The Journal of infusional chemotherapy最新文献

{"title":"Weekly infusional 5-fluorouracil plus/minus other drugs for the treatment of advanced gastric cancer.","authors":"H Wilke,&nbsp;M Korn,&nbsp;U Vanhöfer,&nbsp;U Fink,&nbsp;M Stahl,&nbsp;P Preusser,&nbsp;C Köhne,&nbsp;U Klassen,&nbsp;A Harstrick,&nbsp;H J Schmoll,&nbsp;S Seeber","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Based on preclinical data and the promising results being achieved with infusional 5-FU in colorectal and breast cancer, we investigated a weekly schedule of a 24-hour infusion of 5-FU plus folinic acid (HD-FU/FA) in patients failing to first-line chemotherapy and HD-FU/FA plus cisplatin (C) or plus cisplatin/epidoxorubicin (C/E) in chemo-naive patients with advanced gastric cancer. In all three trials the results achieved with the tested chemotherapy regimens indicated high activity and good tolerability. All three protocols were administered as outpatient treatment. With HD-FU/FA and overall response rate of 24% and a median survival time of 5 months was observed in 17 patients refractory to or relapsing after first-line chemotherapy. HD-FU/FA/C induced an overall response rate of 66% and a median survival time of 13 months. Of note was the high activity of this regimen in patients with malignant ascites. HD-FU/FA/C/E also proved to be an interesting regimen similar active as HD-FU/FA/C but it was subjectively less well tolerated. In patients with locally advanced disease the response rate was 90% (10/11), and in patients with distant metastases 50% (8/16).</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 3","pages":"123-6"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20172277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weekly high-dose infusional 5-fluorouracil (HD-5-FU) combinations in the treatment of advanced breast cancer: results of phase I/II studies with weekly 24-hour infusion of HD-5-FU plus high-dose folinic acid (FA) alone and in combination with paclitaxel and cisplatin.","authors":"U Klaassen,&nbsp;H Wilke,&nbsp;S Seeber","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Unlabelled: </strong>Our Phase II study results demonstrating high efficacy and low toxicity for a weekly schedule of high-dose 5-fluorouracil/folinic acid (HD5-FU/FA) in intensively pretreated metastatic breast cancer prompted addition of paclitaxel to this regimen in a phase I/II study in outpatients.</p><p><strong>Treatment: </strong>Patients were treated with HD5-FU (24-hour infusion)/FA (2h infusion prior to FU) weekly for 6 weeks (d1, 8, 15, 22, 29, 36) and Paclitaxel (3-hour infusion) was administered additionally on day 1 and day 22, q day 50. During Phase I we chose the following dose levels (dl): Fixed doses of FA d11-4 500 mg/m2 followed by HDFU, 24-hour infusion d11: 1.5, d12: 1.8, d13 and d14: 2.0 g/m2. .3-hour infusion of Paclitaxel on day 1 and day 22 d11 to d13: 135. d14: 175 mg/m2. D14 was chosen to be further evaluated during phase II. Results of an interim analysis were presented.</p><p><strong>Patient characteristics: </strong>46 patients entered this trial during phase II and had the following characteristics: age 46 years (26 to 70) WHO performance status 0/1, metastatic disease sites 2.5(1 to 4). All patients had bidimensionally measurable disease. PRETREATMENT: 9 patients had received adjuvant chemotherapy, 16 patients prior chemotherapy for metastasis, and 21 both adjuvantly and for metastasis. Of 29 anthracycline-pretreated patients, 25 had anthracycline-resistant disease.</p><p><strong>Results: </strong>We observed the following results in 35 evaluable patients: CR 3% (1/35), PR 51% (18/35), SD 40% (14/35). PD 6% (2/35). RR (Response rate) was 54%, 95% confidence interval 36 to 76%. The response concerning 20 patients with anthracycline resistant disease was: RR 55% (11/20). Median number of treatment cycles per patient was 3 (1 to 5), time to maximum response 2 months (1 to 5), remission duration 8+ months (2 to 17). Median survival time is not yet reached.</p><p><strong>Conclusions: </strong>The combination of paclitaxel with weekly HDFU/FA is well tolerated in the second-line treatment of metastatic breast cancer and indicates high efficacy also in anthracycline-resistant disease. In an ongoing phase II study, we examine the addition of cisplatin to the regimen in the first-line treatment of metastatic breast cancer. Those trials confirm that infusional weekly HD-5-FU plus folinic acid is of considerable interest in the treatment of advanced breast cancer. Randomized studies are warranted.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 3","pages":"127-32"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20172278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hematopoietic rescue with peripheral blood stem cells: promising strategies in cancer therapy.","authors":"T R Spitzer","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 1","pages":"2-3"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19720610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stem cell transplantation with chemoradiotherapy myeloablation and interleukin-2.","authors":"K R Meehan,&nbsp;U N Verma,&nbsp;C Rajogopal,&nbsp;R Cahill,&nbsp;S Frankel,&nbsp;A Mazumder","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Interleukin 2 (IL-2) stimulates the proliferation of T-cells both in vitro and in vivo. When murine or human peripheral blood (PB) or bone marrow (BM) mononuclear cells are incubated with IL-2 in vitro for 24 hours, cytotoxic T-cells are generated. If these activated cells are infused into mice, the enhanced cytotoxicity continues if low dose IL-2 is administered. This combination of administering activated cells with the subsequent low dose IL-2 infusion results in enhanced tumor cell destruction and improved survival rates in mice with acute myeloid leukemia. The encouraging results of these laboratory experiments prompted the initiation of phase I clinical trials in patients with refractory/relapsed hematologic malignancies and patients with breast cancer (Stages II-IV). Results from these trials demonstrate that stem cell transplantation with IL-2 activated stem cells (either PB or BM) with or without parenteral administration of IL-2 results in hematopoietic reconstitution with mild-to-moderate toxicities. This regimen also generates cutaneous and visceral autologous graft versus host disease (AuGVHD). The majority of our patients with relapsed/refractory hematologic malignancies or breast cancer developed either clinical and/or histological evidence of AuGVHD. Further studies are being conducted to determine if patients who develop AuGVHD experience improved disease-free survival from a possible autologous graft versus tumor (GVT) effect. Current laboratory evaluations include the elucidation of the pathogenesis of AuGVHD and molecular evaluation of the purging efficacy of IL-2.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 1","pages":"28-32"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19721670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot study of ambulatory infusional delivery of a multidrug regimen: ifosfamide, carboplatin and etoposide (ICE).","authors":"J Lokich,&nbsp;N Anderson,&nbsp;C Moore,&nbsp;M Bern,&nbsp;F Coco,&nbsp;E Dow","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the feasibility for administering ICE (ifosfamide, carboplatin, and etoposide) using an ambulatory infusional schedule for each of the three agents in a design that sequentially alternates those agents that are not compatible as an admixture.</p><p><strong>Patients and methods: </strong>Forty-one patients received ICE administered as follows: ifosfamide (500 mg/M2/day) without mesna days 1 to 7 and 14 to 21; carboplatin (30 or 40 mg/M2/day) and etoposide (30 to 40 mg/M2/day) admixed as a single solution infused day 7 to 14. Patients were monitored weekly and cycles repeated at five-week intervals.</p><p><strong>Results: </strong>Seventy-nine courses of therapy were analyzed. Forty-one patients received a median of two cycles with a range of one to five cycles. The only significant toxicity was hematologic with 11 patients experiencing grade III neutropenia and 7 patients grade III thrombocytopenia (18%). Eleven patients did develop significant anemia requiring transfusion and/or the use of erythropoietin. Tumor responses were observed in 7 of 24 evaluable patients, 4 of whom had lung cancer, 2 with small cell with no prior therapy and 2 with nonsmall cell with prior chemotherapy.</p><p><strong>Conclusion: </strong>Ambulatory infusion of ICE using an alternating sequence is feasible, and although the dose per cycle of carboplatin and etoposide is less than that of conventional bolus schedules for either single agent or combination programs, the ability to deliver this combination of agents in an ambulatory setting and without mesna substantially reduces the cost. Phase II studies of ambulatory infusion ICE in nonsmall cell lung cancer, lymphoma, and sarcoma are a reasonable next step.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 1","pages":"39-42"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19721672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intermittent continuous infusion of 5-fluorouracil in combination with epirubicin and cisplatin in advanced gastric cancer: the importance of dose intensity.","authors":"R L Poorter,&nbsp;P J Bakker,&nbsp;P Fockens,&nbsp;C W Taat,&nbsp;J F Bartelsman,&nbsp;C H Veenhof","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Recently, high response rates have been reported in patients with advanced gastric cancer with a schedule of epirubicin, cisplatin, and protracted infusion of 5-fluorouracil (5-FU). We modified this schedule based on the assumption that shorter treatment intervals are more convenient for patients and that cytokinetically based data showed that most gastric cancers have a relatively short potential doubling time of of less than 14 days.</p><p><strong>Patients and methods: </strong>Fourteen patients with advanced gastric adenocarcinoma with progressive, measurable disease entered the study. Patients were treated from days 1 to 14 with 5-FU 200 mg/m2 per day as a continuous infusion using a portable infusion pump. Epirubicin 50 mg/m2 and cisplatin 60 mg/m2 were administered on day 1. Courses were repeated every 4 weeks.</p><p><strong>Results: </strong>No responses were observed (response rate 0% [95% CI 0-23%]). Toxicity was mild. Grade 3 toxicity occurred in only 2 patients (14%). The median progression free survival was 3.5 months (range 2 to 17). The median survival was 6.5 months (range 2 to 31+).</p><p><strong>Conclusions: </strong>The unexpected results of this study are most likely due to a diminished dose intensity. When comparing the results of several schedules with epirubicin, cisplatin, and 5-FU, it seems that the dose intensity for all three drugs may be important, but especially for 5-FU.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 2","pages":"87-91"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19778619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-dose infusional 5-fluorouracil combination therapy of metastatic gastric and colorectal cancer.","authors":"T M Loeffler,&nbsp;T U Hausamen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>To improve the therapeutic ratio of palliative chemotherapy in patients with metastatic colorectal and gastric cancer 5-fluorouracil (5-FU) was administered as weekly high-dose 24-hour continuous infusion in combination with leucovorin (LV) and interferon-alpha-2b (IFN) as biomodulating agents: Chemotherapy consisted of a weekly schedule of 500 mg/m2 leucovorin as a 2-hour infusion, followed by a 24-hour continuous infusion of 2500 mg/m2 5-FU. IFN was administered subcutaneously at a dose of 3 mio I.E. three times a week. In patients with gastric carcinoma, etoposide (VP) 100 mg/m2 as 30-minute bolus infusion was added. Eighty-five patients (colorectal: 55 points, gastric: 30 points) are evaluable for response, toxicity, and survival analysis. Colorectal: CP+PR: 19/55 (34.5%), NC: 25/55 (45.5%), PD: 11/55 (20.0%). Median duration of remission in months (90% confidence interval): 5.2 (3.1 to 9.2), median survival since the start of salvage chemotherapy: 13.9 months (12.3 to 20.1), from initial diagnosis of metastasis: 30.2 months (26.3 to 44.5). Gastric: CR: 8/30 (26.7%), PR: 14/30 (46.6), NC: 5/30 (16.7), PD: 3/30 (10.0%). Median duration of remission in months (90% confidence interval): 6.75 (1.5 to 16.2), median survival since start of chemotherapy: 15.1 months (90% confidence interval 11.8 to 20.3 months). Hematologic toxicity: hemoglobin: I: 20.0%, II: 10.0%, leukocytes: I: 13.3%, II: 33.3%, III: 16.6%, platelets: I: 10.0% and III: 3.3%. Hematologic toxicity was moderate to negligible, peripheral toxicity consisted mainly of tolerable stomatitis and diarrhea. Dose and schedule intensified weekly 5-FU combination therapy in metastatic colorectal and gastric cancer is highly active in terms of response and median survival time. Chemotherapy pretreated patients with colorectal cancer seem to have a substantial survival benefit with this salvage protocol.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 3","pages":"137-40"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20172128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The dead end of 5-fluorouracil double modulation and promise of continuous infusion schedules in the treatment of metastatic colorectal cancer.","authors":"C H Köhne,&nbsp;H Wilke,&nbsp;P Schöffski,&nbsp;H J Schmoll","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 4","pages":"206-10"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20172272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The EORTC GI group experience with high-dose infusional 5-FU in colorectal cancer.","authors":"G H Blijham","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The EORTC Gastrointestinal Tract Cancer Cooperative Group has conducted a randomized trial of high-dose infusional 5-fluorouracil (FU) with or without Methotrexate (MTX). FU was given as a 48-horus infusion of 60 mg/kg every week x 4, biweekly x 4, and subsequently every 3 weeks. Half of the patients also received 40 mg/m2 MTX as a bolus injection just prior to the FU infusion. A total of 312 patients were randomized. High-dose infusional FU was very well tolerated with virtually no haematological, renal, hepatic or cutaneous toxicity. Nausea and vomiting occurred in 35% and diarrhea in 24% of patients but was almost never severe. Cardiac toxicity and ataxia were seen in less than 5% of patients. Methotrexate lead to a significantly higher incidence of stomatitis, which was severe in 10% of patients. Eleven percent of the high-dose infusional FU patients showed an objective response with stabilization in an additional 35%; median survival was 9.3 months. With the addition of methotrexate a 23% response rate was seen (p = 0.025) and survival was 12.5 months (n.s.). We demonstrated the favorable therapeutic index tolaribility of high-dose (60 mg/kg), short-term (48 hours), frequent (weekly-biweekly) infusional FU and the ability of low-dose MTX to positivity modulate this FU treatment.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 3","pages":"114-7"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20172275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of ambulatory infusion devices in infusional cancer chemotherapy: a model for nursing management.","authors":"C Moore,&nbsp;S Herbst,&nbsp;M Lawson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Optimal support of the patient receiving infusional cancer chemotherapy (ICC) in the home setting is partially dependent on the provision of an infusional device that offers minimal complexity and maximal reliability and safety. The selection of the appropriate device is vital to positive patient outcomes and to the comfort level of both patient and care providers. This article presents issues and considerations in the selection of infusion devices and the nursing role in the management of patients utilizing such devices. Aspects of nursing management are presented from the perspective of The Cancer Center of Boston (TCC) model.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 4","pages":"181-5"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20174308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}