[Role of supporting therapy of Juzentaiho-to (JTT) in advanced breast cancer patients].

The patients were randomized with the envelope method, dividing into either A- or B-group. A-group was treated with JTT combined with chemoendocrine therapy. B-group was treated with only chemo-endocrine therapy. Between May 1985 and December 1987, 130 pts were used for this trial, 119 pts were evaluable, and 58 pts belonged to A-group and 61 to B-group. The pts characteristics were well balanced in both those groups. There was no significant difference in the response rates between A- and B-groups. The survival rate up to 38 months was not significantly different between the two groups, but in JTT-SHO group, the survival was significantly higher in the pts belonging to the A-group (Greenwood, p less than 0.05). The quality of life (QOL) was expressed as self-assessment scores for physical condition, appetite and the coldness of extremities. It improved significantly in A-group, especially, by prevention of bone marrow suppression by chemotherapy. It was concluded that treatment with JTT is better than without JTT in treatment for advanced breast cancer patients.

Hairy cell leukemia. Durability of response to splenectomy in 26 patients and treatment of relapse with androgens in six patients.

Twenty-three of 26 patients with hairy cell leukemia evaluable for response to splenectomy had significant improvement in anemia, thrombocytopenia, and/or neutropenia. Eight of the 23 had a recurrence of cytopenia after a median response duration of 4 to 5 months (range, 1-22). The remaining 15 patients did not have a recurrence of cytopenia at 20 months median follow-up (range, 1-76). Six patients with postsplenectomy cytopenia were given androgenic steroids. Two of the six had an improvement in anemia and thrombocytopenia, and a third patient had an improvement in neutropenia. It was concluded that, although most patients with hairy cell leukemia have initial improvement in cytopenia with splenectomy, a significant number of them either fail to respond or have recurrent cytopenia after initial response to splenectomy. A trial of androgenic steroids is a reasonable therapeutic option in these patients. Alternative therapies are reviewed and recommendations made.

Coordinated surgical and drug treatment of cancer.

Normal cells can proliferate to heal wounds while cancer cells die from chemotherapy with selected sulfhydryl (SH) inhibitors. Choice of the drugs is directed by sensitivity tests run immediately after surgery on each patient's own cancer. The SH-bearing nonhistone chromosomal proteins were predicted to play a major role in regulating genes. Much recent work now suggests that these proteins may play a key role in controlling gene expression.

Ancillary measures in treatment of myeloma. Use of immune serum globulin, fluoride, or androgen.

We reviewed the efficacy of three agents advocated as ancillary therapy in myeloma patients. Intramuscularly administered immune serum globulin (gamma globulin) was ineffective in preventing infection. Hemoglobin level was improved in some myeloma patients receiving androgens. However, the response rate and the degree of leukopenia or thrombocytopenia were not superior with androgen-melphalan-prenisone combination therapy, as compared with those resulting from the two-drug combination without androgen. A controlled study evaluating androgen plus melphalan has not been done. The long-term administration of fluoride, supplemented by calcium and androgen, induced radiologically apparent bone fluorosis, but strengthening of lytic bone was not observed. Neither objective nor subjective benefit was demonstrated in a controlled study comparing the effects of fluoride (without calcium supplement) with those of the placebo.