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PubMedDate not supplied

Progesterone receptors in reproduction: functional impact of the A and B isoforms.

Progesterone (P) is a key regulator of female reproductive activity. The effects of P are mediated by two progesterone receptor (PR) proteins, termed A and B, that arise from a single gene and act as ligand-activated transcription factors to regulate the expression of reproductive target genes. Null mutation of the PR gene in mice (PRKO) leads to pleiotropic reproductive abnormalities. This paper will review the reproductive functions of PRs delineated using the PRKO mouse. Further, we will summarize the structure and functional properties of PRs and discuss how functional differences between the PR-A and PR-B isoforms are likely to impact on the overall physiological role of the receptor in reproductive systems.

Animals↗
PubMed2003

Progesterone-dependent regulation of female reproductive activity by two distinct progesterone receptor isoforms.

The steroid hormone, progesterone, is a central coordinator of all aspects of female reproductive activity. The physiological effects of progesterone are mediated by interaction of the hormone with specific intracellular progesterone receptors (PRs) that are expressed from a single gene as two protein isoforms and that are members of the nuclear receptor superfamily of transcription factors. Analysis of the structural and functional relationships of each isoform using in vitro systems has demonstrated that the PR-A and PR-B proteins have different transcription activation properties when liganded to progesterone. More recently, selective ablation of the PR-A and PR-B proteins in mice had facilitated examination of the contribution of the individual PR isoforms to the pleiotropic reproductive activities of progesterone. Analysis of the phenotypic consequences of these mutations on female reproductive function has provided proof of concept that the distinct transcriptional responses to PR-A and PR-B observed in cell-based transactivation assays are reflected in a distinct tissue-selective contribution of the individual isoforms to the reproductive activities of progesterone. In PR-A knock-out mice, in which the expression of the PR-A isoform is selectively ablated (PRAKO), the PR-B isoform functions in a tissue-specific manner to mediate a subset of the reproductive functions of PRs. Ablation of PR-A does not affect response of the mammary gland or thymus to progesterone but results in severe abnormalities in ovarian and uterine function leading to female infertility. More recent studies using PR-B knock-out (PRBKO) mice have shown that ablation of PR-B does not affect either ovarian, uterine or thymic responses to progesterone but results in reduced mammary ductal morphogenesis and alveologenesis during pregnancy. Thus, PR-A is both necessary and sufficient to elicit the progesterone-dependent reproductive responses necessary for female fertility, while the PR-B isoform is required to elicit normal proliferative and differentiative responses of the mammary gland to progesterone. This review will summarize our current understanding of the selective contribution of the two PR isoforms to progesterone action.

Animals↗
PubMed2003

Autonomic neuropathy is associated with hemodynamic instability during human liver transplantation.

INTRODUCTION: End-stage liver disease is frequently associated with autonomic neuropathy (AN). The hemodynamic changes during liver transplantation (LT) require an adequate autonomic response to maintain cardiovascular stability. PATIENTS AND METHODS: Forty-one patients undergoing LT were evaluated for the influence of AN on the evolution after LT. AN was previously evaluated by seven cardiovascular tests assessing sympathetic (Sy) or parasympathetic (P) function. Patients were classified as absent (A), early (E), or definite dysfunction (D). A hemodynamic study was performed before and after vascular clampings. The analysis included the duration of LT, transfusion requirements, intra-operative artenal hypotensive episodes, incidence of postreperfusion syndrome (PRS), cardiac arrhythmias and vasoactive drug requirements. RESULTS: The hyperdynamic circulation worsened during surgery in D patients, as shown by a significantly increased cardiac output and a significantly decreased systemic vascular resistance. The incidence of PRS was greater in the AN group. Arterial hypotension during the neohepatic period was more frequent among patients with AN, more frequently requiring vasoconstrictor and inotropic therapy. CONCLUSIONS: AN is associated with hemodynamic impairment and with increased vasoactive drug requirements during liver transplantation, probably associated with impaired reflex vasoconstrictor responses to surgical manipulations and changes of blood volume. AN may be associated with a greater surgical risk during LT. Preoperative evaluation of AN may select a high-risk population of LT recipients.

Adult↗
PubMed2003

Gemcitabine combined with cisplatin as first-line treatment in patients with epithelial ovarian cancer: a phase II study.

OBJECTIVE: This phase II study was performed to evaluate the activity and toxicity of gemcitabine plus cisplatin as first-line treatment of advanced epithelial ovarian cancer. METHODS: Chemonaive patients with histologically or cytologically confirmed FIGO stage III or IV epithelial ovarian carcinoma were enrolled. Patients received cisplatin 75 mg/m(2) on Day 1 and gemcitabine 1250 mg/m(2) on Days 1 (after cisplatin) and 8 of a 21-day cycle. RESULTS: Of the 42 female patients (median age 60 years) enrolled, 81% had a Zubrod performance status of 0 or 1. Among the 37 response-evaluable patients, there were 5 (13.5%) pathological complete responses (CRs), 16 (43.2%) pathological partial responses (PRs), and 3 (8.1%) clinical PRs, for an overall response rate of 64.9% (95% CI: 47.4-79.8%) and a pathological response rate of 56.8%. Per an intent-to-treat analysis, the overall response rate was 57.1% (95% CI: 41.0-72.3%). After a median follow-up time of 15.8 months, the median survival was 24.0 months and median progression-free survival was 13.4 months. Grade 3/4 neutropenia and thrombocytopenia occurred in 69.0 and 33.3% of patients, respectively, with no febrile neutropenia or hemorrhage. Grade 3/4 nausea and vomiting occurred in 35.7% and grade 3 alopecia in 21.4% of the patients. One patient died due to a toxicity-related death (dyspnea). CONCLUSIONS: Gemcitabine plus cisplatin is active and feasible as first-line treatment of advanced epithelial ovarian cancer. Further clinical trials adding gemcitabine to first-line treatment seem warranted.

Adult↗
PubMed2001

The role of neurosteroids and non-genomic effects of progestins and androgens in mediating sexual receptivity of rodents.

Progestins and androgens modulate sexual receptivity in rodents, in part through mechanisms independent of traditional intracellular steroid receptors. Progesterone (PROG) in the ventromedial hypothalamus (VMH) and ventral tegmental (VTA) facilitates lordosis but has different actions in these brain areas. Primarily using lordosis in rodents as an in vivo experimental model, we have examined the effects that progestins exert in the midbrain and hypothalamus. Localization and blocker studies indicate that PROG's actions in the VMH require intracellular progestin receptors (PRs) but in the VTA they do not. Progestins that have rapid, membrane effects, and/or are devoid of affinity for PRs, facilitate lordosis when applied to the VTA. Manipulation of GABA and/or GABA(A)/benzodiazepine receptor complexes (GBRs) in the VTA alters lordosis, which suggests that progestins may interact with GBRs to facilitate receptivity by enhancing the function of GABAergic neurons. Interfering with PROG's metabolism to, or the biosynthesis of, 3alpha-hydroxy-5alpha-pregnan-20-one (3alpha,5alpha-TH PROG or allopregnanolone), the most effective endogenous GBR agonist, in the VTA attenuates female sexual behavior in rodents. Stimulation of mitochondrial benzodiazepine receptors (MBRs), which enhances neurosteroid production, by infusions of an MBR agonist to the VTA enhances lordosis. 3alpha,5alpha-TH PROG is increased in the midbrain of mated>proestrous>diestrous rodents. These data suggest that in the VTA, PROG may facilitate lordosis following metabolism to and/or biosynthesis of 3alpha,5alpha-TH PROG, which may have subsequent actions at GBRs and/or MBRs to acutely modulate female sexual behavior in rodents. The 3alpha-hydroxysteroid oxidoreduced metabolite of dihydrotestosterone (DHT), 5alpha-androstane-3alpha,17beta-diol (3alpha-androstanediol), is important for termination of sexual receptivity in rodents and has these effects in the absence of functional intracellular androgens receptors. As well, altering GBR function in the hypothalamus can influence 3alpha-androstanediol's inhibition of sexual receptivity. Through actions in the hypothalamus that are independent of intracellular androgen receptors but involving GBRs, 3alpha-androstanediol inhibits lordosis. These findings suggest that the PROG metabolite and pregnane neurosteroid, 3alpha,5alpha-TH PROG, and the testosterone metabolite and androstane neurosteroid, 3alpha-androstanediol, can have proximate influences on lordosis that is via nonclassical actions at intracellular steroid receptors.

Androgens↗
PubMed1997

[Oxaliplatin, folinic acid and 5-fluorouracil (folfox) in pretreated patients with metastatic advanced cancer. The GERCOD].

Preliminary studies suggest synergy between oxaliplatin and fluorouracil (5-FU). To assess this issue, we performed a study in pretreated patients with advanced colorectal cancer (CRC) resistant to leucovorin and 5-FU. Regimen consisted of oxaliplatin day 1, 130 mg/m2 every two cycles (folfox 1) or 100 mg/m2/cycle (folfox 2) or 85 mg/m2/cycle (folfox 3) and leucovorin 500 mg/m2 as a 2-hour infusion, followed by 5-FU 22 h infusion 1.5-2 g/m2 for two consecutive days every 2 weeks. One hundred and thirteen patients have been treated. One complete response (CR) and 32 partial responses (PRs) were observed for an overall response rate of 29.2%. Sixty-seven patients had prior documented progression while receiving the same schedule of leucovorin and 5-FU than the one used in the folfox regimens, among them 18 had PRs (26.9%). The best response rate was observed in patients treated with the folfox 2 regimen: 41.7%. From start of folfox, median progression-free survival was 6 months and median survival 13 months. Limiting toxicities were peripheral neuropathy and neutropenia. Fifty-four percent of the patients experienced WHO toxicity > or = grade 3 with the folfox1 regimen, 45% with the folfox2 and 40% with the folfox3. The folfox regimens achieve a high response rate in pretreated patients with CRC. Further studies are needed to determine the best oxaliplatin dose-intensity.

Adult↗
PubMed1997

A bioadaptive approach for experimental pain research in humans using laser-evoked brain potentials.

In order to find an experimental approach counteracting habituation in experimental pain research using short infrared laser stimulation in humans we developed a bioadaptive method based on subject's report on painfulness of stimulation (pain report; PR). After determination of the initial relationship between the energy of the laser stimulus and the corresponding PRs, the approach continuously adjusts the intensity of noxious stimuli so that PR is kept constant across time. Each difference between the PR evoked by the actual laser stimulus and the desired PR leads to an increase or decrease of the laser output energy value for the next stimulation with the desired PR proportional to the PR difference as well as to the slope of the initial correlation function between laser energy and corresponding PRs. This method has been applied in a study with nine volunteers. Results show that the approach leads to a constant PR by increasing the laser output energy by 0.01 mJ/s per mm2 on the average. Furthermore, an analysis of the laser-evoked brain potentials (LEPs) recorded from Cz was performed for the first and second half of stimuli. However, no significant changes in latencies or amplitudes of the main LEP components recorded at 210 ms (N210) and 350 ms (P350) were found. The method seems to be useful for different approaches in experimental and clinical pain research.

Adult↗
PubMed2000

Neurophysiological brainstem investigations in isolated Pierre Robin sequence.

Polysomnography, electromyography (EMG) of the face, tongue, and soft palate, blink reflexes (BRs), EMG during bottle-feeding, and brainstem auditory evoked responses (BAERs) were performed in 25 newborn babies with isolated Pierre Robin sequence (PRS) to aid in evaluation and management. Obstructive apneas were found in 23/24 patients (the 25th having undergone tracheotomy). Number and duration of central respiratory pauses were always normal, as well as electroencephalographic and clinical organization of sleep stages. EMG recruitment pattern in facial and lingual muscles, and BRs were normal in all cases. EMG recruitment pattern in muscles of the soft palate was normal in 14/25 patients, showed a reduced average amplitude with short-duration and low amplitude motor unit potentials in 10/25, and showed signs of denervation in 1/25. EMG during bottle-feeding showed sucking-swallowing disorders in 20/25 patients. BAERs showed a bilateral conductive impairment with increased latencies and thresholds in 5/19 patients, but with normal and symmetric I-III and I-V interpeak latencies in 19/19. These neurophysiological findings suggest that in isolated PRS a dysfunction of the lingual and pharyngeal motor organization exists without any structural impairment in brainstem nuclei and pathways.

Blinking↗
PubMed2000

Cognitive and neurophysiological evaluation of Japanese dyslexia.

Seven Japanese dyslexic boys were evaluated as to their pedagogic performance on the pupil rating scale (PRS), and psychological and neurophysiological characteristics. One of them suffered from severe English dyslexia despite that his Japanese dyslexia was feeble. PRS did not successfully reveal their reading difficulties. Psychological examination (WISC-R and K-ABC) revealed their cognitive dysfunction, but the results were heterogeneous. The Token test was most useful for detecting their poor reading comprehension. Electroencephalogram (EEG) coherence analysis showed high inter- and intra-hemispheric values. These findings may imply hyperconnectivity of the cerebral white matter in dyslexia. We assumed that the Token test demonstrates the discrepancy between reading and hearing comprehension best of all among these psychological tests and that connectivity between non-functional cortical lesions remains in dyslexic children.

Adolescent↗
PubMed1998

Paclitaxel and cisplatin as salvage treatment in patients with non-seminomatous germ cell tumour who failed to achieve a complete remission on induction chemotherapy.

The purpose of this study was to evaluate the efficacy and toxicity of paclitaxel and cisplatin combination chemotherapy as salvage treatment in patients with non-seminomatous germ cell tumour. Sixteen patients with histologically proven germ cell tumour, measurable disease and/or elevated serum tumour markers were eligible for the protocol. All patients had previously not achieved a complete remission (CR) to platinum-based induction chemotherapy and cytoreductive surgery. The treatment consisted of paclitaxel 175-225 mg/m2 as a 3-hour infusion, followed by cisplatin 100 mg/m2, repeated every 3 weeks for up to four cycles. Seven patients achieved a marker-positive partial remission (PR) by the end of the cisplatin-based induction chemotherapy; the remainder had disease progression at the start of the paclitaxel plus cisplatin treatment. One (6%) CR and 3 (19%) PRs were achieved, with an overall response rate of 25% (90% confidence interval 7-43). The duration of the CR is currently 9+ months; two PRs lasted 2 months. One patient with a PR has been lost to follow-up. During a median follow-up of 8 months (range 1-11), 12 patients died from the disease progression. The median survival for the whole group was 7 months. Toxicity was moderate, with neutropenia grade 3 occurring in 29% of patients, thrombocytopenia grade 1-3 in 29%, creatinine > 130 mmol/l in 36%, peripheral neuropathy grade 1-2 in 50%, and nausea and vomiting in 43%. Paclitaxel plus cisplatin showed modest activity, with an overall response rate of 31% in patients with poor prognosis who had not achieved a CR on induction chemotherapy.

Adult↗
PubMed2003

The stable analog carbocyclic TXA2 but not platelet-released TXA2 induces osteoclast-like cell formation.

Thromboxan A(2) (TXA(2)) is the main product of arachidonic acid metabolism in activated platelets. Platelet-released supernatants (PRS) can induce osteoclast-like cell formation in murine bone marrow cultures via a cyclooxygenase (COX)/receptor activator of NF-kB-ligand (RANKL)-dependent pathway. Here we investigated a possible linkage between platelet-released TXA(2) and osteoclastogenesis. The stable analog of TXA(2), carbocyclic TXA(2) (CTXA(2)) can induce the formation of tartrate-resistant acid phosphatase positive multinucleated cells in murine bone marrow cultures via a RANKL-dependent pathway and requires the presence of stromal cells. Interestingly, the platelet-released instable TXA(2) does not account for osteoclastogenic effects as: (a) PRS-induced osteoclastogenesis in the presence of the TXA(2) receptor antagonist SQ29548; (b) inhibition of platelet TXA(2) synthesis by indomethacin and acetylsalicylic acid failed to decrease the osteoclastogenic potential of the corresponding supernatants; and (c) CTXA(2)-induced osteoclast-like cell formation independent of indomethacin and the selective COX-2 inhibitor NS398.

Acid Phosphatase↗
PubMed1997

Oxaliplatin with high-dose leucovorin and 5-fluorouracil 48-hour continuous infusion in pretreated metastatic colorectal cancer.

Oxaliplatin has shown in vivo cytotoxic activity against colorectal cell lines. Preliminary studies suggest potentiation of fluorouracil (5-FU). To assess this issue, we performed a phase II study in pretreated patients with advanced colorectal cancer (CRC) resistant to leucovorin and 5-FU. The regimen (FOLFOX2) consisted of oxaliplatin 100 mg/m2 as a 2-h infusion on day 1; leucovorin 500 mg/m2 as a 2-h infusion, followed by 5-FU 24-h infusion 1.5-2 g/m2 for two consecutive days every 2 weeks. The initial 5-FU dose was 1.5 g/m2 for two cycles and increased to 2 g/m2 in case of no toxicity > grade 2. 46 patients were treated, all with disease progression on leucovorin and 5-FU therapy for metastatic disease, or relapse less than 6 months after the end of adjuvant therapy. One complete response (CR) and 20 partial responses (PRs) were observed for an overall response rate of 46%. 22 patients had prior documented progression while receiving the same schedule of leucovorin and 5-FU as the one used in the FOLFOX2 regimen, and among them, 10 had PRs (45%). From the start of FOLFOX2, median progression-free survival was 7 months and median survival 17 months. WHO toxicity > or = grade 3 per patient was: peripheral neuropathy 9%, nausea 4%, diarrhoea 9%, mucositis 13%, neutropenia 39%, thrombocytopenia 11%, alopecia 9%, and allergy 2%. Overall, 21 patients (46%) experienced grade 3-4 toxicity. This combination of leucovorin, 5-FU and oxaliplatin achieves a high response rate in pretreated patients with CRC resistant to leucovorin and 5-FU. Limiting toxicities are neutropenia and peripheral neuropathy.

Adenocarcinoma↗
PubMed2000

Two weekly vinorelbine: administration in patients who have received at least two prior chemotherapy regimes for advanced breast cancer.

This study examined the response to and toxicity of two weekly vinorelbine administration in patients with at least two prior chemotherapeutic treatments for advanced breast cancer. This single centre study enrolled 20 patients, 19 of whom had received prior taxane treatment for advanced breast cancer. Taxane treatment was in the form of docetaxel for all but 1 patient who had received paclitaxel. All patients had received two or more prior chemotherapeutic regimes for advanced breast carcinoma, including anthracyclines (epirubicin) in 19 patients. Vinorelbine 25 mg/m2 two weekly was given for 6 months, until disease progression or toxicity precluded further treatment. 5 earlier studied patients started vinorelbine at 25 mg/m2/week; all changed to the two weekly schedule, limiting the incidence and severity of neutropenia. 7 partial responses (PRs) out of 20 assessable patients (35% overall response rate, 95% confidence interval 15-59%) were noted, all PRs occurring in taxane pretreated patients. The median duration of response was 4 months whilst the median time to progression was 2.75 months. Overall, there were 7 neutropenic events (35%) of 2 week median duration, spanning common toxicity criteria (CTC) grades 1-3 in severity. 5 neutropenia cases (25%) occurred in patients whilst on two weekly vinorelbine. 2 cases (10%) required granulocyte colony stimulating factor support, 1 having had febrile neutropenia (52%). One case of thrombocytopenia, neurotoxicity and nausea (each CTC grade 1) were recorded. Although this study involves a small number of cases, these preliminary results suggest that two weekly vinorelbine is effective in heavily pretreated (including taxane pretreated) advanced breast carcinoma. Response is comparable with that of traditionally used weekly regimes, with markedly less toxicity.

Adult↗
PubMed2004

Effect of recovery modality on 4-hour repeated treadmill running performance and changes in physiological variables.

The purpose of this study was to compare the effectiveness of three different recovery modalities--active (ACT), passive (PAS) and contrast temperature water immersion (CTW)--on the performance of repeated treadmill running, lactate concentration and pH. Fourteen males performed two pairs of treadmill runs to exhaustion at 120% and 90% of peak running speed (PRS) over a 4-hour period. ACT, PAS or CTW was performed for 15-min after the first pair of treadmill runs. ACT consisted of running at 40% PRS, PAS consisted of standing stationary and CTW consisted of alternating between 60-s cold (10 degrees C) and 120-s hot (42 degrees C) water immersion. Run times were converted to time to cover set distance using critical power. Type of recovery modality did not have a significant effect on change in time to cover 400 m (Mean +/- SD; ACT 2.7 +/- 3.6 s, PAS 2.9 +/- 4.2 s, CTW 4.2 +/- 6.9 s), 1000 m (ACT 2.2 +/- 4.0 s, PAS 4.8 +/- 8.6 s, CTW 2.1 +/- 7.2 s) or 5000 m (ACT 1.4 +/- 29.0 s, PAS 16.7 +/- 58.5 s, CTW 11.7 +/- 33.0 s). Post exercise blood lactate concentration was lower in ACT and CTW compared with PAS. Participants reported an increased perception of recovery in the CTW compared with ACT and PAS. Blood pH was not significantly influenced by recovery modality. Data suggest both ACT and CTW reduce lactate accumulation after high intensity running, but high intensity treadmill running performance is returned to baseline 4-hours after the initial exercise bout regardless of the recovery strategy employed.

Adult↗
PubMed2005

Effects of experimental hyperandrogenemia on the female rat reproductive axis: suppression of progesterone-receptor messenger RNA expression in the brain and blockade of luteinizing hormone surges.

BACKGROUND: Preovulatory gonadotropin-releasing hormone and luteinizing hormone (LH) surges depend on activation of estrogen-inducible progesterone receptors (PRs) in the hypothalamus. Although testosterone treatment can suppress LH secretion under some circumstances, how androgens affect the release of preovulatory hormone surges, and the cellular mechanisms by which androgens exert any such effects, remains unknown. OBJECTIVE: This study examined the hypothesis that testosterone can block the release of estrogen-induced gonadotropin surges via attenuation of estrogen's ability to induce PRs in the preoptic area (POA)-hypothalamus. METHODS: In experiment 1, proestrus rats were implanted with capsules filled with crystalline testosterone or empty control capsules. Four days later, animals were bled via atrial catheters at 30-minute intervals from noon to 9:00 pm. In experiment 2, proestrus rats received testosterone-filled or empty control capsules, and 3 days later were ovariectomized (OVX) and injected with estradiol benzoate (EB) 30 mug SC or sesame oil vehicle. The next day, blood samples were obtained from the rats. In experiment 3, proestrus rats similarly implanted with testosterone-filled or empty control capsules, OVX, and injected with EB or vehicle were sacrificed, and POA-hypothalamic tissue was collected for quantitative reverse transcription-polymerase chain reaction analysis of PR messenger RNA. RESULTS: In experiment 1, radioimmunoassay of serum revealed that testosterone completely blocked release of LH surges that were fully evident in the control group. In experiment 2, LH radioimmunoassay revealed that high-physiologic testosterone exposure completely abolished the release of EB-induced LH surges. In experiment 3, although EB treatment was found to induce an increase in PR expression in control animals, no such induction of PR expression was observed in the testosterone-treated rats. CONCLUSIONS: Our findings are consistent with the hypothesis that hyperandrogenic interference in the release of preovulatory LH surges is mediated by the suppressive effects of androgens on PR expression in POA-hypothalamic tissue. These findings may have important implications in the understanding of reproductive dysregulation in female hyperandrogenic syndromes, including polycystic ovary syndrome.

Animals↗
PubMed1997

Management of upper airway obstruction in Pierre Robin sequence.

Pierre Robin sequence (PRS) presents in the neonatal period with upper airway obstruction and feeding difficulties. Infants with pronounced micrognathia may fail to thrive because of chronic airway obstruction, or experience severe respiratory distress. This is potentially fatal and surgical intervention in these cases is necessary. We present our series of cases with severe PRS requiring surgical relief of their airway obstruction, and the reasons for preferring tracheostomy over glossopexy.

Airway Obstruction↗
PubMed2000

Parental assessment of behavior in Chinese adoptees during early childhood.

The Parent Rating Scale of the Behavior Assessment Scale for Children (PRS-BASC) was used to examine the behavior of 45 Chinese adoptees. In all but one case, results from the 9 BASC-PRS scales ranged in the average, or normal, range. Thus, as a group, no deviations from normal behavior were revealed. However, the variability of ratings for several scales--Hyperactivity, Aggression, Conduct Problems, and Attention Problems--indicated a greater potential for at-risk behavior. Age of adoption from China was not a significant influence on parents' perceptions of adoptees' behavior. However, older adoptees were more likely to be rated hyperactive or aggressive than younger children, while younger adoptees were more likely to exhibit withdrawal.

Acculturation↗
PubMed2000

Cisplatin-epirubicin-paclitaxel weekly administration with G-CSF support in advanced breast cancer. A Southern Italy Cooperative Oncology Group (SICOG) phase II study.

PURPOSE: It has been shown in vitro that both cisplatin and epirubicin increase the antitumor activity of paclitaxel. Weekly administration could give a substantial improvement in the therapeutic index of cisplatin and paclitaxel. This study was aimed at defining the antitumor activity of a weekly cisplatin-epirubicin-paclitaxel (PET) administration in locally advanced or metastatic breast cancer patients. PATIENTS AND METHODS: Sixty-eight breast cancer patients with advanced disease, who had not received prior chemotherapy (except adjuvant), received weekly cisplatin 30 mg/sqm, paclitaxel 120 mg/sqm and epirubicin 50 mg/sqm plus G-CSF (day 3-5), for a maximum of 12 cycles. Thirty-five patients had stage IIIB and 33 stage IV disease (14 with visceral metastases). RESULTS: All patients were evaluable for response on an intent to treat basis. Overall, 21 complete and 38 partial responses have been recorded for an 87% ORR (95% CI = 76-94%). Fourteen CRs and 19 PRs have been registered in the 35 patients with locally advanced disease for a 94% ORR (95% CI = 81-99%) while 7 CRs and 19 PRs were observed in the 33 patients with metastatic disease for a 79% ORR (95% CI-61-91%). Surgery was performed in 33/35 women with locally advanced disease. Four of these patients (11%) showed no invasive cancer on pathologic examination, and in an additional 8 patients tumor < 1 cm was found in the breast. Only 4/33 patients who underwent surgery relapsed. The projected one-year RFS was greater than 80%. At an 11-month median follow-up (range, 3-19), 11 patients had progressed and 5 had died among the 33 patients with metastatic disease, the median progression-free survival in this group being 14 months. Severe hematologic toxicity was uncommon, grade 3-4 neutropenia and thrombocytopenia occurring in 32% and 4% of patients, respectively. Only 2 episodes of neutropenic sepsis were registered. Packed red blood cell transfusions were required in 7 patients. Vomiting, diarrhoea, mucositis and skin toxicity were severe in 6%, 9%, 10%, and 9% of patients, respectively. Peripheral neuropathy was observed in 47% of patients. CONCLUSIONS: The weekly PET administration is a well tolerated and very effective approach in advanced breast cancer patients. It can produce a 40% clinical complete response rate, with a more than 10% pCR rate in patients with T4 disease, and an about 80% ORR in those with distant metastases. A phase III trial comparing PET with a standard every 3 weeks epirubicin-taxol administration is underway.

Adult↗