Acute leukemia following cisplatin-based chemotherapy in a patient with ovarian cancer

[Special issues related to the treatment of acute leukemias in women]

The treatment of acute leukemia is usually similar in women and men. The outcome is also generally the same. However, diagnosis in women poses additional challenges in clinical practice such as leukemia following breast or ovarian cancers, prevention of abnormal uterine bleeding in premenopausal females, treatment during pregnancy related-problems in long-term survivors. All these special issues are addressed in this review of the literature.

Therapy-related acute myelogenous leukemia with an 11q23/MLL translocation following adjuvant cisplatin and vinorelbine for non-small-cell lung cancer

Cisplatin-based chemotherapy has become an accepted standard in the adjuvant treatment of non-small-cell lung cancer (NSCLC). We present a case of acute myelogenous leukemia with an 11q23/MLL rearrangement diagnosed 1 year after the completion of 4 cycles of cisplatin and vinorelbine for resected NSCLC. To our knowledge, this is the first case of therapy-related acute myelogenous leukemia (t-AML) associated with this chemotherapy combination. The literature on t-AML with the 11q23/MLL rearrangement is reviewed.

Recurrent ovarian cancer metastatic to the sternum, costae, and thoracic wall after prolonged treatment with platinum-based chemotherapy: a case report and review of the literature

Sternal and costal metastases from ovarian cancer are extremely rare. We present here a case of a 47-year-old woman with thoracic wall metastasis from serous-papillary ovarian carcinoma that occurred 3 years after the initial diagnosis, although the patient had received various regimens of intense platinum-based chemotherapy. Special emphasis is given to the effects of alkylating agents, such as cisplatin and carboplatin, on the pattern of tumor spread. We also discuss the possible mechanisms through which the biologic and metastatic behavior of this tumor is expressed.

Toxicities of the platinum antineoplastic agents

The platinum agents (cisplatin, carboplatin and oxaliplatin) are among the most useful anticancer agents available to oncologists. The drugs have the potential to produce both mild and more serious side effects. However, in general, the platinum agents can be delivered with acceptable toxicity, even when used in combination chemotherapy regimens. Furthermore, with appropriate dose modifications, the large majority of patients who may benefit from this class of cytotoxic pharmaceutical drugs will be able to complete a planned therapeutic programme.

Analysis of autopsy evaluations of ovarian cancer patients treated at the National Cancer Institute, 1972-1988

Between 1972 and 1988, more than 500 women were treated for ovarian cancer at the National Cancer Institute in Bethesda, Maryland on approved experimental treatment protocols. Of these, 73 underwent autopsy evaluation on the National Cancer Institute campus. We have analyzed the autopsy reports of those individuals to determine the patterns of disease spread at death. By comparison with the literature, the demographics of the cohort did not differ from previously published reports, other than the extent of chemotherapy received antemortem. Median survival of the cohort was 15.6 months (range, 1.7-108.3 months), and median age at diagnosis was 55 years (range, 24-74 years). The median number of treatments regimens received was two (range, 1-6). The pattern of disease spread at autopsy was different from that in previously published work in that there was a higher proportion of patients with disease found in liver parenchyma, lung pleura, and the pericardium. Patients who received cisplatin as part of their initial treatment regimen had a higher incidence of metastases to the adrenal glands, thoracic nodes, bladder, and liver parenchyma, which was not explained by differences in survival. Median survival for patients who received cisplatin as part of their initial therapy was 15.6 months, compared with a median of 15.4 months for patients who did not. These data suggest a changing pattern of disease spread in patients with ovarian cancer receiving aggressive chemotherapy. This may be caused by some effect of platinum-based therapy on the metastatic potential of the tumor.

Analysis of the Harvey ras gene in cisplatin-initiated mouse skin tumors by polymerase chain reaction and direct DNA sequencing

Cisplatin (cis-dichlorodiammineplatinum (II)) acts as a tumor initiator in the mouse skin model of carcinogenesis. DNA transfection studies suggested that skin tumors initiated by cisplatin contained dominant transforming activity. Since the Harvey-ras (H-ras) gene is known to be activated by point mutations in chemically initiated mouse skin tumors, we used polymerase chain reaction (PCR) and direct DNA sequencing to analyze the DNA sequence of the H-ras gene in twelve different cisplatin-initiated skin tumors. The results of these studies indicated that cisplatin-initiated skin tumors were normal (wild-type) at codons 12, 13, 61 and 117. Thus the transforming activity associated with cisplatin initiated mouse skin tumors was not due to a mutant H-ras gene and this suggests the involvement of other transforming genes during initiation of the mouse skin with cisplatin.