Alessandro Calciati

Thymomas: A review of 169 cases, with particular reference to results of surgical treatment

One hundred sixty‐five patients with surgically treated thymoma were followed over 28 years; 73% had myasthenia gravis at presentation. Invasiveness was based on macroscopic findings at operation. Post‐surgical radiotherapy or chemotherapy were not routinely used. Overall survival was 84%, 79%, and 65% at 3, 5, and 10 years, respectively. Patients with invasive thymoma survived for a shorter period than patients with noninvasive tumors (67% versus 85% at 5 years); when radical excision was possible, no difference was detectable between the two groups. Patients with subtotally resected or only biopsied invasive thymomas survived 59% and 42% at 5 years, respectively. Lymphoepithelial cases had the worst prognosis of the histologic types considered. Myasthenia gravis did not adversely affect survival. Surgery is the basic treatment of thymomas. Macroscopic invasiveness and degree of excision judged by the surgeon have prognostic value and are reliable criteria of malignancy. Radiotherapy and chemotherapy may be effective, but their use should be limited to controlled trials. Cancer 58:765‐776, 1986.

Teniposide in the treatment of small-cell lung cancer: the influence of prior chemotherapy.

Fifty patients with small-cell lung cancer (SCLC) were treated with teniposide (VM26) at 120 to 140 mg/m2 on days 1, 3, and 5, every 3 weeks. Twelve elderly patients were administered VM26 as first-line chemotherapy. Toxicity was manageable, myelosuppression being the major side effect. The response rate for 44 evaluable patients was 34% (36% for untreated patients); the median durations of response and survival were 230 and 208 days, respectively. Effectiveness of prior chemotherapy and time from last administration was found to influence patient response to VM26: 42% of responders to prior chemotherapy responded to VM26, while 0% of the nonresponders to prior chemotherapy responded to the new agent. Moreover, among patients pretreated with chemotherapy, 12% of those recently treated (earlier chemotherapy ending less than or equal to 2.6 months before administration of VM26) responded to VM26, while 53% of patients treated greater than 2.6 months earlier responded to VM26. Survival was influenced by common prognostic factors (performance status, weight loss, prior chemotherapy exposure). Selection of pretreated patients by type of exposure to prior chemotherapy may help in the testing of new drugs in this disease.

Reinduction chemotherapy in small cell lung cancer

Thirteen patients with small cell lung cancer responsive to chemotherapy were retreated with the same regimen at relapse, after a median off-therapy time of 30 weeks. Fifty per cent responded to reinduction; two out of six patients who had complete response to first chemotherapy obtained complete response again at reinduction. Median survival time from start of any therapy was 94 weeks. When induction chemotherapy has been effective and of short duration, the same chemotherapy can be attempted again with success at relapse and it may affect survival of relapsing small cell lung cancer patients.

High dose medroxyprogesterone acetate (MPA) treatment in metastatic carcinoma of the breast: a dose-response evaluation.

The results of a controlled clinical trial that used high doses of medroxyprogesterone acetate (MPA) in the treatment of metastatic breast cancer are reported. Two treatment regimens were used: regimen A, 500 mg daily with a total dose of 30 g; regimen B, 1,000 mg daily with a total dose of 60 g. The overall response rates were similar, with no statistically significant difference between the two treated groups. Regimen A (lower dosage group) reached a remission rate of 44%, whereas regimen B (higher dosage group) had a remission rate of 41%. The mean duration of response was 8 months with regimen A and 9 months with regimen B. The advantages of the lower dosage regimen as opposed to the higher dosage regimen of MPA in the treatment of advanced breast cancer are discussed.

Teniposide (VM26): An effective treatment for brain metastases of small cell carcinoma of the lung

Despite good results of chemotherapy in small cell lung cancer (SCLC), occurrence of brain metastases is frequent and unaffected by commonly employed antineoplastic drugs, mainly because they do not cross the blood-brain barrier. We treated eight patients with SCLC and cerebral metastases with VM26 at 120 mg/m2 given on days 1, 3 and 5 and repeated every 3 weeks. Two patients achieved complete response and one had partial response. Mean response duration was 8.2 months and survival was more than 9 months in responding patients. Toxicity was manageable. VM26 is an active drug in SCLC with brain metastases.

Disorders of serum electrolytes and renal function in patients treated with cis-platinum on an outpatient basis

Two hundred and eighty-one patients received 927 doses of cis-platinum, generally on an outpatient basis, at 55 mg/m2 every 3-4 weeks. Mannitol and 2.2501 of hydration with saline and 5% dextrose plus NaCl and KCl were given in 3-4 hr. No case of acute renal failure ensued and when azotemia occurred (3.5% of patients) it was easily reversible and controlled. An abnormal level of one or more electrolytes was detected in 194 patients (69%) during chemotherapy. K+, Na+, Ca2+ and Mg2+ values usually decreased in serum after DDP administration, but their depletion seldom caused symptoms. Hypomagnesemia developed in 20% of patients, but was symptomatic in only 1%. cis-Platinum, at the doses utilized, is safely given to outpatients, with the hydration program employed. Serum electrolyte decrease during chemotherapy must be expected, and rapidly corrected when symptoms develop.

Cisplatin and etoposide in chemotherapy-refractory advanced breast cancer.

Fourteen evaluable advanced breast cancer patients, extensively pretreated by chemotherapy, received a combination of cisplatin (DDP) and etoposide (VP 16). DDP was given at 60 or 100 mg/m2 on day 1, and VP 16 at 120 mg/m2 on days 1, 2 and 3; cycles were repeated every 4 weeks. Major responses were never obtained; a minor response in 1 patient, no change in 7 patients, and progression in 6 patients were observed. Main side effects were nausea and vomiting (62% severe), and leukopenia (31% leukocytes < 2,000/mm3). Two patients refused further treatment due to intense nausea and vomiting. DDP-VP 16 combination chemotherapy is ineffective and poorly tolerated in heavily pretreated breast cancer patients.

Stevens-Johnson syndrome and fatal pulmonary toxicity to combination chemotherapy containing bleomycin: a case report.

Bleomycin is a commonly used anticancer agent; in particular, it is an important component of multidrug regimens for germ cell tumors. The limiting toxicity of bleomycin is represented by pulmonary interstitial fibrosis; mucocutaneous side effects are common, but usually harmless. We describe a case of a young girl who developed Stevens-Johnson syndrome following the administration of bleomycin in a three-drug regimen containing vinblastine and cisplatin, for an ovarian immature teratoma. The severe dermatologic toxicity was kept under control, but a rapidly evolving respiratory insufficiency due to lung fibrosis developed soon thereafter and caused the patients death.

Lonidamine versus Polychemotherapy in Advanced Non-Small-Cell Lung Cancer. A Preliminary Analysis

No clear evidence of survival benefit has been definitely shown by chemotherapy in advanced non-small-cell lung cancer. We evaluated in a randomized trial the activity of the new drug lonidamine (up to 1050 mg/day) versus MVP (mitomycin C, 10 mg/m2, vinblastine, 5 mg/m2, cisplatin, 100 mg/m2). The preliminary findings on 25 patients showed that lonidamine can be easily administered at these dose ranges, and main toxicity was represented by myalgia and testicular pain. Tolerance to combination chemotherapy (MVP) was superimposable to our prior experience. Responses were recorded in both arms, and no survival difference was apparent. The study is in progress.

Father-son testicular cancer, case report.

A case of familial testicular malignancy in a father and his son is reported. This represents the seventh described case of father-son testicular cancer. The father had seminoma and the son had teratocarcinoma. Both patients’ peripheral blood lymphocytes were tested for 52 HLA specificities: the fathers antigens were HLA A3, B13, B14, Cw6, Cw8 and the sons were HLA A2, A3, B14, Cw8. (Common haplotype: A3, B14, Cw8). The association between HLA antigens and testicular cancer is discussed.