Cis-platinum-diammino-dichloro (CPDD) in chemotherapy of cancers

"Decadose" effects of cisplatin on squamous cell carcinoma of the upper aerodigestive tract. II. Clinical studies

There is evidence that solid tumors rapidly acquire cellular resistance to cisplatin. This resistance is usually mild to moderate and could be circumvented with higher concentrations of drug exposure if ancillary methods were available to avoid systemic cytotoxicity. The purpose of this study was to determine whether a tenfold increase in dose (decadose) would overcome cisplatin resistance. In a clinical trial, response effects of cisplatin at dose intensities ranging from 32.5 to 200 mg/m2 per week, which were delivered by highly selective intra-arterial infusions with a simultaneously administered intravenous neutralizing agent, were measured in 31 patients with squamous cell carcinoma (SCC) of the upper aerodigestive tract (UADT). The overall response rate (complete response [CR] and partial response [PR] to cisplatin therapy at dose intensity intervals of 0 to 74, 75 to 149, and 150 to 200 mg/m2 per week were 45.5%, 72.7%, and 100%, respectively. The average received dose intensities for nonresponders and responders (CR and PR) were 57.8 and 120.7 mg/m2 per week, respectively (P = .031). The results indicate that resistance to standard doses of cisplatin by SCC of the UADT, both previously untreated and recurrent, can be substantially overcome with "decadose" cisplatin therapy. Progress toward improving survival of patients with head and neck cancer, and possibly other site-specific malignancies, may be achieved by incorporating decadose cisplatin therapy into a multimodality treatment plan.

High-dose cisplatin in disseminated melanoma: a comparison of two schedules

A total of 38 patients with metastatic melanoma received monthly chemotherapy with cisplatin at a dose of 200 mg/m2, per cycle; 14 received 20 mg/m2 cisplatin i.v. on days 1-5 and 24 were given 100 mg/m2 i.v. on days 1 and 8. Objective responses were seen in 2/14 treated on days 1-5 and in 5 of 22 evaluable subjects receiving cisplatin on days 1 and 8, for an overall response rate of 22%. The median survival of all patients was 6 months, with no significant difference observed between the two schedules. Severe neurotoxicity and myelosuppression were more common in patients treated on days 1-5. Two patients treated in this manner were bedridden due to neurotoxicity and four developed grade 4 leukopenia after the first cycle of chemotherapy. Only one patient treated with the divided-dose schedule became leukopenic during the first cycle, and none of the patients were debilitated by neurotoxicity. Thrombocytopenia was statistically more severe. Nausea and vomiting, fatigue, ototoxicity, and paresthesia were seen with equal frequency. Very high doses of cisplatin can be delivered with acceptable toxicity using a divided-dose schedule. As the response rate on this schedule appeared to be comparable with that achieved on the more toxic consecutive 5-day schedule, the former deserves to be tested in diseases known to show a dose response to cisplatin. However, in melanoma, administration of 200 mg/m2 per course did not appear to be associated with a markedly improved response rate, compared with cisplatin alone at "standard" doses.

Pharmacokinetics of intra-arterial and intravenous cisplatin in head and neck cancer patients

After administration of cisplatin (50 mg/m2 on days 1 and 2) by intra-arterial or intravenous infusions over 1 or 6 hr to a total of 24 patients with head and neck cancer, the main pharmacokinetic parameters of platinum were determined according to a multicompartmental analysis. Elimination half-life of total platinum is greater than 3 days, the amount of platinum recovered in the urine over 7 days accounting for 15-50% of the administered dose. The half-life of filterable platinum species was calculated from the urinary excretion data: 39 +/- 17 min (i.a./1 hr), 37 +/- 24 min (i.a./6 hr), 58 +/- 17 min (i.v./1 hr) and 51 +/- 22 min (i.v./6 hr). Biopsies of the tumor were also analyzed on day 3 for their platinum content. The mean concentrations of platinum in biopsies were: 2.72 micrograms/g (i.a./1 hr), 3.89 micrograms/g (i.a./6 hr), 1.27 micrograms/g (i.v./1 hr) and 1.38 micrograms/g (i.v./6 hr). Tumor regression, based upon clinical and histological data, was only moderate after this single chemotherapy course.

A phase II study of cis-diamminedichloroplatinum II for advanced breast cancer. Two dose schedules

Thirty-six (36) women with metastatic breast cancer refractory to conventional therapies were treated with cis-diamminedichloroplatinum II. Two dose schedules were used sequentially. The first 15 patients received platinum at a dose of 15 mg/m2 daily for 5 days at 28-day intervals. No response was noted in this group. Subsequently, 21 patients were treated with a dose of 100-120 mg/m2 at 28-day intervals, but with additional induced diuresis with saline, furosemide, and mannitol. Among 13 patients evaluable for response, 2 partial responses were observed.

Chemotherapy strategies in squamous cell carcinoma of the head and neck

Traditionally, chemotherapy has been utilized in the palliation of patients with recurrent or metastatic squamous cell carcinoma of the head and neck. The introduction of more effective agents has spawned many new multi-drug protocols as the initial therapy of patients with previously untreated advanced cancers (Stages III and IV). The combination of cis-platinum and other active agents given in two to three courses has produced overall response rates of 80 to 90% with clinically complete response rates of 20 to 54%. Many of the complete responders were histologically negative for cancer at the time of resection. The number of courses, stage (T and N), and tumor morphology influenced the complete response rate to combination chemotherapy. Responders to chemotherapy had statistically improved survival as compared to nonresponders. Response to chemotherapy was an excellent predictor for subsequent response to radiotherapy. Utilizing the same combination of chemotherapy, we improved the overall response rate in those patients with recurrent and systemic cancer. Although the median survival is still poor, there is improvement of survival at 25 percentile level. Some of the important factors that may influence the response rate and the survival of these patients are performance status, previous radiotherapy, and whether the recurrence is localized or systemic.

Effective chemotherapy for advanced carcinoma of the cervix with bleomycin, cisplatin, vincristine, and methotrexate

This study was designed as a Phase II clinical trial in advanced recurrent or metastatic squamous cell carcinoma of the cervix with a combination of bleomycin (B: 10 u/m2/d) and cisplatin (P: 20 mg/m2/d) administered for five consecutive days in intravenous infusion for 7 hours and vincristine (V: 1 mg/m2) and methotrexate (M: 40 mg/m2) administered only on day one of each cycle which was repeated every 28 days up to a maximum of 6 times. Over a period of 2 years, 15 evaluable patients with measurable disease received at least 3 courses of therapy. Six had recurrent disease and nine had distant metastases. All had previous radiation therapy. There were two dropouts after the first course due to nausea and vomiting which was practically universal. Other side effects included: mild paresthesias of the extremities (89%), stomatitis (41%), diarrhea (17%), moderate pancytopenia and hypomagnesemia which was reduced from 65% to 17% when magnesium sulfate 10% was administered with cisplatin. Sixty-six percent of the evaluable patients achieved remission (7 partial and 3 complete) usually before the fourth course of therapy. The disease-free interval was of 29.7 +/- 15 weeks in all responders (40.6 +/- 15.5 weeks in complete responders). The mean survival from the start of BPVM therapy was of 55.8 +/- 33.3 weeks in responders and of only 14 +/- 2.9 weeks in nonresponders (P less than 0.01). It is concluded that BPVM is an effective combination chemotherapy in advanced squamous cell carcinoma of the cervix. These results should be confirmed in a Phase III trial.

Role of chemotherapy in head and neck cancer: systemic use of single agents and combinations in advanced disease

Chemotherapy of head and neck cancer has recently been receiving increasing attention as a treatment modality. The basis for this interest has been the availability of at least three agents with reproducible antitumor activity: methotrexate, bleomycin, and cisplatinum (diamminedichloroplatinum). These agents alone or in combination have been demonstrated to be of palliative value in patients whose disease recurs or is too advanced for other therapeutic modalities. Although the multiple drug regimens used have not been curative, their relative effectiveness has raised hopes that, in combination with other modalities, they may lead to improvements in survival and in local control in earlier stages of disease. In addition, as a result of multimodality approaches, it is hoped that it may be possible to identify the role of chemotherapy and specific agents in the treatment of various sites of origin of these tumors. The interaction of chemotherapy and radiation--and the use of intraarterial chemotherapy--fall beyond the scope of this review but constitute another important aspect for investigation in the treatment of these malignancies.