Edward Greenwald

Cis‐platin based combination chemotherapy for advanced ovarian cancer. High overall response rate with curative potential only in women with small tumor burdens

Thirty‐eight women with advanced ovarian cancer were given monthly cycles of intravenous cyclophosphamide, Adriamycin (doxorubicin) and cis‐platin, and oral hexamethylmelamine. Of 26 with tumor which would be evaluated for response, 42% had complete remission and 50% partial remission. Median time to disease progression from entry for all 38 patients was 13 months, and median survival 23.5 months. The bulk of tumor at the time chemotherapy was begun was the only significant prognostic factor for time to disease progression and survival. Of the seven women surviving free of disease a median of three years later, five had no mass > 2 centimeters in diameter at entry. Toxicity was predominantly myelosuppression and vomiting, with mild peripheral neuropathy in 27% and no significant renal or cardiac toxicity. The response rate of 92% is much higher than that previously reported with melphalan, and the survival considerably longer. The toxicity is acceptable, given the substantial improvement in results.

Efficacy study of intensive cis‐platin therapy in advanced non‐small cell bronchogenic carcinoma

Thirty patients with advanced non‐small cell bronchogenic carcinoma were treated with cis‐platin, 75 mg/M2 weekly for three weeks, then every three weeks. Eighteen were ambulatory, 22 had distant metastases, 14 had prior irradiation, and none had prior chemotherapy. Ten patients (33%) had objective remissions lasting a median of three months. Responders lived a median of five months, compared to three months for nonresponders. Transient mild azotemia was noted in twelve patients. Cis‐platin has definite but modest activity in non‐small cell bronchogenic carcinoma.

Second-effort surgical resection for bulky ovarian cancer

Eighteen women with bulky ovarian cancer at the start of chemotherapy were brought to second laparotomy after 6 months of combination chemotherapy in an effort to resect previously unresectable tumor masses. Only one of 18 had significant resection of bulk tumor such that no gross tumor was remaining, although 8 of 15 had the residual uterus removed and 6 of 10 had resection of residual ovary or ovaries. Failure to resect tumor was due to absence of any gross tumor (33%), presence of myriad small seedlings not amenable to resection (22%), or massive residual tumor (18%). Partial resection was accomplished in 22%, but all relapsed promptly in spite of continued aggressive therapy with drugs and whole abdominal irradiation. It is concluded that 6‐month “second‐effort” surgical resection is unlikely to benefit many women with bulky ovarian cancer, and that surgical resection must be attempted early in the course of the disease if it is to be effective.

Long-term complete remissions of Kaposi's sarcoma with vinblastine therapy

Four patients with advanced Kaposis sarcoma who were treated with weekly vinblastine therapy achieved long‐term remissions. Three patients are still in complete remission at two years, four years, and four years respectively, while the fourth achieved excellent partial remission lasting seven‐and‐one‐half years. The regimen produced no toxicity. We suggest the use of vinblastine as a useful chemotherapeutic agent for Kaposis sarcoma.

Effective chemotherapy for esophageal cancer with methotrexate, bleomycin, and cis-diamminedichloroplatinum II.

Ten patients with squamous cancer of the esophagus were treated with an outpatient regimen combining cis‐diamminedichloroplatinum (II), methotrexate and bleomycin. Nine of these had metastatic disease or recurrence after radiotherapy. Objective responses were noted in 50%, regardless of performance status or metastatic site. None of three patients with prior radiation therapy responded, however. Median duration of response was six months. Responders survived a median of eight months versus five months for nonresponders. Three patients had severe hematologic toxicity. A single patient with massive disease confined to the esophagus had an excellent response to six weeks of chemotherapy before radical irradiation. He is disease‐free after two years but is paraplegic from radiation myelitis. This chemotherapy program is an effective palliative therapy for metastatic esophageal cancer. Its safety and efficacy as part of the initial treatment of local disease should be further investigated.

High-dose Megestrol Acetate in the Treatment of Patients With Ovarian Cancer Who Have Undergone Previous Treatment: Eastern Cooperative Oncology Group Study Pd884

High-dose megestrol acetate has been reported to be effective salvage therapy for women with ovarian carcinoma. The Eastern Cooperative Oncology Group performed this phase II study of oral megestrol acetate, 200 mg four times daily until disease progression, in 33 patients either with stage III or IV histologically confirmed ovarian carcinoma or with unresectable tumor in the pelvis with measurable or evaluable disease who progressed after treatment with one prior chemotherapy regimen. Thirty and 31 patients were evaluable for response and toxicity, respectively. No patient had an objective response and none had subjective improvement after a median treatment period of 1.4 months. Nausea or vomiting occurred in most patients, usually grade 1-2. Megestrol acetate is ineffective salvage therapy for patients with inoperable, previously treated ovarian carcinoma.

BCNU (1,3‐Bis‐(2‐chloroethyl)‐1‐nitrosurea) lung. Drug‐induced pulmonary changes

The occurrence of pulmonary disease associated with long‐term BCNU therapy is reported in two patients treated for astrocytoma grade II whose clinical presentations of pulmonary complications and corresponding tissue alterations showed striking differences. One patient presented with a dramatic, fulminating, and rapidly fatal pulmonary disease. His lungs revealed atypical proliferation of pneumocytes, moderate interstitial inflammation, fibrosis and intra‐alveolar hyalin membranes. The second patient presented with slowly progressive dyspnea, ultimately leading to death secondary to severe diffuse alveolar septal fibrosis. Individual differences in response to toxicity are suggested and discussed.

Effect of tamoxifen treatment on cortisol metabolism and the course of the disease in advanced breast cancer

Twenty‐nine postmenopausal women with advanced breast cancer were treated with Tamoxifen, a non‐steroidal antiestrogen. The effect of the drug on the plasma concentration, production rate, and metabolism of cortisol was measured, and the relationship of the changes in these parameters to the course of the disease was investigated. After six weeks of Tamoxifen treatment the plasma cortisol concentration and the cortisol‐binding globulin concentration increased by 26 and 64%, respectively, but the production rate of cortisol and the urinary excretion of its tetrahydro metabolites THF, ATHF, and THE decreased by 35 and 13%, respectively; all of these changes were statistically significant. When the group consisting of complete or partial responders was compared with one consisting of patients whose disease remained stable or worsened, no significant difference was detected between these two groups in the change in any of the above parameters. It was concluded that any improvement due to Tamoxifen was not related to changes in cortisol metabolism.

Adult Wilms Tumor Treated with Radiotherapy and Chemotherapy: A Case Report

A 24-year-old man underwent a left radical nephrectomy for a mass that was found to be a Wilms tumor. The postoperative course, consisting of combined radiotherapy and chemotherapy, is discussed and the recent literature is reviewed.

Malignant melanoma in spouses

A study of three married couples where both spouses developed malignant melanoma was undertaken at the New York University‐Bellevue Medical Center melanoma registry. An upper bound was calculated for the number of spouses expected to develop melanoma, along with the origin of the disease and its relation to nation‐wide rates of incidence. The observed number was six times greater than the bound.