Gerold Bepler

Prognostic value of pretreatment carcinoembryonic antigen, neuron-specific enolase, and creatine kinase-BB levels in sera of patients with small cell lung cancer

Carcinoembryonic antigen (CEA), neuron‐specific enolase (NSE), and the BB isoenzyme of creatine kinase (CK‐BB) were evaluated before therapy in the sera of 195 patients with histologically confirmed small cell lung cancer (SCLC) in a prospective multicenter trial. Forty‐four percent (84 of 193) of all patients had CEA levels higher than 5 ng/ml, 66% (111 of 168) had NSE levels higher than 12.5 ng/ml, and 32% (40 of 123) had CK‐BB levels higher than 10 ng/ml. Clear pathologic levels were less frequently observed. Significantly higher pretreatment titers for CEA, NSE, and CK‐BB were found in patients with bone marrow and/or liver metastases. The most elevated marker levels were observed in the group of nonresponding patients with bone marrow and/or liver metastases. Only a slight correlation between the pretreatment CEA level and survival time could be observed. Patients with pathologic NSE (greater than or equal to 30 ng/ml) levels and, in particular, those with pathologic CK‐BB (greater than or equal to 25 ng/ml) levels had a significantly shorter median survival than those with normal or elevated levels. In addition, a positive linear correlation between pretreatment NSE and CK‐BB (n = 116, r = 0.54) levels was found, but CEA levels did not correlate with other marker levels. From these data it is concluded that pretreatment CEA, NSE, and CK‐BB levels are helpful in the clinical management of a subset of patients with SCLC, i.e. those with bone marrow and/or liver metastases.

Alternating versus sequential chemotherapy in small cell lung cancer. A randomized german multicenter trial

A total of 306 patients with small cell lung cancer (SCLC) were randomized to receive chemotherapy in a sequential or alternating mode. Sequential chemotherapy consisted of eight cycles of cyclophosphamide, Adriamycin (doxorubicin), and vincristine (CAV) and alternating chemotherapy consisted of three cycles (1, 3, 5) of etoposide, vindesine, and ifosfamide (EVI); three cycles (2, 4, 6) of cisplatin, Adriamycin, and vincristine (PAV); and two cycles (7, 8) of cyclophosphamide, methotrexate, and CCNU (CMC). Responsive patients received prophylactic cranial irradiation after three cycles and chest irradiation after eight cycles of chemotherapy. No maintenance therapy was applied to patients achieving complete remission. Minimum follow‐up was 2 years. Of the 302 patients evaluable, overall response rate was 59% in the sequential arm and 70% in the alternating arm. Patients treated with CAV had a complete response rate of 21% in contrast to 36% for those receiving alternating therapy. The median survival for all patients was 9.8 versus 11.3 months, for limited disease 11.1 versus 13.4 months, and for extensive disease 8.9 versus 9.9 months, all in favor of the alternating treatment. Two‐year survival rate for all patients was 6% versus 9%, for limited disease 11% versus 14%, and for extensive disease 3% versus 6%, all preferring the alternating treatment mode. Progression‐free survival demonstrated a strong correlation to the extent of response irrespective of the treatment regimen applied. Toxicity included 11 lethal and 8 life‐threatening complications with a higher frequency in the alternating treatment arm. These results suggest that alternating treatment of SCLC with different drug combinations is more effective than sequential application of CAV. Cancer 59:1072‐1082, 1987.

Atypical mycosis fungoides with cerebral involvement

SummaryThis report concerns a 17-year-old male patient with atypical mycosis fungoides (m.f.). Initial examination revealed generalized lymphoma and uncharacteristic livid skin efflorescence. The patient developed bone marrow involvement and meningeal leukaemia 6 months later. Diagnosis was confirmed by immunohistochemistry and electron microscopy. Aggressive chemotherapy yielded no response.

Circulating immune complexes of Hodgkin's disease contain an antigen that is present in Hodgkin and reed-sternberg cells

SummaryCirculating immune complexes (CIC), isolated from the serum of a patient with Hodgkins disease (HD) and from control serum (CS) of healthy adults, were used to generate heterologous antisera in rabbits. The antiserum directed against CIC from HD (AS-HD) and the antiserum directed against CIC from CS (AS-CS) were used to identify immunoglobulins, complement factors and alpha2-macroglobulin as immune complex components. After adsorbing both antisera with normal human sera, we found that the adsorbed AS-HD was immunoreactive with radiolabelled CIC from HD serum but not with radiolabelled CIC from CS. Sera of patients with different diseases and sera of healthy adults were assessed for the occurrence of this Hodgkin immune complex-associated antigen (HIC-Ag). The HIC-Ag was present in 37% (12/33) of sera from patients with HD, 8% (8/101) of sera from patients with nonmalignant diseases, and 0% (0/6) of sera from healthy adults. This antigen was equally distributed among HD patients with and without symptoms, but its occurrence correlated with an advanced clinical stage of the disease. Using the adsorbed AS-HD in the immunoperoxidase technique, we identified the HIC-Ag as a cytoplasmic antigen in Hodgkin and Reed-Sternberg cells; whereas, the adsorbed AS-CS did not reveal any staining. These data indicate the presence of an HIC-Ag in the sera of patients with HD and suggest that the adsorbed AS-HD might be useful for isolation and characterization of this antigen for future use as a tumour marker.