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Biomedical subjects

T J Ervin

Publications and source records attributed to T J Ervin.

54 records · Page 3Linked to original sources
PubMed1983

Small cell carcinomas of the larynx: results of combined modality treatments.

Four cases of primary small cell carcinoma of the larynx are described. Two patients presented with extensive metastatic disease and two with tumor limited to the larynx. All four cases responded (3PR, 1CR) to systemic combination chemotherapy. Long-term remission was achieved in one patient with limited disease who underwent chemotherapy with a complete response followed by definitive radiotherapy. Treatment results are compared with previously reported cases. The importance of early diagnosis through staging, and combined treatment in small cell carcinoma of the larynx is discussed.

Aged↗
PubMed1982

Chemotherapy of advanced salivary gland neoplasms.

Fourteen patients with advanced salivary gland malignancies were treated with combination chemotherapy. Five of 13 patients responded to cyclophosphamide and adriamycin and two patients in the responding groups underwent further potentially curable treatment, rendering them disease-free. Three patients with mucoepidermoid carcinoma failed to respond to this regimen, but two of three patients treated with a combination of cisplatinum, bleomycin and methotrexate responded. The potential role for chemotherapy in the treatment of salivary gland malignancies is discussed.

Adult↗
PubMed1982

A phase I trial of combination therapy with continuous-infusion PALA and continuous-infusion 5-FU.

Thirty-four patients were treated with N-(phosphonacetyl)-L-aspartate (PALA) at a dose of 850 mg/m2/day x 5 by continuous intravenous infusion (days 1-5) and 5-fluorouracil (5-FU) on an escalating dose schedule of 300-630 mg/m2/day x 5 by continuous intravenous infusion (days 2-6). Dose-limiting oral mucositis occurred at a 5-FU dose of 560 mg/m2/day; other toxicities included nausea, vomiting, diarrhea, skin rash, and superficial venous phlebitis. Myelosuppression was rare. One partial response was observed in a patient with metastatic colorectal carcinoma. Plasma PALA levels were monitored in seven patients. Steady-state levels were achieved by the 2nd day of drug infusion and ranged between 10 and 20 micrograms/ml.

Adult↗
PubMed1982

Toxicity of aggressive multimodality therapy including cisplatinum, bleomycin and methotrexate with radiation and/or surgery for advanced head and neck cancer.

A combined modality regimen employing induction chemotherapy with cisplatinum, bleomycin and methotrexate followed by surgery and/or radiation therapy was initiated in patients with advanced squamous cell carcinoma of the head and neck. In the first 23 patients treated with this program there was a 90% response rate to induction chemotherapy (9% CR and 81% PR). Toxicity associated with radiotherapy, but not surgery, was increased with 11 of 23 patients (48%) who experienced some toxicity during or immediately after radiotherapy. Mucositis was worse than expected and severe delayed mucositis was seen in 2 patients, one or whom required hospitalization. Late complications, possibly related to therapy included one myocardial infarction and one episode of hypoglycemia, both of which were fatal. One other patient voluntarily failed to take prescribed oral leucovorin, dying of unrescued methotrexate toxicity during adjuvant therapy, a questionable suicide. Further follow-up and analysis of failure will be necessary to determine if the value of a combined modality regimen in producing an increased cure rate and long term survival will out weight increased toxicity.

Adolescent↗
PubMed1982

Phase II trial of combination therapy with continuous-infusion PALA and bolus-injection 5-FU.

Fifty-seven patients were treated with continuous infusion of PALA at a dose of 850 mg/m2/day x 5 and iv bolus injection of 5-FU at a dose of 300 mg/m2/day x 5, which was given at the end of each 24-hour PALA infusion; the treatment interval was 28 days. The overall response rate among 43 evaluable patients was 14%. Two of 21 patients (10%) with colorectal carcinoma, two of eight patients with pancreatic carcinoma, and two of four patients with breast carcinoma achieved partial responses lasting 2-12 months. One of the responding patients with colon cancer and two with breast cancer had failed to respond to prior therapy with 5-FU; one of the responding patients with breast cancer had previously received an inadequate trial of a similar regimen. Toxic effects were mild to moderate and were confined to oral mucositis in most patients. It is concluded that this regimen offers little enhancement of the antitumor activity of 5-FU in patients with colorectal cancer previously treated with 5-FU. Investigation of other infusion techniques for the PALA and 5-FU combination is recommended, with particular attention to the treatment of colorectal, pancreatic, and breast carcinomas.

Adult↗
PubMed1982

Pulmonary complications during granulocyte transfusions: incidence and clinical features.

The use of granulocyte transfusions in profoundly neutropenic patients has increased markedly in recent years. Whenever a pulmonary infiltrate develops during the course of these transfusions, the question arises as to what role the transfusions are playing and whether the transfusions should be discontinued to prevent pulmonary deterioration. We have analyzed our recent experience of 593 granulocyte transfusions in 93 patients. 18 patients (19%) developed respiratory compromise or pulmonary infiltrates at some time during the course of granulocyte transfusion. 6 of the 18 cases were reactions to the granulocytes while the remainder were due to fluid overload or other causes. The risk of pulmonary complications did not correlate with the development of cytotoxic leukocyte antibodies, length of transfusion, or concomitant use of Amphotericin. They appeared to be more common in patients with active sepsis. Acute life-threatening pulmonary reactions were rare. Patients receiving granulocyte transfusions should be monitored carefully for pulmonary infiltrates, but other cases should be sought before the transfusions are discontinued.

Acute Disease↗
PubMed1981

Increased therapeutic index using moderate dose methotrexate and leucovorin twice weekly vs. weekly high dose methotrexate-leucovorin in patients with advanced squamous carcinoma of the head and neck: a safe new effective regimen.

A new intensive methotrexate regimen for the treatment of advanced squamous carcinoma of the head and neck is presented, employing twice-weekly parenteral low-moderate doses of methotrexate and a single parenteral dose of leucovorin 24 hours following methotrexate. Toxicity and therapeutic results in 20 patients treated with this regimen favorably with results of weekly high-dose methotrexate-leucovorin in 36 patients treated immediately before initiation of the new regimen. Moderate nephrotoxicity and mild gastrointestinal/mucosal toxicity were common to both, while myelotoxicity was rarely seen with the low dose regimen and was more frequent with the high-dose regimen. Partial response was observed in 60% of patients treated on the intensive low-moderate dose schedule, and 50% of patients previously untreated with methotrexate on the weekly high-dose schedule. None of 12 patients previously failing low-moderate doses of methotrexate responded to high doses administered in this trial. The characteristics of antitumor response with low-moderate and high-dose schedules were similar except for the median dose required to attain response (50 mg/m2 vs. 3 g/m2) and the lesser toxicity of intensive lower dose therapy with leucovorin.

Adult↗
PubMed1981

Chemotherapy for advanced carcinoma of the head and neck. A clinical update.

Optimal therapy for stage III and stage IV squamous carcinoma arising in the head and neck requires a multidisciplinary approach, including chemotherapy. Advances have identified several chemotherapeutic agents and combinations of agents that show substantial antitumor activity in this disease. While antitumor activity can be documented, experience indicates the duration of antitumor effect is short, and the toxicity may limit further therapy. To date, studies have not shown an advantage of combination chemotherapy over single agents. Theoretically, combination chemotherapy should increase patient survival through regression of the primary tumor as well as ablation of distant metastases. An analysis of recent trials with patients who received induction chemotherapy before definitive local treatment suggests that regression of tumor in stage III and stage IV lesions before definitive therapy may increase local treatment for regional disease. Randomized trials are needed to confirm or disprove the efficacy of combination chemotherapy for advanced squamous carcinoma of the head and neck.

Carcinoma, Squamous Cell↗
PubMed1981

Improved survival for patients with advanced carcinoma of the head and neck treated with methotrexate-leucovorin prior to definitive radiotherapy or surgery.

Patients presenting with Stage III-IV squamous carcinoma of the head and neck often relapse following aggressive surgery and/or radiotherapy. In an attempt to increase survival in this high risk group of patients, HD-MTX, 3 gm./m2/dose, given weekly, was administered to 21 inoperable patients with Stage III/IV squamous carcinoma of head and neck prior to, and for 1 month after, definitive surgery and/or radiotherapy. Six of 11 patients (55%) who showed a significant response (greater than 50% reduction in tumor volume) to HD-MTX are alive and free of tumor greater than 38 months following treatment (p = 0.6) (Fisher Exact Test). Responder median survival is greater than 38 months while non-responder median survival is 15 months (p = .02) (Log Rank Test). For the entire treatment group, at a mean duration of 44.2 months following initiation of therapy, 7 patients (33%) remain alive and free of tumor. Patients responding to induction MTX-LCV more often become eligible for combined modality approach than did the non-responder group. This "downstaging" of the tumor prior to aggressive surgery or radiotherapy may be responsible for the increased survival rate seen in those patients who responded to MTX-LCV.

Carcinoma, Squamous Cell↗
PubMed1980

Quantitation of the antitumor agent N-(phosphonacetyl)-L-aspartic acid in human plasma and urine by gas chromatography-mass spectrometry-selected ion monitoring.

N-(Phosphonacetyl)-L-aspartic acid (PALA) is an antitumor agent which is currently under clinical study. A gas chromatography--mass spectrometry--selected ion monitoring assay procedure using [13C]PALA as the internal standard has been developed for the quantitation of PALA in biological samples. Standard curves which related ion intensity peak height ratios (m/e 220/221) to PALA concentrations in plasma and urine were described by a non-linear least square analysis with correlation coefficients of R2 greater than 0.995 and greater than 0.996, respectively. Over concentration ranges for PALA of 1--60 micrograms/ml of plasma and 1--160 micrograms/ml of urine the coefficient of variation from the fitted curve was 4--18%. This methodology has been used to quantitate PALA in human plasma samples in a study on the clinical pharmacology of the drug.

Antineoplastic Agents↗
PubMedDate not supplied

Phase II trial of ifosfamide and mesna in previously treated patients with non-Hodgkin's lymphoma: Cancer and Leukemia Group B study 8552.

Ifosfamide (1.25 g/m2 intravenously/day x 5) with mesna (20 per cent of the ifosfamide dose x six doses on each day of ifosfamide therapy) was administered to 46 previously treated patients with non-Hodgkin's lymphoma of which 31 were eligible and evaluable. A 29 per cent response rate (9/31) was observed (two CR and seven PR) with a median duration of response of 2.5 months. Myelosuppression was dose-limiting. Hemorrhagic cystitis was observed in three patients (10 per cent). Nausea and vomiting was generally mild or moderate. One patient developed transient neurotoxic symptoms with confusion and disorientation. An additional patient developed an anaphylactic-type reaction with shortness of breath and respiratory stridor during the fourth course of therapy. Ifosfamide, as a single agent, produces remissions of limited duration in non-Hodgkin's lymphoma in patients in second or third relapse.

Adolescent↗
PubMedDate not supplied

A quick and efficient way to pool platelets.

An easy and efficient method for pooling multiple platelet concentrates is presented. By adaption of a laboratory vacuum system, the process of pooling platelet units was significantly shortened without platelet loss. In our laboratory time study, the use of this pooling system resulted in time savings of 27.5 percent and 35.9 percent during pooling of four-unit and six-unit platelet packs, respectively. Platelet loss by the vacuum method was not distinguishable from that of the hand method (p = 0.4 by two-sample t test).

Adult↗
PubMedDate not supplied

Role of chemotherapy in the multidisciplinary approach to advanced head and neck cancer: potentials and problems.

Chemotherapy as initial treatment for advanced squamous carcinoma has received much recent attention. Despite sparse experimental data supporting its usefulness, such chemotherapy is now used for a variety of advanced malignancies. This experience is conceptually reviewed, with special emphasis on squamous carcinoma of the head and neck. Factors which influence treatment results, such as drug dosage, radiation treatment planning, and surgical resection, will require careful analysis in the evolution of the multidisciplinary approach to advanced head and neck cancer.

Antineoplastic Agents↗
PubMedDate not supplied

Chemical modulation of the hypoxic fraction in the treatment of head and neck cancer.

Treatment of large squamous carcinomas of the head and neck often requires intensive of multidisciplinary treatment. Despite such aggressive measures, local recurrence is common. Possible reasons for such local failure are numerous. Hypoxic but viable tumor cells may be one means of resistance to radiotherapy and chemotherapy. If surgical removal cannot eliminate these cells, tumor regrowth may occur. Modulation of the hypoxic fraction is one means of potentially altering resistance to radiotherapy. Misonidazole, a radiosensitizer, has been thought to increase free radical formation in hypoxic cells in vitro thus increasing the radiosensitivity. This observation is discussed with reference to advanced head and neck cancer.

Animals↗
PubMedDate not supplied

Treatment of advanced squamous cell carcinoma of the head and neck with cisplatin, bleomycin, and methotrexate (PBM).

Twenty-nine of 32 patients with advanced squamous cell carcinoma of the head and neck were treated with two courses of an intensive chemotherapy regimen consisting of cisplatin, bleomycin, and methotrexate (PBM). The frequency of toxic effects (in 29 evaluable patients) associated with this regimen was low. Serious neutropenia occurred in 17% and thrombocytopenia in 10% of the courses. Nausea (50%) and severe vomiting (6%) were easily managed. All 26 (100%) evaluable patients with squamous cell carcinoma had significant reduction (less than 50%) of measurable tumor. Complete regression was noted in seven patients (27%). Fifteen patients were treated with PBM prior to receiving radiation therapy or surgery as definitive treatment for their disease. Antitumor response in these patients was rapid, occurring within 3 weeks from the initiation of chemotherapy. Maximal antitumor effect was achieved by Week 6 of induction chemotherapy. No patient showed tumor regrowth prior to the institution of radiation therapy or surgery. Twelve patients with recurrent disease following previous radiotherapy and/or surgery also received PBM chemotherapy. In our study, previous radiotherapy or surgery did not diminish the antitumor effect of PBM, but toxicity was more severe.

Adolescent↗
PubMedDate not supplied

Phase I trial of combination therapy with PALA and 5-FU.

PALA is an inhibitor of de novo pyrimidine biosynthesis. Studies combining PALA with 5-FU in experimental models have demonstrated synergistic antitumor activity with only additive toxicity. The phase I study of PALA in combination with 5-FU is described. Sixteen patients received a total of 29 courses of PALA given as a 24-hour infusion daily for 5 days and 5-FU given by iv bolus at the end of each 24-hour PALA infusion. Cycles were repeated at 28-day intervals. Mucositis was dose-limiting when 940 mg/m3/day of PALA was given with 345 mg/m2/day of 5-FU. Diarrhea, skin rash, and myelosuppression (in decreasing order of frequency) occurred but were not dose-limiting. Alopecia occurred in all patients. Objective responses were seen in single patients with large cell carcinoma of the lung, fibrous histiocytoma, and adenocarcinoma of the colon refractory to prior 5-FU therapy. These studies support further phase II evaluation of the PALA and 5-FU combination.

Adenocarcinoma↗
PubMedDate not supplied

Phase I trial of N-(Phosphonacetyl)-L-aspartic acid (PALA).

N-(Phosphonacetyl)-L-aspartic acid (PALA) was given as a 5-day continuous infusion in a phase I trial. Dose-limiting toxic effects noted were diarrhea occurring at doses of greater than or equal to 6 g/m2/course, mucositis occurring at doses of greater than or equal to 7.5 g/m2/course, and skin rash occurring at doses greater than 9 g/m2/course. No significant CNS, hemorrhagic, gastrointestinal, or hematologic toxicity was noted. In patients with measurable tumor volume, no significant antitumor responses were seen. A dose of 9 g/m2/course is recommended for a phase II trial.

Adult↗