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S Monfardini

Publications and source records attributed to S Monfardini.

At least 91 records · Page 5Linked to original sources
PubMed1994

The aged patient with lung cancer. Management recommendations.

Elderly patients with lung cancer have not benefited from the therapeutic improvements obtained during the 1980s with younger adults. Potentially operable non-small-cell lung cancers are more common in elderly patients, who are more likely to have localized disease at diagnosis. Even so, elderly patients are rarely treated with surgery. Radiotherapy remains the most frequently adopted tool to treat non-small-cell lung cancer in this age group. Epipodophyllotoxin derivatives constitute the best option for chemotherapy of elderly patients with small-cell lung cancer. When used as single agent regimens, these drugs show the same overall response rate as combination chemotherapy, but with reduced toxicity. Haematopoietic growth factors are used to reduce bone marrow damage following cytotoxic chemotherapy, and may be a promising tool in elderly patients. Special attention should be given to increasing the number of elderly patients with small-cell lung cancer enrolled in phase I and II studies to investigate new agents for the treatment of this tumour.

Aged↗
PubMed1994

AIDS-associated Kaposi's sarcoma and non-Hodgkin's lymphomas reporting in Italy: a linkage study.

To evaluate the completeness and accuracy in the reporting of AIDS-associated Kaposi's sarcoma (KS) and non-Hodgkin's lymphomas (NHL) in Italy, a linkage study of the notifications to the Italian AIDS Registry (RAIDS--the national compulsory AIDS surveillance system) and the clinical and pathological records of the Italian Cooperative Group on AIDS-related tumors (GICAT--a nationwide voluntary reporting system for HIV-infected individuals who develop cancer) was carried out. A total of 288 cases of KS and 258 cases of NHL fulfilling the AIDS definition criteria, histologically diagnosed by the GICAT centers between January 1987 and March 1992, were matched with the 16,860 AIDS cases reported to the RAIDS up to March 1993. The linkage procedure, based on name, gender, and date of birth, identified 276 cases of KS (96%) and 241 cases of NHL (93%) present in both files ("linked" cases). The diagnosis of KS did not appear among the clinical manifestations of AIDS in the RAIDS file in 67 out of the 276 linked KS (24%), either with coincident dates of KS diagnosis and of case notification (19 cases) or when the KS diagnosis followed by > or = 2 months the case notification to RAIDS (48 cases). Of the 241 linked NHL, 84 (33%) had no such neoplastic complications of AIDS listed in the RAIDS file, 23 with coincident dates of NHL diagnosis and of case notification and 61 with the NHL diagnosis made > or = 2 months after the notification. A noteworthy discrepancy in the classification of the three histologic subtypes of NHL emerged between the GICAT and the RAIDS. The degree of underreporting of AIDS-associated cancers that emerged from the present study suggests that augmentation with other sources of oncological information is important to better estimate the burden of AIDS-related tumors and to study the interaction between HIV infection and cancer.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Activation of cytolytic activity in peripheral blood monocytes of renal cancer patients against non-cultured autologous tumor cells.

Our purpose was to evaluate the ability of blood monocytes of renal cancer patients to become cytotoxic against fresh, autologous tumor cells. Fresh target cells were obtained by mechanical enzymatic dissociation of tumor and normal renal tissue. The A375 cell line, derived from a human melanoma, and the SW626 cell line, derived from a human ovarian carcinoma, were used as positive target cell controls. Monocytes from renal cancer patients and normal volunteers were activated in vitro with lipopolysaccharide (LPS), or muramyl tripeptide (MTP-PE), or multilamellar vesicle liposomes containing MTP-PE (MLV-MTP-PE), with or without a pre-incubation with r-IFN-gamma, and tested for cytotoxicity in a 72-hr 111Indium-release assay. All patients were tumor-free at the time of the monocyte study. No difference in cytotoxic activity was observed between monocytes from healthy volunteers and those from cancer patients. Freshly dissociated tumor cells were as susceptible to tumoricidal monocytes as the 2 cell lines. Moreover, no cell population appeared to be resistant to activated monocytes, which were cytotoxic to both allogeneic and autologous fresh tumor cells. Activated monocytes maintained their ability to discriminate between normal and neoplastic cells and were not cytotoxic against autologous or allogeneic normal non-neoplastic cells. Our data indicate that MLV MTP-PE liposomes activate peripheral blood monocytes from cancer patients to a tumoricidal status against fresh, dissociated non-cultured autologous tumor cells.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed1993

Phase I-II intraperitoneal mitoxantrone in advanced pretreated ovarian cancer.

36 previously treated patients (25 with anthracyclines) with advanced epithelial ovarian cancer have been treated with intraperitoneal (i.p.) mitoxantrone (M) at increasing doses. The response was evaluated through repeated laparoscopy with multiple biopsies and serial measurement of Ovarian Cancer Antigen 125 (CA 125); 11/36 patients had a complete (6 patients) or partial (5 patients) response. Toxicity (both local and general) was observed starting from 25 mg/m2 of M per cycle. The amount of drug reaching systemic circulation was monitored by measuring M plasma value after i.p. treatment. This study showed wide variations in serum levels obtained after i.p. doses ranging from 23 to 36 mg/m2. The area under the curve (AUC) of mitoxantrone plasma samples, did not correlate with the i.p. administered dose. Conversely, a correlation seems to exist between the plasma AUC and the responder status. Patients who showed clinical responses to i.p. treatment with mitoxantrone had AUCs and plasma peak levels of the drug that were significantly higher than those in non-responders (P = 0.03, Fisher's exact test).

Adult↗
PubMed1993

Commission of the European Communities "Europe Against Cancer" Programme. European school of oncology advisory report. Cancer treatment in the elderly.

Within the EC approximately one million cases of cancer are diagnosed every year. At present, more than 55% of cancers occur in subjects aged over 65 years. There has been little clinical attention to the problem of neoplasia in the elderly. They are not receiving the same standard of specialised oncological care as younger patients. Other diseases (co-morbidity conditions) associated with cancer, and influencing its treatment and outcomes are not being properly considered. Information on surgery, radiotherapy and chemotherapy in younger patients exists for all cancers and could be adapted for the elderly. Controversial aspects of neoplasia in the elderly concern the intensity of chemotherapy, extent of surgery and the relative roles of specialised cancer centres, community hospitals and primary care providers. Future research should aim to replace subjective opinions on presence of frailty with objective instruments such as the multidimensional geriatric assessment scale. New trials could then seek to improve treatment in well-defined populations in terms of both efficacy and quality of life. Funding priorities should firstly consider that clinical trials for tumours in the elderly must be organised from cancer institutes and specialised referral centres in collaboration with geriatricians, primary care and community hospital physicians. Continuing education of doctors should be reported. A document such as this with appropriate modifications might be used as an initial message on neoplasia in the elderly to be published for information to clinicians and the public throughout Europe. Specific measures of quality assurance need financial support to evaluate the improvements in patterns of care. The 10 points of the 'Europe Against Cancer Guidelines' need reemphasising.

Aged↗
PubMed1993

Epirubicin and ifosfamide in advanced soft tissue sarcomas.

BACKGROUND: To evaluate the feasibility, toxicity and efficacy of the combination of (IFO) ifosfamide and epirubicin (EPI) given at conventional doses for monochemotherapy, we started a phase II study in advanced/metastatic soft tissue sarcoma patients. PATIENTS AND METHODS: Treatment consisted of: epirubicin 75 mg/m2 i.v. day 1; IFO 1.8 g/m2 days 1 to 5; MESNA 20% of the IFO dose at 4-hour intervals three times a day during IFO administration. Cycles were given every 3-4 weeks for at least three cycles. RESULTS: The overall response rate for non-visceral sarcomas (51 pts) was 31% (95% confidence limits +/- 13%). Among the 13 visceral sarcomas no response was seen for the leiomyosarcomas of the gastrointestinal tract, whereas one complete and one partial remission were observed for the uterine sarcomas. The duration of response was 10 months (range 5-34+) for complete responses and 9 (range 4-42+) for partial responses. The median survival for responders is 18 months (range 2-60+) and for non-responders 10 months (range 1-33) (p < 0.004). CONCLUSIONS: This combination proved to be feasible and tolerable. The overall response rate does not appear to be superior to those with other standard treatments, but it should be pointed out that our patient population was totally unselected.

Adolescent↗
PubMed1993

5-Aza-2'-deoxycytidine (Decitabine) induces trilineage response in unfavourable myelodysplastic syndromes.

The preliminary results of a disease-oriented phase I-II study aimed at evaluating the clinical activity of 5-aza-2'-deoxycytidine (Decitabine) in patients affected by advanced myelodysplastic syndromes (MDS) are reported. Two patients affected by refractory anemia with excess of blasts (RAEB) and eight with RAEB in transformation (RAEB-T) were treated with Decitabine at a daily dose of 45 mg/m2, divided into three 4 h infusions for 3 days (six patients) or as continuous infusion of 50 mg/m2 for 3 days (four patients). Treatment with Decitabine resulted in a significant increase in circulating neutrophils, platelets, and hemoglobin with respect to pretreatment values in over 50% of patients. These changes were accompanied by the improvement of the marrow myeloid relative differentiation index (median fivefold increase in the whole group of patients) and of the myeloid to erythroid cell ratio (median twofold increase) in most of the patients. In four out of ten patients a complete normalization of peripheral blood (PB) and bone marrow (BM) picture (complete hematologic response) was obtained. The evaluation of the percentage of CD34-positive BM cells showed a slow but progressive reduction of early leukemic progenitors in most of the patients. A transient slight BM hypoplasia was obtained in less than 50% of patients while a severe marrow aplasia was never observed in our group of MDS patients during treatment with Decitabine. Extra-hematological toxicity was very mild in all the patients. The preliminary results of our study indicate that Decitabine is able to induce trilineage hematological responses in advanced MDS patients along with a stable normalization of the PB and BM picture in some of the subjects. Decitabine appears an active agent in advanced MDS and this deserves careful investigation in this heterogeneous group of disorders.

Aged↗
PubMed1993

Pilot study of 5-aza-2'-deoxycytidine (Decitabine) in the treatment of poor prognosis acute myelogenous leukemia patients: preliminary results.

5-Aza-2'-deoxycytidine (Decitabine) is a new cytosine analog with potent antileukemic activity and able to induce in vitro gene activation and cellular differentiation by a mechanism probably involving DNA hypomethylation. The aim of this pilot study was to evaluate the efficacy and the toxicity of Decitabine, used as single induction agent, in the treatment of poor prognosis acute myeloid leukemia (AML) patients, and to explore its mechanism of action. A total of 12 patients were treated with Decitabine at 90-120 mg/m2 as a four hour intravenous infusion, three times daily for three consecutive days every four to six weeks. A minimum of two courses were required for response evaluation and to consider a patient as therapeutic failure. A total of 10/12 patients were fully evaluable for response; three patients achieved a complete remission (CR) and one a partial remission (PR). Extra-hematological toxicity was generally mild. As for the mechanism of action, both a differentiation induction effect and a cytotoxic mechanism have been observed. In particular, CRs and PRs were probably obtained through the induction of leukemia cell differentiation as shown by the kinetic of remission and immunotyping studies. The preliminary results of this ongoing study suggest that Decitabine may have a prominent role in the treatment of those AML patients with poor general conditions and/or advanced age.

Aged↗
PubMed1992

Adjuvant therapy for primary breast cancer in a female patient affected by autoimmune liver disease: does it cure breast cancer and primary biliary cirrhosis?

Polychemotherapy (CMF or CMF-like regimens) is the treatment of choice in premenopausal breast cancer patients with 1-3 positive nodes. In clinical practice, patients with abnormal biochemical tests of liver function are usually excluded from this potentially curative methotrexate-containing regimen in order to avoid worsening of hepatic damage. On the other hand, recent reports have shown a beneficial effect of methotrexate in a particular autoimmune liver disease such as primary biliary cirrhosis. We discuss the case of a female patient with breast cancer and primary biliary cirrhosis whose biochemical tests of liver function and the titer of antimitochondrial antibody persistently improved after treatment with 3 cycles of CMF. In conclusion, we suggest that the CMF regimen is potentially useful in patients with breast cancer and primary biliary cirrhosis.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Phase II study of weekly 4'-epidoxorubicin in patients with metastatic squamous cell cancer of the cervix: an EORTC Gynaecological Cancer Cooperative Group Study.

In this study 24 patients with metastatic cervical cancer were treated with a weekly bolus injection of 4'-epidoxorubicin at a dose of 12.5 mg/m2. All patients were followed until disease progression. Toxicity was generally absent or very mild. Only 1 patient (4%) had a partial remission lasting 23 weeks and 9 patients (38%) had stable disease with a median duration of 13 weeks (range 7-36). 4'-Epidoxorubicin at this dose and schedule is not active in metastatic squamous cell carcinoma of the cervix.

Adult↗
PubMed1992

Feasibility and efficacy of arginine 2-mercaptoethanesulfonate (ARGIMESNA) in the prevention of hemorragic cystitis from ifosfamide (IFO).

Tolerability and efficacy of the new uroprotective agent ARGIMESNA was assessed within a randomized cross-over study comparing it to sodiummercaptoethanesulfonate (MESNA), in patients treated with IFO. MESNA i.v., 20% of IFO dose, was given to all patients before chemotherapy; 4 h later, at random, they received ARGIMESNA p.o., 20% of IFO dose every 2 h x 4, or MESNA p.o., 40% of IFO dose every 4 h x 2. Overall, 78 cycles of oral uroprotection were administered: 37 for ARGIMESNA capsules; 41 for MESNA vials p.o. ARGIMESNA was subjectively better tolerated, determining gastro-intestinal discomfort in only 12 out of 37 cycles versus 34/41 of MESNA p.o. (p less than 0.001). Both preparations were equivalent for subjective and objective efficacy since no cycles were complicated by urinary symptoms (dysuria, stranguria, or hematuria). Nevertheless, 2 patients (7.7%) refused further oral assumption of both uroprotectors, whereas MESNA i.v. was added in other 7 patients because of nausea and vomiting caused by chemotherapy. In conclusion, this new oral preparation of mercaptoethanesulfonate turned out to be well tolerated, safe and active in the prevention of haemorrhagic cystitis from IFO.

Adolescent↗
PubMed1992

Treatment of malignant mesothelioma with epirubicin and ifosfamide: a phase II cooperative study.

From May 1988 to March 1990, 17 consecutive patients with histologically proven malignant mesothelioma were treated with epirubicin 75 mg/sqm i.v. on day 1 and ifosfamide 1.8 gr/sqm/day i.v. from day 1-5. Treatment was repeated every 3 weeks until progression. Fifty-three chemotherapy cycles were administered to the 17 patients treated (median, 3 cycles/patient). No complete responses, 1 partial response, 8 stable diseases and 8 progressions were noted. Toxocity was acceptable and no treatment-related deaths occurred. Actuarial median survival was 6 months. In this study, a combination of full doses of epirubicin and ifosfamide did not prove to be active in malignant mesothelioma.

Adult↗