"Quick Cycle" neoadjuvant chemotherapy in squamous cell carcinoma of cervix
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Abstract:
Objective: To evaluate the efficacy and safety of a 'Quick cycle' neoadjuvant chemotherapeutic regime in squamous cell carcinoma (SCC) of cervix and monitor the response to chemotherapy using Squamous Cell Carcinoma Antigen (SCC-Ag) as tumor marker.Materials and Methods: Thirty patients with SCC of cervix (Stage I-IV) entered the study to receive three courses of multiagent neoadjuvant chemotherapy (vincristine, cisplatin and bleomycin) in a weekly regime. SCC-Ag was evaluated in these patients' pre and post-chemotherapy.
Results: Patients with stage IB2 had a complete response and two of seven patients with stage IIB became operable. The overall response rate was 47.8% and complete response rate was 8.7%. Decrease in tumor volume post-chemotherapy was significant (P<0.002). Toxicity including myelosuppression was minimal. A statistically significant decrease in SCC-Ag (stage II and III) was seen post-chemotherapy (P <0.04 and 0.005, respectively).
Conclusion: The weekly chemotherapeutic regime was found to be safe and effective and SCC-Ag is a useful tumor marker for monitoring response to chemotherapy.
Complete response
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Lung Fibrosis
Pneumonitis
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Thirty-eight children with metastatic neuroblastoma were given a combination of vincristine sulfate and cyclophosphamide in addition to standard surgical and radiotherapeutic management. The two agents were given intravenously on alternating weeks for 12 weeks or longer. Results were best in eight infants under 1 year, five of whom continued to survive free of disease for 16 months. The overall response rate in patients of all ages was 32% (nine out of 28), and the mean survival was 12 months. The combination of the two agents was effective.
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Sixteen children with Stage III and N neuroblastoma were treated using two different chemotherapy protocols; six with a James' therapy plus adriamycin, and ten with a regimen consisting of high-dose cyclophosphamide, vincristine and adriamycin in a nonrandomized fashion. The highdose cyclophosphamide with vincristine and adriamycin appeared to improve the duration of survival; that is, in the patients treated by this protocol, the median survival duration was 25 months, the one-year survival rate was 75% and the three-year survival rate was 50%. On the other hand, none of the patients treated by James' therapy plus adriamycin survived for more than one year. Their median survival was only four months.
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배경(Background): Vincristine은 vinca alkaloid계 약물로 세포내 미세소관의 구조를 저해하여 여러 종류의 종양 치료제로 광범위하게 사용된다. 또한 임상의학에서는 황산염의 형태인 항암제로 사용하고 있으며, 특히 조혈기의 종양 즉 급성백혈병, 호지킨병, 림프육종 등에 효과가 있다고 한다. 주로 일반적인 치료에 반응하지 않는 특발성 혈소판감소성자반증에서도 사용된다는 보고도 있다. 이에 저자들은 특발성혈소판감소자반병(ITP)환자에 대해 치료적 목적의 Vincristine을 투입한 성분채집혈소판의 제조경험을 가져 이에 보고하는 바이다. 재료 및 방법(Materials and Methods): 환자와 동일한 혈액형의 성분채집혈소판 1 unit와 신선동결혈장 2 unit를 준비하여, 혈장을 제거하기 위해 성분채집혈소판을 원심을 한다. 여기에 Vincristine 5mg을 주입한 후 어두운 장소내 37℃ 교반기에서 1시간동안 혈소판과Vincristine 반응의 결합력을 극대화 시킨다. 무균적 연결장치를 이용하여 상층을 제거한 후 혈소판내 신선동결혈장을 채워준다. 또한 혈소판 입자을 안정시키기 위해 10분간 방치한 후상층액을 제거한다. 추가로 신선동결혈장을 채워주어 30분동안 혈소판 교반기에 보관한 후30분에 걸쳐 천천히 수혈한다. 결과(Resultss): 특발성혈소판감소자반병(ITP)질환을 가진 62세 여성으로 스테로이드 및 면역글로부린 투여를 꾸준히 실시하였으며, 추가로 치료를 위해 본원에 내원하여 Vincristine을 투입한 성분채집혈소판을 수혈하였다. 투입 전 각각 혈소판수치는 25K, 38K, 15K 이었으며, Vincristine 투입 후 혈소판 수치 결과는 100K로 증가한 후 68K, 48K로 감소하였으나 스테로이드 제제와 병용한 후 118K로 증가하였다. 고찰(Discussion): 특발성혈소판감소자반병(ITP)은 혈액 내 혈소판 수와 골수에서 거대핵세포수가 정상내지 증가된 소견을 보인다. 이러한 환자를 대상으로 Vincristine은 세포 및 면역억제 작용을 하여 혈소판 관련 항체의 생성을 억제하리라 예상되며, 이 약물이 혈소판내의 미세관에 부착되고 혈소판이 대식세포에 탐식됨으로써 혈소판의 피괴가 감소한다고 한다. 또한 Vincristine의 투여로 난치성 특발성혈소판감소자반병(ITP)의 약 80%에서 혈소판 수의 증가를 보인다는 보고도 있다. 이러한 Vincristine은 특발성혈소판감소자반병(ITP)환자의 치료에 효과적이며, 부작용이 적은 치료법으로 이러한 제조과정을 경험하여 이에 보고하는 바이다.
Vinca
Vinca alkaloid
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Between 1970 and 1977, 69 children with newly diagnosed stage III or IV neuroblastoma were treated with pulses of either cyclophosphamide and vincristine (CV) (n = 23), or cyclophosphamide, vincristine, and adriamycin (CVA) (n = 46). The 9complete9 and partial response rates were 35 and 22% to CV, and 43 and 26% to CVA. For 9complete9 responders the median time to relapse was 18 months for those treated with CV, and 17 months for those treated CVA; for partial responders the times were 5 and 7 months respectively. At 2 1/2 years only 17% of the CV patients and only 13% of the CVA patients were alive and free of disease, giving a 15% overall survival rate. The addition of adriamycin to cyclophosphamide and vincristine did not significantly improve the response rate, duration of response, or survival in these children with advanced neuroblastoma. The previously noted favourable effects of age less than 1 year at diagnosis and of female sex were confirmed. The equally poor survival for stage III and stage IV patients justifies the inclusion of stage III patients in a bad prognosis group.
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人膀胱癌の1つの治療体系の確立を目的として, 温水潅流法による温熱 (Hyperthermia) 療法 (42～43℃) の臨床的検討を行つた. 温熱単独, 温熱と bleomycin の併用療法, 温熱と放射線の併用療法, 温熱と放射線と bleomycin の3者併用療法の4通りの療法を受けた34例の膀胱癌 (移行上皮癌) 患者につき, 治療効果, 副作用, 生体免疫能におよぼす影響につき検討を行つた.温熱単独では6例中2例に, 温熱と bleomycin の併用では4例中1例に, 温熱と放射線の併用では9例中5例に, 温熱と放射線と bleomycin の3者の併用では15例中12例に, 腫瘍の明らかな縮小や消失の治療効果が認められた.副作用は膀胱刺激症状, 尿道痛が主なものであり, 重篤な副作用は認められなかつた.PHAや Con Aによるリンパ球幼若化能等を指標として生体免疫能におよぼす温熱療法の影響を検討した. 温熱と放射線の併用, および温熱と放射線と bleomycin の3者併用療法を受けた患者のこれら指標は, 治療の経過に伴つて抑制されたが, 放射線単独療法を受けた患者のそれとは差が認められなかつた.これらより, 膀胱癌の温熱療法に特に温熱と放射線と bleomycin の3者の併用療法は充分臨床応用が可能と考えられた.
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A controlled clinical study in children with lymphoblastic leukemia was conducted to measure the potential benefit of time sequencing vincristine and cyclophosphamide. Vincristine and cyclophosphamide were utilized in a maintenance regimen in children after a remission had been obtained. Patients received vincristine either 24 hours before cyclophosphamide or simultaneously with cyclophosphamide. The median time to relapse and the number of continued remissions was significantly increased for patients receiving vincristine 24 hours before cyclophosphamide when compared to those patients receiving both drugs simultaneously. The results of this comparative study indicate that the sequential use of vincristine and cyclophosphamide for maintenance of a second relapse in childhood ALL produces a greater duration of remission than when both are used simultaneously.
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THE Pediatric Division of the Southwest Cancer Chemotherapy Study Group has reported on the effectiveness of cyclophosphamide (Cytoxan) in inducing remissions in children with advanced acute leukemia.1 , 2 These preliminary results were particularly encouraging because cyclophosphamide, an alkylating agent of the mustard group, was found to act independently of other antileukemic drugs: steroids; 6-mercaptopurine (Purinethol, a purine antagonist); and methotrexate (a folic acid antagonist). It is also assumed to act with no crossresistance to vincristine (a periwinkle alkaloid). Subsequently, 137 patients with untreated acute leukemia were admitted to a Cooperative study to determine the effectiveness of cyclophosphamide at the beginning of . . .
Folic Acid Antagonists
Mercaptopurine
Nitrogen mustard
Acute lymphocytic leukemia
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This randomized study, conducted by the Eastern Cooperative Oncology Group, compared Adriamycin (doxorubicin) (70 mg/m2) versus vincristine (1.4 mg/m2) and Adriamycin (50 mg/m2); and cyclophosphamide (750 mg/m2) versus vincristine (1.4 mg/m2), actinomycin-D, (0.4 mg/m2), and cyclophosphamide (750 mg/m2) for treatment of metastatic mesenchymal malignancies. The respective response rate seen in 200 evaluable patients to the treatments were, 27, 19, and 11%. The response rate to Adriamycin was significantly better than the response to vincristine, actinomycin-D, and cyclophosphamide (P = 0.03, two-sided). The respective median survivals on the three treatments were 37, 34, and 41 weeks and were not significantly different. Moderate or severe vomiting occurred in 60% of patients receiving vincristine—cyclophosphamide—adriamycin, a greater frequency than in Adriamycin alone (P = .09 two-sided). Severe or life-threatening hematologic toxicity (leukocytes <2000, platelets <50,000) occurred in 30% of patients receiving the Adriamycin combination, a markedly increased frequency when compared to the other two regimens (P = 0.07, P = 0.02, two-sided). This trial establishes that Adriamycin has a better response rate than the combination of vincristine—actinomycin-D—cyclophosphamide in advanced sarcomas. The combination of vincristine, Adriamycin, and cyclophosphamide increased toxicity and did not add to the therapeutic effect achieved with Adriamycin alone.
Nitrogen mustard
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