Eugene P. Flannery

Possible radiation pericarditis precipitated by actinomycin D.

Actinomycin D was associated temporally with the onset of a pericardial effusion in a man who had received 4,000 r to the mediastinum 21 months earlier. No tumor, infection, or other etiology was foun

Leucovorin in combination chemotherapy of breast cancer.

Cyclophosphamide, 5‐fluorouracil, methotrexate, and prednisone were administered for 165, 28‐day cycles to 33 patients with metastatic breast cancer. Because of serious infections (fever ≥° F, granulocytes <1,000/mm,3 and hospitalization) and 1 drug death in the first 4 patients, oral calcium leucovorin, 20 to 30 mg/m2 orally, was given 2 days after methotrexate in subsequent treatment cycles. There were 26 cycles without calcium leucovorin and 6 serious infections; 139 cycles with calcium leucovorin and 5 serious infections (p = 0.002). Objective response was seen in 13 of 18 evaluable patients with no previous treatment and in only 2 of 11 evaluable patients with previous treatment (p = 0.0065). Equivalent doses were given to all subsets of patients. It is concluded that leucovorin added to the above combination of drugs can preserve antitumor activity while decreasing serious infections and that prior therapy significantly decreases the response rate to this combination.