SYMPOSIUM on anti-tumour agents: cytostatic agents.
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Selection of cytostatic agents for intrathecal administration is the subject of this paper.Both the toxic side effects-destruction of blood-brain barrier and change of body weight-and the cytostatic effects on intracranially transplanted Yoshida ascites sarcoma were investigated of intrathecal administration of various cytostatic agents. As a result, it may be concluded that Methotrexate and Endoxan and lower dose of mitomycin C are suitable drugs for intrathecal chemotherapy.Based on these findings, clinical cases of malignant brain tumours were treated with intrathecal chemotherapy.Grateful acknowledgement is made to Professor Dennosuke Jinnai for his constant interest and guidance in this investigation.
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After cytostatic treatment severe arrhythmias, the development of angina pectoris and even the development of acute myocardial infarction and sudden death were observed. Therefore we made in 42 patients with malignant haematological disease treated with cytostatics 96 Holter monitorings of the electrocardiographic signal. The monitoring was made during the administration of cytostatics as well as during the time interval between the administration of combinations of cytostatics. In both instances (during the administration and during the interval between administration) we recorded a surprisingly high, mean all-day as well as maximal, heart rate. In the group monitored during administration of chemotherapeutic drugs we observed 5-8 hours after administration of cytostatics serious ventricular arrhythmias [incl. ventricular tachycardia], denivelization of the ST segment, paroxysms of supraventricular tachycardia. In the group monitored during the interval between administration of cytostatics the sick-sinus syndrome was recorded, as well as a passive nodal rhythm, disorders of the intraventricular conduction. The described changes are explained by the release of vasoactive substances after administration of cytostatics, by a change of the transmembrane calcium transport leading to an increased excitability of the heart muscle and possibly to coronary spasms and direct irreversible damage of the conduction system.
Successful therapy with the anticancer cytostatic agents are remarkably dependent on the appropriate dosage and schedules of the treatment. To this end however it is highly important to have insights into the tumorbiological, pharmacokinetics, pharmacobiochemical and molecular-biological factors which underline the efficacy of the cytostatic agents. The present communication intend to provide a comprehensive survey for the medical doctors attending cancer patients concerning the mode of action of those anti tumour agents traditionally classified as alkylating agents, antimetabolites, topoisomerase inhibitors, and antimitotic agents. It will be emphasized that the currently available agents show no specific action on the malignant cells because they are inhibitors of cell proliferation and target certain molecular mechanism implicated in the cell cycle. The basis for the relatively selective antitumour action are rather different for the various cytostatic agents, nevertheless the differential activation and also the repair capacity in the tumour and in the normal organs offer an explanation for the agents acting directly or indirectly on DNA. Knowledge of the mode of action of the cytostatic agents offer not only a better understanding for their therapeutic failure but gives guidelines for those tumorbiological features which are necessary for their efficacy. In the last years substantial data have accumulated which indicate the possibility to improve the therapeutic action by modulating the pharmacokinetic or the pharmacobiochemical determinants of the antitumour drug action.
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