Survival of breast cancer patients with meningeal carcinomatosis.

BACKGROUND: Breast cancer is the leading nonhematologic cause of meningeal carcinomatosis (MC). The aim of this study was to report the outcome of patients diagnosed with breast cancer MC and treated in single institution by a high-dose intrathecal methotrexate (MTX) regimen. METHODS: Ninety-one patients were diagnosed with breast cancer MC from 2000 to 2007. Intrathecal treatment was MTX 15 mg/day (days 1-5), hydrocortisone acetate (day 1) and oral folinic acid (days 1-5), repeated every 2 weeks. Patients and tumor characteristics were associated with the early clinical and biological outcome and with the overall survival (OS). RESULTS: The median survival was 4.5 months (range 0-53). In multivariate analysis, adverse prognostic factors at diagnosis were performance status >2 [P = 0.006, response rate (RR) = 0.33 (0.15-0.71)], more than three chemotherapy regimens before MC diagnosis [P = 0.03, RR = 0.40 (0.19-0.93)], negative hormone receptor status [P = 0.02, RR = 0.4 (0.19-0.90)] and high Cyfra 21-1 level [P = 0.048, RR = (0.09-0.99)]. Clinical progression after one cycle and biological response after two cycles were independently associated with OS [P < 0.001, RR = 0.09 (0.02-0.37) and P = 0.003, RR = 3.6 (1.5-8.5), respectively]. We propose a prognostic score in order to define three distinct groups of prognosis. CONCLUSIONS: MC presents a poor prognosis, but 1-year survival rate was 25%. This score may become a useful tool for treatment decision and clinical trials.

Sugar beet Ca-pectate gel as a cost-effective immobilized-cell matrix for metal biosorption.

Whole bacterial (Pseudomonas putida) and yeast (Saccharomyces cerevisiae) cells were immobilized by entrapment in gel beads of Ca-pectate obtained from sugar beet pulp and gel beads of commercial Ca-alginate (of algal origin). These immobilized-cell particles were tested for Cd2+ removal from dilute aqueous solutions and their mechanical properties were evaluated. Only Ca-pectate gel beads loaded with yeast cells displayed enhanced cadmium-binding efficiency (13.8 mg Cd2+ per g dry matter) as compared to sterile beads (10.7 mg/g). Sterile Ca-pectate gel beads were noticeably more brittle than algal alginate counterparts. The presence of cells reduced the mechanical resistance of both types of beads, however. The practical use of cell-loaded sugar beet Ca-pectate gel as a metal biosorbent is discussed in light of these results.

Efficacy and tolerance of vinorelbine and fluorouracil combination as first-line chemotherapy of advanced breast cancer: results of a phase II study using a sequential group method.

PURPOSE: To assess the antitumor efficacy and safety profile of the combination of Fluorouracil (5FU) and vinorelbine given as first-line therapy to patients with advanced breast cancer. PATIENTS AND METHODS: As defined in the seven consecutive steps of a phase II group sequential design, 63 patients received 5FU 750 mg/m2/d for 5 consecutive days as a continuous infusion and vinorelbine 30 mg/ m2 on days 1 and 5 as a short intravenous (I/V) infusion every 3 weeks. RESULTS: Forty-one of 63 patients achieved an objective response, which allowed us to discontinue the study and reject a response rate less than 50% with a statistical power of 90%. The unbiased estimate of the response rate was 61.6%. Response rate did not differ significantly according to the following: (1) type of prior adjuvant therapy (none, n = 23; without anthracycline, n = 6; with anthracyline, n = 34); (2) site of metastatic disease; and (3) number of metastatic sites. The median time to progression was 8.4 months. The median response duration was 12.3 months, and the median duration of complete response (CR), from the first assessment of CR, was 7.3 months. The median overall survival time was 23 months (28.1 months for patients with a CR). The main toxicities (grades 3 and 4) were neutropenia (90% of patients), infection (12.7%), mucositis (37%), and constipation (9.5%). Nevertheless, treatment could be given on an outpatient basis to the majority of patients, and the median relative dose-intensity was 86%. CONCLUSION: This phase II study, which used a group-sequential design, shows that the combination of 5FU and vinorelbine is an active and tolerable regimen for the treatment of first metastatic progression of breast cancer. It provides an alternative regimen for patients who have previously received anthracycline-based adjuvant chemotherapy or in whom anthracyclines cannot be used.

Chemotherapy of carcinomas of the digestive tract.

Adjuvant chemotherapy trials in gastric and colorectal carcinomas are reviewed and no clear benefit from such treatment could be observed. To improve existing chemotherapy regimens, several pilot studies were performed in 95 gastric cancer and 85 colorectal carcinomas patients. Response rate for gastric carcinomas using the mitomycin C plus adriamycin plus 5-fluorouracil (5-FU) (FAM) regimen was 40% and was not improved by the addition of nitrosoureas. In colorectal carcinomas none of the combinations used gave better results than 5-FU alone. Fourteen patients with esophageal carcinoma were treated with combination CDDP and the response rate was as high as 50%.