Ralph S. Freedman

Treatment of advanced uterine sarcoma with vincristine, actinomycin D, and cyclophosphamide

Between 1971 and 1979, seventy-four patients with metastatic or advanced recurrent sarcoma of uterine origin were treated with combination chemotherapy consisting of vincristine, actinomycin D, and cyclophosphamide (Cytoxan). The probability of survival at 2 and 5 years was 23 and 15%, respectively. The response rate for patients with measurable disease was 28.9% (15.6% partial responses and 13.3% complete responses). The median duration of a complete response was 16 months and that of a partial response was 5.5 months. The median survival of the complete responders was prolonged when compared to nonresponders.

Intraarterial cis-platinum in the management of squamous cell carcinoma of the uterine cervix.

Abstract Intraarterial cis -platinum was infused by hypogastric artery catheters in nine patients with squamous cell carcinoma of the uterine cervix. The dose of cis -platinum was 120 mg/m 2 and the infusion was repeated at 4-week intervals. Six patients had pelvic recurrences following radiation therapy and three had large-volume, primary cancers not amenable to conventional therapy. Three patients experienced partial tumor regression (greater than 50% reduction in measured diameters persisting for 3 months), while six had progressive disease. Five patients achieved substantial palliation. Toxicity was similar to that seen with systemic administration. There were no significant catheter complications.

Natural immunity against ovarian tumors.

We have analysed natural killer (NK) cytotoxic activity in peripheral blood and ascitic fluids of patients with advanced stage of ovarian epithelial carcinoma. All patients displayed low NK activity in peripheral blood and virtually no cytotoxicity in ascitic fluids. NK activity in ascitic fluids could be substantially augmented after regional administration of virus-modified tumor cell extracts (VMTE), and that in peripheral blood after culture of effector cells with interleukin-2 (IL-2) in vitro. Activated NK cells displayed cytotoxic activity against NK-sensitive and NK-resistant tumor cell lines as well as against fresh ovarian tumors. Parallelism was found between regional NK augmentation and regression of malignant ascites. The latter observation suggests possible NK cell role in defense against ovarian tumors.

Virus-modified homologus tumor-cell extract in the treatment of vulvar carcinoma

SummaryEight patients with squamous carcinoma of the vulva and two or more positive nodes have received adjunctive immunotherapy with a virus modified homologous cell extract. Seven of eight patients received radiation therapy in addition. Cells derived from the SW962 vulvar carcinoma cell line were infected with PR8/A/34 strain of influenza and a membrane extract was used for immunization. The extract was administered by the intradermal route weekly for three doses and then biweekly for up to 2 years. Each dose is equivalent to 1.5 mg protein. None of the patients have recurred and durations of remission are 24, 24, 22, 22, 21, 16, 7, and 2 months respectively. This compares favourably with similar groups of patients who were treated with surgery alone (22/33 recurred, median recurrence time 14.8 months) or surgery plus radiation therapy (8/9 recurrences, median recurrence time 11.0 months). No serious side effects have occurred with more than 200 doses of extract.Post immunization monitoring has indicated good in vitro and in vivo immunological responses and antibody titers to PR8 increased significantly in five of eight patients.

A survey of tumor markers in patients with squamous cell carcinoma of the uterine cervix

Abstract The circulating levels of carcinoembryonic antigen (CEA), α-fetoprotein (AFP), and chorionic gonadotrophin (B-hCG) were correlated with the extent of disease in 47 patients with squamous cell carcinoma of the uterine cervix. Pretherapy serum CEA levels were elevated (> 10 ng/ml) in 12 of 47 (26%) of the patients. The greatest incidence and the highest CEA elevations were observed in the sera of patients with Stage III disease. No elevations of serum AFP were observed in any of the patients, and B-hCG was elevated in only 4 of the 47 cases. In 2 of the 4 cases, elevations of the serum B-hCG were associated with pregnancy and in the remaining 2 cases the serum CEA value was also elevated. Contrary to a study reported by other investigators, our data indicate the the tumor marker profile consisting of CEA, AFP, and B-hCG does not increase the incidence of abnormal findings when compared to the CEA test used alone. Also, our CEA data are consistent with other reports which demonstrate that CEA may be a useful tumor marker in 23% of the patients with Stage I and II disease, 57% of the patients with Stage III disease, and 33% of patients with Stage IV disease. The serum CEA test does not appear to be useful for the early detection of noninvasive ( in situ ) disease.

Bleomycin and mitomycin‐C (BLM‐M) in recurrent squamous uterine cervical carcinoma

Bleomycin and mitomycin‐C (BLM‐M) induction therapy was administered to 23 patients with recurrent squamous carcinoma of the uterine cervix. Six patients (26%) responded. Although these results are much lower than originally reported with BLM‐M, there is statistical evidence that patients with disease outside the previous radiation therapy field have improved or more easily determined responses. There was no difference in survival between responders and nonresponders for patients who survived at least six weeks. Therapy was found to be relatively nontoxic with no deaths related to therapy.

Tumor antigenicity and the immune system in gynecological cancer: A review

Abstract A review of tumor immunology with particular emphasis on three gynecological malignancies, gestational trophoblastic disease, uterine cervical carcinoma, and ovarian carcinoma. Commentary includes the immune reactive cells and their functions as determined by in vitro and in vivo tests; serum and tissue antigen markers; and effects on the immune response of ionizing radiation, surgery, and chemotherapy.

Transfer factor and possible applications in gynecology

Dialyzable transfer factor (TFd) is reviewed against its historical background, preparation methods, physiochemical properties, possible mechanisms of action, pharmacology, and clinical studies, including several areas relating to gynecology. The possible role of TFd as an adjunct in the treatment of cancer is discussed. The discussion centers on gynecologic cancer in several patients who have received TFd. The difficulties and future possibilities for this modality of treatment are considered.