Francis C. Grumbine

Taxol: A Unique Antineoplastic Agent with Significant Activity in Advanced Ovarian Epithelial Neoplasms

Abstract Study Objective:To assess the activity of taxol in patients with advanced, progressive, and drug-refractory ovarian cancer and to delineate more clearly the toxicity of taxol in this patie...

Abdominopelvic computed tomography in the preoperative evaluation of early cervical cancer

Abstract The efficacy of abdorainopelvic computed tomography (CT) in determining the extent of disease in the patient with early cervical cancer was evaluated in 24 patients (FIGO Stage Ia-1, Ib-18, IIa-5). The CT stage was compared to both the clinical and surgical pathological staging, CT was accurate only in 58% of the cases in determining parametrial extension. It was unable to detect any of the 6 cases of histologically documented lymph node metastases. CT appears to have limited use in the patient with early cervical carcinoma because with parametrial thickening it lacks sufficient specificity to differentiate between malignant and nonmalignant tissues and there is not sufficient sensitivity to detect early nodal involvement.

Cutaneous metastasis of endometrial carcinoma.

Five cases of endometrial carcinoma with cutaneous metastases are reported. Cutaneous metastases of endometrial carcinoma are uncommon. There are no other cases reported in the literature. In 91 autopsy cases only one example (1%) could be found. The appearance of subcutaneous nodules is evidence of widespread dissemination and a harbinger of early demise.

Pregnancy following chemotherapy for an ovarian immature embryonal teratoma.

Abstract A patient with an immature embryonal teratoma of the ovary treated with intensive multiagent chemotherapy became pregnant after her second-look operation. The importance of this new facet in the management of patients with malignant teratomas is discussed.

Mixed Mullerian tumors of the uterus: Clinical and pathologic correlations

The 10‐year experience at The Johns Hopkins Hospital with 61 cases of mixed Mullerian tumors were reviewed. The patients had a mean age of 63.7 years and the similar constitutional factors of diabetes mellitus, hypertension and nulliparity of endometrial adenocarcinoma. Only one patient had estrogen exposure. Eighteen percent had had prior exposure to pelvic radiation. The life table survival of the 61 patients was 41.1% at 5 years. The 2‐year life table survival was 76% for disease confined to the uterus and 16.5% for extrauterine disease. There was no difference in survival between homologous and heterologous tumors. The surgical staging and the autopsies reviewed documented widely disseminated disease even when the tumor appeared to be confined to the uterus. It thus appears essential in order to improve survival these patients require aggressive staging and consideration of systemic adjuvant chemotherapy.

The diagnosis and management of cervical intraepithelial neoplasia in the patient under the age of twenty-one

The diagnosis and management of 260 patients between the ages of 15 and 21 with cervical intraepithelial neoplasia is discussed. These patients represented 22% of all new patients seen in the Colposcopy Clinic of The Johns Hopkins Hospital between January 1975 and December 1979.

Taxol: A unique antineoplastic agent with significant activity in advanced ovarian epithelial neoplasms

STUDY OBJECTIVE To assess the activity of taxol in patients with advanced, progressive, and drug-refractory ovarian cancer and to delineate more clearly the toxicity of taxol in this patient population. DESIGN Nonrandomized, prospective phase II trial. PATIENTS Forty-seven patients with drug-refractory epithelial ovarian cancer who had one or more lesions measurable in perpendicular diameters. Of these patients, 45 were evaluable for toxicity and 40 were evaluable for response. INTERVENTIONS PATIENTS were treated every 22 days with varying doses of taxol (110 to 250 mg/m2 body surface) given as a 24-hour infusion with subsequent doses based on adverse effects. A premedication regimen was used to avoid acute hypersensitivity reactions. MEASUREMENTS AND MAIN RESULTS Twelve patients (30%; CI, 16% to 44%) responded to taxol for periods lasting from 3 to 15 months. The dose-limiting toxicity was myelosuppression with leukocytes affected more severely and commonly than thrombocytes or reticulocytes. Leukopenia was usually brief in duration but was associated with sepsis in 3 cases (2 fatal). Other adverse effects included myalgias, arthralgias, alopecia, diarrhea, nausea, vomiting, mucositis, and peripheral neuropathy. Rare cases of cardiac and central neurotoxicity were also noted. CONCLUSIONS Taxol is an active agent in drug-refractory ovarian cancer and deserves further study in combination with other active drugs in previously untreated patients with advanced ovarian cancer.