The Journal of infusional chemotherapy最新文献

{"title":"Drug stability and compatibility in oncology care.","authors":"D A Williams","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Infusional chemotherapy has been increasingly used based upon the fact that most drugs have a relatively short half-life following bolus exposure, and increasing the available drug concentration over time may maximize the antitumor effect. As a practical matter, the application of infusional chemotherapy especially in an ambulatory setting, absolutely requires that the individual antineoplastic agents be stable in solution at room temperature (or at body temperature for implanted pump systems) and that the drugs in the infusion (including antiemetics) be compatible. The capacity to mix antineoplastic agents and antiemetics (also colony-stimulating factors) in a single solution facilitates infusional combination chemotherapy. Technologic advances are on the horizon which will provide the capability of administration of multiple drugs through a single access site to allow one to utilize a single delivery source obviating the need for admixtures of drugs. However, in the interim, admixtures represent the optimal method for the delivery of multi-agent chemotherapy in the setting in which continuous infusional drug delivery for 24 hours or more is employed. The goal of continuous infusion cancer chemotherapy is to ensure delivery of an unaltered cytotoxic drug, avoiding situations that could affect the stability of the infusion admixture. With cancer chemotherapy infusion therapy being administered through oncology clinics without the benefits of a pharmacist, the nurse plays a pivotal role in the preparation of the infusion, supervision of the patient, and when applicable in providing counseling on the proper storage, handling of the cytotoxic drugs, and disposal of contaminated infusion materials. Thus, by optimizing the integrity of the chemotherapeutic infusion, the patient achieves maximum benefits of cancer chemotherapy and the level of success anticipated with oncology care. The nurse may also be involved with clinical studies involving the preparation of other combinations of infusional chemotherapy including antiemetics and colony-stimulating factors, requiring integrity of the infusion to incompatibility and instability. In order to avoid failure of the infusion through improper preparation or reconstitution of the infusion or improper storage conditions and the resulting unnecessary waste and disposal expenses, the nurse needs to be fully aware of the factors affecting the stability and compatibility of the infusion and to interact with other health professionals and the literature for the critical information related to maintaining the integrity of the cancer chemotherapy infusion. \"Good intentions without good communication equals potential disaster.\"</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 4","pages":"195-202"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20174310","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":"Peripheral blood stem cells: a historical perspective.","authors":"E Cirenza","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Peripheral blood stem cells (PBSC) are rapidly becoming the primary rescue modality for autologous transplantation and are now actively being investigated in the allogeneic transplant setting. Many investigators and clinical researchers believe that PBSC are likely to replace bone marrow stem cells entirely, for use in clinical transplantation in the not too distant future (1). In order to better understand the rapidly changing developments in this field, it would be helpful to understand the historical development of this technology. The purpose of this article is to build for the reader a strong historical foundation with the intent to integrate the history of peripheral blood stem cells with their subsequent isolation, mobilization, collection, and clinical applications.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 1","pages":"4-7"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19720611","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":"Platinum dose-intensity.","authors":"G Los","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The rationale for platinum dose-intensity is based on pharmacologic principles, laboratory observations, and retrospective analysis of clinical studies. However, prospective studies have indicated that dose-intensity studies have been limited by toxicities, restricting the dose increase for cisplatin to approximately twice the conventional dose and for carboplatin two- to three-fold the standard AUC. Phase I and II studies indicated that the response rates for high-dose carboplatin with hematopoietic cell support improved significantly but were short lasting, lacking a significant effect on survival. Recently, a new IA dose-intensity approach employing extremely high and locally administered cisplatin doses with systemic neutralization, demonstrated a very high response rate in advanced head and neck cancer. Overall, high-dose intensity of platinums may potentially increase treatment efficacy in tumors sensitive to platinum containing drugs. Successful examples are the high dose carboplatin with hematopoietic support and the IA high-dose cisplatin approach with systemic neutralization. However, the key to future success will depend on the selection of patients with drug sensitive tumors.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 2","pages":"64-8"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19778614","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":"CPT-11: the European clinical development.","authors":"C Terret,&nbsp;C Couteau,&nbsp;J P Armand","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>CPT-11 is a camptothecin derivative with a broad spectrum of antitumor activity, both in vitro and in vivo. Like camptothecin, CPT-11 is a selective DNA topoisomerase I inhibitor. Phase I trials were conducted in Europe to determine the dose and schedule for phase II trials. These phase I trials assessed the toxicity of CPT-11 in 235 patients and tested three administration schedules: a single infusion once every 3 weeks; a weekly infusion for 3 out of 4 weeks; and a daily infusion for 3 consecutive days every 3 weeks. The maximum tolerated dose (MTD) was 115 mg/m2 in the daily schedule and 145 mg/m2 in the weekly schedule. When the drug was administered once every 3 weeks, diarrhea became the dose-limiting toxicity at doses above 350 mg/m2. This schedule offered the highest dose intensity and the best tolerability profile, and was the most convenient for outpatient treatment. Finally, using this schedule, concomitant administration of high-dose loperamide allowed the dose of CPT-11 to be increased to 750 mg/m2. An ongoing phase I trial is investigating the combination of CPT-11 and 5-fluorouracil (5-FU) in various solid tumors. Although the MTD has not yet been reached, preliminary results show no pharmacokinetic interaction between the two drugs, contrary to a previous Japanese study. Based on the results of the three phase I trials, CPT-11 350 mg/m2 as an intravenous infusion over 30 minutes once every 3 weeks was recommended for phase II trials, which started in Europe in 1992. To date, CPT-11 has shown remarkable efficacy in colorectal cancer, even in patients resistant to 5-FU. Interesting results have also been obtained in pancreatic, cervical and lung cancers. Future trials will explore the place of CPT-11 in combination with other cytotoxic agents or radiotherapy.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 3","pages":"152-7"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20172132","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 purging ex vivo.","authors":"M V Seiden,&nbsp;K C Anderson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Over the last several years there has been significant progress in developing several techniques designed to detect contaminating tumor cells in bone marrow (BM) and peripheral blood progenitor cells (PBPC). These techniques include immunohistochemistry, in situ hybridization (ISH), flow cytometry, clonogenic tumor assays, and polymerase chain reaction (PCR) based assays. These assays have detection capabilities ranging from 1 tumor cell in 100 normal cells (ISH) to 1 tumor cell in a million tumor cells (RT-PCR). These techniques have confirmed that BM and PBPC are frequently contaminated with tumor cells, with most studies suggesting higher tumor contamination in the BM as compared to the PBPC. Comparison of immunocytochemistry with the clonogenic assay has demonstrated good but not perfect correlation of these two techniques. Gene marking studies have confirmed that these tumor cells are viable and capable of contributing to disease relapse. Many of the assays are at least semiquantitative and are effective at monitoring for persistent residual tumor cell contamination after ex vivo processing of autografts including purging strategies and/or positive selection techniques. Preliminary data are conflicting, although some data suggest that patients receiving autografts with residual tumor cell contamination do worse than patients receiving autografts free of detectable tumor cells. Many purging techniques are capable of reducing tumor contamination by 3 to 5 logs; positive selection techniques are probably slightly less effective, reducing tumor contamination by 3 to 4 logs. The clinical benefit of purging remains to be demonstrated in randomized clinical trials.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 1","pages":"17-22"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19720614","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":"Dose intensity: not the only path to clinical dose optimization.","authors":"F M Muggia","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 2","pages":"57-8"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19778612","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":"Dual modulation of 5-fluorouracil with folinic acid and hydroxyurea in metastatic colorectal cancer.","authors":"A de Gramont,&nbsp;C Louvet,&nbsp;M Bennamoun,&nbsp;C Varette,&nbsp;B Demuynck,&nbsp;K Beerblock,&nbsp;S Moreau,&nbsp;D Soubrane,&nbsp;F Mal,&nbsp;J D Grangé,&nbsp;D Zylberait,&nbsp;M Krulik","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Leucovorin and 5-fluorouracil (5-FU) can be further modulated with hydroxyurea. Sixty-eight patients with advanced colorectal cancer received every 2 weeks hydroxyurea per os 1.5 g to 2 g days -1, 1, and 2; leucovorin 200 mg/m2 iv over 2 hours started at least 1 hour after hydroxyurea and per os 100 mg/m2 12 hours later, on days 1 and 2; 5-FU, bolus 400 mg/m2 during leucovorin infusion and 24 hours continuous infusion 600 mg/m2, repeated on days 1 and 2. Two complete responses (7%), 8 partial responses (30%), 12 no change (44%), and 5 progressions (19%) were observed among 31 nonpreviously treated patients. Four partial response (11%), 15 no change (43%), and 16 progressions (46%) were observed among 37 pretreated patients. Nineteen were treated after progression on the same regimen without oral leucovorin and hydroxyurea, 1 achieved PR and 10 showed no change. Among them, 6 experienced response or stabilization of longer duration than with previous treatment. Twelve-month survival was 61% in non-pretreated and 43% in pretreated patients as of the start of chemotherapy. Toxicity was mild with nausea in 46%, diarrhea in 37%, and mucositis in 36%. The first-line response rate is in the range of leucovorin and 5-FU alone. Some pretreated patients benefited from this regimen.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 2","pages":"97-101"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19779755","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-FU in the treatment of advanced colorectal cancer: a summary of the European experience.","authors":"J A Wils","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>5-fluorouracil (5-FU) is the best available drug for the treatment of advanced colorectal cancer. A review of published data strongly suggest that with continuous infusion an enhanced treatment outcome as opposed to treatment with standard bolus injections can be obtained. This could be due to the schedule, the high dose-intensity or both. It is likely that there exists a relationship between the dose intensity of 5-FU and the response in colorectal cancer. With weekly 24 to 48 hours continuous infusion of 5-FU a very high dose intensity can be achieved. High-dose infusional 5-FU is noncross-resistent with (modulated) bolus 5-FU and the European experience with this treatment modality will be reviewed. The comparison of the activity of modulated \"standard\" bolus 5-FU versus high-dose infusional 5-FU, given by weekly intermittent or by protracted continuous infusion (PCI), is the subject of ongoing trials. Additional studies will answer the question whether modulation of high-dose 5-FU will result in a superior treatment outcome compared with high-dose 5-FU alone.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 3","pages":"145-8"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20172130","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 \"stem cell\" transplantation: are there any clouds on an expanding horizon?","authors":"P A Lowry","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Clinicians contemplating stem cell transplantation for the treatment of their patients are faced with an increasing number and complexity of options for the source of the stem cells and their manipulation prior to transplant. Many of these strategies focus on the traditional concept of the \"hematopoietic stem cell\" as a unitary and independent source of reconstitution. Evolving animal studies suggest that the stem cell concept is incompletely defined and that the stem cell compartment retains significant heterogeneity of function. These findings should be combined with the increasingly heterogeneous goals of stem cell transplantation to induce caution in proceeding forward with new technologies.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 1","pages":"9-11"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19720612","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":"To modulate or not to modulate; to infuse or to bolus; the enigma of 5-fluorouracil is still alive after all these years.","authors":"J Lokich,&nbsp;J Ahlgren","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 2","pages":"82-3"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19778617","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}