[Histopathologic study on resected hepatocellular carcinoma after transcatheter hepatic arterial chemo-embolization]

21 cases of hepatocellular carcinoma (HCC) were surgically resected about 14 or 21 days after transcatheter hepatic arterial chemo-embolization (TACE) mostly for histopathologic assessment of effectiveness. Results showed that complete necrosis of all the tumor bulk was seen in one case (case no. 8) in this series. Partial necrosis of the tumor mass was demonstrated in 19 cases. In 6 cases, the necrotic area was over 50%. In 8 cases, it was between 25-49% and in 5 cases it was below 25%. This strongly indicates a certain effectiveness of TACE on HCC. However, the presence of viable residual tumor in 20 cases, including one with complete viability of the tumor (case no. 1), also suggested the necessity of surgical resection. The case of complete necrosis was related to the frequency of the catheter arriving at the tumor, to the types of embolizing drug, and to the morphopathologic features of the tumor.

Intra-Peritoneal Chemo-Hyperthermia (CHIP): a new therapy in the treatment of the peritoneal seedings. Preliminary report

After an experimental study in dogs, authors report a new therapeutic device for peritoneal seedings (Intra-Peritoneal Chemo-Hyperthermia) and their preliminary results in five patients. They observed no mortality and no morbidity with this protocol using Mitomycin as antimitotic and hyperthermia as sensibilisation agent. This new technique means important technological and time investment but preliminary results appear to be encouraging and authors intend to standardize the present apparatus in order to go on using this device and obtain more experience.

Acute erythroleukemia with t(3;5) accompanied by hepatocellular carcinoma

A female patient in whom acute nonlymphocytic leukemia (ANLL, FAB-M6) developed during treatment of hepatocellular carcinoma (HCC) is described. Two years after partial hepatectomy and subsequent chemotherapy, leukemia developed following a 2 month preleukemic stage. Chromosomal analysis revealed an abnormal karyotype, 46,XX,-5, + der(5)t(3;5)(q25;q31). The balanced translocation t(3;5) has been observed in all types of ANLL and MDS except for ANLL M3 subtype. We summarize patients with ANLL M6 and t(3;5).

5-Fluorouracil (FU) and mitomycin C (MMC) in the management of colorectal carcinoma. Part II. In vitro activity of the two drugs in short-term tumor cultures

Eighty-seven colorectal adenocarcinomas from untreated patients were investigated by short term tumor cultures to test in vitro sensitivity to 5-fluorouracil and mitomycin C. This study reports the preliminary results of a multistep program aimed at the prospective clinical application of the assay. At present this in vitro experience was performed in parallel with a clinical trial carried out with the same drugs. The in vitro activity of the two anticancer agents is in agreement with the response rate reported in monochemotherapy; our data would suggest an increase of responses using the combination of fluorouracil and mitomycin in comparison to single drug therapy. A low cosensitivity rate and a high number of cases sensitive to one drug but resistant to the other, account for the use of this test as screening of active drugs in the individual patient.

5-Fluorouracil (FU) with folinic acid (FA) and mitomycin C (MMC) in the adjuvant treatment of colorectal carcinoma. Part I. Evaluation of toxicity

Ninety-six patients with colorectal cancer (stage B2-C) were randomized to the control arm or to receive adjuvant chemotherapy with folinic acid, FU and MMC. Ninety-three patients are evaluable. The median follow up is 12 months. The average time between surgery and the start of therapy is 28 days. Toxicity is evaluable in 36 of 41 treated patients. Four patients (10%) failed to complete the projected treatment due to toxicity. Toxicity observed in 208 courses of therapy was mostly gastrointestinal and hematological. No cases of treatment related death or cancer-associated hemolytic uremic syndrome (C-HUS) were reported. The average relative dose intensity (rDI) of the projected treatment was 82.6%. Our study is ongoing and further patients are required to achieve statistically significant results.

Effects of primary chemotherapy in conservative treatment of breast cancer patients with operable tumors larger than 3 cm. Results of a randomized trial in a single centre

272 women with operable breast adenocarcinomas larger than 3 cm were included in a randomized trial. The patients in group A (n = 138) with histological nodal involvement (N+) or a lack of estrogen and progesterone receptors (EPR-) were treated by initial mastectomy and axillary node dissection + adjuvant chemotherapy. Those in group B (n = 134) were treated by initial chemotherapy (the same as in group A) followed by loco-regional treatment, adjusted according to their response to chemotherapy. Prognostic factors were identical in the two groups. In group A, 32 patients received no adjuvant treatment (N- and EPR+), while 104 were given adjuvant chemotherapy (N+ and/or EPR-). Two patients were lost to follow-up. In group B, all patients received initial chemotherapy; 44 were in complete clinical remission and were treated with radiotherapy only; 40 with residual tumor (less than 20 mm) were treated with tumorectomy + axillary node dissection + radiotherapy; 49 with residual tumors (greater than 20 mm) had mastectomies. Conservative treatment was administered to 84 patients in group B (62.6%). EPR-tumors responded better to chemotherapy than did EPR+ ones (p = .003). After a median follow-up of 34 months, isolated local recurrences were more frequent in the group with initial chemotherapy, which, however, experienced a better overall survival (p = 0.04).

Hepatic arterial infusion chemotherapy with complete hepatic venous isolation and extracorporeal chemofiltration: a feasibility study of a novel system

When chemotherapeutic drugs with low liver extraction are used for hepatic arterial infusion (HAI), dosage limits are usually determined by systemic rather than hepatic toxicity. If such agents could be administered by HAI at dosages limited by hepatic toxicity, regional drug exposure and therapeutic efficacy might be significantly enhanced. We report herein a novel system that achieves complete hepatic venous isolation using a dual-balloon vena cava catheter that can be inserted percutaneously. This catheter is connected to a carbon filter in an extracorporeal venous bypass circuit to recover drug that is not absorbed by the liver after HAI. The hemodynamic response to this system was evaluated in six pigs. When the animals were placed on the extracorporeal circuit, we observed a 22% decrease in cardiac output that was well tolerated without significant change in blood pressure. When the filter was incorporated into the circuit, cardiac output was significantly reduced (50%); however, continuous infusion of phenylephrine rapidly normalized blood pressure, heart rate, cardiac output, and left ventricular filling pressures. Initial testing of chemofiltration efficacy was performed in four of the six animals, the remaining two animals being used only to assess hemodynamic response. One each of the four tested animals received either doxorubicin (3 or 9 mg/kg), mitomycin C (1 mg/kg), or cisplatin (1 mg/kg) by HAI. The filter removed over 90% of hepatic venous doxorubicin and mitomycin C and 65% of hepatic venous cisplatin. This feasibility study confirms that hepatic venous isolation with chemofiltration can significantly reduce systemic exposure to high-dose chemotherapeutic agents given by HAI.

[An experimental study on hepatic arterial embolization with 131I-MMC-GM]

We designed a new gelatin microsphere (GM, 65 micron in diameter), which could combine with mitomycin C and 131I. The test in vitro showed that the GM had excellent drug release effect. Hepatic arterial embolization was carried out in 6 dogs with 131I-MMC-GM. The dogs survived from 4 to 28 days before being killed. Scintigraphy indicated that high radioactivity was concentrated in the liver, but was very low in the blood and thyroid. Pathologic study found that the GM was trapped in hepatic arterioles. The GM was eliminated by foreign body giant cells and the lumen of arterioles was occupied by granulations 14-28 days after operation. 131I-MMC-GM is a multiple anticancer agent which can exert triple action of targeting chemotherapy, internal radiotherapy and arterial embolization.

Intravesical chemotherapy (mitomycin C) versus immunotherapy (bacillus Calmette-Guérin) in superficial bladder cancer

Both intravesical mitomycin C (MMC) and bacillus Calmette-Guérin (BCG; Pasteur strain F) were effective in the present prospective randomized multicenter study consisting of 91 patients with frequently recurrent superficial (Ta-T1) bladder cancer. The result was in favour of BCG, as shown by the measurements with complete response (CR), disease-free interval and recurrence rate. CR of 58% with MMC and 40% with BCG were reached in 22 instillation series on carcinoma in situ of 18 patients. Due to side effects, MMC instillations were discontinued in 8.6%, and BCG instillations in 19.6%, respectively. After the 2-year follow-up also 1 case of pulmonary tuberculosis occurred in the BCG group.

Combined intravesical chemotherapy with mitomycin C and local bladder microwave-induced hyperthermia as a preoperative therapy for superficial bladder tumors. A preliminary clinical study

Twelve patients suffering from superficial transitional cell carcinoma of the bladder underwent treatment combining simultaneous mitomycin C topical instillation and local endocavitary hyperthermia as a preoperative adjunct to transurethral resection in a preliminary clinical study. A specifically designed system to deliver and monitor local bladder hyperthermia was used. The feasibility, the subjective tolerance and the side effects of the combined treatment were the main target of our investigation. Endoscopic and histologic features, assessed before, during and after this combined approach, showed selective damage to neoplastic areas with minimal changes in the normal urothelium. Local intravesical concurrent chemotherapy and hyperthermia administration is found to be a safe and well-tolerated approach for superficial bladder tumor treatment. The preliminary results encourage further studies to define the limits and prospects of this regimen, in both superficial bladder tumor ablation and prophylaxis of recurrences.

Evaluation of two consecutive regimens in advanced gastric cancer

Treatment of gastric cancer still presents a challenge in cancer chemotherapy. In our Institute, from January 1981 to November 1984, 45 patients were given 5-fluorouracil (5FU) 600 mg/m2 Days 1, 8, 29, and 36; doxorubicin (A) 30 mg/m2 Days 1 and 29; mitomycin-C 10 mg/m2 Day 1 (FAM regimen) every 8 weeks. From December 1984 to October 1986, 26 patients were treated with 5FU 300 mg/m2 on Days 1-5, A 40 mg/m2 on Day 1, cisplatin (P) 100 mg/m2 on Day 1 (FAP regimen) every 3 weeks. In the FAM group, 42 patients are evaluable for response; 5 (12%) partial remission (PR), 9 stable disease (SD), and 28 progressions (PRO) were observed. Median duration of response (MDR) was 21 weeks (range 13-45) and the median survival (MS) in the whole group was 27 weeks. In the FAP group, 23 patients are evaluable: 2 CR (9%), 11 PR (47%), 2 SD (9%), and 8 PRO (34%) were observed; CR duration was 24 and 107+ weeks, respectively, MDR of PR was 22 weeks (5-35). The MS of all patients was 16 weeks. Toxicity (WHO criteria) was mild in the FAM group and severe in the FAP group. In spite of a higher objective response rate, the short MS and the severe toxicity observed in the FAP group do not merit recommendation of this regimen in patients with gastric cancer; therefore neither FAM nor FAP appear to be an ideal standard therapy.

BOMM regimen for the treatment of advanced head and neck carcinoma

Eighty patients with Stage III and IV head and neck cancer were treated with a four-drug regimen consisting of bleomycin, vincristine, methotrexate, and mitomycin-C (BOMM regimen). Of 69 patients evaluable for response, 7 complete and 40 partial responses were achieved, with an overall response rate of 68%. The median duration of response was 13 weeks (range 3-41 weeks). Anorexia, lassitude, febrile reactions, and myelosuppression were major side effects. The BOMM regimen produced a response rate significantly better than VCR, BLM, and MTx combination (VBM) which we previously reported with improved response duration. This study demonstrates that the BOMM regimen, which can be administered on an outpatient basis, achieved a response rate comparable to cisplatin-containing regimens. The BOMM regimen may be beneficial to patients with poor general condition and/or marginal renal dysfunction who are in high risk of toxicity-associated cisplatin-containing regimens.

Portal vein obstruction complicating intra-arterial chemo-infusion for hepatic metastases

In three patients with colon cancer and liver metastases who had received intra-arterial chemo-infusion of fluorouracil (5FU) and mitomycin C and/or cis-diamminedichloroplatinum (CDDP), intrahepatic portal vein thrombosis (PVT) was incidentally demonstrated by computerized tomography (CT) 6, 1 and 7 months respectively after the cessation of administration of anti-cancer agents. One patient developed complete PVT in the whole liver as shown by follow-up CT 6 months after a diagnosis of pre-existing sclerosing cholangitis, and died from rupture of oesophageal varices. In the remaining two patients, PVT was found incidentally by follow-up CT in the right portal vein (Case 2) and the right anterior portal vein (Case 3) respectively; it spontaneously recanalized in Case 2 and was still present in Case 3 2 months later. PVT seems to be one of the complications of hepatic arterial chemo-infusion and its possibility must be borne in mind in such patients, even though the exact interval between the arterial chemo-infusion and occurrence of PVT could not be determined.

Clinical evaluation of chemotherapy under angiotensin II-induced hypertension in patients with advanced cancer

The clinical efficacy and indications for Angiotensin II (AT II)-induced hypertension chemotherapy were evaluated as a drug delivery system in 101 patients with advanced carcinoma. The sites of primary tumor studied included stomach (44), pancreas (18), colon (16), esophagus (6), bile duct (4), liver (3), breast (7) and 3 other single organs. Seventy four cases had distant metastases (lymph node (25), liver (29), peritoneum (16), and lung (4)). Additionally, the protocol was used 12 cases as postoperative adjuvant chemotherapy and 15 cases following exploratory laparotomy. The blood pressure was elevated to a level 1.5 times base-line. The regimens used consisted of MMC + ADR (55), FAM (38) and CDDP (8). The dosages administered were MMC 7 mg/m2, ADR 14 mg/m2 and 5-FU 350 mg/m2. The cancer chemotherapy protocol with AT II was repeated for an average of 2.6 cycles with a 2-3 week interval. The drug concentration in tumor tissues was increased 1.7 fold by AT II treatment. The response rate was 15.8% (CR 7 and PR 9), and in those patients with lymph node, liver and peritoneal metastases was 48.0, 6.9 and 6.3%, respectively. The serum levels of tumor markers decreased in 9 patients. Subjective symptoms, such as hoarseness, edema and pain, were improved. The mean survival in patients with distant metastasis who responded was 343 days, and in nonresponders was only 168 days (p less than 0.05). The side effects of this therapy were slight, typically being grade 1 and 2. Thus, the chemotherapeutic agents studied in conjunction with AT II were effective in patients with lymph node metastasis. Additionally, this regimen could be performed safely with minimal side effects.

Antitumor effect of KW2149, a new mitomycin derivative, administered by different modalities

The effectiveness of a new mitomycin derivative, KW2149, against human tumors was evaluated by the 4 days subrenal capsule assay (SRCA) and the nude mice screening assay (NMSA). Evaluation by the SRCA showed a 50% response rate at a maximum dose of 3.8 mg/kg for 3 consecutive days. When evaluated by NMSA, the response rate was 100, 75 and 25% after the intermittent administration of 7.5, 5.6 and 4.5 mg/kg (q4dx3) respectively. Although the efficacy was reduced when mice were administered a single dose equivalent to the intermittent one, the new analog was along more effective than MMC administered by either modality.

Combination therapy with mitomycin C (NSC-26980), 5-fluorouracil (NSC-19893), and cytosine arabinoside (NSC-63878) for advanced cancer in man

The combination of mitomycin C, 5-fluorouracil, and cytosine arabinoside (MFC), which had a marked synergistic effect in the treatment of L1210 mouse leukemia, was used clinically against advanced cancer. Response was assessed according to criteria proposed by Karnofsky. Of 90 patients with various kinds of solid tumors, 17 (19%) had I-B responses and 20 (22%) had I-A responses. Either I-A or I-B responses were observed in 15 (55%) of 27 patients with cancer of the stomach and in nine (60%) of 15 patients with cancer of the colon, indicating that the MFC combination is especially effective against gastrointestinal adenocarcinoma. Bone marrow suppression and gastrointestinal toxicity were observed; however, if the MFC therapy is carried out carefully with adequate intervals between treatments and periodic blood tests, it can be expected to be a safe and useful treatment that is superior to other chemotherapy especially for gastrointestinal cancers.