Outcomes of high-dose chemotherapy and autologous stem-cell transplantation in stage IIIB inflammatory breast cancer.

PURPOSE: To evaluate the disease-free survival (DFS) and overall survival (OS), prognostic factors, and treatment-related mortality of women with stage IIIB inflammatory breast cancer (IBC) treated with combined modality therapy (CMT) and high-dose chemotherapy (HDCT) with autologous stem-cell transplantation. PATIENTS AND METHODS: Between 1989 and 1997, 47 consecutive patients with stage IIIB IBC were treated with CMT and HDCT and were the subject of this retrospective analysis. Chemotherapy was administered to all patients before and/or after definitive surgery. Neoadjuvant and adjuvant chemotherapy was administered to 33 and 34 patients, respectively, and 20 patients received both. All patients received HDCT with autologous stem-cell transplantation, and 41 patients received locoregional radiation therapy. Tamoxifen was prescribed to patients with estrogen receptor (ER)-positive cancer. RESULTS: The mean duration of follow-up from diagnosis was 30 months (range, 6 to 91 months) and from HDCT was 22 months (range, 0.5 to 82 months). At 30 months, the Kaplan-Meier estimates of DFS and OS from diagnosis were 57.7% and 59.1%, respectively. At 4 years, the Kaplan-Meier estimates of DFS and OS from diagnosis were 51.3% and 51.7%, respectively. In a multivariate analysis, the only factors associated with better survival were favorable response to neoadjuvant chemotherapy (P =.04) and receipt of tamoxifen (P =.06); however, the benefit of tamoxifen was only demonstrated in patients with ER-positive breast cancer. At last follow-up, 28 patients (59. 6%) were alive and disease-free. Seventeen patients (36.2%) developed recurrent breast cancer. Seventeen patients died: 15 from disease recurrence and two (4.2%) from treatment-related mortality due to HDCT. CONCLUSION: In this analysis, the early results of treatment with CMT and HDCT compare favorably with other series of patients with stage IIIB IBC treated with CMT alone. These outcomes must be confirmed with longer follow-up and controlled studies.

Vindesine and mitomycin C in metastatic breast cancer. A Southeastern Cancer Study Group Trial.

64 eligible women with previously treated metastatic breast cancer received mitomycin C plus vindesine chemotherapy. Dosage was based on investigators' estimate of patients' bone marrow reserve. There were 19 evaluable patients in the good marrow reserve category, with two complete and three partial responses (26%). In the poor marrow reserve category there were 29 evaluable patients with four partial responses (14%). The 26% response rate in patients with good marrow reserve is consistent with results obtained with this and similar combinations by other investigators.

Vinblastine-associated pulmonary toxicity in patients receiving combination therapy with mitomycin and cisplatin.

Two of 33 patients entered in a local pilot study of mitomycin, vinblastine, and cisplatin for non-small cell lung cancer developed vinblastine-associated pulmonary toxicity. As with other reports of vinca alkaloid-related pulmonary toxicity, the regimen included mitomycin. Based on these cases and others previously reported, the incidence of abrupt pulmonary toxicity following vinca alkaloid administration as part of mitomycin/vinca alkaloid combination appears to be three to six percent. Suggestions for management are given.

Mitomycin C and vindesine associated pulmonary toxicity with variable clinical expression.

A patient receiving mitomycin and vindesine chemotherapy for lung cancer developed abrupt onset of shortness of breath following vindesine administration. Pulmonary function tests both before and after rechallenging him with vindesine showed an acute obstructive pattern, which resolved with bronchodilator therapy; persisting lung damage was evident by arterial blood gas analysis. A record review of the 126 patients placed on the same chemotherapy regimen uncovered an additional 6 patients with possible lung toxicity. These seven patients (5.5%) had a variable clinical picture, from acute, reversible shortness of breath temporally related to vindesine administration to a progressive, fatal interstitial infiltrate. Physicians administering the combination of mitomycin and a vinca alkaloid should be aware of potential lung toxicity with variable clinical expression and be prepared to take appropriate action should they encounter it.

A randomized prospective study of vindesine versus doxorubicin and cyclophosphamide in the treatment of epidermoid lung cancer.

A randomized prospective study was conducted comparing vindesine (VDS) with doxorubicin and cyclophosphamide (D/C) in the treatment of advanced squamous cell carcinoma of the lung. No patient had a complete response. Seven of 28 (25%) patients had partial response (PR) to VDS while one of 19 (5%) had a PR to D/C (P less than 0.08). Adding PR plus minor response (MR), ten of 28 (36%) patients responded to VDS while two of 19 (11%) responded to D/C (P less than 0.05). Median survival was improved among patients showing PR and MR over those not responding (P less than 0.05). This study concludes, VDS is an active agent in the treatment of squamous cell carcinoma of the lung and should be considered for combination chemotherapy and adjuvant trials. VDS toxicity appears acceptable with six weekly doses of 3 mg/m2. The benefit of a maintenance schedule could not be demonstrated.

Vindesine (VDS) monochemotherapy for non-small cell lung cancer: a report of 45 cases.

Fifty-three patients with non-small cell lung cancer were treated with vindesine. Of the 45 evaluable patients, 11 (24%) had a partial response. Responses were all evident within 6 weeks. Median duration of response was 8 weeks from documentation. Median survival was not improved significantly among responders (P less than 0.10, two-tailed test of significance). The most frequent toxic effect was leukopenia. The most troublesome toxic effect was peripheral neuropathy, with patients greater than 60 years old experiencing this more frequently.

Sterilization of Ommaya reservoir by instillation of vancomycin.

We describe the management of a patient with a Staphylococcus epidermidis infection of an Ommaya reservoir that was being used for the treatment of carcinomatous meningitis. Intravenous vancomycin failed to eradicate the organism. We treated our patient successfully with parenteral antibiotics and local instillation of vancomycin (25 micrograms/ml) without removing the reservoir. The patient tolerated the intraventricular vancomycin well. We recommend this approach in the treatment of infected Ommaya reservoirs in patients who have diseases with extremely poor prognoses and who wish to be discharged from the hospital early.

Head and neck involvement with malignant histiocytosis: case report and literature review.

Malignant Histiocytosis (MH) is a disease being recognized with greater frequency. A case is reported together with a literature review to determine the frequency of this occurrence. Of the 108 case reports of MH reviewed, 43 (39%) had head and neck involvement described, with 22 (20%) having extranodal disease. Nine (40%) of the 22 cases with extra-nodal disease had primary involvement with an apparent survival advantage over the 13 (60%) with secondary involvement (12 mo. vs. 4 mo.). Although those with primary involvement may have apparently localized disease, systemic spread was eventually described in all case reports. Based on the above, MH should be considered as a diagnostic possibility in patients with head and neck lesions, and when diagnosed, systemic therapy should be administered even when the disease is apparently localized.

A rational approach to the patient with cancer.

Acquisition of an adequate data base is essential to the management of the cancer patient. Staging systems currently in use are not applicable to the patient having either advanced disease or a complicating illness. We have found it useful to organize our approach to cancer patients by asking a series of eight questions. Such a structured approach helps to focus on critical aspects of the patient's cancer and any complicating illness, as well as gather a necessary data base. In so doing, it provides for maximum flexibility at the time of therapeutic decision-making.