Value of estrogenic recruitment before chemotherapy: first randomized trial in primary breast cancer.

PURPOSE: Several preclinical studies showed that short-term pretreatment of breast cancer cells with estrogens can increase the antitumor efficacy of different cytotoxic drugs. Some early clinical studies in patients with advanced breast cancer did seem to support these findings. Therefore, the efficacy of estrogenic recruitment followed by chemotherapy was compared with that of chemotherapy alone in a randomized phase III study in women with lymph node-positive primary breast cancer. PATIENTS AND METHODS: Three hundred twenty-eight patients with stage II/IIIA breast cancer who were younger than 66 years of age were randomly allocated to chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide (FAC) or FAC plus pretreatment with ethinyl estradiol (EE(2)). FAC (500, 50, and 500 mg/m(2), respectively) was administered intravenously once every 4 weeks for four cycles. EE(2) (0.5 mg) was administered orally, both 24 hours and immediately preceding FAC chemotherapy. RESULTS: Patient and tumor characteristics and chemotherapy dosages were comparable in both treatment groups. Of 318 assessable patients, with a median follow-up of 6.8 years, 177 patients had a relapse and 127 died. No significant differences were observed between the two treatment groups with respect to relapse-free, local recurrence-free, and overall survival according to univariate and multivariate analyses adjusted for age, menopausal status, tumor size, grade, number of positive nodes, and steroid-receptor status. The power for the detection of an increase of 50% in the median relapse-free survival was 80%. CONCLUSION: Estrogenic recruitment of breast cancer cells before FAC chemotherapy did not influence the efficacy of adjuvant chemotherapy in stage II/IIIA breast cancer patients after a follow-up of 6.8 years.

Paradoxical response of intracranial tuberculomas during chemotherapy: an immunologic phenomenon?

Intracranial tuberculomas are rare in developed countries, occurring mostly in non-Caucasian patients. We describe a white Dutch patient with miliary tuberculosis, who was noted to have intracranial tuberculomas on computed tomographic scanning. During antituberculous chemotherapy the systemic tuberculosis was responding satisfactorily, while intracranial tuberculomas developed or enlarged. Although this caused anxiety and led to some changes in chemotherapy, the lesions eventually disappeared. Possible mechanisms of this paradoxical response are discussed.

Fever caused by hydroxyurea: a report of three cases and review of the literature.

Hydroxyurea (HU) is generally regarded as an effective and well-tolerated drug for the treatment of the chronic myeloproliferative syndromes. It has rarely been implicated as a cause of drug fever. We report two patients with primary thrombocythaemia and one patient with polycythaemia vera who developed fever and shaking chills during treatment with HU. Infection was highly suspected and all patients were examined extensively. The fever subsided after discontinuation of therapy with this drug. However, the fever recurred within 1 day after rechallenge. The mechanism of HU-induced fever remained unclear, but the experience in our patients and the reviewed cases in the literature are highly suggestive of a hypersensitivity reaction. Clinicians should be aware of this rare adverse effect.

Lipoid pneumonitis complicating treatment of Hodgkin's disease.

The development of lipoid pneumonitis (LP) is associated with exposure to mineral, animal or vegetable oils through inhalation or local application. We report here on a 34-year-old patient with lipoid pneumonitis complicating the treatment of Hodgkin's disease. A review of the relevant literature on the pathophysiology and diagnosis of LP is provided with emphasis on possible mechanisms of development of LP in Hodgkin's disease.

Benign thymic cyst following mantle radiotherapy for Hodgkin's disease.

The case history of a patient who was treated for Stage IA Hodgkin's disease involving the left supraclavicular region is presented. Shortly after mantle field radiation therapy she developed a mass in the anterior mediastinum. Histological examination of the lesion revealed it to be a benign cyst of the thymus. We consider it important that the possibility of the existence of such a benign growth be considered when a mediastinal mass appears in a patient treated for Hodgkin's disease, before more intensive tumour therapy is given.