Handan Karaoguz

Two dose levels of ifosfamide in malignant mesothelioma

Thirty-one consecutive patients with histologically proven and symptomatic malignant mesothelioma were treated with two dose levels of ifosfamide. The first group of 15 patients were given 2.3 g/m2/day for 5 days (group A) and the following 16 patients were treated with 1.2 g/m2/day for 5 days of ifosfamide (group B). Treatment cycles were repeated every 3 weeks. While the partial response rate (PR) in group A was 38.5%, it was only 6.25% in group B (P > 0.05). The 95% confidence interval for the difference in PR rates was 3.3-61.2% > The overall survival (OAS) of groups A and B were similar (8 months and 9 months, respectively). Higher Grade 3-4 myelotoxicity was observed in group A when compared to group B (30.8% vs. 18.7%; P > 0.05). In conclusion, a favourable response rate could be achieved in malignant mesothelioma with high dose ifosfamide at the cost of increased toxicity.

Phase II study of cisplatin and dacarbazine for metastatic colorectal carcinoma resistant to 5-fluorouracil.

Twenty-six patients with metastatic colorectal cancer were given cisplatin (CDDP) and dacarbazine (DTIC). Patients who relapsed while receiving adjuvant 5-fluorouracil (FU) or had 5-FU-resistant metastatic disease were included. Median age was 52 years and the male-to-female ratio was 1. Performance status (ECOG) was 3 in 5 patients and 0–2 in the remainder. CDDP (20 mg/m2/day i.v.) and DTIC were given (250 mg/m2/day i.v.) on days 1–5. The treatment was repeated every 3 weeks until disease progression. Total response rate was 19.2% (95% confidence interval: 4.5–34.3%) with one clinical complete response (3.8%) and 4 partial responses (15.4%). Median response duration was 5 months. Median survival for the whole group and for responders was 6 and 8 months, respectively. In conclusion, CDDP + DTIC combination has modest activity in patients with colorectal cancer resistant to 5-FU treatment.

Mesna/Ifosfamide, Mitoxantrone, Etoposide, Bleomycin, Vincristine, Prednisone (Mine-Bop) Combination Chemotherapy In The Treatment Of Refractory And Relapsed Non-Hodgkin'S Lymphoma

Twenty-one consecutive patients with refractory or relapsed non-Hodgkins lymphomas were treated with a novel combination chemotherapy (MINE-BOP), comprising myelosuppressive (ifosfamide, mitoxantrone, etoposide) and non-myelosuppressive (bleomycin, vincristine and prednisone) drugs. Median age of the patients was 42 years and all had intermediate or high-grade lymphoma. Fifteen patients had refractory disease. All patients had previously been treated with one or two regimens, containing anthracyclines. In all cases the duration between the last chemotherapy and the MINE-BOP regimen was shorter than 12 months. Response rate was 57% with 33% complete remission (CR). Median disease-free and overall survivals were 7 and 10 months respectively. The serum LDH level was the only significant prognostic factor in this study. The toxicity of this regimen was moderate with 24% of febrile neutropenia and 9% of microscopic hematuria. Toxic death due to febrile neutropenia was observed in one patient who had bone marrow involvement. To conclude, the addition of non-myelosuppressive drugs to the chemotherapy regimen and shortening the interval between the application of cytotoxic drugs as used in the present study did not show any improvement of response and survival in this group of patients.

Phase II study of a modified combination of etoposide, doxorubicin, and cisplatin for patients with advanced gastric cancer

SYNOPSIS: Etoposide, doxorubicin, and cisplatin combination chemotherapy in a modified combination was an effective treatment in advanced gastric cancer, with an overall response rate of 40.5%. Disease extension and pretreatment performance status had significant effects on survival.

Treatment of metastatic malignant melanoma with 24 hours continuous venous infusion of dacarbazine and cisplatin

Twenty consecutive patients with metastatic malignant melanoma were treated with a combination of 24 hours continuous infusion of dacarbazine (250 mg/m2) and cisplatin (20 mg/m2) for 5 days every 3 weeks. One patient (5%) achieved a complete response (CR) and 3 patients (15%) obtained a partial response (PR) with an overall response rate of 20%. Minimal response was observed in 5 other patients (25%). Complete response duration was 8 months. Median response duration of partial responders was 7 months. Median survival of all responders (CR+PR) was 8.5 months. Toxicity was mild to moderate.

Results of the Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone (CHOP) ± Bleomycin Treatment and Evaluation of Prognostic Factors in Aggressive Lymphomas in Turkey

Prognostic factors and the results of the cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) +/- bleomycin treatment in 93 consecutive evaluable patients with aggressive lymphomas are presented. The overall response rate, excluding 7 patients with primary extranodal lymphoma who were in complete remission after surgery, was 83% with a complete response (CR) rate of 69%. Overall survival (OS) rates of all patients and disease-free survival (DFS) rates of complete responders at 4 years were 52 and 66%, respectively. Almost two thirds of the patients could be given at least 75% of the planned chemotherapy doses. Treatment toxicities were in acceptable limits, only 10% of the patients had grade 3-4 hematological toxicity. Age, performance status (PS), stage, number of extranodal sites (ENS) (< or = 1 vs. > 1), B symptoms, serum LDH levels were evaluated as prognostic factors. Univariate survival analysis yielded stage, ENS and PS as significant prognostic factors for OS (p = 0.0009, p = 0.0028 and p = 0.0155, respectively). Only involvement of more than 1 ENS was strongly associated with low CR (p = 0.0479) and high relapse rates (p = 0.0118), and it was also determined as the only independent prognostic factor for OS in patients younger than 60 (p = 0.0015). A modified age-adjusted prognostic index, including ENS in addition to stage, LDH and PS, was found to be more significant than the original age-adjusted International Prognostic Index (IPI) for both DFS (p = 0.0030) and OS (p < 0.00001). In conclusion, modified age-adjusted index may be a convenient alternative to the original age-adjusted IPI to identify high-risk patients with aggressive lymphomas in Turkey and probably also in other developing countries for experimental intensive regimens.