Seminars in oncology
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Seminars in oncology · Oct 1994
Clinical Trial Controlled Clinical TrialHigh-dose ifosfamide/carboplatin/etoposide: maximum tolerable doses, toxicities, and hematopoietic recovery after autologous stem cell reinfusion.
We treated 115 patients in a phase I/II dose-escalation study of ifosfamide/carboplatin/etoposide (ICE) followed by autologous stem cell rescue. Patients treated had a variety of diagnoses, including breast cancer (high-risk stage II disease with eight or more positive nodes, stage III disease, and responsive metastatic disease), non-Hodgkin's lymphoma, Hodgkin's disease, acute leukemia in first remission, and various solid tumors that were responsive to induction therapy. Patients received autologous bone marrow stem cells or peripheral blood stem cells primed by one of several methods. ⋯ Neutrophil recovery times varied based on the source of stem cells used, with the earliest engraftment times seen for patients receiving peripheral blood stem cells primed with cyclophosphamide and granulocyte colony-stimulating factor. Platelet recovery times were not statistically different for any of the subsets. In conclusion, the maximum tolerated dose of ICE has been defined, and the source of stem cells and the use of hematopoietic growth factors influence hematopoietic recovery.
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Seminars in oncology · Oct 1994
Clinical TrialVinorelbine (Navelbine)/carboplatin combination therapy: dose intensification with granulocyte colony-stimulating factor.
Treatment with platinum agents or the new vinca alkaloid vinorelbine (Navelbine; Burroughs Wellcome Co, Research Triangle Park, NC; Pierre Fabre Médicament, Paris, France) results in prolonged survival in patients with advanced non-small cell lung cancer (NSCLC). To determine whether a unique combination of these agents might enhance activity against NSCLC, a combination chemotherapy regimen consisting of intravenous carboplatin, administered on days 1 and 29, and intravenous vinorelbine, given once weekly, was evaluated. Because the dose-limiting toxicity of both agents is myelosuppression, an additional study goal was to assess the ability of granulocyte colony-stimulating factor to alleviate hematologic toxicity and allow on-time, full-dose vinorelbine therapy. ⋯ Four cohorts of patients were studied, ranging from those who received no vinorelbine to those who received drug doses of up to 30 mg/m2. Patients were able to tolerate the highest dose of vinorelbine, but the majority required granulocyte colony-stimulating factor support to do so. No novel toxicities were observed in patients treated with the combination of carboplatin and vinorelbine.(ABSTRACT TRUNCATED AT 250 WORDS)
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Seminars in oncology · Oct 1994
Vinorelbine (Navelbine)--a new agent for the treatment of non-small cell lung cancer: a summary.
A large body of preclinical and clinical data concerning the new semisynthetic vinca alkaloid vinorelbine (Navelbine; Burroughs Wellcome Co, Research Triangle Park, NC; Pierre Fabre Médicament, Paris, France) are now available. At both the cellular and clinical levels, this drug shows reduced neurotoxicity compared with other vinca alkaloids. In phase III clinical trials of patients with advanced non-small cell lung cancer (NSCLC), treatment with the combination of vinorelbine and cisplatin resulted in survival advantages greater than those achieved by vindesine plus cisplatin. ⋯ Vinorelbine is now being actively investigated in combination and multimodality regimens in patients with various stages of NSCLC. New strategies to avoid vinorelbine-related granulocytopenia are also being developed. Vinorelbine-containing regimens hold the promise of providing effective, well-tolerated treatment for patients with NSCLC.
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In women with recurrent epithelial ovarian cancer, secondary treatment options include surgery and chemotherapy. Surgery should be considered in patients with persistent disease at the time of second-look laparotomy and before chemotherapy in those whose disease recurs following long-term remission. With regard to secondary chemotherapy, active agents include cisplatin, carboplatin, ifosfamide, and paclitaxel. ⋯ Patients who receive platinum therapy initially and relapse after long periods of remission often respond to second-line platinum treatment. Ifosfamide may be effective in patients receiving one or two prior cisplatin-containing regimens, but is contraindicated in those with hepatic or renal insufficiency. Paclitaxel is the drug of choice for patients who have developed primary resistance to platinum therapy.