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1.
J Clin Oncol ; 4(3): 295-305, 1986 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-3512783

RESUMO

To study the influence of chronologic age on treatment outcome in patients with advanced, diffuse large-cell (histiocytic) lymphoma (DHL), we reviewed the results of two recent Southwest Oncology Group (SWOG) clinical trials. From 1974 to 1982, members entered 307 eligible patients treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with or without bleomycin, and CHOP with or without immunotherapy using BCG, levamisole, or both. Complete response (CR) rates declined progressively with advancing age: 65% in those under 40, 60% in the 40 to 54 age group, 55% in the 55 to 64 age group, and 37% in those 65 and older (P = .001). Likewise, survival decreased significantly in older patients: medians were 101 +, 52, 34, and 16 months, respectively (P less than .001). Treatment guidelines included an initial dose reduction of 50% for patients aged 65 or older and for younger patients with bone marrow compromise. Despite protocol specifications, 23 of 81 patients aged 65 or older received initial full-dose therapy. When these patients were compared with younger patients on whom full-dose chemotherapy was started, survival curves, but not CR rates, were still significantly different. There were no significant differences in duration of CR or frequency of treatment complications. These data suggest that older age is associated with a worse prognosis in advanced DHL. Moreover, the initial dose reduction for patients aged 65 or older may have contributed to their inferior outcomes.


Assuntos
Linfoma Difuso de Grandes Células B/terapia , Adulto , Fatores Etários , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Vacina BCG/administração & dosagem , Ensaios Clínicos como Assunto , Terapia Combinada , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Feminino , Humanos , Levamisol/administração & dosagem , Linfoma Difuso de Grandes Células B/mortalidade , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Prognóstico , Distribuição Aleatória , Vincristina/administração & dosagem , Vincristina/efeitos adversos
2.
J Clin Oncol ; 3(10): 1318-24, 1985 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-3900301

RESUMO

Between 1977 and 1983 the Southwest Oncology Group (SWOG) evaluated chemotherapy alone (cyclophosphamide, doxorubicin, vincristine, prednisone; CHOP) or chemoimmunotherapy (CHOP-levamisole or CHOP-levamisole-BCG) in a randomized prospective clinical trial involving 715 eligible patients with all types of malignant lymphoma (ML). Of 281 evaluable patients with favorable histologic types of ML, 171 (61%) achieved complete remission (CR) and there was no difference in CR rate, CR duration, or survival according to the type of initial treatment. Of 388 evaluable patients with unfavorable histologic types of ML, 194 (50%) achieved CR. Levamisole appeared to adversely affect CR rates in nodular mixed and nodular large-cell lymphoma and CR duration in patients with unfavorable histology ML. Chemoimmunotherapy with levamisole or levamisole-BCG offers no advantage in terms of CR rates, CR duration, or survival compared to CHOP chemotherapy alone, and levamisole may have had an adverse impact on outcome in certain subtypes of ML.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Vacina BCG/administração & dosagem , Levamisol/administração & dosagem , Linfoma/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Vacina BCG/efeitos adversos , Ensaios Clínicos como Assunto , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Humanos , Levamisol/efeitos adversos , Linfoma/mortalidade , Linfoma/patologia , Estadiamento de Neoplasias , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Estudos Prospectivos , Distribuição Aleatória , Vincristina/administração & dosagem , Vincristina/efeitos adversos
3.
J Clin Oncol ; 5(4): 592-600, 1987 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-3031226

RESUMO

In 1979 we initiated a phase III study in the Southwest Oncology Group (SWOG) which was designed to determine the value of chest radiation in limited-stage small-cell lung cancer patients achieving complete response after induction chemotherapy, and to test the use of wide-field v more limited-volume radiation in patients with partial responses (PRs) and patients with stable disease (SD). The induction chemotherapy (VMV-VAC) consisted of vincristine, 2 mg intravenously (IV) every week for six doses; methotrexate, 60 mg/m2 IV days 1 and 43; VP-16, 50 mg/m2/d IV days 1 to 5 and 43 to 47; doxorubicin, 60 mg/m2 IV days 22 and 64; and cyclophosphamide, 1,000 mg/m2 IV days 22 and 64. Four hundred ninety-four patients were registered, of whom 473 were eligible. Of 466 response-evaluable patients, 153 (33%) achieved complete disease remission (CR) with chemotherapy. A total of 387 patients entered the consolidation phase of treatment after chemotherapy and response determination. CR patients were prospectively randomized to receive chest radiation, consisting of 4,800 rad administered in a split-course scheme, or to continue chemotherapy without interruption. The treatment volume was based on tumor extent before the induction chemotherapy. Maintenance chemotherapy consisted of cyclophosphamide and VP-16 administered for four cycles before a period of reinduction chemotherapy consisting of VMV-VAC as described above. Patients receiving chest radiation therapy were given the same maintenance and reinduction chemotherapy programs following completion of the chest radiation. One hundred ninety-one eligible patients achieving PR or SD status after induction chemotherapy were randomized to a preinduction treatment volume or to a postinduction reduced tumor volume, with treatment portals designed according to tumor extent before or after induction chemotherapy, respectively. After completion of the entire treatment plan, there were 218 (47%) CRs and 121 (26%) PRs. These figures represent the greatest response achieved at any point in the treatment program. The median survival for all eligible patients was 57 weeks (74 weeks for CRs). Overall survival for CR patients was not different for patients who did or did not receive chest radiation. However, patterns of tumor relapse were affected by the chest radiation, as 38 of 42 relapsing patients who did not receive radiation had intrathoracic recurrences in comparison to only 20 of 36 radiated patients.(ABSTRACT TRUNCATED AT 400 WORDS)


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Radioterapia/métodos , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma de Células Pequenas/radioterapia , Ensaios Clínicos como Assunto , Terapia Combinada , Ciclofosfamida/administração & dosagem , Dactinomicina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Distribuição Aleatória , Vincristina/administração & dosagem
4.
Am J Med ; 77(3): 415-7, 1984 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-6089560

RESUMO

In the first study of combined chemotherapy and radiation therapy for small cell lung cancer by the Southwest Oncology Group, 17 patients survived more than five years after treatment was initiated (4.6 percent). Late relapse, or a second primary malignancy three to six years after diagnosis, accounted for death in five of these patients. Late recurrences involved the chest, bone, and liver; none occurred in the central nervous system. Disease-free survival continues in 10 patients (6 percent of those with limited disease and 1 percent of those with extensive-stage diseases) at a minimal follow-up in excess of six years. One definite case of chronic treatment-related toxicity occurred: congestive cardiomyopathy after 450 mg/m2 of doxorubicin, successfully managed with digitalis and diuretics. One severe neurologic problem (orthostatic hypotension with preterminal dementia) and two less severe neurologic complications (occasional falling episodes without documented cause and cerebrovascular accident) may be treatment-related. Progressive pulmonary disability, post-herpetic pain syndromes, organic brain syndrome, and hematologic abnormalities have not been observed to date. Nitrosourea administration and/or co-administration of a nitrosourea or methotrexate during the induction phase of treatment with radiotherapy to the brain may account for the higher incidence of complications observed by others in long-term survivors.


Assuntos
Carcinoma de Células Pequenas/mortalidade , Neoplasias Pulmonares/mortalidade , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Pequenas/fisiopatologia , Carcinoma de Células Pequenas/terapia , Terapia Combinada , Humanos , Neoplasias Pulmonares/fisiopatologia , Neoplasias Pulmonares/terapia , Estadiamento de Neoplasias , Prognóstico , Radioterapia/efeitos adversos
5.
Recent Results Cancer Res ; 80: 83-91, 1982.
Artigo em Inglês | MEDLINE | ID: mdl-6173904

RESUMO

The Southwest Oncology Group (SWOG) performed a randomized study (SWOG 7518, CAR 2) of chemotherapy using ten courses of nitrogen mustard, vincristine, procarbazine, and prednisone (MOPP) plus low-dose bleomycin (LDB), versus three courses of combined therapy, MOPP + LDB plus radiotherapy (XRT) from October, 1974, to April 1980, in pathologic stage III Hodgkin's disease. The present report includes data on 136 registered patients, of whom 112 are fully or partially evaluable. At this preliminary analysis, complete remission rates are 82% for chemotherapy alone and 82% for combined treatment. There are no statistically significant differences in survival or relapse-free survival between the two treatment programs, and no specific trends for stage IIIA versus IIIB. The estimated 3-year survival rate for all patients was 82%. Toxicities are comparable when considering the highest grades. There was one case of acute myeloblastic leukemia on combined treatment. Preliminary evidence suggests that patients with nodular sclerosis histologic type are more likely to relapse on chemotherapy alone than on combined treatment.


Assuntos
Doença de Hodgkin/tratamento farmacológico , Bleomicina/uso terapêutico , Ensaios Clínicos como Assunto , Esquema de Medicação , Quimioterapia Combinada , Seguimentos , Doença de Hodgkin/radioterapia , Humanos , Mecloretamina/uso terapêutico , Estadiamento de Neoplasias , Prednisona/uso terapêutico , Procarbazina/uso terapêutico , Vincristina/uso terapêutico
6.
Laryngoscope ; 95(1): 57-9, 1985 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-3965829

RESUMO

Vocal cord paralysis has been reported in 33 patients with thyroid lymphoma for an estimated overall incidence of 17%. There is little expectation of vocal cord function recovery, both because neoplastic invasion is believed irreversible and since surgery often necessitates sacrifice of the recurrent laryngeal nerve. Unlike in most well differentiated thyroid malignancies, external radiation therapy plays a vital role in the treatment of thyroid lymphoma. The patient presented here had complete recovery of vocal cord function following radiation therapy for a large thyroid lymphoma associated with vocal cord paralysis. This is the first reported case of such recovery following treatment for a thyroid neoplasm. The rather rapid and complete recovery of neural function suggests that, at least in some, paralysis is caused by reversible compression rather than by neural invasion or tumor-induced neurolysis.


Assuntos
Linfoma/radioterapia , Neoplasias da Glândula Tireoide/radioterapia , Paralisia das Pregas Vocais/fisiopatologia , Prega Vocal/fisiologia , Idoso , Feminino , Humanos , Linfoma/complicações , Neoplasias da Glândula Tireoide/complicações , Paralisia das Pregas Vocais/etiologia
7.
Cancer ; 44(4): 1408-13, 1979 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-498018

RESUMO

The patients with the typical clinical course and pathology of Mycosis Fungoides (MF) were found also to have Hodgkin's Disease (HD), nodular sclerosing type. In two cases, HD was diagnosed 2 years after the diagnosis of MF; in the third case, both diseases were diagnosed simultaneously. Previous claims of MF transforming into second lymphomas are reviewed. The possible significance of our observed association of MF and HD is discussed.


Assuntos
Doença de Hodgkin/complicações , Micose Fungoide/complicações , Neoplasias Primárias Múltiplas/patologia , Neoplasias Cutâneas/patologia , Doença de Hodgkin/etiologia , Doença de Hodgkin/patologia , Humanos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Micose Fungoide/etiologia , Micose Fungoide/patologia , Neoplasias Primárias Múltiplas/etiologia , Neoplasias Cutâneas/etiologia , Fatores de Tempo
8.
Am J Hematol ; 21(4): 357-65, 1986 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-3006477

RESUMO

Three elderly females are reported who presented with high-grade lymphoma of the thyroid and subsequently were found to have extensive gastrointestinal (GI) lymphoma that dominated their clinical courses. One of the patients remains free of disease 30+ months after extensive resection of involved bowel and combination chemotherapy. Two died from disseminated lymphoma. Optimal delivery of therapy in both of the latter patients was impeded by massive gastrointestinal hemorrhage. A review of previously reported cases of thyroid lymphoma, plus those described here, suggests a predilection for these tumors to involve the GI tract independent of other organ metastases.


Assuntos
Carcinoma de Células Pequenas/patologia , Neoplasias do Jejuno/secundário , Linfoma/secundário , Neoplasias Primárias Múltiplas/patologia , Neoplasias Gástricas/secundário , Neoplasias da Glândula Tireoide/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Pequenas/radioterapia , Carcinoma de Células Pequenas/cirurgia , Terapia Combinada , Neoplasias Duodenais/tratamento farmacológico , Neoplasias Duodenais/patologia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Neoplasias do Jejuno/tratamento farmacológico , Neoplasias do Jejuno/cirurgia , Linfoma/tratamento farmacológico , Linfoma/radioterapia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/radioterapia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/patologia , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/radioterapia , Doenças da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia
9.
Cancer ; 35(1): 199-207, 1975 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-45888

RESUMO

Possible predictive criteria of the refractoriness to therapy of the blastic phase of Ph-1-positive chronic granulocytic leukemia (CGL) have been sought. Eight cases in the blastic phase were studied. The blasts were noted to be of two types: some displayed a high nuclear:cytoplasmic ratio with deep blue cytoplasm, while others had a comparatively low nuclear:cytoplasmic ratio and bluish gray cytoplasm containing a few small granules. Electron microscopic studies showed a variety of features, including defective organelles and giant mitochondria. Cytochemical staining revealed the majority of blast cells to be peroxidase- and Sudan black-negative; granular PAS positivity was the rule. Serial cytogenetic studies demonstrated increasing aneuploidy. Bone marrow biopsy showed myelofibrotic changes in two cases. Two patients entered complete remission with prednisone and vincristine and with Ara-C and thioguanine, respectively. It is concluded that the blastic phase of CGL may manifest heterogeneity.


Assuntos
Células da Medula Óssea , Medula Óssea/ultraestrutura , Aberrações Cromossômicas , Leucemia Mieloide , Doença Aguda , Adulto , Fosfatase Alcalina/metabolismo , Aneuploidia , Biópsia , Medula Óssea/enzimologia , Núcleo Celular/ultraestrutura , Criança , Citarabina/uso terapêutico , Citoplasma/ultraestrutura , Feminino , Histocitoquímica , Humanos , Leucemia Mieloide/tratamento farmacológico , Leucemia Mieloide/patologia , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Mitocôndrias , Organoides/ultraestrutura , Peroxidases/metabolismo , Prednisona/uso terapêutico , Remissão Espontânea , Coloração e Rotulagem , Tioguanina/uso terapêutico , Vincristina/uso terapêutico
10.
Cancer Treat Rep ; 66(3): 553-6, 1982 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-6277487

RESUMO

Sixty-three previously untreated patients with metastatic non-small cell lung cancer (40 patients with adenocarcinoma and 23 with large cell undifferentiated carcinoma) were treated with combination chemotherapy consisting of 5-FU (300 mg/m2) given as an iv bolus on Days 1-4 and vindesine (3 mg/m2) and mitomycin (10 mg/m2), both given as an iv bolus on Day 1 of each treatment course (FEMi). FEMi was repeated at 3-week intervals for three treatment courses and thereafter at 6-week intervals until disease progression. Major objective responses were seen in 13 of 63 patients (21%). Minor responses were seen in an additional 12 patients (19%). The median survival for all patients was 23 weeks and for responding patients was 38 weeks. The pretreatment performance status had a significant effect on both the response rate and survival time. Patients having an initial Karnofsky performance score greater than or equal to 70% had a 54% response rate, with a median survival of 42 weeks for responding patients. FEMi was well-tolerated: 18 patients (29%) did not have any side effects and only five (8%) experienced vomiting.


Assuntos
Adenocarcinoma/tratamento farmacológico , Antineoplásicos/administração & dosagem , Carcinoma de Células Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Adenocarcinoma/mortalidade , Adulto , Idoso , Carcinoma de Células Pequenas/mortalidade , Esquema de Medicação , Avaliação de Medicamentos , Quimioterapia Combinada , Feminino , Fluoruracila/administração & dosagem , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Mitomicinas/administração & dosagem , Vimblastina/administração & dosagem , Vimblastina/análogos & derivados , Vindesina
11.
Cancer Treat Rep ; 63(4): 647-53, 1979 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-87277

RESUMO

Between 1972 and 1977, the Southwest Oncology Group studied the following three chemotherapy programs for the treatment of patients with advanced forms of mycosis fungoides: (a) cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP) (seven patients); (b) adriamycin, vincristine, and prednisone (HOP) (five patients); and (c) cyclophosphamide, vincristine, prednisone, and bleomycin (COP plus bleomycin) (12 patients). Among the 24 evaluable patients there was an overall objective response rate of 95% with seven (29%) achieving a complete remission. With the adriamycin-containing chemotherapy, five (42%) of 12 patients achieved a complete remission compared to two (17%) of 12 patients treated with COP plus bleomycin. The median duration of remission (partial plus complete) was longer with the COP plus bleomycin combination (median, 47 weeks) than with the adriamycin-containing combinations (median, 22 weeks; P = 0.03). The median survival for all 24 evaluable patients was 95 weeks and was similar regardless of remission-induction therapy. In summary, combination chemotherapy proved to be effective palliative therapy for advanced mycosis fungoides.


Assuntos
Antineoplásicos/administração & dosagem , Micose Fungoide/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Adulto , Idoso , Bleomicina/administração & dosagem , Ensaios Clínicos como Assunto , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Remissão Espontânea , Fatores de Tempo , Vincristina/administração & dosagem
12.
Cancer ; 36(3): 855-60, 1975 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-1182675

RESUMO

A series of 30 unselected patients with acute nonlymphoblastic leukemia (ANLL) was treated with combination chemotherapy, including three courses of cytosine arabinoside (Ara-C) by 5-day continuous i.v. infusion, vincristine i.v. weekly, and prednisone daily to complete remission. Ara-C was administered alone as a 5-day continuous i.v. infusion monthly for maintenance. Ten (33%) achieved a complete remission (CR). The remaining 30 (67%), including temporary partial remissions, hematologic improvements, inadequate trials, and early deaths, were all considered failures. The CR rate was 57% in those 17 cases receiving an adequate trial. After After 5 1/2 years' followup, the overall median survival, including cases failing to achieve CR, was 3.1 months. For those having adequate trials the median survival was 16.6 months, and for those achieving a CR, 36.6 months. Two patients are still alive, one at 55.2 months on maintenance therapy, and the other at 62.8 months, currently unmaintained.


Assuntos
Citarabina/uso terapêutico , Leucemia/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Fatores Etários , Idoso , Doenças da Medula Óssea/induzido quimicamente , Criança , Citarabina/efeitos adversos , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Leucemia/urina , Pessoa de Meia-Idade , Muramidase/urina , Prednisona/uso terapêutico , Vincristina/uso terapêutico
13.
Am J Hematol ; 20(2): 119-28, 1985 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-2931021

RESUMO

Peripheral blood mononuclear cells from 11 patients with remission Hodgkin disease and 20 normal controls were incubated with irradiated allogeneic lymphocytes in one-way mixed lymphocyte cultures. Simultaneously, modified assays were performed by adding supplemental irradiated PBM, T lymphocytes, or adherent cells autologous to the responders. Baseline allogeneic responsiveness of patients and controls was not different. However, significant suppression (p less than .01) was demonstrated when the cultures were supplemented with patient mononuclear cells or adherent cells, an effect not found with similar supplemental cells from controls. Conversely, T-cell supplementation of control cultures produced more than twofold increases in proliferation but significantly less augmentation in the patients' cultures (p less than .01). T-cell subset analysis in six patients showed decreased helper: suppressor cell ratios. Hodgkin disease patients have adherent suppressor cells, which persist during remission, as well as a defect in T-cell helper function.


Assuntos
Doença de Hodgkin/imunologia , Adulto , Idoso , Humanos , Contagem de Leucócitos , Teste de Cultura Mista de Linfócitos , Pessoa de Meia-Idade , Monócitos/imunologia , Receptores Imunológicos/análise , Formação de Roseta , Linfócitos T/imunologia
14.
Cancer Treat Rep ; 68(7-8): 963-7, 1984.
Artigo em Inglês | MEDLINE | ID: mdl-6744347

RESUMO

Seventy-eight patients with Hodgkin's disease and non-Hodgkin's lymphoma who had failed prior chemotherapy or radiation therapy were treated with a combination of vindesine, carmustine, doxorubicin, and prednisone (EBAP). Outpatient therapy was administered at 21-day intervals. Complete and partial responses were seen in 32 patients (41%). The response rate was higher for Hodgkin's disease (59%) than for non-Hodgkin's lymphoma (31%). The median duration of response was 31 weeks in both groups, with a median survival of all patients of 35 weeks (responders, 122 weeks; nonresponders, 16 weeks). Myelotoxicity was greater using EBAP than in the earlier reported program with vincristine, carmustine, doxorubicin, and prednisone, and in the absence of higher response rates does not support the use of vindesine over vincristine in combination programs using nitrosoureas, anthracyclines, and prednisone.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma/tratamento farmacológico , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carmustina/administração & dosagem , Carmustina/uso terapêutico , Doxorrubicina/administração & dosagem , Doxorrubicina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Recidiva , Vimblastina/administração & dosagem , Vimblastina/análogos & derivados , Vimblastina/uso terapêutico , Vindesina
15.
Am J Obstet Gynecol ; 146(6): 613-6, 1983 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-6191568

RESUMO

A multiagent regimen (vinblastine, bleomycin, hexamethylmelamine, and cis-platinum) partly designed on the basis of data from a human tumor stem cell assay was used to treat 36 patients with relapsing epithelial ovarian cancer. All patients included in this study had previously received alkylating agent therapy, and 78% (28/36) had also received Adriamycin. Thirty-five patients were clinically evaluable for response; eight achieved complete clinical remission, and nine achieved partial remission, for an overall response rate of 49%. The median duration of response was 10 months, and three of the complete responders are in remission at 10+, 17+, and 22+ months. Mild to moderate peripheral neuropathy was the major side effect, occurring in 11% (4/35) of patients. Myelotoxicity was well tolerated. We conclude that this four-drug regimen is effective in the treatment of relapsing ovarian cancer patients and should be considered for study as a front-line combination chemotherapy for previously untreated patients.


Assuntos
Neoplasias Ovarianas/tratamento farmacológico , Altretamine/uso terapêutico , Bleomicina/uso terapêutico , Cisplatino/uso terapêutico , Células Clonais , Quimioterapia Combinada , Feminino , Humanos , Recidiva Local de Neoplasia , Vimblastina/uso terapêutico
16.
Cancer Treat Rep ; 66(4): 847-53, 1982 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-6176321

RESUMO

Mature data from four clinical trials conducted by the Southwest Oncology Group from 1971 to 1978 for patients with all stages of Hodgkin's disease (HD) are reviewed in this paper. In the RAC #1 trial of stage I and II HD we demonstrated that involved-field radiotherapy plus six courses of MOPP chemotherapy improved relapse-free survival compared to standard radiotherapy alone (P = 0.12), especially in patients with B symptoms (P less than 0.03) or mediastinal disease (P = 0.08). However, at present, there is no significant difference in overall survival. In the CAR #1 study for patients with pathologic stage IIB, IIIA, and IIIB HD, we demonstrated that three or four courses of MOPP before radiotherapy produced a 90% complete remission (CR) rate, with 70% of the patients remaining free of disease at 5 years. In the CAR #2 study for patients with pathologic stage IIIA or IIIB disease, we demonstrated that chemotherapy alone (MOPP-bleomycin) was as effective as combined modality treatment (MOPP-bleomycin plus radiotherapy) in terms of CR rate (85% versus 89%, respectively), relapse-free survival, and survival. For advanced stages of HD we added doxorubicin to our MOPP-bleomycin schedule and demonstrated that MOP-BAP produced a 77% CR rate compared to 67% for MOPP-bleomycin (P = 0.10). Moreover, MOP-BAP produced consistently superior CR rates and survival in patients with more prognostically favorable presentations of HD. Our new ongoing study (MOPP #6) incorporates many of the concepts derived from these earlier clinical investigations.


Assuntos
Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/radioterapia , Antibióticos Antineoplásicos/administração & dosagem , Bleomicina/administração & dosagem , Ensaios Clínicos como Assunto , Doxorrubicina/administração & dosagem , Quimioterapia Combinada , Doença de Hodgkin/mortalidade , Humanos , Mecloretamina/administração & dosagem , Naftacenos/administração & dosagem , Prednisona/administração & dosagem , Procarbazina/administração & dosagem , Vincristina/administração & dosagem
17.
Med Pediatr Oncol ; 16(5): 312-9, 1988.
Artigo em Inglês | MEDLINE | ID: mdl-3054453

RESUMO

One hundred twenty-two patients with advanced adenocarcinoma of the breast were randomized to receive adriamycin (AD) alone or a combination of VP-16 plus lower dose adriamycin (VAD). The patients were stratified to good and poor risk. The starting dose (day 1) of AD was 60 mg/m2 for good risk and 45 mg/m2 for poor risk. The starting dose of the VAD combination for the good-risk patient was VP-16, 75 mg/m2 daily x 5 plus adriamycin 35 mg/m2. The poor-risk dose for VAD was VP-16, 50 mg/m2 daily x 5 plus adriamycin, 30 mg/m2 on day 1. The total dose of AD was 450 mg/m2 on both arms. The patients who were on the VAD arm continued on VP-16 maintenance. Both arms were repeated every 21 days. There were 54 evaluable patients on the adriamycin arm and 52 evaluable patients on the VAD arm. Both arms were similar with regard to age, menopausal status, performance status, and prior hormonal therapy. More hematologic toxicity was seen in the adriamycin arm. Complete responses were observed on both arms, three (5%) with adriamycin and three (5%) with combination. Eleven (19%) and ten (18%) partial responses were observed with the adriamycin and VP-16 plus adriamycin, respectively. AD produced more stable disease than VAD (41% vs. 29%). Complete responses were seen only in the good-risk patients. Time to progression was delayed on the combination arm (P = 0.02). The survival in both arms was similar. The addition of VP-16 to adriamycin does not offer an important clinical advantage.


Assuntos
Adenocarcinoma/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Doxorrubicina/uso terapêutico , Adenocarcinoma/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/análise , Ensaios Clínicos como Assunto , Doxorrubicina/administração & dosagem , Avaliação de Medicamentos , Etoposídeo/administração & dosagem , Humanos , Pessoa de Meia-Idade , Distribuição Aleatória , Receptores de Estrogênio/análise
18.
Med Pediatr Oncol ; 14(2): 78-80, 1986.
Artigo em Inglês | MEDLINE | ID: mdl-3713640

RESUMO

Because "the standard" chemotherapy for advanced gastric adenocarcinoma, the FAM combination of 5-fluorouracil, adriamycin, and mitomycin, is only minimally effective, there is a clear need for other choices. Therefore, the Southwest Oncology Group tested the new adriamycin analog, bisantrene, hoping that it might be more effective than the "parent drug." Twenty-six patients with gastric adenocarcinoma were treated on a program of every-3-week 2-hour bisantrene infusions. The starting dose was 260 mg/m2 (208 if poor risk), with subsequent doses based on prior toxicity. The regimen caused sufficient toxicity (especially local phlebitis with pain and swelling) to assure an adequate test. One person (3.8% of eligible patients) experienced a clinically useful 3-month response. He had previously had progressive disease on FAM. Nevertheless, we conclude that bisantrene is not an addition to the small list of drugs useful in the management of gastric adenocarcinoma.


Assuntos
Adenocarcinoma/tratamento farmacológico , Antibióticos Antineoplásicos/uso terapêutico , Neoplasias Gástricas/tratamento farmacológico , Antracenos/efeitos adversos , Antracenos/uso terapêutico , Humanos
19.
Cancer ; 43(2): 417-25, 1979 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-84706

RESUMO

As a part of an ongoing prospective controlled trial, the Southwest Oncology Group compared the results of treatment of advanced non-Hodgkin's lymphoma with two CHOP regimens (cyclophosphamide, adriamycin, vincristine and prednisone with either low-dose bleomycin or BCG by scarification) to a COP regimen (cyclophosphamide, vincristine and prednisone) with low-dose bleomycin (COP-Bleo). The study design emphasized histopathology review and systematic restaging to define complete remission (CR). Confirmed rates of CR for 443 evaluable patients were 59% for 286 patients receiving the CHOP regimens and 59% for 157 patients receiving COP-Bleo. Rates of CR were higher for patients with nodular lymphoma (69%) compared to those with diffuse lymphoma (54%) (p = 0.005). For patients with nodular lymphoma there was no difference in CR rates according to treatment. For patients with diffuse lymphomas the CR rate was higher with the CHOP programs (58%) than with COP-Bleo (44%) (p = 0.10). Overall duration of CR and survival was significantly longer for patients with nodular lymphoma compared to diffuse lymphoma (p less than 0.01). At this time, remission duration and survival were similar regardless of induction regimen used in patients with nodular lymphoma. However, in patients with diffuse lymphoma, the duration of CR and overall survival were improved by treatment with the CHOP regimens compared to COP-Bleo (p = 0.02). Thus, in this controlled study we have demonstrated that initial combination chemotherapy employing the CHOP regimen was a superior remission induction therapy for patients with diffuse lymphoma.


Assuntos
Antineoplásicos/administração & dosagem , Doxorrubicina/administração & dosagem , Linfoma/terapia , Antineoplásicos/efeitos adversos , Vacina BCG/administração & dosagem , Bleomicina/administração & dosagem , Ensaios Clínicos como Assunto , Ciclofosfamida/administração & dosagem , Quimioterapia Combinada , Humanos , Prednisona/administração & dosagem , Remissão Espontânea , Fatores de Tempo , Vincristina/administração & dosagem
20.
Cancer Invest ; 9(6): 613-20, 1991.
Artigo em Inglês | MEDLINE | ID: mdl-1721000

RESUMO

Based on a preliminary trial that suggested that CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), and PVB (cisplatinum, vinblastine, bleomycin), are at least partially non-cross-resistant, the Southwest Oncology Group treated patients with unfavorable histology, non-Hodgkin's lymphoma with CHOP and PVB. In the first study, 76 eligible patients were given three courses of CHOP, with complete or partial responders receiving three courses of PVB followed by three further courses of CHOP. Nonresponders after the initial three cycles of CHOP, received six courses of PVB. In the second study, 154 eligible patients were treated with alternating cycles of the two drug regimens. The overall objective antitumor response (CR + PR) was 77% for the first study and 58% for the second. The complete remission rates were 48% and 38%, respectively. The overall survival for both studies is similar. These results are interpreted in terms of the Goldie-Coldman hypothesis.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Linfoma não Hodgkin/tratamento farmacológico , Antineoplásicos/uso terapêutico , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Masculino , Prednisona/administração & dosagem , Fatores de Risco , Análise de Sobrevida , Vimblastina/administração & dosagem , Vincristina/administração & dosagem
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