patients, new treatments are being investigated that maintain efficacy and ameliorate toxicity. For "poor-risk" patients, innovative therapy is needed to increase the proportion of complete responders. Further progress will be made only through careful randomized trials and the discovery of new drugs.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1987

Phase II trial of carboplatin in patients with advanced germ cell tumors refractory to cisplatin.

A phase II trial of carboplatin was conducted in 22 patients with advanced germ cell tumors refractory to cisplatin-based chemotherapy. Twenty of 22 patients were evaluable for toxicity and response. Two partial responses and one minor response were seen. The major toxic effect was myelosuppression. Carboplatin has antitumor activity in patients with advanced germ cell tumors refractory to cisplatin, and phase II and III studies of combination chemotherapy are indicated.

Adolescent↗

PubMedDate not supplied

Renal cell carcinoma.

Renal cell carcinoma (RCC) is characterized by (a) lack of early warning signs, which results in a high proportion of patients with metastases at the time of diagnosis; (b) protean clinical manifestations; and (c) resistance to radiotherapy and chemotherapy. The estimates of new diagnoses and deaths from kidney cancer in the United States during 1996 are 30,600 and 12,000, respectively. RCC occurs nearly twice as often in men as in women. The age at diagnosis is generally older than 40 years; the median age is in the midsixties. The incidence of RCC has been rising steadily. Between 1974 and 1990, there was a 38% increase in the number of patients who had a diagnosis of RCC. This increase was accompanied by a significant improvement in 5-year survival. Both trends are likely the result of improved diagnostic capability. Newer radiographic techniques, including ultrasonography, computed tomography, and magnetic resonance imaging, are detecting kidney tumors more frequently and at a lower disease stage, when tumors can be resected for cure. Surgical treatment is the only curative therapy for localized RCC. Radical nephrectomy remains the mainstay of surgical management, but techniques are being modified. These modifications include partial nephrectomy and resection of vena caval thrombi. In highly selected cases, surgical resection of locally recurrent RCC or of disease at a solitary metastatic site is associated with long-term survival. Metastatic RCC is highly resistant to the many systemic therapies that have been extensively investigated. A minority of patients achieve complete or partial response to interferon, interleukin-2, or both. Response can be dramatic but is rarely durable. Because most patients do not achieve response, these agents are not considered effective treatments for RCC, but the response in some patients indicates the need for continued research on their use. Identification of new agents with better antitumor activity against metastases remains a high priority in clinical investigation of therapy for this refractory disease.

Antineoplastic Agents↗

PubMedDate not supplied

A phase II study of pyrazoloacridine in patients with advanced renal cell carcinoma.

The aim of this study was to determine the antitumor activity of pyrazoloacridine in patients with renal cell carcinoma. Eligible patients had advanced renal cell carcinoma with bidimensionally measurable disease, a Karnofsky performance status of at least 70, life expectancy of greater than three months, no prior treatment with chemotherapy, and no evidence of brain metastases. Patients were treated intravenously with 750 mg/m2 every three weeks. Twelve patients were enrolled in this study and all were evaluable for response and toxicity. Of the twelve patients, no major responses were achieved. Toxicity was mild, with three patients requiring a 20% dose reduction. At the dose and schedule used in this trial, pyrazoloacridine is inactive in renal cell carcinoma.

Acridines↗

PubMedDate not supplied

Expression of the retinoblastoma gene product in renal tumors.

BACKGROUND: Alterations in the retinoblastoma (Rb) gene and its protein product have been detected in numerous solid tumor malignancies. Loss of Rb function is believed to contribute to neoplastic transformation or to the development of metastases. To define the role of Rb in renal cancer, we analyzed renal tumor specimens for molecular alterations in the Rb gene and for lack of Rb protein expression, and correlated the results to clinicopathological characteristics. MATERIALS AND METHODS: Thirteen renal cancer cell lines, 62 primary renal tumors, and 5 metastatic renal cancers were studied by Southern blot analysis for defects in the Rb gene, and by immunohistochemistry for Rb protein expression. Results were correlated with histopathological parameters and patient survival. RESULTS: Structural alterations in the Rb gene were not detects in any of the renal cancer cell line or primary renal tumors studied. A rearranged Rb gene was observed in 1/5 metastatic tumor specimens. Western blot analyses revealed a truncated Rb protein in one of 13 renal cancer cell lines; immunohistochemical analysis revealed Rb protein in all papillary and oncocytic tumors, and in 39/44 non-papillary tumors. Rb expression patterns did not correlate with pathological stage, histological grade or the development of metastatic disease. CONCLUSION: Molecular alterations of the Rb gene are infrequent (<2%) in renal cancers, and Rb protein is present in the majority of primary (92%) and metastatic (100%) renal tumors. Loss of Rb expression does not appear to significantly contribute to malignant transformation or progression of renal cancers.

Adenocarcinoma↗