Seminars in oncology
-
Seminars in oncology · Dec 1997
ReviewTreatment of patients with upper gastrointestinal carcinomas.
Carcinomas of the stomach and esophagus are a major health problem worldwide. Cancer remains incurable when it is metastatic or unresectable, and new active agents are needed to improve the outcome for these patients. Three phase II studies of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) are described here. ⋯ Toxicity with this combination has been moderate, and there have been no treatment-related deaths. With the reduced starting dose of 5-fluorouracil, the tolerance of this combination has improved substantially both in the inpatient and outpatient settings, resulting in a low frequency of grade 3 or 4 nonhematologic toxicity. Response has been higher in patients with squamous cell carcinoma.
-
Seminars in oncology · Dec 1997
ReviewStereotactic radiosurgery and radiotherapy: new developments and new directions.
Stereotactic irradiation is a precise method for the delivery of focused radiation beams to small intracranial targets. Treatment can be administered in single or multiple fractions (radiosurgery or stereotactic radiotherapy, respectively). The technology has evolved rapidly because of advances in both hardware and software design. Clinical indications are unfolding through the prospective trial mechanism.
-
Seminars in oncology · Oct 1997
ReviewSystemic treatment options in advanced colorectal cancer: perspectives on combination 5-fluorouracil plus leucovorin.
A variety of 5-fluorouracil (5-FU)- based chemotherapy regimens have been investigated in colorectal cancer patients in randomized trials over the past decade. The standard regimen for treatment of colorectal cancer is combination 5-FU plus leucovorin (LV). The results from 12 randomized trials indicate that 5-FU/LV is more active than single-agent 5-FU (25% v 14% of evaluable patients); however, median survival was unchanged (12.2 months v 11.4 months, respectively). ⋯ Other modulatory strategies that appear to produce higher response rates than single-agent intravenous push 5-FU include sequential methotrexate/5-FU (19% v 10%) and continuous infusion schedules (22% v 14%). Although 5-FU-modulated strategies improve response rates over those observed with single-agent 5-FU, median survival in multi-institutional trials unfortunately has not generally exceeded 12 months. The mechanism of action, clinical activity, and toxicity of single-agent 5-FU and 5-FU-modulated regimens are reviewed.
-
Seminars in oncology · Aug 1997
ReviewDocetaxel in combination chemotherapy for metastatic breast cancer.
Due to its novel mechanism of action, docetaxel has significant in vitro activity against a variety of solid tumors, including breast cancer. In phase II clinical trials, docetaxel 100 mg/m2 every 3 weeks has shown substantial single-agent activity in patients with both previously untreated and heavily pretreated metastatic breast cancer. As single-agent chemotherapy is rarely curative in this setting, docetaxel has been combined with other anticancer agents with proven efficacy against breast cancer (doxorubicin, vinorelbine, fluorouracil, cyclophosphamide, cisplatin, and doxorubicin plus cyclophosphamide) in an attempt to increase efficacy and prolong patient survival. ⋯ Combination studies with fluorouracil, cisplatin, and cyclophosphamide, and a study of sequential administration with doxorubicin + cyclophosphamide, are ongoing. Interim results indicate that these docetaxel-based combinations have acceptable safety profiles and encouraging levels of antitumor activity. The full results of these studies will help to elucidate the potential contribution of docetaxel-based combination chemotherapy to the management of metastatic breast cancer.