Cyclophosphamide-induced urticaria. Occurrence in a patient with no cross-sensitivity to chlorambucil.

A patient receiving adjuvant chemoimmunotherapy for breast carcinoma developed urticaria secondary to cyclophosphamide, one of the drugs of the chemotherapy regimen. Chlorambucil, another alkylating agent, was substituted with no cross-sensitivity noted.

Spontaneous regression of breast carcinoma.

Spontaneous regression of breast carcinoma occurred in a patient with a malignant pleural effusion and bone metastases. The patient did not receive any form of hormonal manipulation or systemic chemotherapy. It is postulated that the spontaneous regression of the carcinoma may have been caused by immunological factors.

Pigmentation of the tongue and mucous membranes associated with cancer chemotherapy.

Hyperpigmentation of the tongue and buccal mucosa was observed after administration of conbination chemotherapy containing doxorubicin. The pigmentation lessened after discontinuation of doxorubicin, suggesting this drug as the possible causative agent.

Periodontal disease: predisposing factor to chemotherapy-induced stomatitis.

Periodontal disease and dental plaque may predispose patients receiving antineoplastic drugs to stomatitis. Dental evaluation and appropriate treatment including oral hygiene are proposed to reduce the incidence and severity of stomatitis.

Chemoimmunotherapy of sarcomatoid renal cell carcinoma.

Sarcomatoid renal adenocarcinomas are rare, invariably fatal tumors. There is only one report of treatment of this tumor with chemotherapy. We report a case of an advanced sarcomatoid renal adenocarcinoma treated with chemoimmunotherapy consisting of cyclophosphamide, vincristine, Adriamycin (doxorubicin), DTIC, BCG, and sarcoma viral oncolysate. The patient had an objective response with a marked reduction in the size of the tumor mass. The residual tumor was removed surgically, and the patient remains in complete remission two years after the diagnosis was made.

Cerebromedullospinal disconnection after intraventricular methotrexate.

A case of cerebromedullospinal disconnection or "locked-in" syndrome after intraventricular methotrexate is described. This is an unusual complication of intraventricular methotrexate instillation. Ventral pontine infarction is postulated to be responsible for the syndrome.

Amphotericin B and combination chemotherapy in the treatment of refractory metastatic breast carcinoma and sarcoma.

Nineteen patients resistant to an adriamycin-containing regimen were treated with 4 days of amphotericin B and the same adriamycin-containing chemotherapy regimen that had been given without amphotericin B. Of the 14 evaluable patients (11 with breast carcinoma and three with sarcoma), one patient with breast carcinoma achieved a partial remission and a second patient with breast carcinoma remained stable. All other patients developed progressive disease. Both hematologic and nonhematologic toxicity were significantly increased when amphotericin B was added to chemotherapy.

Endobronchial metastases in breast carcinoma.

In a consecutive series of 1,628 patients with breast carcinoma, six cases of endobronchial metastases were diagnosed for an incidence of 0.4 percent. The median latent interval from the diagnosis of the primary carcinoma until the time of diagnosis of endobronchial metastases was 21 months. Endobronchial metastases can be the initial manifestation of recurrent cancer and can present with no abnormalities shown on x-ray films of the chest. Because of similar symptomatology, the diagnosis of endobronchial metastases may be confused with a central bronchogenic carcinoma but the histological appearance could differentiate the two entities. Local treatment with radiation therapy is usually inadequate and patients should also be treated with some form of systemic treatment such as chemotherapy. The median survival after the diagnosis of endobronchial metastases was 13 months.

Immune-complex glomerulonephritis secondary to nonspecific immunotherapy.

Hematuria and renal failure developed in two patients with metastatic breast carcinoma while they were receiving nonspecific immunotherapy and chemotherapy. The electron microscopy picture was suggestive of immune-complex glomerulonephritis.

Mitomycin-C and megestrol acetate in treatment of breast cancer refractory to hormonal and combination chemotherapy.

Fifty patients with breast cancer refractory to endocrine manipulation and/or combination chemotherapy were treated with mitomycin-C 20 mg/m2 I.V. every 4-6 weeks and megestrol acetate 160 mg daily. Of 48 evaluable patients, 4% achieved complete remission (CR), 23% had partial remission (PR). Median duration of response for CR and PR was 7 months. Non-responders had a median survival of 2 months. The difference in survival of responders (both CR and PR) and non-responders was statistically significant at p less than 0.01 level. Attenuated doses of mitomycin-C were administered at increasing intervals due to cumulative myelosuppressive toxicity.

Adriamycin and mitomycin C: possible synergistic cardiotoxicity.

Ninety-one patients with advanced breast cancer failing adriamycin (ADR)-containing combination chemotherapy were treated with a combination of mitomycin C (MMC) and megestrol acetate. Congestive heart failure (CHF) occurred in 14 (15.3%) of 91 MMC-treated patients compared to three (3.4%) of 89 patients treated with similar ADR-containing combination chemotherapy without MMC (P = 0.01). The median time from the last dose of ADR to evidence of CHF was 8.5 months for the MMC group compared to 1.5 months for the other group. A significantly higher incidence of late onset of CHF implicates MMC as a possible cardiotoxic agent.

Combined chemoimmunotherapy and radiation therapy of inflammatory breast carcinoma.

Thirty-two patients with a diagnosis of primary inflammatory breast carcinoma were treated with combination chemoimmunotherapy consisting of 5-fluorouracil, doxorubicin hydrochloride (Adriamycin), and cyclophosphamide (FAC) plus BCG followed by radiation therapy. This group of patients was compared to a group of 32 consecutive historical controls treated with radiation therapy alone. The estimated mean disease-free interval for the FAC-BCG group was 16 months, compared to 9 months for the radiation therapy alone group (P less than 0.01). The estimated median survival for the FAC-BCG treated group was 24 months, compared to 18 months for the radiation therapy alone group (P = less than 0.03). The combined modality approach consisting of chemoimmunotherapy and radiation therapy significantly improved the disease-free interval and survival of patients with inflammatory breast carcinoma.

Chemoimmunotherapy with or without oophorectomy in premenopausal patients with advanced breast cancer.

Ninety-eight premenopausal patients with stage IV breast cancer were treated with chemoimmunotherapy alone, or with combination oophorectomy-chemoimmunotherapy either simultaneously (chemoimmunotherapy within four weeks of oophorectomy) or sequentially (delayed chemoimmunotherapy until evidence of progressive disease or no response to oophorectomy). The chemoimmunotherapy consisted of a three-drug combination of Adriamycin, cyclophosphamide, and 5-fluorouracil or Ftorafur; immunotherapy consisted of either oral levamisole, BCG by scarification, or a combination of both. Forty patients underwent simultaneous oophorectomy-chemoimmunotherapy, with a response rate of 85% and a median duration of response of 25 months. Response rate of 69% and a median duration of response of 16.6 months was observed with the 29 patients who received sequential oophorectomy-chemoimmunotherapy. Another 29 patients were treated with chemoimmunotherapy alone and achieved a response rate of 87% and a median duration of response of 11.8 months. Though there were no significant differences in the response rate, patients treated with chemoimmunotherapy alone had a significantly shorter median duration of response (P less than 0.05). This would suggest that oophorectomy in combination with chemoimmunotherapy is the most favorable treatment modality for premenopausal patients with advanced metastatic breast cancer.