Combination Chemotherapy with Cyclophosphamide, Adriamycin, Vincristine and Prednisone (CHOP) for Non-Hodgkin's Lymphomas with Unfavorable Histology: Preliminary Results

From January 1978 to June 1979, 29 selected, previously untreated patients with unfavorable histology of non-Hodgkin's lymphomas (12 DPDL, 7 DM, 9 DH and 1 DU) were submitted to the combination chemotherapy CHOP (cyclophosphamide, 750 mg/m2 i.v. on day 1; adriamycin, 50 mg/m2 i.v. on day 1; vincristine, 1.4 mg/m2 i.v. on day 1, and prednisone, 100 mg p.o. on day 1 through 5) every 21 days. Eighteen patients were in early stage (I or II) and 11 of them were also submitted to involved field radiotherapy (60Co), immediately before (stage I) or during (stage II) the chemotherapy, with a mean dosage of 4,500 rad. The remaining 11 patients were in advanced stage (III or IV) of disease and were treated with chemotherapy alone. We obtained 20 complete remissions (68%), 8 partial remissions (28 %) and 1 no response (4 %) to therapy. Sixteen of 18 patients (89 %) in early stages and 4 of 11 patients (36 %) in advanced stages achieved a complete remission. The bone marrow toxicity of the chemotherapy was moderate. Nausea, vomiting and diarrhea were frequent but well controlled by the support therapy. The actuarial survival rate of patients, after 18 months of follow-up, is 41 % (40 % in complete remission). The patients who achieved a complete remission are all alive and 65 % of them still relapse free. We believe that the combination chemotherapy CHOP improves the complete remission rate as well as the survival of patients with unfavorable histology of non-Hodgkin's lymphomas.

Follow-up with CA125 after primary therapy of advanced ovarian cancer: in favor of continuing to prescribe CA125 during follow-up

Serum cancer antigen 125 (CA125) is widely used in ovarian cancer to monitor the effectiveness of therapy both in first line and recurrence. It is also widely used during follow-up, where it is able to identify a percentage of patients with asymptomatic recurrence. Although a recent Medical Research Council (UK)/European Organisation for Research and Treatment of Cancer trial has demonstrated that early chemotherapy in asymptomatic patients based only on CA125 increase does not prolong survival, we still believe that CA125 monitoring should be prescribed to patients during follow-up. In fact, it can help to identify patients who should undergo radiology in order to select those that can benefit from surgery or from early treatment before the onset of symptoms, which are usually related to an excessive disease burden. The delay of disease symptoms, such as those associated with the appearance of ascites or bowel occlusion, is in our view an important goal of our treatment of recurrence. Moreover, research should be done in patients with asymptomatic CA125 increase in order to identify more effective therapies that will improve survival. Finally, the reliability of CA125 as a surrogate of response under treatment with biological agents should be validated in prospective trials.

Phase I clinical study on docetaxel/zoledronic acid combination administered in two different sequences in hormone refractory prostate cancer patients

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Background: Docetaxel (DTX) has been proposed in the treatment of hormone-refractory prostate carcinoma (HRPC) as single agent and the combination between DTX and prednisone and that one between DTX and estramustine has been reported to give a higher survival as compared with the combination between mitoxanthrone and estramustine. Zoledronic acid (ZOL) is an important therapeutic weapon in the treatment of the patients affected by advanced hormone refractory prostate cancer (HRPC). Our preliminary data on prostate cancer cells in vitro suggest that ZOL and DTX are synergistic on the growth inhibition of these cells and the synergism is sequence-dependent. Prostate cancer is, therefore, a suitable target for a pharmacological combination between DTX and ZOL. On the basis of these considerations, a phase I trial on the combination between ZOL and DTX was designed in the treatment of HRPC. Methods: Phase I study with a dose-escalation DTX in combination with a defined and fixed dose of ZOL (2 mg), both administered every 14 days. The following two different sequences of administration were, moreover, explored: Sequence A: DTX at the day 1 followed by ZOL at the day 2. Sequence B: ZOL at the day 1 followed by DTX at the day 2. The first dose level of DTX was 30 mg/m2 with a programmed dose escalation of 10 mg/m2 for each level until 50 mg/m2. Sear and PBMC were also collected prior and after the different treatments at each cycle. Results: Up to date the MTD was not achieved. We have reached the second level (40 mg/m2) without recording any treatment related toxicities. Interestingly one of the 2 sequences induced a less number of haematological side effects and absence of gastrointestinal effects. A different pattern of modulation of circulating angiogenic factors (interleukin 8 and 12, VEGF, PDGF), cytokines (TNF alpha, IFN gamma, interleukin-6 and 4) and gamma/delta T lymphocyte subpopulation is recording in the 2 sequences of administration. Conclusions: The study is still ongoing and further results will be presented at ASCO meeting.

No significant financial relationships to disclose.

Phase I study of ifosfamide plus high-dose epirubicin in advanced non-small-cell lung cancer

The present phase I study was designed to determine the maximum tolerated dose (MTD) of epirubicin given in combination with ifosfamide at a dose of 3 g/m2, recycled every 4 weeks, in patients with advanced non-small-cell lung cancer (NSCLC). A total of 18 patients entered the study; they received the following four dose levels of epirubicin (i.v., day 1): 75 (6 patients), 90 (3 patients), 105 (3 patients, and 120 mg/m2 (6 patients). The MTD of epirubicin was 120 mg/m2, neutropenia being the dose-limiting toxicity. We observed 1/6, 1/3 1/3, and 2/6 partial responses (PRs) at epirubicin dose levels of 75, 90, 104, and 120 mg/m2, respectively. A phase II study of epirubicin given at a dose of 120 mg/m2, in association with conventional-dose ifosfamide in advanced NSCLC is in order.

[Nasopharyngeal carcinoma: multidisciplinary treatment]

One hundred and twenty-eight cases of nasopharyngeal carcinoma treated at National Cancer Institute of Naples from 1980 to 1992 were retrospectively studied in order to evaluate the effectiveness of radio and chemotherapy. The histological types were the following: 75 cases of undifferentiated carcinoma, 49 cases of squamocellular carcinoma, 3 cases of lymphoma and 1 case of chordoma. Four cases were classified as Stage I (UICC 1977), 10 cases Stage II, 30 cases Stage III and 84 cases Stage IV. The patients were classified in four groups in relation to the treatment given: group A: 46 patients treated with radical radiotherapy alone; group B: 45 patients treated with radiotherapy and adjuvant chemotherapy (VCA); group C: 13 patients treated with neoadjuvant chemotherapy (CABO); group D: 24 patients treated with alternating radio-chemotherapy (CDDP-5FU) in the period between 1990-1992. The overall actuarial survival rate in all groups was 59% at three years and 52% at five years. There was a significative difference in survival actuarial rates between group A and B: the three-year survival rate was 54% in group A vs 46% in group B and the five-year survival rate was 43% vs 35%. In group D complete remission was obtained in 62.5% of the cases and partial remission in 25% of the cases. In conclusion the use of chemotherapy in combination with radiotherapy appeared to significantly increase the chance of long-term survival and probable healing.

[Bacterial infections in cancer patients without neutropenia. Comparison between 2 antibiotic combinations (aztreonam and oxacillin versus cefoxitin and tobramycin)]

In the treatment of infections arisen in neoplastic patients without neutropenia, 2 antibiotic combinations (aztreonam + oxacillin vs tobramycin + cefoxitin), have been compared with regard to therapeutic effectiveness and tolerability. Twenty patients (age: 30-75) have been studied. Tolerability of both combinations was excellent. Results of this study showed a lower percentage of superinfections and a higher percentage of cure in patients treated with the combination aztreonam + oxacillin, even if the data were not statistically significant.