Pentti Gröhn

Adjuvant postoperative radiotherapy, chemotherapy, and immunotherapy in stage III breast cancer. II. 5-year results and influence of levamisole

One hundred twenty pathologically confirmed operable Stage III breast cancer patients were randomized to receive either postoperative radiotherapy or chemotherapy, or a combination of these, with or without levamisole immunotherapy. Radiotherapy was given to regional lymph nodes and chest wall. Chemotherapy consisted of six cycles of vincristine, doxorubicin, and cyclophosphamide. Radiotherapy provided local and chemotherapy systemic control over the tumor, but the best patient‐saving results were achieved with a combination of radiotherapy and chemotherapy. This clinical trial was commenced in 1976, and the first 60 of 120 patients also received oral levamisole, 150 mg/day, on 2 consecutive days weekly as immunotherapy. All patients were followed for at least 5 years. At this stage levamisole seems to increase disease‐free and overall survival in all three treatment arms (radiotherapy, chemotherapy, combined treatment). Significance is reached in disease‐free survival (P = 0.035) and overall survival, adjusted for all other treatment modalities (P = 0.019).

Treatment of metastatic carcinoid tumour with recombinant interferon alfa

14 patients with metastatic carcinoid tumour were treated with recombinant interferon alfa 6-30 x 10(6) IU weekly for 3-25 (median 6.5) months. A decrease in the 24-h urinary 5-hydroxyindoleacetic acid (5-HIAA) level to less than 50% of the pretreatment value was observed in 5 of the 10 cases with an elevated urinary 5-HIAA level. In 4 of the 5 remaining patients, the 5-HIAA level decreased 30-50% from the pretreatment value. 5 of the 9 evaluable patients with carcinoid syndrome experienced symptomatic relief, but none became symptom-free. Severe toxicity was not observed. The median time to progression was 4.5 months, and, in patients with a greater than 50% decrease in 24-h urinary-5-HIAA, it was 17 months. Objective regression in tumour size could not be demonstrated in any of the patients.

Oral carmofur in advanced gastrointestinal cancer.

One hundred and twenty-four patients with a diagnosis of metastatic gastrointestinal cancer and no prior therapy were included in this clinical study of carmofur monotherapy, 300–500 mg/m2 daily for 6 weeks. For the 115 evaluable patients, the response rates were 19.4% in gastric cancer, 27.2% in cancer of mobile colon, and 12.5% in rectal cancer. No objective responses were seen in 38 patients with pancreatic cancer, although the disease of 13 of these patients has remained stable over a considerably long period of follow-up. The toxicity profile was interesting; the main adverse effects were urinary bladder symptoms and flush. Hematologic toxicity was minimal. The treatment proved to be safe and could be used for outpatients.

Carcinoma of the uterine cervix stage III: A report of 311 cases

Abstract A series of 311 cases of carcinoma of the uterine cervix stage III treated during 1964–1973 and followed up at least for 5 years is presented. In 1964–1969 (period I), local applications of radium were first given, followed by X-ray treatment of parametria with Mullers apparatus. This therapy was replaced in 1970–1973 (period II) by external megavoltage treatment followed by radium applications. A total of 169 patients were treated in period I and 142 in period II. The 5-year observed survival rate was 28% in the former and 36% in the latter period. The higher survival rate of the latter period was, however, statistically significant only in the first 2 years after treatment. The relative survival rates for the older age groups of patients were better than those for the younger groups, a trend which was statistically highly significant. Megavoltage therapy increased the frequency of transient complications. Severe complications, however, were equally represented in both periods. Fistulas were observed in 12.5% of the patients. In 13% of the series a surgical operation was performed for correction of a complication.

Phase II evaluation of peroral carmofur, cyclophosphamide, and hexamethylmelamine as a second-line therapy in advanced epithelial ovarian carcinoma

A prospective phase II study was performed to evaluate the effect and tolerability of a peroral combination chemotherapy consisting of hexamethylmelamine, cyclophosphamide, and carmofur in patients with epithelial ovarian cancer previously heavily treated by cisplatin-based chemotherapy but no longer responding to it. Of the 27 patients 1 showed a clinical complete remission lasting 15+ months and 4 a partial remission of 6+ to 21 months. A further 7 patients had an unchanged situation of 4 to 13+ months. The median survival of the nonresponders was 3 months. The side effects were tolerable, mostly nausea and vomiting. Only 4 of 27 patients suffered from severe vomiting causing discontinuation of the therapy. The peroral ambulatory chemotherapy prolonged markedly the overall survival of about one-half of the patients with ovarian cancer who previously failed to respond to cisplatin-based chemotherapy.

Nandrolone decanoate added to tamoxifen in the treatment of advanced breast cancer

SummarySince 1980 we have been carrying out a prospective randomized trial comparing tamoxifen with the combination of tamoxifen plus nandrolone decanoate in advanced breast cancer. The tamoxifen dose is 30 mg daily and the nandrolone decanoate dose 100 mg i.m. once a week for four weeks and thereafter every other week. 98 post-menopausal patients have been evaluated for the response. The number of patients is 49 in both groups.The overall response rates (CR +PR) to tamoxifen and tamoxifen plus nandrolone decanoate were not significantly different; in the tamoxifen group the response rate was 49% and in the combination group 45%. The mean time to progression in tamoxifen group is over 13 months and in tamoxifen plus nandrolone decanoate group over 12 months. Our results do not suggest a synergistic effect from combining tamoxifen and nandrolone decanoate treatments. The response rates to tamoxifen at different sites of metastases were as follows: bones 47%, soft tissues 56%, and viscera 48%. The respective figures with the combination therapy were 36%, 64%, and 40%.Both treatments were well tolerated and in no patient was withdrawal of the therapy necessary. Mild virilization and hoarseness were experienced by all patients treated with nandrolone decanoate. Side-effects associated with tamoxifen were rare, although five patients experienced nausea and two had hot flushes.

Transfer factor immunotherapy in Hodgkin's and non-Hodgkin's lymphoma

SummaryHuman dialyzable transfer factor was administered in a double-blind fashion to patients with Hodgkins disease and non-Hodgkins lymphoma. Two groups were examined; patients with active disease and patients in remission. Parameters of cellular and humoral immunity were studied. The effect of transfer factor on the clinical condition was not evaluated.Transfer factor tended to intensify the skin test reactions of patients in remission to several recall antigens, but had no effect on the other parameters or the other patient group.