The Journal of infusional chemotherapy最新文献

{"title":"Infusional 5-fluorouracil in the treatment of gastrointestinal cancers: The Royal Marsden Hospital experience.","authors":"P J Ross, A Webb, D Cunningham, J Prendiville, A R Norman, J Oates","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 3","pages":"141-4"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20172129","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":"First-line protracted venous infusion fluorouracil with CisDDP or carboplatin in advanced colorectal cancer.","authors":"E Garcia-Giralt,&nbsp;P Beuzeboc,&nbsp;D Deffontaines,&nbsp;V Diéras,&nbsp;T Dorval,&nbsp;M Jouve,&nbsp;T Palangie,&nbsp;S Scholl,&nbsp;P Pouillart","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A total of 55 patients with measurable colorectal metastatic carcinoma were studied to evaluate the impact on toxicity, response, and survival of protracted venous infusion (PVI) 5-FU 200 mg/m2 per day with Cis-DDP 80 mg/m2 or carboplatin 300 mg/m2 every 3 weeks, 1-hour infusion. Patients received continuous uninterrupted therapy until there were signs or symptoms of toxicity. Both 5-FU and cisplatin were withheld when patients experienced grade II stomatitis and diarrhea, severe nausea or vomiting not controlled by standard antiemetic therapy, and clinically significant hand-foot syndrome. The toxicity was neurological (20% grade 2 and 3) hematological (13% grade 2) and dermatological (11% grade 2). The overall response (CR+PR) was 24% with a median survival of 13 months. The results of our study show that there is no improvement in response rate, response duration or survival compared with historical trials. However, this study does confirm the valuable palliative role of the protracted 5-FU infusion treatment. Colorectal carcinoma is one of the most common neoplasms in Western societies, being second only to lung cancer as a cause of death from malignancy. The management of nonmetastatic primary disease in surgical, with adjuvant chemotherapy for those at high risk of relapse. However, for those with metastatic disease at diagnosis or recurrent disease after resection, cytotoxic chemotherapy is the treatment of choice and fluorouracil (5-FU) is the most active cytotoxic agent in this disease, with a response rate of approximately 20%. Efforts to improve the response rate have focused on the use of agents to modulate 5 FU. The Southwestern Oncology Group (SWOG) study reported by Leichman et al. (1) and a study from the United Kingdom by Hill et al. (2) compared conventional FU to modulated FU and found no improvement in response rate or survival. In the SWOG study, two different schedules of bolus FU and LV were compared with bolus FU alone and to continuous infusion FU administered alone or modulated by LV or PALA. In this study, the results obtained with bolus FU were superior to most of the studies in the literature: The response rate was 26%, and the median survival was 14 months. The high- and low-dose LV and FU groups showed response rates and survival similar to bolus FU alone. However, in 12 previously reported randomized studies comparing FU and LV or FU alone, nine reported that the combination of FU and LV produced significant increases in response rates and two reported significant increase in survival (3, 4). Many of these trials used the dose schedules reported in the SWOG trial. Protracted venous infusion (PVI) 5-FU has been shown to have superior efficacy with less toxicity in colorectal cancer when compared to bolus 5-FU and synergy between cisplatin and 5-FU has been demonstrated in vitro. Consequently, we have investigated the efficacy of the combination of bolus cis or carboplatin and PVI 5 FU in 55 patients with advan","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 3","pages":"149-51"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20172131","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 Spanish experience with high-dose infusional 5-fluorouracil (5-FU) in colorectal cancer. The Spanish Cooperative Group For Gastrointestinal Tumor Therapy (TTD).","authors":"E Aranda,&nbsp;A Cervantes,&nbsp;A Carrato,&nbsp;A Antón-Torres,&nbsp;T Massutí,&nbsp;C Fernández-Martos,&nbsp;E Díaz-Rubio","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background In a previous phase I to II trial, we have shown that the maximum tolerable dose (MTD) of 5-Fluorouracil (5-FU) in 48-hour continuous infusion (CI) weekly was 3.5 gr/m2. In a subsequent confirmative phase II trial with 85 evaluable patients, a 38.5% response rate was obtained and the median survival reached was 12 months. These data were comparable to those achieved by biochemical modulation of 5-FU with Leucovorin. On this basis we tried to modulate high-dose 5-FU (3 gr/m2) with oral leucovorin (LV) but the regimen was too toxic and the dose had to be reduced. A new phase II trial with 2 g/m2/week plus oral leucovorin was planned. Patients received a median dose intensity of 5-FU of 1.6 g/m2/week (range 0.9-2). Three complete responses and 36 partial responses were observed. Overall response rate was 37.5% (95% CI, 28% to 46.8%). Median time to progression has been 7.4 months, and median survival 14.4 months. WHO grade 3 diarrhea was seen in 27 patients (24.5%). Grade 3 mucositis was also seen in 9 (8.1%) patients, and grade 4 was observed in one. Grade 3 nausea and vomiting was reported in 13 (11.7%) patients. Grade 3 hand-foot syndrome was detected in only 5 (4.5%) patients. Grade 4 leukopenia was observed in 1 case and grade 3 to 4 thrombocytopenia was observed in two cases, respectively. Oral leucovorin modulation of weekly 48-hour continuous infusion of 5-FU at 2 g/m2 is an active regimen, with diarrhea and mucositis as main limiting toxicities. Its antitumor activity does not seem superior to that obtained with a weekly 48 hour continuous infusion of 5-FU alone at a dose of 3.5 g/m2.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 3","pages":"118-22"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20172276","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":"Ambulatory infusional cancer chemotherapy: nursing role in patient management. The Cancer Center of Boston.","authors":"C Moore,&nbsp;D Strong,&nbsp;J Childress,&nbsp;B Fougere,&nbsp;S Gotthardt","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The role of nursing in infusional cancer chemotherapy (ICC) may vary depending on the practice setting. Nurses in free-standing centers and office practices perform many duties that nurses in other facilities may not, because of the lack of many of the supports that benefit hospitals with their multidepartmental and hierarchical structures. Nurses function collaboratively with physicians in the planning and the implementation of patient treatment. Patient-related nursing responsibilities include patient/family education, drug preparation and administration, patient assessment for treatment toxicity, recognition and management of complications related to the catheter or infusion device, and telephone triage. Other duties more removed from patient care might include inventory management, research data collection and management, quality assurance and improvement, compliance with regulatory issues, and a myriad of other responsibilities. The transition of patient care to the outpatient setting has broadened the scope of nursing to include nonpatient care responsibilities due to financial constraints brought about by health care reform, changes in reimbursement patterns, and overhead required to maintain and deliver quality patient care. As a result of nursing responsibilities, it becomes paramount that the aforementioned constructs for program support are in place and that all nurses are consistently trained and have a template to follow for patient treatment and management. Nursing ability to perform patient-related tasks should be proven by formal written and practical competencies repeated annually and as procedural changes are implemented. The paragraphs to follow suggest nursing management of patients receiving ICC using a model developed at The Cancer Center of Boston (TCC).</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 4","pages":"164-70"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20174306","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":"Surveillance of the patient receiving infusional cancer chemotherapy: nursing role in recognition and management of catheter-related complications. The Cancer Center of Boston.","authors":"C Moore,&nbsp;D Strong,&nbsp;J Childress,&nbsp;B Fougere,&nbsp;S Gotthardt","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Surveillance of the patient on infusional cancer chemotherapy (ICC) is paramount to patient safety. Key to this issue is diligence in monitoring for complications of infusion catheters. Nursing knowledge and awareness are essential for the early detection of such complications. The following is a composite of the manifestations of commonly experienced catheter-related complications. The incidence, detection and management issues are presented from the perspective of 15 years experience with ICC at The Cancer Center of Boston (TCC).</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 4","pages":"171-80"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20174307","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":"Infusional therapy with alkylating agents.","authors":"R B Jones","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In 1990, Donehower editorialized in the Journal of the National Cancer Institute, entitled \"Evaluating Cancer Chemotherapy by Infusion\" (92). In the same issue, Goldberg reported a phase III study comparing etoposide and cDDP administered by either bolus or infusion to patients with non-small cell lung cancer (93). There was no advantage to the infusional schedule; in fact, it produced greater myelotoxicity. In the editorial, Donehower commented that the daily etoposide dose was not substantially pharmacokinetically different from a daily bolus schedule (because of the drug's relatively long half-life), and the greater myelotoxicity of infusional cDDP might have been predicted by preclinical studies. He suggested that studies of cancer drugs given by infusion should only be undertaken in the context of strong accompanying pharmacologic and preclinical experimental rationale, and that phase III studies of this concept should only be undertaken after a strong justification is developed. The concept that infusions of AA are generally less toxic than bolus dosing formed much of the rationale for infusional AA administered with BMT. The detailed studies of Teicher (1) and Frei (89), cited above, provided strong preclinical data suggesting that improvement in the therapeutic index could be achieved for most AA when infusional schedules were used. Additionally, the high toxic risk accompanying high-dose combination AA therapy with hematopoietic cell support mandated detailed PK studies. Data produced by these efforts (5, 12) now add additional basis for systemic exploration of AA infusions. Armed with the basic data suggested by Donehower, a more scientifically based study of AA infusion can take place in the future. Compelling rationales now support such studies. The availability of means to avoid fatal hematologic toxicity for virtually all patients suggests that the next era of exploration of AA infusions will be fruitful, and accompanied by a deeper understanding of the relationship between visceral organ toxicities and PK/PD changes produced by AA administered over prolonged periods.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 2","pages":"74-81"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19778616","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":"A pilot trial of continuous infusion 5-fluorouracil with levamisole for adjuvant therapy of colon cancer.","authors":"C G Leichman,&nbsp;E Poplin,&nbsp;M Zalupski,&nbsp;Y Garcia,&nbsp;A Grant,&nbsp;A Angeles,&nbsp;L DeJong,&nbsp;L Leichman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The relatively high response rate demonstrated with the use of continuous infusion 5-Fluorouracil (CIFU) 200 to 300 mg/m2 per day in disseminated colon cancer is the rationale behind a NCI-sponsored intergroup trial (INT 0153) for postoperative adjuvant therapy of stage III colon cancer. Because CIFU necessitates a significant reduction in the dose of the modulator leucovorin compared with bolus 5-FU, a pilot study of continuous infusion 5-FU in several doses with levamisole was conducted to determine any unexpected toxicity of this combination, and to assess completion rates of levamisole was conducted to determine any unexpected toxicity of this combination, and to assess completion rates of this dose intensive schedule. CIFU, scheduled as two 12-week cycles, was administered at 250 mg/m2 per day. Pending toxicity at the initial dose, CIFU was to be escalated (300 mg/m2) or de-escalated (200 mg/m2). All but one patient entered on this trial completed 24 weeks of adjuvant CIFU+levamisole. Eight patients (57%) completed 24 weeks of therapy with the 2-week scheduled break. One of these 8 patients required a dose reduction without interrupting the schedule. Six patients had toxicity from the CIFU, which obliged us to interrupt the schedule. Limiting toxicities were stomatitis and hand-foot syndrome. No dose-limiting hematologic toxicity was encountered. Three patients (21%) had catheter problems that required replacement. These data suggest that up to 30% of patients started on this regimen may require dose reduction, shorter infusion courses with rest breaks, or both to complete 24 weeks of adjuvant treatment in order to achieve desired dose intensity.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 2","pages":"84-6"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19778618","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":"Continuous infusion etoposide in advanced AIDS-related kaposi sarcoma.","authors":"S C Remick,&nbsp;M Reddy,&nbsp;K Ekman,&nbsp;R Vyzula,&nbsp;J Hilstro,&nbsp;J Horton","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We conducted a preliminary phase II clinical trial to determine the toxicity, response, and survival rate of 72-hour continuous infusion etoposide administered to patients with AIDS-related Kaposi sarcoma. Nine patients with biopsy proven and measurable disease AIDS-related Kaposi sarcoma were treated with a continuous infusion of etoposide at a dose of 100 mg/m2 per day for 3 days every 3 weeks. All patients were evaluated for toxicity, response, and survival employing the NCI Common Toxicity Criteria, and both the Eastern Cooperative Oncology Group (ECOG) and AIDS Clinical Trials Group (ACTG) response criteria. All patients enrolled had at least two on-study poor risk factors by ACTG staging criteria. A total of 17 cycles of therapy were administered. Thirty-five percent of cycles were associated with grade 3 or greater leukopenia. Infectious complications were common, and there was one toxic death. Two partial responses (22%) by ACTG criteria were observed (95% confidence interval, 0% to 51%). In the absence of objective responses using more strict solid tumor response criteria and toxicity encountered we believe further evaluation of a 72-hour continuous infusion schedule of etoposide in patients with advanced AIDS and poor risk Kaposi's sarcoma is not warranted.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 2","pages":"92-6"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19779754","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 French experience with infusional 5-FU in gastric and pancreatic cancer.","authors":"M Ducreux,&nbsp;P Rougier","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Ninety-five patients with metastatic pancreatic (n = 38) or gastric (n = 57) carcinomas were treated by 5-day continuous infusion of 5-fluorouracil (5-FU) plus cisplatin in two parallel phase II trials. 5-fluorouracil was given at a dose of 1000 mg/m2 for 5 consecutive days and cisplatin was given on day 2 at a dose of 100 mg/m2. The total number of cycles administered was 425, and each patient received a median number of four cycles. Severe toxicities were observed in around 20% of the patients and 2 toxic deaths occurred. Response rate assessed in 92 evaluable patients was 34%. The overall median survival was 8 months. There were no clinical or biological factors predictive of response, but a better survival was observed in patients with objective response and CA 19-9 blood levels lower than 100 UI/I. These two predictive factors are independent when tested in a multivariate model. The combination of infusion 5-FU plus cisplatin can be considered as a standard for the treatment of gastric metastatic carcinomas and as a promising schedule for pancreatic carcinomas.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 4","pages":"203-5"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20174311","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 cryopreservation.","authors":"J Gorlin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The recent widespread use of protocols, including high dose chemotherapy with peripheral blood progenitor cell rescue, has resulted in increased demand for cryobiological services to freeze and thaw the collected progenitors. This has led to reexamination of many cryobiological practices and proposal of alternative methodologies. This review examines the scientific bases of cryobiological practices, how cryoprotectants work and alternative methods of freezing and thawing. Finally, while blood banks have come under tremendous regulatory pressure from federal agencies, hematopoietic stem cell processing has been relatively unburdened by such regulation to date. Recent meetings between the FDA and interested organizations make it clear that this largesse is coming to an end. Hence many organizations are promulgating standards that apply to marrow and peripheral stem cell processing.</p>","PeriodicalId":79426,"journal":{"name":"The Journal of infusional chemotherapy","volume":"6 1","pages":"23-7"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19721669","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}