Ezra M. Greenspan

CISPLATIN THERAPY OF OVARIAN CANCER

Publisher Summary This chapter presents a study of cisplatin in ovarian cancer. It has been recognized that there is an activity of adriamycin (doxorubicin) in a variety of cancers including gynecologic neoplasia. The combination of adriamycin and cisplatin has been explored in a broad phase II trial. In patients with advance ovarian cancer, a prospective trial has been undertaken for adriamycin and cisplatin in combination versus cisplatin alone versus a standard chemotherapeutic regimen in use in the institutions consisting of an alkylating agent and an antimetabolite, thioTEPA, with or without methotrexate. Regimens containing adriamycin and cisplatin, particularly when cyclophosphamide and hexamethylmelamine, are additional components, constitute an effective therapeutic approach to relapsed ovarian cancer. The results from the studies of ovarian cancer recommend the use of these regimens for primary therapy. The studies of adriamycin and cisplatin, aggressive gynecologic oncologic surgery, and the evolution of additional chemotherapeutic components for inclusion in the therapeutic regimen have provided the basis for an emerging curative treatment of disseminated ovarian cancer.

Phase I study of mitoxantrone on a daily X 5 schedule.

MITOXANTRONE (Nsc-301739) IS A SYNTHETIC AMINO anthraquinone DNA intercalater active in several experimental tumor systems. Thirty-three patients with advanced cancer received the drug on a daily ± 5 schedule. Myelosuppression, especially leukopenia, was the dose-limiting toxicity and was reversible. Nausea and vomiting occurred sporadically. No definite hepatic, renal, or cardiac toxicities were noted. The recommended dose for phase II evaluation in solid tumor patients with little or no prior therapy is 4.2 mg/m2/day ± 5. Patients with prior myelosuppressive therapy but adequate bone marrow reserve may be started at 2.6 mg/ m2/day ± 5.

Tuberculosis and Response to Cancer Chemotherapy

To the Editor.— In the apparent cure of a disseminated large cell bronchogenic carcinoma, four years after two years of single alkylating agent therapy with lomustine, Gerald J. Vosika, MD (241:594, 1979), overlooked the other fascinating aspect of his therapy. Tuberculosis developed before the lomustine therapy was concluded, and it was treated with antituberculous chemotherapy. This sequence should not be ignored—nor should the reverse, ie, recovery from tuberculosis followed later by development of a cancer that is responsive to chemotherapy followed by long-term control or apparent cure. Among patients surviving four or more years with metastatic breast cancer that is successfully suppressed by chemotherapy, I have observed an inordinate number of patients with calcified lung foci (Ghon) from concentration camp tuberculosis or history of healed tuberculosis. Two middle-aged women with stage III-B ovarian cancer are now cured for seven and 11 years, respectively, after recovering previously from pulmonary tuberculosis. My