Caring About Women and Cancer (CAWAC): a European survey of the perspectives and experiences of women with female cancers.

This paper reports on the findings of the largest ever European survey of female patients' perceptions of their cancer treatment. It has provided clarification of what women consider important in relation to their management and has identified several areas where more research is needed. It has shown that women's knowledge about cancer before diagnosis is poor and the number undergoing regular screening could be improved. Women are not being adequately prepared and educated about what to expect from treatment and steps should be taken as a matter of urgency to redress this shortcoming. It was revealed that whilst families were the primary source of support to female cancer patients, women also derive considerable support from healthcare professionals, particularly senior doctors; more attention should be paid by specialists and nurses to developing psychological skills to cope with this. In this context, further research is needed into how support groups may best meet patient needs.

Non-small cell lung cancer: meta-analysis of efficacy of chemotherapy.

The recent meta-analysis of 52 trials evaluating outcomes of non-small cell lung cancer patients treated with various modalities is discussed. From these data, three priorities can be proposed: (1) lung cancer physicians should alter their practices to include cisplatin-containing combination chemotherapy in their management protocols, (2) many more patients with lung cancer should be entered into clinical trials, and (3) the reporting of trial data, both response and toxicity data and quality of life assessments, needs to be improved. In addition, the poor outcome of non-small cell lung cancer patients, even those with the smallest volume of disease at the time of diagnosis, emphasizes the need for application of more aggressive treatments at the earliest possible stage of disease and the need for continued new drug development.

Chemotherapy for advanced disease. How to raise enthusiasm.

Over the last 5 years, the newer chemotherapeutic agents (cisplatin, vindesine, vinorelbine tartrate [Navelbine], taxoids, and gemcitabine) have given greater hope in the treatment of patients with non-small cell lung cancer. Despite this, it has proved very difficult to organize trials large enough to show significant differences. Reasons for this include negative physician attitudes, the high cost of entering patients in trials, lack of cooperation between research organizations, and the perception of a self-imposed disease. To overcome this, communication with lung physicians, surgeons, and patients as well as oncologists is needed, and they must be involved through an appropriate choice of journals for publishing results, interaction between organizations, an information network linking hospitals, general physicians, and patients, and briefing of local and national media experts.

Phase I/II study of intraperitoneal mitoxantrone in refractory ovarian cancer.

BACKGROUND: Mitoxantrone has demonstrable clinical activity when administered intravenously in a wide range of malignancies. The feasibility and toxicity of intra-peritoneal administration was established in a phase I study. The optimal dose from the phase I was subsequently evaluated in a phase II study. PATIENTS AND METHODS: 19 patients with refractory malignancies and extensive abdominal disease (13 ovarian cancer, 4 breast cancer, 2 mesothelioma) were entered in a phase I study. The dose of intraperitoneal mitoxantrone was escalated from 10 mg/m2, administered in 21 of fluid via a Tenckhoff catheter, to 55 mg/m2, in increments of 5 mg/m2. Cycles were repeated every three weeks. Sixty-seven cycles of mitoxantrone were administered, the maximum tolerable dose being 25 mg/m2. A phase II study at this dose was conducted in 14 patients with refractory ovarian cancer, all of whom had previously received systemic platinum based therapy. Five of the 14 had also previously been treated with intraperitoneal carboplatin. Fifty-one cycles were administered. RESULTS: The dose limiting toxicity in the phase I study was peritoneal irritation and pain. Leucopenia was frequent at doses equal or greater than 30 mg/m2. Three complete remissions were documented in the phase I study (2 breast cancer and 1 ovarian cancer). There was no significant haematological toxicity in the phase II assessment, though local toxicity precluded further therapy in 2 patients. No objective responses were seen in the phase II evaluation. CONCLUSIONS: These studies demonstrate the feasibility of intra-peritoneal mitoxantrone therapy in patients with peritoneal disease, but do not support its routine use in ovarian cancer.

Intraperitoneal-administered carboplatin in patients with ovarian cancer; influence of a dwell-time on toxicity and response.

PATIENTS AND METHODS: Twenty-one patients with metastatic ovarian cancer with minimal residual disease confined to the peritoneal cavity, were treated with intraperitoneal-administered carboplatin. Carboplatin was added to 2 liters of fluid and given via a Tenckoff-catheter. A dwell-time of 4 hours was allowed. After removal of fluid the amount of recovered carboplatin was determined. RESULTS: It appeared that the median recovery of carboplatin was 25.5% (range 2%-56%). There was a great interpatient variability of carboplatin recovery but it was relatively constant during consecutive courses. CONCLUSIONS: Optimal dosing of intraperitoneal-administered carboplatin with a dwell-time is not possible because of the differences in recovery. This manifested itself in the fact that the absorbed dose, as well as a calculated Area Under the concentration versus time Curve (AUC), were much better related to toxicity than the administered dose.

Reduction of cisplatin nephrotoxicity by sodium selenite. Lack of interaction at the pharmacokinetic level of both compounds.

Administration of sodium selenite (Na2SeO3) 1 hr before cis-diamminedichloroplatinum(II) (referred to herein as cisplatin) can protect against the nephrotoxicity of cisplatin. The pharmacokinetic aspects of this interaction were studied in rodents with radiolabeled selenite and cisplatin. Total [75Se]selenium in plasma consisted of [75Se] selenium in plasma proteins and [75Se]selenite in plasma ultrafiltrate. After a short distribution phase, the elimination of [75Se]selenite and total [75Se]selenium proceeded biphasically in the rat, with an initial plasma elimination half-life of [75Se]selenite of 22 +/- 2 min. Coadministration of cisplatin had no effect on the initial nor on the much slower terminal elimination phase of [75Se]selenite nor of total [75Se] selenium. Sodium selenite, in doses protecting against the nephrotoxicity of cisplatin, did not significantly affect areas under the plasma concentration time curve from 0-6 hr nor the initial plasma half-lives of [195mPt]cisplatin (t1/2, 28 +/- 2 min) and total [195mPt]platinum (t1/2, 30 +/- 3 min) in plasma. The much slower terminal elimination phases in plasma and the cumulative urinary excretion of [195mPt] cisplatin and total [195mPt]platinum were neither influenced by sodium selenite. Sodium selenite does not react chemically with cisplatin in vitro. Apparently, bioactivation of selenite is required for its protective effect in vivo. Distribution studies in a mice tumor model indicated that [75Se]selenium is concentrated strongly in the kidney and that the bioactivation of selenite also most likely occurs primarily in the kidneys. We conclude that sodium selenite protects rodents against cisplatin-induced nephrotoxicity without influencing the systemic availability of cisplatin and total platinum.(ABSTRACT TRUNCATED AT 250 WORDS)