Oral ondansetron for the control of cisplatin-induced delayed emesis: a large, multicenter, double-blind, randomized comparative trial of ondansetron versus placebo

PURPOSE

To investigate the efficacy and safety of oral ondansetron in the control of cisplatin-induced delayed emesis in patients who do not require rescue antiemetic therapy for acute emesis.

PATIENTS AND METHODS

Five hundred thirty-eight chemotherapy-naive patients who received cisplatin chemotherapy (> or = 70 mg/m2), and who were not rescued for acute emesis, were eligible to be randomized to receive one of the three oral regimens to control delayed emesis. Group I received placebo on days 2 to 6; group II received ondansetron 8 mg twice daily on days 2 and 3 and placebo on days 4 to 6; group III received ondansetron 8 mg twice daily on days 2 to 6. All patients received intravenous ondansetron (0.15 mg/kg every 4 hours for three doses) for the control of acute emesis on day 1. The number of emetic episodes on days 2 and 3 combined (days 2/3, when incidence and severity of delayed emesis were expected to be greatest) was considered the primary measure of efficacy.

RESULTS

Patients who received odansetron had significantly fewer emetic episodes on days 2/3, 4, and 5 than those who received placebo (P < or = .002 on each day). Additionally, significantly more patients who received ondansetron had a complete plus major response (C+MR; < or = two two emetic episodes) than those who received placebo on days 2/3 (56% v 37%, P = .001), 4 (94% v 85%, P = .005), and 5 (98% v 88%, P = .006). Patients who received ondansetron had significantly less nausea on day 2/3 when day-1 nausea was used as the baseline score (P = .025). Patients who received ondansetron also had significantly less nausea on day 4 (P = .042) and the results approached significance on day 5 (P = .066).

CONCLUSION

Oral ondansetron had a significant effect in the control of cisplatin-induced delayed emesis and nausea in patients who had not required rescue antiemetics during the acute emesis period. The control of delayed nausea and vomiting was most notable in the immediate 2 days following cisplatin administration, with the clinical difference narrowing between the two treatment arms on subsequent days.

Ifosfamide/carboplatin/etoposide chemotherapy in patients with metastatic non-small cell lung cancer

We have evaluated the combination of ifosfamide, carboplatin, and etoposide (ICE) along with mesna in 46 patients with stage IV non-small cell lung cancer. Treatment consisted of ifosfamide (1.25 g/m2/d with mesna) and etoposide (80 mg/m2/d) given intravenously on days 1 to 3 and carboplatin (300 mg/m2) given intravenously on day 1 every 4 weeks. Eligibility criteria included measurable disease; adequate hematologic, hepatic, and renal functions; no prior chemotherapy; and an Eastern Cooperative Oncology Group performance status (PS) of 0 to 3. Two patients were lost to follow-up and one had received prior chemotherapy, leaving 43 patients evaluable for response and toxicities. There were 27 male and 16 female patients. Twenty-three patients had a PS of 0 or 1 and 20 had a PS of 2 or 3. Eighteen patients had received prior radiotherapy. There were two complete responses and nine partial responses. The response rate was 35% in PS 0 or 1 patients and 15% in PS 2 or 3 patients. The most frequent toxicity was myelosuppression; 44% of patients experienced grade 3 or 4 leukopenia and 14%, grade 3 or 4 thrombocytopenia. Patients receiving prior radiation were significantly more prone to develop leukopenia (P = .01). Five patients developed leukopenic fever, and three died of sepsis. Gastrointestinal toxicities were mostly mild. No neurologic or genitourinary toxicities were observed. The median length of survival was 209 days for patients with a PS of 0 or 1 and 123 days for the entire group. The 1-year survival rate was 22% and 19%, respectively, in these two patient subgroups. ICE is an active regimen in patients with metastatic non-small cell lung cancer and a good PS. Myelosuppression is the major dose-limiting toxicity. Hematopoietic growth factors may be indicated in subsequent studies, especially in patients who had prior radiation therapy. The therapeutic effect of ICE on patients with a poor PS remains unsatisfactory and requires further investigation.

Phase I study of escalating doses of paclitaxel (Taxol) with fixed doses of ifosfamide, carboplatin, and etoposide

The combination of ifosfamide (with mesna uroprotection), carboplatin, and etoposide (ICE) has demonstrated activity in a variety of cancers. Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ), a dipertene compound extracted from the Pacific yew Taxus brevifolia, appeared a good candidate for study as an addition to the ICE regimen (ICE-T) because of its broad antitumor activity, its unique mechanism of action, and its toxicity profile, which was not expected to impact the ICE regimen adversely. In a phase I study, we evaluated the impact of adding escalating doses of paclitaxel (120 mg/m2, 135 mg/m2, 150 mg/m2, and 175 mg/m2) to the ICE regimen in 13 previously untreated (with two exceptions) patients with breast cancer, sarcoma, lung cancer, and adenoid cystic carcinoma. In general, ICE-T was well tolerated with some myelosuppression observed. Responses were seen at all dose levels. To date, the maximal tolerated dose of paclitaxel has not been reached; we are currently administering 175 mg/m2.

Paclitaxel by 3-hour infusion followed by 96-hour infusion on failure in patients with refractory malignant disease

To explore the potential therapeutic differences between 3- and 96-hour infusions of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) in patients with refractory malignant diseases, we conducted a phase II study in which patients were treated first with paclitaxel 135 mg/m2 by 3-hour infusion. If patients did not respond or relapsed after response, they were then treated by 96-hour infusion of paclitaxel at the same dose. Patients with metastatic or incurable breast, ovarian, lung, head/neck carcinomas, and lymphoma were eligible. They were required to have an Eastern Cooperative Oncology Group performance status of 2 or better and adequate hematologic, hepatic, and renal functions. In 22 patients entered thus far, we have observed one partial response in 10 lung cancer patients treated by 3-hour paclitaxel and one partial response in six patients treated by 96-hour infusion. Four partial responses were observed with 3-hour paclitaxel alone in nine breast cancer patients, while three partial responses occurred in five patients with 96-hour infusion after the 3-hour infusion failed. Nonhematologic toxicities such as fatigue, peripheral neuropathy, and mucositis occurred more commonly in the 96-hour infusion group. Our preliminary results suggest (1) that 3-hour infusion of paclitaxel is active against refractory breast cancer, (2) that 96-hour infusion of paclitaxel can induce partial response in breast cancer that was refractory to 3-hour treatment of paclitaxel, and (3) that more studies are needed to define the optimal treatment schedule of paclitaxel.

Pilot study of vinorelbine (Navelbine) and paclitaxel (Taxol) in patients with refractory breast cancer and lung cancer

Vinorelbine (Navelbine; Burroughs Wellcome Co, Research Triangle Park, NC; Pierre Fabre Médicament, Paris, France) and paclitaxel (Taxol; Bristol-Myers Oncology, Princeton, NJ) as single-agent therapy exhibit good activity in breast and lung cancers. Concurrent administration of vinorelbine and paclitaxel achieves synergistic cytotoxicity against MCF-7 and MDA-MB-231 breast cancer cells in vitro. Because these agents bind to distinct sites on tubulin and affect microtubules in opposite ways, a pilot study was conducted of the combination of vinorelbine and paclitaxel in patients with metastatic breast cancer or lung cancer who were refractory to first-line chemotherapy. Entry criteria included measurable disease, a Karnofsky performance status of > or = 70, adequate bone marrow reserve, adequate hepatic and renal functions, and no central nervous system metastasis. Seven patients entered the study (one with breast cancer and six with lung cancer; three men and four women, with an age range of 39 to 79 years). The first three patients received vinorelbine 25 mg/m2 intravenously for 5 to 10 minutes on days 1 and 8, and paclitaxel 90 mg/m2 intravenously over 3 hours on day 1 after the administration of vinorelbine. Premedication prior to paclitaxel consisted of dexamethasone, cimetidine, and diphenhydramine. The subsequent four patients enrolled in the study received the identical dose of vinorelbine, but the paclitaxel dose was increased to 175 mg/m2 in the same sequence. Patients received granulocyte colony-stimulating factor 5 micrograms/kg subcutaneously from days 3 to 17 (except day 8) or until the absolute granulocyte count was 10,000/microL or higher. Preliminary results showed that one of the first three patients developed grade 4 neutropenia and grade 5 infection. In the subsequent four patients, there were two grade 3 and two grade 4 cases of neutropenia; leukopenic fever or infection did not occur. Two patients required red blood cell transfusions. Two patients developed grade 1 and one patient developed grade 2 peripheral neuropathy. Myalgia and fatigue were common but self-limited. The one patient with breast cancer had a partial response; no response was noted in the lung cancer patients.

Phase II trial of gallium nitrate, amonafide and teniposide in metastatic non-small cell lung cancer. An Eastern Cooperative Oncology Group study (E2588)

Fifty-five patients with metastatic non-small cell lung cancer (NSCLC) were entered into this phase II randomized study for evaluating three new agents: gallium nitrate, amonafide and teniposide. The patients had to have ECOG performance status 0 or 1, no prior chemotherapy, and adequate hematological, hepatic and renal functions. Forty-seven patients were eligible and evaluable. Fourteen were randomized to receive gallium nitrate, 18 to amonafide and 15 to teniposide. Seventy-four percent of eligible patients were male. The majority of patients (89%) had an ECOG performance status 1. ECOG grade 4 toxicity occurred twice in patients on gallium nitrate, seven times on amonafide and 18 times on teniposide. The cause of death was attributed to amonafide in one patients (from sepsis) and to teniposide in two patients (due to infection and leukopenia). There was no objective response in all the patients entered. The overall survival times ranged from 2 weeks to 156 weeks with a medium of 23 weeks. There were no survival differences among the three treatment arms. We conclude that gallium nitrate, amonafide and teniposide are inactive in metastatic NSCLC and do not warrant any further testing in this disease.

Phase II study of ifosfamide, carboplatin, and etoposide in patients with advanced non-small cell lung cancer

This study was to define the efficacy of ifosfamide, mesna, carboplatin, and etoposide (ICE) in patients with metastatic non-small cell lung cancer (NSCLC). From September 1990 to October 1991, 33 patients were treated with ifosfamide/mesna 1.25 g/m2/day and etoposide 80 mg/m2/day intravenously from days 1 to 3, and carboplatin 300 mg/m2 on day 1 every 4 weeks. There were 20 male patients and 13 females. The median age was 65 (range: 38-79). Seventeen patients had a performance status (PS) of 0 or 1, and 16 had a PS of 2 or 3. All had measurable diseases. Nine had initial treatment for localized disease with concurrent radiation, 5-fluorouracil, and interferon-alpha 2b and four had radiation only. None had received chemotherapy for metastatic disease. There were nine partial responses (PR) (27.3%, 9/33) with a median response duration of 8 months (range: 2-16 months). Five patients had stable diseases (SD), which lasted for 3, 6+, 7+, 10+, or 13.4 months. The median survival was 8 months for PR and SD and 4 months for the entire group. Patients with PS of 2 or 3 were less likely to respond (18.8% vs 35.3%) and had a shorter median survival (2.7 months vs 6 months) than patients with better PS. Dose-limiting toxicity was myelosuppression. Seventeen (51.5%, 17/33) patients developed grade III-IV leukopenia with four septic episodes and three septic deaths. Grade III or IV thrombocytopenia was seen in five patients. Patients with prior radiation were significantly more prone to develop leukopenia (P < .005). Gastrointestinal toxicity was mostly mild. No neurologic or genitourinary toxicity was observed. In conclusion, ICE is active in patients with advanced NSCLC and good PS. Besides myelosuppression, it is well tolerated. Further study is indicated to evaluate if granulocyte-colony stimulating factor can reduce myelosuppression from ICE in good PS patients.

Characterization and application of microdialysis probes with an active exchange length compatible with small-size brain nuclei in the rat

We communicated the construction, characterization and application of microdialysis probes with an active exchange length that is suitable for experiments involving small-size nuclei in rat brain. Using substance P (SP) as the test substance, we determined that probes with an active exchange length of 180-200 microns exhibited an in vitro recovery of 14.2 +/- 0.8% and in vivo recovery at the nucleus tractus solitarii (NTS) of 24.9 +/- 1.7% for the undecapeptide, calibrated at an infusion rate of 1 microliter/min. We also demonstrated that microinfusion of SP via these probes into the NTS allowed for a correlation of changes in tissue levels of both SP (exogenous substance) and norepinephrine (endogenous substance) with alterations in baroreceptor reflex responses (physiologic phenomenon).

Evaluation of a 24-hour infusion of etidronate disodium for the treatment of hypercalcemia of malignancy

BACKGROUND

Hypercalcemia is a serious and common complication of malignancy. Etidronate, a known inhibitor of osteoclastic bone resorption, is approved in the therapy of hypercalcemia of malignancy (HCM) at a dose of 7.5 mg/kg/day infused during a period of 2-4 hours on 3 consecutive days. A multicenter study was conducted to evaluate the safety and efficacy of a single 24-hour infusion of etidronate disodium in patients with HCM.

METHODS

Selected patients with HCM had disease refractory to at least 24-hours of intravenous fluid (more than 3 l/day) with two albumin-adjusted serum calcium concentrations greater than 11.5 mg/dl drawn 24 hours apart before etidronate treatment. Thirty patients were enrolled; 13 received 25 mg/kg for 24 hours, 12 received 30 mg/kg for 24-hours, 3 received incorrect doses (2 overdoses, and 1 underdose) and 2 died of disease-related complications before day 7. Of the 25 evaluable patients, 15 were men and 10 were women. Median age was 53 years (range, 20-75 years). Twelve patients (6 in each treatment group) had confirmed skeletal metastases.

RESULTS

During the week after treatment, the 25 mg/kg group had adjusted serum calcium levels fall from a mean preinfusion baseline of 13.3 +/- 0.3 mg/dl (plus or minus the standard error of the mean) to a mean nadir of 10.9 +/- 0.4 mg/dl (the average of each patient's lowest calcium values). The 30 mg/kg group had adjusted serum calcium levels fall from a mean preinfusion baseline of 13.8 +/- 0.4 mg/dl to a mean nadir of 10.5 +/- 0.3 mg/dl. The average day that nadir occurred was day 5.7 for the 25 mg/kg group and day 5.6 for the 30 mg/kg group. The mean maximum reduction (delta) derived from the patients' nadirs in the 25 mg/kg dose group was 2.5 +/- 0.4 mg/dl and 3.3 +/- 0.3 mg/dl for the 30 mg/kg dose. Time to effect (either a partial response defined as a 15% or greater decrease in the adjusted serum calcium from the preinfusion value or a complete eucalcemic response defined as a reduction to the laboratory's eucalcemic range) occurred on average on day 4.6 in the 25 mg/kg group and day 3.7 in the 30 mg/kg group. Nine of the 13 (69%) patients in the 25 mg/kg treatment group had either partial or complete response to the 24-hour infusion. Five of these patients (38% of the 13 patients) of the 25 mg/kg group had serum calcium levels fall to their laboratory's eucalcemic range before day 7 (a complete response), 4 (31%) had partial response only, and 4 had no response. In the 30 mg/kg group, 11 of 12 (92%) patients had at least partial responses. Eight of the 12 (67%) patients had adjusted serum calcium concentrations fall to the eucalcemic range by day 7, 3 (25%) had a partial response, and 1 had no response. Reported adverse experiences generally were attributable to the underlying disease. The reduction in the serum calcium throughout the week for the 30 mg/kg dose group was significantly greater than that for the 25 mg/kg group (analysis of variance, P < 0.0001).

CONCLUSIONS

Etidronate, when administered intravenously at 30 mg/kg during a period of 24 hours, apparently was safe and effective in this study for treatment of hypercalcemia in patients with a wide variety of tumor types. This regimen may offer a more convenient method of administration than does standard etidronate therapy for the treatment of HCM.

Power spectral analysis of electroencephalographic desynchronization induced by cocaine in the rat

Whereas it is well-known that cocaine induces EEG desynchronization and behavioral excitation in animals and human subjects, the detailed effect of cocaine on EEG activity remains to be fully elucidated. This communication reports our attempts in quantifying the effect of cocaine on EEG signals recorded from the somatosensory cortex of adult male Sprague-Dawley rats under chloral hydrate anesthesia (400 mg/kg i.p.). Continuous, on-line and real-time power spectral analysis revealed that i.v. administration of two doses of cocaine (1.5 or 3.0 mg/kg) dose-dependently induced EEG desynchronization, as indicated by a decrease in the root mean square and an increase in the mean power frequency values. More interestingly, whereas both doses of cocaine promoted a reduction in the alpha (8-13 Hz), theta (4-8 Hz) and delta (1-4 Hz) spectral components, the beta band (13-32 Hz) underwent differential alterations. The lower dose of cocaine elicited a transient increase, followed by a decrease in the power of the beta band. A prolonged increase in the power of the beta band, on the other hand, was observed after the higher dose of cocaine. These results suggest that subtle changes in the individual EEG spectral components, which are dose-dependent, may underlie the EEG desynchronization induced by cocaine.

Neoplasms of the mediastinum, chest wall, and pleura

Although primary malignant diseases of the mediastinum, chest wall, and pleura are rare, the interest in investigational activity in mesothelioma and thymoma has increased because of new technologies such as magnetic resonance imaging, monoclonal antibody testing, thoracoscopy, and genetic engineering. Improvement in treatment outcome among patients with mesothelioma has been slow, due in part to the rarity of the disease and in part to resistance to treatment. Groupwide or intergroup studies are needed to assess the biology and treatment of these disorders. Advanced malignant thymoma has been shown to be sensitive to chemotherapy. Active studies to define the optimal treatment regimen continue.

Phase II study of echinomycin in the treatment of renal cell carcinoma ECOG study E2885

Seventeen patients were treated with echinomycin for metastatic renal cell carcinoma. Echinomycin is a bifunctional DNA intercalating agent with broad preclinical antitumor activity. It was given at 1200 mg/m2 by intravenous infusion over 30-60 min weekly for 4 weeks. The treatment was repeated every 6 weeks. There were no responses observed in the study. No life threatening or lethal toxicity was documented in 13 eligible patients. The median survival of these patients was 13.7 months. We conclude that echinomycin is not active against metastatic renal cell carcinoma at the dose and schedule tested.

Combined Betaseron R (recombinant human interferon beta) and radiation for inoperable non-small cell lung cancer

PURPOSE

Based on in vitro evidence of radiosensitization by Betaseron (beta-IFN), a Phase I/II study was undertaken to determine toxicity and response using combined radiation (RT) and B-IFN in patients with unresectable Stage III and nonsmall cell lung cancer.

METHODS AND MATERIALS

Varying doses of beta-IFN(10 to 90 x 10(6) IU) were administered IV immediately preceding RT on the first three days of weeks 1, 3, and 5. The RT dose was 1.8 Gy/day, 5 days/week for a total of 54 or 59.4 Gy.

RESULTS

Thirty-nine patients were entered, 32 of whom were evaluable. The median follow-up time at time of analysis was 60 months. Responses were based on CT scan. The response rate for the total group was 81% with 44% achieving complete response. Seventy-eight percent of patients with complete response survived a minimum of 21 months. Twenty-six patients had Stage III A/B disease with a median tumor size of 6.5 cm. and median survival was 19.7 months. The 5-year actuarial survival for this group was 31%, with a plateau persisting after 3 years. There were no treatment related deaths nor any event of life threatening toxicity. Of eight patients surviving 3-5 years, no long-term toxicity has been observed. Karnofsky indices were 90-100 and respiratory symptoms were minimal.

CONCLUSION

beta-IFN is well-tolerated. Response and survival rates are sufficiently encouraging to warrant further investigation in a randomized trial which has been accepted as an RTOG study awaiting drug availability.

Continuous wave dye-laser technique for simultaneous, spatially resolved measurements of temperature, pressure, and velocity of NO in an underexpanded free jet

Gas dynamic quantities within an underexpanded nitrogen free jet, seeded with 0.5% NO, were measured nonintrusively by using an intracavity-doubled, rapid-tuning, cw ring dye laser. The UV beam passed obliquely through the jet axis, and its frequency repetitively scanned across adjacent rotational lines in the NO gamma band near 225 nm at a rate of 4 kHz. Spatially resolved excitation scans were obtained by monitoring the induced broadband fluoresence. Modeling the Doppler-shifted excitation scans with Voigt profiles permitted simultaneous determinations of NO velocity, rotational temperature, and pressure. Zero Doppler shift was referenced to an absorption trace obtained across a static cell and recorded concurrently with the excitation scan. Typically, the measured and predicted axial distributions agreed within 10%. At high Mach numbers there was evidence of rotational freezing of NO.

Alternating chemotherapy and twice-daily thoracic radiotherapy in limited-stage small-cell lung cancer: a pilot study of the Eastern Cooperative Oncology Group

PURPOSE

This pilot study was undertaken to determine the efficacy and feasibility of alternating cisplatin and etoposide with multiple daily fractions of thoracic radiotherapy (TRT) in patients with limited-stage small-cell lung cancer (SCLC).

PATIENTS AND METHODS

Thirty-four SCLC patients received four courses of cisplatin (30 mg/m2/d x 3) plus etoposide (120 mg/m2/d x 3) (PE) every 3 weeks. TRT was administered twice daily (1.5 Gy per fraction) for 5 consecutive days in the week after cycles 1, 2, and 3 of chemotherapy (total TRT dose, 45 Gy). Patients who achieved a complete response (CR) received one course of late-intensification (LI) treatment consisting of cyclophosphamide (4 g/m2) and etoposide (900 mg/m2). Prophylactic cranial irradiation (PCI) was optional.

RESULTS

Nineteen of 32 assessable patients achieved a CR (59%) and 12 had a partial response (38%), for an overall response rate of 97% (95% confidence interval [CI], 84% to 99%). Median survival was 18 months, while 2-year progression-free survival was 47%. Leukopenia < or = 1,000/microL occurred in 12% of induction treatment cycles. Severe esophagitis was uncommon. Pulmonary fibrosis that was asymptomatic or minimally symptomatic was observed in eight patients (25%). There was one episode of adult respiratory distress syndrome (ARDS) during LI chemotherapy. Life-threatening neutropenia (< or = 500/microL) developed in all patients who underwent LI chemotherapy, with a median duration of 10 days (range, 8 to 19). Two patients died of sepsis during LI chemotherapy.

CONCLUSION

Alternating PE and TRT as performed in this trial is an effective brief induction regimen for limited-stage SCLC. However, this particular regimen did not appear to be substantially different in terms of efficacy or toxicity compared with regimens using concurrent chemotherapy and standard-fraction TRT. LI chemotherapy was associated with unacceptable toxicity and did not appear to have a favorable impact on survival.

Phase II study of taxol, merbarone, and piroxantrone in stage IV non-small-cell lung cancer: The Eastern Cooperative Oncology Group Results

BACKGROUND

Patients with metastatic (stage IV) non-small-cell lung cancer usually have a poor prognosis and disease refractory to chemotherapy. Three new agents--taxol, merbarone, and piroxantrone--have shown promising antitumor treatment in vitro and in animals. Taxol is an antimicrotubular agent that interferes with mitosis during cell division. Merbarone, a conjugate of thiobarbituric acid and aniline, is a topoisomerase II inhibitor, which thus inhibits DNA synthesis and tumor growth. Piroxantrone, an anthracenedione derivative, is a DNA intercalating agent that has shown potent antitumor activity in animal studies.

PURPOSE

Our randomized phase II study was designed to evaluate the efficacy and toxicity of these agents in the treatment of stage IV metastatic non-small-cell lung cancer.

METHODS

Eligible patients (119) were randomly assigned to receive one of the three treatments given every 3 weeks: 250 mg/m2 taxol by a 24-hour intravenous infusion, 1000 mg/m2 merbarone by continuous intravenous infusion through a central catheter daily for 5 days, or 150 mg/m2 piroxantrone by intravenous infusion over 1 hour. Patients had received no chemotherapy. Response and toxicity were evaluated every 3 weeks.

RESULTS

Twenty-five patients were randomly assigned to receive taxol, 47 to receive merbarone, and 47 to receive piroxantrone. One of 44 assessable patients (2.3%) treated with piroxantrone had a complete response. Rates for partial response were 20.8% (five of 24 patients) and 5.7% (two of 35) for assessable patients treated with taxol or merbarone, respectively. One-year survival rates were 41.7%, 21.6%, and 22.6%, and median survival times were 24.1, 19.9, and 29.3 weeks for taxol, merbarone, and piroxantrone, respectively. These differences were not statistically significant, but this study was not designed to compare survival. In general, toxicity was manageable. With premedication, no anaphylaxis was observed with taxol. The most common toxic effects were leukopenia with taxol or piroxantrone treatment and thromboembolic complications with merbarone. Death directly related to treatment occurred in 4% (one patient), 11.4% (four), and 5% (two) of the assessable patients receiving taxol, merbarone, and piroxantrone, respectively. Cardiotoxicity and neurotoxicity occurred only occasionally in all three arms.

CONCLUSION

On the basis of the response rate (20.8% partial response) and 1-year survival rate (41.7%), taxol is an active agent for the treatment of metastatic non-small-cell lung cancer. Merbarone and piroxantrone are relatively inactive.

IMPLICATIONS

Further study of taxol is warranted. In future studies, taxol should be combined with other agents, and granulocyte colony-stimulating factor should be used to ameliorate myelosuppression.

Pulmonary changes induced by combined mouse beta-interferon (rMuIFN-beta) and irradiation in normal mice--toxic versus protective effects

This study in normal mice was undertaken to investigate possible enhancement of pulmonary toxicity by interferon-beta (IFN-beta) combined with single doses of irradiation. A pharmacokinetic study preceded the toxicity study to determine the optimal route and timing of IFN administration. Graded single doses of radiation were combined with graded doses of IFN. Pulmonary toxicity was determined using endpoints of alveolar surfactant and procollagen in lung lavage fluid at 7 days, breathing frequency, lethality and histology. Increased lethality was seen when IFN was combined with irradiation at 12.5 Gy vs. irradiation alone. This occurred between 20 and 30 weeks post treatment with no increased breathing frequency or surfactant release, suggesting independent mechanisms of injury. Increased breathing frequency after 40 weeks, usually associated with fibrosis, was less pronounced for IFN treated vs. irradiation only controls. Ultrastructural studies at 72 weeks suggest reduced fibrosis in lungs of IFN treated vs. irradiation only controls. Supporting this was the finding that Procollagen III, a biosynthetic precursor of collagen, was increased in the lavage fluid at 7 days for all radiation doses but decreased with the addition of IFN at 12.5 and 15 Gy. Interferons can act either as sensitizers or radioprotectors, depending on the biological system and type of interferon. Our study suggests that while IFN-beta may increase the acute effects of radiation in the mouse lung, some protection from radiation-induced fibrosis, possibly related to alteration of immune mechanisms, may exist.

Rapid tuning cw laser technique for measurements of gas velocity, temperature, pressure, density, and mass flux using NO

An intracavity-doubled rapid-tuning cw ring dye laser was used to acquire fully resolved absorption profiles of NO line pairs in the A ? X band at 225 nm at a rate of 4 kHz. These profiles were utilized for simultaneous measurements of flow parameters in the high speed 1-D flows generated in a shock tube. Velocity was determined from the Doppler shift measured using a pair of profiles simultaneously acquired at different angles with respect to the flow direction. Temperature was determined from the intensity ratio of the adjacent lines. Pressure and density were found both from the collisional broadening and the fractional absorption. From this information the mass flux was determined. The results compare well to 1-D shock calculations.

Continuous wave laser absorption techniques for gasdynamic measurements in supersonic flows

Line-of-sight measurements of velocity, temperature, pressure, density, and mass flux were performed in a transient shock tube flow using three laser absorption schemes. All methods employed an intracavity-doubled ring dye laser tuned to an OH transition in the A(2) summation operator(+) ? X(2)II (0,0) band at 306 nm. In the first scheme, the gas was labeled by 193.3-nm excimer photolysis of H(2)O, and the passage of the generated OH was detected downstream. In the second method, the laser was tuned at a rate of 3 kH(z) over the R(1)(7) and R(1)(11) line pair, and absorption was simultaneously monitored at 90 and 60 degrees with respect to the flow. Velocity was determined from the Doppler shift of the profiles and the temperature from the intensity ratio of the lines. Pressure was determined from both the magnitude of absorption and the collisional broadening. In the third method, the laser wavelength was fixed at a single frequency, and a continuous measurement of velocity and pressure was obtained using the signals from the two beam paths. All methods gave results which compare favorably to calculated values.

Nasopharyngeal carcinoma in young patients

We have reviewed retrospectively the records of 157 patients, less than or equal to 30 years of age with nasopharyngeal carcinoma (NPC) from 218 such cases identified in the tumor registry files of three major teaching hospitals in Taipei, Taiwan. These cases were diagnosed between 1 January 1982 and 31 December 1985, with a minimum follow-up of 2 years. The average age was 25, with a male/female ratio of 1.67. The TNM (tumor size, nodes, metastases) classification of 127 patients showed T1, 22%; T2, 33.1%; T3, 23.6%; T4, 21.3%; N0, 26%; N1, 16.5%; N2, 27.6%; N3, 30%; and M1, 13.4%. Antibody titer to Epstein-Barr virus capsular antigen (EBVCA) were elevated in 45 of 48 patients tested. Of the 29 patients who had hepatitis B (HB) viral survey done 34.5% were positive for HB surface antigen (HBsAg). Of 13 patients with elevated EBVCA antibody who were also tested for HB, six were HBsAg carrier. Actuarial survival rates of 2 and 3 years are 70 and 62%, respectively, among the 90 patients who were followed regularly or to death. HBsAg carriers and patients with M1 disease had a shorter survival time. We concluded that patients less than 30 years of age seemed to have an increased incidence of NPC, compared to that in an earlier report. Our patients frequently presented with advanced stage and poor prognosis. The high rate of HB carrier raises the possibility that HBV may play a role in the carcinogenesis and tumor growth in some NPC patients. Future prospective studies are needed.

Simultaneous measurements of velocity, temperature, and pressure using rapid cw wavelength-modulation laser-induced fluorescence of OH

The beam from a rapid-tuning single-frequency laser was used to probe the R(1)(7) and R(1)(11) A(2)Sigma(+) ? X(2)II (0, 0) line pair of OH at a 45 degrees incident angle in a combustion-driven, supersonic free jet. Absorption line shapes were recorded in spatially resolved, single-point fluorescence. The Doppler shift, intensity ratio, and collisional broadening of the measured line pair were used to determine velocity, temperature, and pressure. The repetition rate of the measurement was 3 kHz.

Phase II trial of 6-diazo-5-oxo-L-norleucine versus aclacinomycin-A in advanced sarcomas and mesotheliomas

Ninety-eight patients with previously-treated advanced soft tissue sarcoma, bone sarcoma, or mesothelioma were randomly assigned to one of two intravenous single-agent treatment regimens, either 6-diazo-5-oxo-l-norleucine (DON; brief infusions of 50 mg/m2/day for 5 consecutive days every 4 weeks) or aclacinomycin-A (ACM-A, as 30-min infusions of 100 mg/m2 or 85 mg/m2, administered every 3 weeks). Of 43 patients who were evaluable for response, survival and toxicity, there were two responses (5%) produced by ACM-A; one in a male with mesothelioma, and one in a female with malignant fibrous histiocytoma. None of the 36 evaluable patients treated with DON developed an objective tumor response. Median survival was 4.8 months in the DON treatment arm, and 6.8 months in the ACM-A treatment arm. No patients on the DON arm experienced lethal or life-threatening toxicities, and severe toxicities resulting from this treatment included nausea and emesis (10%), stomatitis (2%), gastrointestinal toxicity (2%), and anemia (2%). Moderate toxicities included vomiting (24%), hematologic toxicity (24%), neurologic toxicity (7%), diarrhea (7%), mucositis (5%), fever (5%), palpitations (2%), hepatotoxicity (2%), bleeding (2%) and edema (2%). Fifteen percent experienced at least one severe reaction, and 63% experienced at least one moderate or greater toxicity. ACM-A was associated with four cases of life-threatening myelosuppression (7%); severe toxicities included myelosuppression (11%), neurologic toxicity (4%), diarrhea (2%), respiratory toxicity (2%), pain and muscle spasms (2%), edema (2%), and ulceration following extravasation (2%).(ABSTRACT TRUNCATED AT 250 WORDS)