Pilot study of UFT combined with 5 consecutive days cisplatin in non-small cell lung cancer.

Combined use of 5-fluorouracil (5-FU) and cisplatin has proven to have synergistic effects in many experimental systems and clinical studies. UFT, an oral preparation of uracil and tegafur in a 4:1 molar ratio, was reported to have enhanced activity as compared with 5-FU or tegafur alone against various human tumors. Based on those results, we conducted a pilot study to confirm the feasibility and antitumor effect of UFT in combination with cisplatin in patients with advanced non-small cell lung cancer (NSCLC). UFT was orally administered at a dose of 400 mg/m2 according to a protocol for step-wise prolongation of the administration period, such as days 1-14 in step I, days 1-21 in step II, days 1-28 in step III. During to course, cisplatin was administered at a fixed dose of 20 mg/m2/day on days 8 through 12. The course was repeated every 4 weeks. Numbers of patients enrolled in steps I, II, III were six, ten and six (a total of 22), respectively. There were three females and 19 males, PS scored 0/1/2 = 7/14/1, stage IIIA/IIIB/IV = 3/8/11. Adenocarcinoma/squamous cell carcinoma/large cell carcinoma = 11/7/4, and median age 68 (range 52-79). All 22 patients were evaluable for toxicity, and 21 for efficacy. Compliance of UFT declined as the administration period of UFT was prolonged. In step I, one patient had grade 3 toxicity of each neutropenia, thrombocytopenia, nausea/vomiting and diarrhea. In step II, grade 3, 4 neutropenia was seen in four patients, grade 3 thrombocytopenia and anorexia in one patient, and grade 3 nausea/vomiting in four patients. In step III, there was grade 3 neutropenia in two patients and grade 3 anorexia in one patient. All other toxicities were mild. The overall response rate was 38% (one CR and 7 PR, 95% C.I.: 21-59%). Combination therapy with oral UFT and 5-day infusion of cisplatin is feasible with substantial antitumor effect against advanced NSCLC. Since UFT compliance decreased in step III (no patient in step III received > 2 courses of treatment), we considered the step II schedule to be worth for further evaluation in a combination phase II study.

A phase II trial of oral UFT plus cisplatin (CDDP) in patients with non-small cell lung cancer (NSCLC).

Based on the results of our previous pilot study, we conducted a multi-institutional phase II study of combination chemotherapy consisting of oral UFT (Taiho Pharmaceutical Co. Ltd, Tokyo) plus cisplatin (CDDP) in patients with advanced non-small cell lung cancer (NSCLC). UFT capsule containing 100 mg tegafur and 224 mg uracil was orally administered in two divided doses on days 1 through 21 making the total tegafur dose 400 mg/m(2)/day (maximum 600 mg/body). CDDP was administered by drip infusion at a dose of 20 mg/m(2) on a 5-day schedule from day 8 to 12. Treatment was repeated every 4 weeks as long as the criteria for initiation of therapy were still met. Between April 1995 and March 1997, 51 patients were entered into the study. The mean age of all 50 eligible patients was 64 years(range: 40-78). There were 21 patients with clinical stage IIIB disease and 29 patients with IV disease. Thirty-two patients had adenocarcinoma, 14 had epidermoid carcinoma, and four had large cell carcinoma. Of the 47 assessable patients, 18 achieved a partial response with an overall response rate of 38.3% (95% confidence interval: 24.4-52.2%). The median response duration was 113 days. The median survival time of the eligible patients was 12.8 months, and the 1-year survival rate was 54%. Among the 51 patients enrolled, grade 3 or 4 leukopenia developed in one patient (2%), neutropenia in six patients (11. 8%), thrombocytopenia in six patients (11. 8%), and anemia in three patients (5. 9%). Non-hematological grade 3 or 4 toxicities included anorexia in 10 patients (19.6%), nausea in ten (19.6%), vomiting in two (3.9%), and diarrhea in two (3. 9%). Grade 3 abnormal laboratory data included bilirubinemia in four (7. 8%), GPT elevation in one (2.0%), and hematuria in one (2.0%). In conclusion, combination of CDDP plus oral UFT is efficacious, with low toxicity, in the treatment of advanced NSCLC. In particular, the low hematological toxicity may warrant application of this regimen to the treatment of elderly patients and in trials of concurrent chemoradiotherapy in patients with locally advanced NSCLC.

cis-Diamminedichloroplatinum (CDDP)-fosfomycin (FOM) combination in lung cancer patients with respect to the peripheral T lymphocyte subsets.

An antibiotic FOM was found to be preventive of the side effect of an antineoplastic drug CDDP on the peripheral T lymphocytes in lung cancer patients. Whereas finding a significant decrease in T3+ cells (p less than 0.01) and T4+ subset (p less than 0.05) with CDDP alone, the initial levels of these cell populations were kept unchanged in combination with FOM. T8+ subset showed no substantial change. A protective effect of FOM on T4+ subset was suggested to be an additional aspect of its action at least in combination with CDDP.

Prophylaxis of 3-methylcholanthrene-induced tumorigenesis in mice with the yeast polysaccharide preparation.

Prophylaxis of 3-methylcholanthrene-induced epithelial tumor formation in ddI mice with our Candida utilis glucomannan preparation (YPS) was confirmed further in the present system of fibrosarcoma production. A single subcutaneous dose of MCA (0.5 mg per mouse) was either preceded by or followed by 10 or 30 daily intraperitoneal (i.p.) injections of YPS at the dosage of 100 mg/kg per dose according to various time schedules. Protective effect of YPS was demonstrable by a significantly lengthened latent period before the tumor appearance and a slower rate of the subsequent tumor production until around day 100. All the schedules of pre- or post-treatment were found to be effective, although the one delayed until two weeks post MCA was so only marginally. It was also disclosed by prolonging the observation period that this protection was of a transient nature, 100 per cent tumor incidence being found by around 150 days post MCA in all the experimental groups. A longer latency due to the treatment with YPS was generally found in association with a faster growth of the tumor and a shorter life span of the host animal. Temporary protection of MCA-induced tumorigenesis in ddI mice was not reproducible in C3H/He mice, and was thus suggested the possible strain-dependent nature of YPS effect.

Tumor histology and the immunoregulatory T lymphocyte subsets in lung cancer patients.

The immunoregulatory T lymphocyte subsets (CD4+, CD8+) in 39 patients with primary lung cancer were analyzed as for the possible correlation with tumor histology. Compared to the healthy controls (n = 36), cancer lymphocytes were generally characterized by a higher proportion of CD8+ subset (p less than 0.01) with no difference in either CD4+ subset or CD3+ cells. There was, however, a significant difference (p less than 0.05) between one extreme of epidermoid carcinoma with the highest CD8+ and the lowest ratio (CD4+/8+) and the other end of adenocarcinoma with the lowest CD8+ and the highest ratio. Large cell and small cell carcinomas were of the intermediate values. A spectrum of the subset marker profiles was thus found in associated with tumor histology. A diversity in the host immune status was suggested in primary lung cancer, although clinical implication remains to be clarified.

Antitumor effect of the organogermanium compound Ge-132 on the Lewis lung carcinoma (3LL) in C57BL/6 (B6) mice.

Effects of the organogermanium compound Ge-132 (i.p.) were examined on the 3LL local tumor (1 X 10(5)/mouse, s.c.) and its pulmonary metastases in B6 mice. A characteristic feature of its action was the preferential antimetastatic effect under strictly defined conditions. Either inhibition or facilitation was observed depending on the treatment schedules; 7 daily doses of 100 mg/kg yielded the inhibition ratio 49% when started from day 1, whereas the treatment from day 8 resulted in the ratio -99%. The maximum inhibition was obtained at 100 mg/kg. The postsurgical-adjuvant treatment with Ge-132 was of no beneficial effect. The local tumor growth was affected only marginally and temporarily. When inoculum size was minimized (1 X 10(4)), a single dose of 300 mg/kg on day 1, but not on day 8, was effective in prolonging the latency before tumor take. The antitumor action of Ge-132 was discussed with reference to its interferon (IFN)-inducing activity.

Antitumor effect of the yeast polysaccharide preparation in syngeneic mouse tumor models.

Antitumor effect of our Candida utilis glucomannan preparation (YPS) was evaluated in two syngeneic transplantable tumors; the Lewis lung carcinoma (3LL) in C57BL/6 (B6) mice and the 3-methylcholanthrene (MCA)-induced fibrosarcoma in C3H/He mice. YPS inhibited preferentially the 3LL pulmonary metastases only when optimal dosage was given at an earlier stage; 7 daily intraperitoneal (i.p.) doses of 100 mg/kg per dose from the next day of tumor inoculation (1 X 10(5)/mouse, subcutaneously, s.c.) substantially reduced the number of metastatic nodules, yielding the inhibition ratio 54% on day 21. However, the same treatment delayed until day 8 markedly facilitated the metastatic spread (-105%). Postsurgical-adjuvant therapy with YPS (10 daily i.p. doses of 100 mg/kg per dose from the next day of surgery) was effective in improving the survival rate with no evidence of metastatic growth on day 200, even though the amputation of the tumor-bearing legs was performed after the pulmonary metastases had been established (on day 20). In the MCA-fibrosarcoma model, YPS treatment from day 3 (10 daily doses of 100 mg/kg per dose) was effective in prolonging the survival period. The 3LL local tumor was affected only marginally and temporarily, while the MCA-tumor was not at all.

Changes in the immunological parameters after a single dose of forphenicinol, a new small molecular immunomodifier.

Forphenicinol [L-2-(3-hydroxy-4-hydroxymethyl-phenyl) glycine, M.W. 197.19] is a derivative of forphenicine, an inhibitor of alkaline phosphatase discovered by Umezawa. In order to find an optimal dose, a single dose of the drug ranging from 10 to 600 mg per body was orally administered to a total of 55 patients (36 cancer, 13 tuberculosis, and 6 others). The possible changes in the percentages of the peripheral T and B lymphocytes, natural killer (NK) activity, and the proliferative response to phytohemaglutinin (PHA) were studied as immunological parameters. A significant effect of forphenicinol was demonstrated in restoring the normal proportion of T and B cells, especially in those who had 'low'-T and/or 'high'-B before administration of the drug. No difference was found between cancer and tuberculosis. The mean percentage of T cells increased from the low initial level of 68.0 to 75.6 in cancer (n = 12, p less than 0.05) or from 63.1 to 78.5 in tuberculosis (n = 7, p less than 0.05), while that of B cells decreased from the high initial level of 34.6 to 26.9 in cancer (n = 7) or from 34.9 to 14.3 in tuberculosis (n = 6, p less than 0.025). The effect of a single dose of the drug tended to disappear by day 8, a peak response being found on day 3 in most cases. With respect to this parameter, an optimal dose was found in a range from 60 to 100 mg. Forphenicinol was rather inhibitory on the NK activity, while it exerted diverse effect on the lymphocyte proliferation. No evidence of adverse effect was observed.

Establishment of an etoposide (VP-16)-resistant subline of THP-1 human monocytic leukemia cell line.

A VP-16-resistant subline was established from THP-1 human monocytic leukemia cells by subculturing in stepwise increasing concentrations of the drug. The resistant cells (THP-1/E) were capable of sustaining continuous growth in 1.0 microgram/ml VP-16. The 50% inhibition dose (IC50) was 1.4 micrograms/ml or a 35-fold of the parent cells. A more than 18-fold IC50 was also obtained with teniposide (VM-26). However, no substantial cross-resistance was observed with 5 other antineoplastic drugs, IC50 values being limited below several times of THP-1.

Chemotherapy in small cell lung cancer--from view point of dose intensity.

Results of chemotherapy trials for small cell lung cancer carried out for the past 5 years were analyzed from view point of dose intensity. Early study of CDDP+EP+ADM (1985 to 1987) showed moderate response rate (RR) of 72% with MST of 369 days. Succeeding alternative protocol of CDDP+EP+VCR/CPM+ADM+MTX (1989-1990) showed improved RR of 88% and MST of 13 months. Actual dose and interval for the alternating regimen was superior to the single arm regimen. Projected relative dose intensity against MAOP protocol including 6 drugs common to our regimen was 0.86 and delivered RDI was 0.61 with comparable RR and MST. The results may indicate that change of dose intensity within the conventional range does not result in major advantage or disadvantage for substantial prolongation of the survival in SCLC patients.