RESUMO
In this randomized study involving patients with limited-stage small-cell lung cancer (LD-SCC), we compared treatment with either cyclophosphamide; doxorubicin, and vincristine (CAV) or CAV plus etoposide (CAVE). All patients received identical thoracic radiation consisting of 3,750 cGy in 15 fractions and prophylactic cranial radiation (3,000 cGy in 10 fractions). Among 231 evaluable patients, the two treatment arms were well matched with respect to sex, age, performance score, and presence or absence of heart disease. A major regression (REGR) was observed in 83% of all patients and a complete response (CR) in 60%. There was no difference in the response rate between the two treatment regimens. The median time to progression is 10.4 months (95% confidence interval [Cl], 8.9 to 12 months) for CAVE versus 8.9 months (95% Cl, 7.9 to 10.4 months) for CAV (P = .04). The median survival is 15.1 months (95% Cl, 11.7 to 17.8 months) for CAVE versus 12.4 months (95% Cl, 11 to 14.4 months) for CAV. This difference is not significantly different (P = .13). Toxicity was primarily myelosuppression and was significantly greater for the four-drug regimen. Fatal treatment-related toxicity was observed in two patients on the CAVE regimen and no treatment-related deaths were observed on the CAV treatment. In conclusion, the addition of etoposide to the CAV regimen resulted in increased toxicity but did not lead to a meaningful improvement in survival.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma de Células Pequenas/mortalidade , Carcinoma de Células Pequenas/patologia , Terapia Combinada , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Dosagem Radioterapêutica , Radioterapia de Alta Energia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Vincristina/administração & dosagem , Vincristina/efeitos adversosRESUMO
The administration of single oral doses of delta-9-tetrahydrocannabinol (THC) to patients with cancer pain demonstrated a mild analgesic effect. At a dose of 20 mg, however, THC induced side effects that would prohibit its therapeutic use including somnolence, dizziness, ataxia, and blurred vision. Alarming adverse reactions were also observed at this dose. THC, 10 mg, was well tolerated and, despite its sedative effect, may analgesic potential.
Assuntos
Analgésicos/uso terapêutico , Cannabis/uso terapêutico , Codeína/uso terapêutico , Dronabinol/uso terapêutico , Dor/tratamento farmacológico , Cuidados Paliativos , Fitoterapia , Aspirina/uso terapêutico , Ensaios Clínicos como Assunto , Dextropropoxifeno/uso terapêutico , Dronabinol/efeitos adversos , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias , PlacebosRESUMO
A preliminary trial of oral delta-9-tetrahydrocannabinol (THC) demonstrated an analgesic effect of the drug in patients experiencing cancer pain. Placebo and 5, 10, 15, and 20 mg THC were administered double blind to ten patients. Pain relief significantly superior to placebo was demonstrated at high dose levels (15 and 20 mg). At these levels, substantial sedation and mental clouding were reported.
Assuntos
Analgésicos/uso terapêutico , Cannabis/uso terapêutico , Dronabinol/uso terapêutico , Fitoterapia , Administração Oral , Pressão Sanguínea/efeitos dos fármacos , Ensaios Clínicos como Assunto , Relação Dose-Resposta a Droga , Dronabinol/administração & dosagem , Dronabinol/efeitos adversos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Neoplasias/complicações , Dor/tratamento farmacológico , Dor/etiologia , Placebos , Fatores de TempoRESUMO
One hundred fifty-one women with advanced breast cancer who had failed prior chemotherapy were randomized to monthly courses of doxorubicin (60 mg/m2 I.V. day 1, observation after 500 mg/m2) or doxorubicin (40 mg/m2 I.V. day 1; maximum 500 mg/m2) and mitolactol (135 mg/m2 orally, days 1-10; 180 mg/m2 after maximum doxorubicin). Median survival times were 232 days for doxorubicin and 225 days for doxorubicin + mitolactol, and median times to progression were 112 days and 97 days, respectively. Results are inconsistent with a 25% improvement in survival or time to progression for doxorubicin + mitolactol (p = 0.04 and 0.02, respectively, adjusted for stratification factors but not multiple testing). Regression rates for all patients, both measurable and evaluable, were 30% for doxorubicin alone and 26% for doxorubicin + mitolactol. Regression rates were significantly higher in patients with measurable indicator lesions. Cardiac toxicity was seen in four patients, all of whom were receiving doxorubicin alone. It appears that the combination of doxorubicin + mitolactol is not substantially more effective than doxorubicin alone in women with advanced breast cancer and prior chemotherapy exposure.
Assuntos
Neoplasias da Mama/tratamento farmacológico , Doxorrubicina/uso terapêutico , Mitolactol/uso terapêutico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Ensaios Clínicos como Assunto , Doxorrubicina/efeitos adversos , Avaliação de Medicamentos , Feminino , Humanos , Leucopenia/induzido quimicamente , Pessoa de Meia-Idade , Mitolactol/efeitos adversos , Distribuição Aleatória , Trombocitopenia/induzido quimicamenteAssuntos
Morfina/metabolismo , Administração Oral , Adulto , Dióxido de Carbono/metabolismo , Radioisótopos de Carbono , Cromatografia em Papel , Glucuronatos/urina , Meia-Vida , Humanos , Injeções Intramusculares , Injeções Intravenosas , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Sulfatos/urina , Fatores de TempoAssuntos
Morfina/metabolismo , Propranolol/farmacologia , Antagonistas Adrenérgicos beta/farmacologia , Adulto , Dióxido de Carbono/análise , Radioisótopos de Carbono , Depressão Química , Glucuronatos/sangue , Frequência Cardíaca/efeitos dos fármacos , Humanos , Isoproterenol/farmacologia , Masculino , Morfina/sangue , Morfina/isolamento & purificação , Morfina/urina , Respiração/efeitos dos fármacos , Fatores de TempoAssuntos
Síndrome de Stevens-Johnson/etiologia , Adolescente , Adulto , Fatores Etários , Idoso , Antibacterianos/efeitos adversos , Anticonvulsivantes/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Penicilinas/efeitos adversos , Fatores Sexuais , Síndrome de Stevens-Johnson/epidemiologiaAssuntos
Guanetidina/farmacologia , Morfina/metabolismo , Adulto , Análise de Variância , Dióxido de Carbono/metabolismo , Radioisótopos de Carbono , Remoção de Radical Alquila , Depressão Química , Humanos , Masculino , Morfina/sangue , Morfina/urina , Respiração/efeitos dos fármacos , Fatores de TempoAssuntos
Alcanossulfonatos/metabolismo , Antipirina/metabolismo , Microssomos Hepáticos/enzimologia , Tri-Iodotironina/farmacologia , Alcanossulfonatos/administração & dosagem , Alcanossulfonatos/sangue , Alcanossulfonatos/urina , Aminopirina N-Desmetilase/metabolismo , Antipirina/administração & dosagem , Antipirina/sangue , Antipirina/urina , Remoção de Radical Alquila , Humanos , Consentimento Livre e Esclarecido , Cinética , Masculino , Metilaminas/administração & dosagem , Metilaminas/sangue , Metilaminas/urina , Estatística como Assunto , Fatores de TempoAssuntos
Antipirina/metabolismo , Hipertireoidismo/metabolismo , Hipotireoidismo/metabolismo , Adulto , Aminopirina N-Desmetilase/metabolismo , Antipirina/administração & dosagem , Eletrocardiografia , Feminino , Meia-Vida , Humanos , Hipertireoidismo/radioterapia , Hipotireoidismo/tratamento farmacológico , Radioisótopos do Iodo/uso terapêutico , Masculino , Mesilatos/administração & dosagem , Mesilatos/metabolismo , Microssomos Hepáticos/enzimologia , Pessoa de Meia-Idade , Fatores de Tempo , Tri-Iodotironina/uso terapêuticoAssuntos
Mixedema/sangue , Tri-Iodotironina/uso terapêutico , Varfarina/farmacologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mixedema/tratamento farmacológico , Tempo de Protrombina , Tri-Iodotironina/administração & dosagem , Varfarina/administração & dosagem , Varfarina/sangueRESUMO
The combination of both auscultation and percussion in the diagnostic examination improves both auscultation and percussion and, in so doing, increases the skill of palpation. Auscultatory percussion (AP) is easy to learn, easy to use and requires little time to perform. The size of normal organs and the size of abnormal masses as determined by AP are usually similar to measurements determined by X-rays and CT scans. Abnormalities found by AP need to be evaluated and confirmed by other diagnostic procedures. AP brings increased precision to physical diagnosis and is felt to be a valuable addition to medical practice.
Assuntos
Auscultação/métodos , Percussão/métodos , Abdome , Dorso , Competência Clínica , Humanos , Pescoço , TóraxRESUMO
This prospective randomized Eastern Cooperative Oncology Group (ECOG) study (1071) was designed to compare a new and promising cytotoxic agent TIC Mustard (triazeno imidazole carboxamide mustard, NSC 82196) with DTIC (dimethyl triazeno imidazole carboxamide, NSC 45388) in the treatment of inoperable melanoma. One hundred and seventy-eight patients were randomized to receive either DTIC (150 mg/m2/day X 5) or TIC Mustard (800 mg/m2/day X 5). Of this group 145 patients were evaluable for tumor response at the completion of the study. Objective responses were seen in 15/79 (19.0%) DTIC patients and 4/66 (6.1%) TIC Mustard patients. Adjustment of crude response rates yielded final response rates of 18.2% for DTIC patients and 5.8% for TIC Mustard. These differences were significant at the p less than or equal to .03 level. Median response duration was 15 weeks for the DTIC responders and 4 weeks for the TIC Mustard responders. Responders and nonresponders did not differ significantly in any of the standard prognostic categories. However, responders had a significantly longer median survival (47.5 weeks) compared to that for nonresponders (17.8 weeks). Toxicity was tolerable for either drug and no deaths were ascribed to either. We conclude that TIC Mustard has limited usefulness in the treatment of malignant melanoma and is less effective than DTIC.
Assuntos
Dacarbazina/uso terapêutico , Imidazóis/uso terapêutico , Melanoma/tratamento farmacológico , Compostos de Mostarda Nitrogenada/uso terapêutico , Triazenos/uso terapêutico , Ensaios Clínicos como Assunto , Dacarbazina/administração & dosagem , Dacarbazina/efeitos adversos , Avaliação de Medicamentos , Feminino , Humanos , Imidazóis/administração & dosagem , Imidazóis/efeitos adversos , Masculino , Compostos de Mostarda Nitrogenada/administração & dosagem , Compostos de Mostarda Nitrogenada/efeitos adversos , Estudos ProspectivosRESUMO
In an Easter Cooperative Oncology Group trial, Cytoxan-prednisone (CP) Induction was compared to BCNU-prednisone (BP) in 273 patients with lymphocytic lymphoma. Response rates were comparable, with 21% achieving complete response and 40%, partial response. Patients with a nodular pattern responded better. Maintenance phase comparing cyclic intensive therapy (BCVP) with intermittent chlorambucil revealed the superiority of BCVP as demonstrated by improvement of the quality of response and somewhat longer remissions. The value of the Rappaport classification in the evaluation of lymphoma chemotherapy results is discussed. It is suggested tha NHL be separated into "favorable" and "unfavorable" groups, based on the presence or absence of nodularity and treatment schedules devised accordingly.