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Biomedical subjects

B H Weinerman

Publications and source records attributed to B H Weinerman.

At least 19 recordsLinked to original sources

A phase II survival comparison of patients with adenocarcinoma of the pancreas treated with 5-fluorouracil and calcium leucovorin versus a matched tumor registry control population.

Carcinoma of the pancreas is a virulent malignancy. We performed a Phase II survival study by treating 30 patients with pancreatic cancer with leucovorin, 200 mg/m2 x 5 days immediately followed by 5-fluorouracil, 370 mg/m2 every 4 weeks. We examined the survival of our 30 study patients with patients drawn from the Manitoba Tumor Registry, matched for important prognostic criteria. Classical response rates were also evaluated in those patients who had measurable tumors. The response rate was 13% with two complete remissions and one partial remission, with 40 patients (7.8%) demonstrating stable disease for 2 months, and 39% of patients demonstrating progressive disease while on treatment. The mean survival of the Phase II-treated group was 16 weeks, compared to 12 weeks in the matched controls, which indicated an increase in survival of 30%. This was significant at the p = .001 level. Toxicity was not as great as expected. This trial demonstrates that there may be marginal survival benefit with 5FU leucovorin in pancreatic cancer, but more profound prolongation needs to be seen with chemotherapy regimens before instituting randomized trials.

Adenocarcinoma↗

Late recurrence of testicular cancer.

Late recurrence of nonseminomatous germ cell tumours of the testis is rare. The authors report on a 35-year-old man treated initially for embryonal cell carcinoma of the testis with metastases, who presented 12 years later with an increasing serum alpha-fetoprotein level and a biopsy-proven embryonal cell cancer in the hilus of the left lung. Because the tumour was highly resistant to two separate courses of cis-platinum-based chemotherapy and one course of radiotherapy, surgical resection for salvage was carried out. The patient was free of disease 3.5 years after the second operation. The possible reasons for the occurrence of this highly resistant metastatic testicular cancer are discussed. They include a second primary tumour and malignant degeneration of the original tumour. In this patient the latter cause was the most plausible.

Adult↗

Escalated as compared with standard doses of doxorubicin in BACOP therapy for patients with non-Hodgkin's lymphoma.

BACKGROUND AND METHODS: In 1981 the Clinical Trials Group of the National Cancer Institute of Canada completed a pilot study in patients with advanced-stage non-Hodgkin's lymphoma with aggressive tumor histology. That study demonstrated the potential efficacy of escalating the dose of doxorubicin used in a regimen of bleomycin, doxorubicin, cyclophosphamide, vincristine, and prednisone (BACOP). In the present study, we compared standard BACOP (s-BACOP) with BACOP that included escalated doses of doxorubicin (esc-BACOP) in 238 patients 16 to 70 years old with previously untreated, advanced-stage intermediate- or high-grade non-Hodgkin's lymphoma. During the first 28-day cycle all patients received doxorubicin in a dose of 25 mg per square meter of body-surface area on days 1 and 8. Patients randomly assigned to receive s-BACOP subsequently received five identical cycles, whereas those assigned to receive esc-BACOP received 40 mg of doxorubicin per square meter on days 1 and 8 of five subsequent cycles if granulocytopenia (< 1000 cells per cubic millimeter) had not developed during the first cycle. RESULTS: The 119 patients assigned to the esc-BACOP regimen received doxorubicin at a significantly higher mean weekly dose intensity (13.5 vs. 10.4 mg per square meter per week, P < 0.001) and mean total dose (296 vs. 231 mg per square meter, P < 0.001). Because of granulocytopenia during the first cycle of therapy, only 56 of these patients (47 percent) received the escalated doses of doxorubicin. During a median follow-up of 65 months, there were no differences between the s-BACOP and esc-BACOP groups in response rate, overall survival, or survival without disease progression. When the patients who actually received the escalated doses of doxorubicin were compared with the patients in the s-BACOP group in whom neutropenia did not develop during the first treatment cycle, no difference between their outcomes was observed. Toxicity was greater in the esc-BACOP group. CONCLUSIONS: In patients with advanced-stage intermediate- or high-grade non-Hodgkin's lymphoma, escalating the dose of doxorubicin in the BACOP regimen increases toxicity but does not improve the rate of response or survival.

Adolescent↗

Low-dose (diagnostic-like) x-ray as a cocarcinogen in mouse colon carcinoma.

To test the hypothesis that low-dose (diagnostic-like) radiation may play the part of a cocarcinogen in inflammatory bowel disease, we used four groups of BALB/C mice, (a control, dimethylhydrazine, dimethylhydrazine plus low-dose radiation, and low-dose radiation). We found no protective or carcinogen effects of the radiation in combination with dimethylhydrazine compared to dimethylhydrazine alone. This type of negative experimental finding is important in that individuals with inflammatory bowel disease have many diagnostic x-rays throughout life.

Animals↗

Phase II study of lonidamine in patients with metastatic renal cell carcinoma: a National Cancer Institute of Canada Clinical Trials Group Study.

The National Cancer Institute of Canada Clinical Trials Group conducted a phase II study of lonidamine, given in an escalating oral daily schedule in patients with measurable advanced renal cell carcinoma. Two responses were seen in 25 evaluable patients. Toxicity was mild or moderate in most patients and included myalgia, nausea, vomiting, somnolence, and testicular pain. Lonidamine was not myelosuppressive. This agent had only minimal activity against renal cell carcinoma when given in this oral schedule.

Adult↗

Toxicity of oral N-methylformamide in three phase II trials: a report from the National Cancer Institute of Canada Clinical Trials Group.

Three National Cancer Institute of Canada phase II studies of N-methylformamide (NMF), given in a three times/week oral schedule, closed early because of frequent and occasionally severe toxicity. Eighteen of 41 (44%) cycles of treatment were not completed because of problems with NMF-induced hepatic and gastrointestinal toxicity. Several other reactions occurred, including skin rashes, abdominal pain, and gastritis, which were drug induced. One death occurred on study and was thought to be due in part to NMF toxicity. Further work exploring alternative schedules is needed before phase II studies of oral NMF can be done.

Alkaline Phosphatase↗

Non-Hodgkin's lymphoma in Manitoba, 1968-77: the impact of chemotherapy.

Manitoba tumour registry data for patients with non-Hodgkin's lymphoma diagnosed between 1968 and 1977 inclusive who were given chemotherapy were reviewed. The Rappaport classification of these tumours enabled general pathologists in the province to distinguish three main prognostic groups. Combination chemotherapy improved survival significantly more than single-agent chemotherapy only for the patients with diffuse histiocytic lymphoma, not for those with diffuse poorly differentiated lymphocytic lymphoma or the more favourable histologic types of non-Hodgkin's lymphoma--diffuse well differentiated lymphocytic and nodular poorly differentiated lymphocytic. For the last two types, therefore, the more intensive chemotherapy is not justified.

Antineoplastic Agents↗

Second malignancies in non-Hodgkin's lymphoma.

Six hundred thirty cases of non-Hodgkin's lymphoma (NHL) in the Tumour Registry of Manitoba spanning an 11-year period from January 1968 to December 1978 were reviewed. There were 34 cancers from 31 individuals who developed the cancer at least six months after diagnosis of NHL. There was no statistical difference in the incidence of second malignancies in this disease compared with an age-matched population in Manitoba. In particular, no cases of acute leukemia were identified.

Aged↗

MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) given during pregnancy.

A 26-year-old woman with Hodgkin's disease was treated with multiple-agent chemotherapy at 26 weeks' gestation. She responded well to therapy. Labor was induced at 38 weeks' gestation, and a normal male infant was delivered with no complications. The patient and infant continue to do well at 8 months following delivery. This is one of the first reports of multiple-agent chemotherapy used in early pregnancy.

Adult↗

Impaired serum antibody response to inactivated influenza A and B vaccine in cancer patients.

The serum antibody response to vaccination with bivalent inactivated influenza vaccine containing A/Port Chalmers/1/73 (H3N2) and B/Hong Kong/5/72 antigens was assessed in 44 patients with cancer and in 27 healthy control subjects. A fourfold or greater increase in antibody titre after vaccination occurred in 16 of the 44 cancer patients and 25 of the 27 controls for the A antigen, and in 14 of the 44 cancer patients and 20 of the 27 controls for the B antigen. Patients with lymphoma, who tended to have hypogammaglobulinemia, responded less well than did patients with solid tumours. Among the latter the failure to show a fourfold or greater increase in antibody titre correlated with a poorer 18-month survival.

Adult↗

Secondary malignant neoplasms in patients with Hodgkin's disease.

Retrospective analysis of 232 cases of Hodgkin's disease (HD) treated at the University of Manitoba from Jan. 1, 1965, to Dec 31, 1973, and followed up to 44.3 months disclosed five cases of secondary malignant neoplasms. Two cases of acute leukemia were discovered compared with an expected value of 0.05 in our community. All neoplasms developed in the mixed cellularity group, representing only 28% of the HD cases. Combinations of radiotherapy and chemotherapy may have increased the incidence of leukemia, but its frequency does not appear high enough to abandon combined modality treatment.

Adult↗

Diffuse histiocytic lymphoma. The need for aggressive restaging.

Fifteen patients with stage III and IV diffuse histiocytic lymphoma were treated with combination chemotherapy: cyclophosphamide, vincristine sulfate, prednisone, and procarbazine hydrochloride (COPP). Eight achieved a complete clinical remission. Of these, five relapsed, but remission was reinduced in three of these. Median survival of partial responders was 52 weeks compared to more than 129 weeks for complete responders. Complete clinical remission in diffuse histiocytic lymphomas did not presage a long disease-free interval as has been reported in biopsy proved remission series. Biopsy and staging by pathologic examination appear necessary to document remission in this disease.

Adult↗

Subsequent neoplasia in chronic lymphocytic leukemia.

We performed a retrospective analysis of all 102 cases of chronic lymphocytic leukemia (CLL) treated by the Hematology Service of the University of Manitoba from Jan 1, 1955, to April 1, 1974. The incidence of secondary cancer was compared with that in the Cancer Registry population of Manitoba of the same age and sex distribution. The risk of all cancers developing in patients with CLL was threefold that for the age- and sex-matched population, eightfold for skin cancers, and twofold for all cancers excluding skin cancer.

Aged↗