Comparison of the antiemetic effect of high-dose intravenous metoclopramide and high-dose intravenous haloperidol in a randomized double-blind crossover study.

Metoclopramide is an effective antiemetic for cisplatin-induced vomiting when given in parenteral high-dose regimens but not oral low-dose regimens. Metoclopramide was compared to haloperidol, also given in a high-dose parenteral regimen. Patients received two cycles of cisplatin at a dose greater than or equal to 70 mg/m2. Metoclopramide (2 mg/kg intravenous) was given every two hours for five doses beginning one half hour before cisplatin. Haloperidol (3 mg intravenous) was given on the same schedule. A randomized double-blind crossover design was used to control subjective bias and to compare the same patient's experiences. Twenty-eight patients completed both study arms. Excellent control of vomiting was achieved with both drugs. Metoclopramide resulted in 1.92 vomiting episodes (range, 0-5) with 36% having no vomiting. Haloperidol resulted in 3.04 vomiting episodes (range, 0-8) with 20% having no vomiting. Significantly fewer vomiting episodes were noted with metoclopramide rho = .006, paired sign test). However, responses to the two drugs were well correlated (Spearman's rho = .39, P = .03). Metoclopramide and haloperidol are both excellent antiemetics when given in sufficient dosage by an effective route. Metoclopramide does show a mild advantage. However, the positive correlation in response to these agents suggests a common mechanism of action. The ability to identify related antiemetics will be useful in the design of rational combination antiemetic therapy.

Phase II study of etoposide (VP-16) in the treatment of advanced head and neck cancer.

Eighteen patients with advanced and heavily pretreated squamous cell carcinoma of the head and neck were treated with etoposide (VP-16). Of 16 patients evaluable for response, two (13%) achieved partial response lasting 3 to 4 months, and five (31%) achieved stable disease status lasting 2 to 7 months. One patient achieved a partial response in regional lymph nodes and the primary site, while a second patient achieved a partial response of a regional lymph node recurrence. Toxicity was significant but acceptable, consisting mainly of leukopenia and alopecia. Thrombocytopenia and mild nausea were also seen. VP-16 demonstrated modest activity in this disease and might be considered for further trials.

Hepatomas in young women on oral contraceptives: report of two cases and review of the literature.

Hepatocellular carcinoma (HCC) developed in two women who had ingested oral contraceptives for prolonged duration. One of the patients had hepatoma restricted to the liver, and it was successfully resected. The other patient presented with metastatic HCC to the sacrum and lung, and she died after an initial response to chemotherapy in 12 months. Review of literature showed 23 previously reported cases of HCC associated with "pill" use since 1973. Although the reported instances of HCC in pill users are few in number, the majority of affected females were in their 20s and early 30s, without any preexisting liver disease. Even though the risk of developing HCC on oral contraceptives is low, this association adds to the list of complications induced by oral contraceptives in premenopausal women. Two cases are reported and literature reviewed.

Cryosurgery as a treatment for advanced stage hepatocellular carcinoma: results, complications, and alcohol ablation.

BACKGROUND: The objective of this study was to investigate the use of cryosurgery and to determine whether there is a role for combined therapy with alcohol ablation in the treatment of patients with hepatocellular carcinoma. METHODS: Twelve patients with biopsy proven hepatocellular carcinoma underwent ultrasound-guided cryosurgical ablation of their liver tumor. Postoperative alcohol ablation was performed on those patients who were found to have residual tumor or recurrence after the cryosurgical procedure. RESULTS: Of the 12 patients (9 males, 3 females) the size of the primary tumor ranged from 3-13 cm with average size of 7 cm in greatest dimension. Most patients had advanced disease according to the TNM staging system: 9 patients had Stage IVA disease, 2 Stage III, and 1 Stage II. Three patients had residual tumors after the cryosurgical procedure. The residual tumor was treated with alcohol ablation. The 1-year survival rate for the entire group was 50% (5 of 10) and the 2-year survival rate was 30% (3 of 10). At last follow-up, 1 patient with an 8-cm tumor was disease free for 3 years and another patient with a 13-cm tumor was disease free for 2.5 years. Both of these patients had Stage IVA disease. CONCLUSIONS: The authors found cryosurgery to be promising in the treatment of this extremely aggressive form of cancer, with the ability to prolong patient survival. Follow-up treatment with alcohol ablation is an important adjunct in treating residual tumor and controlling recurrences.