Maria Teresa Cattaneo

Transient blindness and seizure associated with cisplantin therapy

SummaryA 38-year-old woman with adenocarcinoma of unknown origin was treated with cisplatin and etoposide. After the 4th course of chemotherapy she complained of blindness and had a seizure with spontaneous recovery in 4 days. The relationship between these events and the known neurotoxicity of other heavy metals indicate cisplatin as a possible etiologic factor.

CISPLATIN-VINORELBINE COMBINATION CHEMOTHERAPY IN LOCALLY ADVANCED NON-SMALL CELL LUNG CANCER

Aim The North Milan Group presents the results of a phase II study on a cisplatin-vinorelbine combination schedule in the treatment of locally advanced non-small cell lung cancer to evaluate its activity and tolerability. Methods Seventy-six consecutive patients entered the study. Patients’ characteristics were the following: males/females 69/7; median age, 61.4 years (range, 40-73); ECOG performance status, 0-1; 17 stage IIIa and 59 stage IIIb. There were 49 squamous cell carcinomas, 20 adenocarcinomas, and 7 large cell carcinomas. All patients had not been previously treated and showed measurable disease. Treatment consisted of vinorelbine, 25 mg/m2 on days 1 and 8, plus cisplatin, 80 mg/m2 on day 1, administered intravenously every 21 days for three standard courses. Results Seventy-four patients were evaluable for response. Objective responses were documented in 42/74 patients with an overall response rate (CR+PR) of 56.7%; 18/74 patients (24.3%) showed stable disease and the remaining 14/74 (18.9%) went into progression. Twelve patients (16.2%) were suitable for a subsequent surgery. The median duration of response was 13.3 months. Survival time ranged from 4 to 36 months: it was 14.6 months for PR patients, 8.6 months for NC and 5 months for PD. Mean survival time is presently 12.85 months (SE, 1.2 months). Toxicity evaluated on 222 cycles administered was acceptable, and it was necessary to use G-CSF or delay the treatment because of severe leukopenia in only a few cases. Conclusions The regimen is active and safe: the slight survival increase is likely due to the small amenability to surgery achieved (16.2%). However, our results are fully comparable to others obtained with vinorelbine in two/three drug combination chemotherapy regimens.

Pharmacokinetics of nitrosoureas: levels of 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) in organs of normal and Walker 256/B carcinoma bearing rats after i.v. bolus.

The disappearance of 1,3-bis-(2-chlorethyl)-1-nitrosourea (BCNU) from plasma, liver, kidney, lung, brain, spleen, tumor tissue and epididymal adipose tissue of Walker 256/B carcinoma-bearing rats and healthy animals was measured by differential pulse polarography after i.v. bolus of the drug. Only BCNU, not its decomposition products, was detected by the Polarographic assay. Levels of BCNU in liver of tumor-bearing animals were significantly lower (about 10 times) than those on healthy rats. A bi-exponential fit was used to calculate the kinetics of BCNU in plasma, kidney, lung and brain, but no difference could be found between healthy and Walker tumor-bearing rats. BCNU disappeared faster from adipose tissue of tumor-bearing animals than from normals.

Polarographic assay of submicrogram quantities of cis-dichlorodiamineplatinum (II) in biological samples.

Differential pulse Polarographic assay of the antineoplastic agent cis-dichlorodiamineplatinum II and its analogues was performed after acid oxidative hydrolysis (HCIO4, HNO3, HCI) of biological samples (plasma, tissue homogenates, urine) and reaction with ethylenediamine. Platinum levels and kinetics were determined in blood and urine of patients with non-oat-cell lung carcinoma. Detection limit of the polarographic assay was 0.5 ng platinum; analytical error was ± 3%. Levels of free cis-dichlorodiamineplatinum (II) in plasma fell in samples stored at –20 °C; the half-life of free drug was 38 h.

A Case of Bullous Dermatitis Induced by Erlotinib

Herein, we report a case of bullous dermatitis that occurred in a 61-year-old woman 5 days after beginning therapy with erlotinib for the treatment of stage IV pulmonary adenocarcinoma with metastases at the hypophyseal level. Skin reactions are the most common adverse drug reactions (ADRs) associated with epidermal growth factor receptor tyrosine kinase (EGFR-TK) inhibitors, and acneiform rash is the most frequently reported ADR in patients treated with erlotinib. To our knowledge, this is the first case of bullous dermatitis induced by erlotinib. This report highlights the need for additional research in the field of skin toxicity of EGFR-TK inhibitors.

Pharmacokinetics of Nitrosoureas: Comparison of 1,3-Bis-(2-Chloroethyl)-1-Nitrosourea (Bcnu) and 1-(2-Chloroethyl)-3-Cyclohexyl-1-Nitrosourea (Ccnu) after Oral and Intravenous Administration to Rats

Differential pulse Polarographic assay of intact nitrosoureas revealed the lower bioavailability of CCNU (1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea) in stomach and liver after oral administration to rats in comparison to BCNU (1,3-bis-(2-chloroethyl)-1-nitrosourea); blood levels of CCNU were below the detection limit of the method (20 ng). After i.v. bolus the CCNU concentration in plasma fell faster than that of BCNU. The rate of CCNU decomposition during incubation with blood at 37 °C was 3 times lower than that of BCNU.

Enzymuria in carboplatin nephrotoxicity.

Urinary excretion of N-acetyl-beta-glucosaminidase (NAG) is an early marker of nephrotoxicity. NAG activity was assayed by the fluorimetric method of Leaback and Walker in 17 patients treated (22 courses) with carboplatin (CBDCA, 220–550 mg/m2) before infusion and 24, 48, 72 and 96 h after. Increased excretion of NAG, a sensitive index of renal tubular damage, was observed following 10 of the 22 courses. A transient increase in plasma creatinine and/or abnormal proteinuria was observed in 6 cases. Impaired renal function prior to therapv seems to be a predisposing factor to the nephrotoxicity.

A Psychophysiological Approach to Assess Adequacy of Cognitive Therapy for Early Demented Depressed Patients

Cognitive Therapy as a treatment for depression, manualized intervention pioneered by Aaron Beck (Beck, Rush, Shaw, Emery, 1979), is a widely used form of psychotherapy that focuses on changing dysfunctional cognitions (thoughts), emotions and behaviors. This form of psychotherapy has received considerable empirical support, especially with regard to depression.

Six-drug sequential chemotherapy in non small cell lung cancer. A North Milan Group Study.

Forty-five patients with inoperable non small cell lung carcinoma were treated according to a sequential polychemotherapeutic regimen with cisplatin-vinblastine (A), cyclophosphamide-etoposide (B), and adriamycin-vincristine (C). Patients were evaluated every two cycles. Ten patients (22.2 %) showed a partial response with a mean duration of 20 weeks, and mean survival of 50.8 weeks. It is remarkable that, among them, 6 patients (13.3 %) lived over 12 months and three (6.6 %) over 18 months. The mean survival for all patients was 35.7 weeks. Toxicity was acceptable and reversible.