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Biomedical subjects

C Kamby

Publications and source records attributed to C Kamby.

At least 19 recordsLinked to original sources
PubMed1998

Oral treosulfan as second-line treatment in platinum-resistant ovarian cancer: a phase II study. The Danish Ovarian Cancer Study Group.

OBJECTIVE: To evaluate the effect of oral treosulfan in patients with platinum-resistant ovarian cancer. METHODS: A phase II trial of oral treosulfan 500 mg per day in 30 females with platinum resistant ovarian cancer. All patients had measurable or evaluable disease. RESULTS: The treatment was well tolerated. One patient (3%) achieved a partial response lasting 12+ months. Seven patients had stable disease for 5.3 months (median) range 4.4-7.5 months. Median time to progression was 11.5 weeks (95% C.L. 11-12 weeks). Median survival was 31 weeks (95% C.L. 30-35 weeks). CONCLUSION: Oral treosulfan in the present schedule is not recommended in platinum resistant ovarian cancer.

Adult↗
PubMed1997

Treatment outcome following radiotherapy in elderly patients with bladder cancer.

BACKGROUND AND PURPOSE: The optimal treatment of elderly patients with bladder cancer is not established. This study aimed to evaluate prognostic variables for survival and morbidity, which may be important for treatment strategy. MATERIAL AND METHODS: The medical records of 94 patients aged > or = 75 years receiving curatively intended radiotherapy for bladder cancer were reviewed retrospectively. RESULTS: Median age was 78 years (range 75-93 years). Fifty patients had T1-2 tumors, and 42 patients had T3-4 tumors. The total planned dose was 57.6-62.6 Gy in 24-30 fractions in 6 weeks. In 76 patients, a 2 week rest period was planned after 16 fractions (split course). Half of the patients were hospitalized during or after the treatment because of gastrointestinal or urogenital side effects. Median survival was 13.9 months (range 0.6-150.0 + months), 29% survived for 2 years and 7% survived for 5 years. Patients aged > 78 years survived for a shorter period than patients aged 75-78 years (13.4 versus 16.1 months). Univariate survival analysis revealed that low stage (T1-2), good performance status (PS < or = 1), split course treatment, no treatment interruption due to side effects, and no hospitalization during treatment were associated with long survival. In multivariate analyses, T-stage, split course treatment, and performance status were independent prognostic factors. CONCLUSION: The results confirm that curative intended radiotherapy is feasible in elderly patients, but patients with stage T3-4 and PS > 1 have a short survival. These patients should be offered palliative treatment.

Age Factors↗
PubMed1997

Pattern of dissemination and survival following isolated locoregional recurrence of breast cancer. A prospective study with more than 10 years of follow up.

PURPOSES: The study evaluated prognostic factors for dissemination and survival in patients with local or regional recurrence of breast cancer. Furthermore, the aim was to define subgroups of patients at different risk of developing metastases in specific anatomical sites. PATIENTS AND METHODS: The study included 140 patients with isolated local or regional node recurrence, who entered a prospective study for staging of patients with first recurrence of breast cancer in the period 1983-85. The primary treatment was a simple mastectomy; node positive patients received adjuvant radiotherapy and chemotherapy or tamoxifen. If possible, the locoregional recurrence was treated with surgery and/or radiotherapy, otherwise by systemic therapy. RESULTS: Median follow up was 10.4 years; 78 patients developed distant metastases (soft tissue, 32%; bone, 45%; viscera 40%). Median time to dissemination was 4.4 years, and the ten year dissemination rate was 72%. Median time to dissemination was 3.7 years for patients with recurrence in the regional nodes compared to 6.5 years for patients with chest wall recurrence only, p = 0.05. No specific time sequence (temporal pattern) was observed in the anatomical distribution of metastases, and the anatomical site of recurrence could not be predicted by any of the prognostic factors. At follow up, 93 patients had died. The median survival was 5.6 years and 30% were alive after 10 years. Forty-three of the 99 patients who received local therapy only did not develop metastases. Fifteen of these patients died without evidence of metastatic disease while 28 patients were still alive without distant recurrence after a median follow up time of 9.3 years (range, 6.5-11.9 years). Level of LDH and the number of positive regional nodes (NPOS) at primary diagnosis were significant independent prognostic factors for survival after recurrence. CONCLUSIONS: Approximately one third of the patients receiving local treatment only, were alive and without distant metastases up to ten years after locoregional recurrence, indicating that there is a subset of patients which may be long term survivors after local treatment only (surgery or radiotherapy). The duration of survival can be estimated by LDH and NPOS, but the model needs validation in a separate data set before clinical use.

Breast Neoplasms↗
PubMed1996

A phase 2 study with epirubicin as second-line treatment of patients with advanced epithelial ovarian cancer.

Thirty-six patients with advanced epithelial ovarian cancer received epirubicin as second-line therapy after primary treatment with carboplatin and cyclophosphamide. Thirty-four patients were evaluatable for response, 36 for toxicity. There were 9 responses (response rate 26.4%, 95% CI = 12.9-44.4), 2 complete and 7 partial. Median duration of response was 149 days (range 42-183); 4 patients with partial remission are still on study. Toxicity consisted of fatal cardiac failure and paravenous injection (1 patient), fatal leukopenia and sepsis (1 patient), and severe loss of appetite, nausea and vomiting, fatigue, and general malaise in 3 patients. Platelet nadir grade 4 (WHO) was observed in 2 patients while leukocyte nadir grade 4 was seen in 3 patients. The present study showed a high response rate from standard-dose epirubicin. Toxicity was acceptable in most patients, but 2 patients died from treatment complications which gives a treatment-related mortality rate of 6%. Response was primarily seen in patients with minor tumor load and in good general condition.

Adult↗
PubMed1996

Pattern of metastases in relation to characteristics of primary tumor and treatment in patients with disseminated urothelial carcinoma.

PURPOSE: The anatomical pattern of recurrence and metastases in patients with urothelial cancer are described, and the relationship between treatment and features of the primary invasive tumor and the subsequent pattern of metastases is analyzed. MATERIALS AND METHODS: Between 1976 and 1991, 240 patients with recurrent or metastatic urothelial cancer were admitted to our department. RESULTS: The majority of the patients had recurrence within 2 years after initial diagnosis. Local recurrences and lung metastases were diagnosed significantly earlier than other metastases. Multiple sites were involved in more than half of the patients. The most common sites of recurrence were local in the bladder in 65% of the cases and bone in 35%, followed by lymph nodes in 26% and lung in 20%. The pattern of metastases was similar in patients with different histological findings, grade and location of the primary tumor. Patients younger than 60 years and those with cancer of the renal pelvis more often had distant metastases compared to older patients with bladder cancer. Local recurrences were less frequent in patients who had undergone cystectomy compared to those treated with radiotherapy only. Moreover, patients with local recurrences were likely to have metastases elsewhere. CONCLUSIONS: Bone was the most frequent site of metastases outside the pelvis and all patients suspected to have recurrence should be examined for bone metastases. The results indicate that the pattern of recurrence and metastases are not dependent on the features of the primary tumor.

Age Factors↗
PubMed1995

Platinum analogue combination chemotherapy: cisplatin, carboplatin, and methotrexate in patients with metastatic urothelial tract tumors. A phase II trial with evaluation of prognostic factors.

BACKGROUND: Cisplatin is one of the single drugs that has shown the best documented effect in treating patients with locally recurrent or metastatic urothelial cancer. To the authors' knowledge, the effect of the combination of different platinum analogues in treating transitional cell carcinoma has not been evaluated previously neither experimentally nor in clinical studies. METHODS: A Phase II trial of carboplatin (200 mg/m2), cisplatin (100 mg/m2), and methotrexate (250 mg/m2) with folinic acid rescue every 3 weeks was performed on 55 previously untreated patients with metastatic or locally recurrent urothelial cell carcinoma. RESULTS: A response (complete response and partial response) was achieved in 21 of 51 evaluable patients (41%; 95% confidence limits, 28-56%). Twelve patients had no change, whereas 18 had progressive disease. Eight patients (16%) achieved a complete response, and most of these survived more than 2 years. No patient with poor performance (performance status score > or = 2) or bone metastases achieved a complete response. The median survival for all patients was 8.4 months. Multivariate survival analyses showed that performance status and alkaline phosphatase levels were significant prognostic factors for survival. CONCLUSION: Combination therapy with cisplatin, carboplatin, and methotrexate is feasible but offers no advantage over other combinations with cisplatin and methotrexate in treating metastatic urothelial cell cancer. It is important to select patients for treatment carefully, and further studies of prognostic factors in these patients are warranted.

Adult↗
PubMed1995

Serum YKL-40: a new potential marker of prognosis and location of metastases of patients with recurrent breast cancer.

YKL-40 is a recently discovered glycoprotein which is related in amino acid sequence to the chitinase protein family, but has no chitinase activity. Although the function of YKL-40 is presently unknown, the pattern of its expression by some tissues suggests that YKL-40 could function in tissue remodelling. The diagnostic features and relation to survival of serum YKL-40 have not been examined previously in human malignancies. In the present study YKL-40 was measured in serum obtained from 60 patients at the time that breast cancer recurrence was suspected. The median serum YKL-40 in patients with visceral or bone metastases was 328 and 157 micrograms/l, respectively and significantly higher compared to controls (99 micrograms/l, P < 0.001). Kaplan-Meier survival curves demonstrated that survival rates after 18 months were 24% for patients with high serum YKL-40 (> 207 micrograms/l = the 95 percentile of controls) and 60% for patients with normal serum YKL-40. The significance of the difference between the shorter survival of patients with high serum YKL-40 and the longer survival of patients with normal serum YKL-40 was high (P < 0.0009). When evaluated with other prognostic factors of survival after recurrence of breast cancer, serum YKL-40 and serum lactate dehydrogenase (LDH) were the most significant independent factors. The results indicate that determination of serum YKL-40 can be used as a prognostic marker related to the extent of disease and survival of patients with recurrence of breast cancer. In addition, the serum YKL-40 level may be of value in the follow-up of patients with breast cancer and in evaluating potential metastatic spread.

Adipokines↗
PubMed1994

Prognostic factors and significance of chemotherapy in patients with recurrent or metastatic transitional cell cancer of the urinary tract.

BACKGROUND: Prognostic factors for patients with disseminated transitional cell carcinoma of the urothelium (TCC) has been examined only in patients selected for studies with chemotherapy. This study was performed to determine important prognostic factors in patients with disseminated TCC and evaluate the impact of chemotherapy. METHODS: The prognostic factors for survival were analyzed in 240 patients with disseminated TCC admitted from 1976 to 1992. Information on prior medical history, baseline variables, and treatment were related to survival after dissemination. Both univariate and multivariate analyses were performed to identify factors of independent importance. RESULTS: Univariate analyses indicated that performance status; hemoglobin; leukocyte count; platelet count; concentrations of serum creatinine, aspartate aminotransferase, lactate dehydrogenase, and alkaline phosphatase; hydronephrosis; bone metastases; disease extension; and chemotherapy were related significantly to survival. Multivariate analysis demonstrated that a good performance status, a normal alkaline phosphatase concentration, and a normal serum creatinine concentration were independent prognosticators for long survival. When chemotherapy was included in the analysis, it was found to be the most important independent prognostic factor in conjunction with alkaline phosphatase and performance status. CONCLUSION: This study has established the importance of performance status and alkaline phosphatase as the most important prognostic factors of survival in patients with disseminated TCC regardless of treatment. Chemotherapy was found to be an independent prognostic variable that indicates a possible prolongation of survival in patients receiving chemotherapy.

Adult↗
PubMed1994

[The significance of prognostic factors on the occurrence of metastases from breast cancer to various localizations].

The aim of the study was to identify and compare risk factors for development of metastases from breast cancer at specific anatomical sites. The sites were grouped into ten categories, simultaneous occurrences at several sites being common. The influence of various risk factors for recurrence at one specific site can be modelled by well-established survival analysis techniques such as the Cox regression model. Recently, a generalization has been proposed that allows for joint occurrences at more than one site. The prognostic influences of various risk factors on recurrence at different sites may be compared using these models. Both methods were applied to data from the Danish Breast Cancer Cooperative Group on recurrence after breast cancer; the risk factors examined were degree of anaplasia, number of positive lymph nodes, site of primary tumour, skin or deep fascial invasion, age of the patient and adjuvant treatment regimens. Adjuvant therapy had the same effect on recurrence at all sites. For chemotherapy, this effect was marginally significantly positive. The number of positive lymph nodes was associated with an increased risk of metastases at all sites except the brain, where an opposing trend was found. The degree of anaplasia was associated with a somewhat increased risk of metastases at all sites, again the brain was an exception, here the effect of degree of anaplasia was significantly more pronounced. Application of the new types of models resulted in fewer differences between the relative influence of the prognostic factors than are implied by the use of the traditional regression models.

Adult↗
PubMed1993

[Systemic chemotherapy in bladder cancer].

This review reports the results of chemotherapy in advanced bladder cancer with emphasis on the latest studies concerning combination chemotherapy containing cisplatin and methotrexate. The main conclusion is, that chemotherapy has a tumor-reducing effect on both metastatic disease and local/regional recurrences, but it remains to be proven whether overall long-term survival is affected. Among patients who respond to chemotherapy, the survival seems to be prolonged, 10-15% of these patients achieving more than two years of disease-free survival. The most effective treatment regimes contain cisplatin and methotrexate. It is assumed that many patients with muscle-invasive bladder tumors have microscopic dissemination of the disease at the time of diagnosis, and chemotherapy has been given to these patients as primary treatment alone or as an adjuvant to cystectomy or radiotherapy. These studies have not been able to show any benefit in terms of prolonged survival of patients receiving chemotherapy. The results of on-going randomised studies are still awaited. It is concluded that chemotherapy to patients with both primary and metastatic bladder cancer is still an experimental treatment, which should only be used in the context of investigational studies.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

[The value of bone marrow scintigraphy in patients with recurrent breast cancer].

Attempts were made to assess the value of various methods of demonstration of bone metastases in patients with recurrence of cancer of the breast. A material of 123 patients with suspected or verified recurrence of cancer of the breast was submitted to a programme of investigation consisting of conventional X-ray survey of the axial skeleton and thorax, bone tissue scintigraphy, bone marrow scintigraphy, bone biopsy and aspiration of marrow and blood status including serum alkaline phosphatase. 54% and 29% of the patients had bone, metastases as assessed radiographically and by biopsy, respectively. In patients with radiographically demonstrated bone metastases, the predictive value of positive (PV-pos) whole-body scintigraphy was 79%. The findings on bone tissue scintigraphy and bone marrow scintigraphy were in agreement with the radiographic findings in 78% and 72%, respectively, and with the biopsy findings in 71% and 74%, respectively, of the cases. All of the cases of metastases verified by biopsy were identified also by radiographic examination and by bone tissue scintigraphy. The predictive value of negative bone tissue scintigraphy (PV-neg) was 76% and of bone marrow scintigraphy 65%. With biopsy as the final proof, bone tissue scintigraphy, bone marrow scintigraphy and radiography were found to have PV-pos values of 96%, 89% and 95%, respectively and PV-neg values of approximately 50% for all three forms of examination. Bone marrow scintigraphy has thus no diagnostic advantages as compared with bone tissue scintigraphy.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Marrow↗
PubMed1993

The diagnostic and prognostic value of serum bone Gla protein (osteocalcin) in patients with recurrent breast cancer.

Serum bone Gla protein (S-BGP), a marker of bone metabolism, was measured in 60 patients included in a staging programme for recurrent breast cancer. Other diagnostic procedures comprised S-alkaline phosphatase (S-AP), bone scan (B-scan), bilateral iliac crest bone marrow biopsies, and radiological bone survey. The sites of recurrence were bone (61%), bone marrow (46%), soft tissue (52%), lung (13%), pleura (11%), liver (4%), and brain (2%). Radiology and bone biopsy served as key diagnoses as to the presence or absence of bone metastases. The diagnostic efficiency of B-scan and S-AP was greater than that of S-BGP, and the result of BGP measurement was associated with neither extent nor number of bone metastases. However, the BGP values were significantly lower in patients who had visceral metastases, and the median duration of survival after recurrence was 13 months for patients with low S-BGP levels (= < 2.0 nmol l-1), compared to 18 months for patients with medium S-BGP values (2.0-2.9 nmol l-1), and 25 months for patients with high values (> 3.0 nmol l-1) (p = 0.19). Analyses of the simultaneous effect of univariate prognostic factors were performed using the Cox proportional hazards model. S-alkaline phosphatase (S-AP) and S-BGP were the only significant, independent prognostic factors.

Adult↗
PubMed1992

Differential influence of prognostic factors on the occurrence of metastases at various anatomical sites in human breast cancer.

The present study was initiated by data on the anatomical occurrence of metastases from breast cancer. Metastases may occur at various organs, here grouped into ten categories, and simultaneous occurrences at several sites are common. Our aim was to identify and compare risk factors for development of metastases at each site. The influence of the various risk factors for recurrence at one specific site can be modelled as a standard competing risk problem, using well-established survival analysis techniques such as the Cox regression model. Recently a generalization to joint occurrences at more than one site has been proposed. The more general models allow comparison of the differential prognostic influence of various risk factors on recurrence at different sites. We applied these methods to data from the Danish Breast Cancer Cooperative Group on recurrence after breast cancer, and examined the effect of degree of anaplasia, number of positive lymph nodes, size of primary tumour, skin or deep fascial invasion, age of the patient and adjuvant treatment regimen, as possible risk factors. There were no differential effects of type of therapy on recurrence in different sites. However, chemotherapy had a marginally significant positive effect at all sites. Moreover the number of positive lymph nodes was associated with an increased risk of metastases, homogenous across sites, except for brain where an opposing trend was found. Similarly the degree of anaplasia was associated with a somewhat increased risk of metastases, homogenous except for brain. For brain metastases a significantly more pronounced effect of degree of anaplasia was found. Comparison of the results obtained from the two types of models reveals that the new more general models confirm fewer differences between the influence of the prognostic factors than the traditional regression models suggest.

Adult↗
PubMed1992

Site-specific effect of chemotherapy in patients with breast cancer.

The efficacy of cytotoxic therapy in different anatomical sites can be studied by analyzing the anatomical distribution of recurrences following adjuvant therapy or the rate of response according to site of metastasis. Cumulated data from 7 adjuvant studies showed that the relative reduction in the rate of recurrence was 37% for local and regional recurrences versus 25% for distant metastases. There are only sparse and inconclusive data concerning the anatomical pattern of recurrence according to type of adjuvant chemotherapy. Thus, the majority of trials have not demonstrated significant differences in distribution of metastases in patients receiving different types of adjuvant systemic therapy. The available data on the rate of response in relation to metastatic site showed higher response rates in soft tissue metastases (55%), compared to visceral and bone metastases (40%). Cumulated data from 12 trials showed no differences in response rates between different soft tissue lesions (skin, subcutaneous tissue, lymph nodes, breast), or between metastases demonstrated by paraclinical tests (lung, liver, bone). However, there was a tendency for soft tissue lesions to have a higher response rate (55-60%) than visceral and bone metastases (31-44%). The reason for the observed differences is unknown. At the time of diagnosis soft tissue lesions may be smaller (with better blood supply) than visceral lesions. This might increase the likelihood of response, since experimental data show that the response rate is inversely correlated with tumour burden and tumour size. Another explanation is based on the hypothesis of site-specific clonal selection of tumour cells, which differ with respect to sensitivity to cytotoxic agents. However, the observed differences can also be ascribed to methodological errors or differences in assessing response of tumours at specific sites. Thus, the false positive response rate in soft tissue lesions, evaluated by physical examination, is approximately 20% compared with less than 10% in lung lesions evaluated by x-rays.

Antineoplastic Agents↗
PubMed1991

Prognostic indicators of metastatic bone disease in human breast cancer.

The time to detection of metastatic bone disease (MBD) by radiographic examination was studied in 221 patients with advanced breast cancer. None of the patients had bone metastases by radiography or bone marrow carcinosis, evaluated by bilateral iliac crest biopsy. The period of follow-up after first recurrence was 46 months. Fifty-five patients (25%) had MBD; 89 patients died without MBD. The cumulated rate of MBD was 14% and 27% after 1 and 2 years, respectively. The actuarial time to MBD was associated significantly with the presence of positive regional lymph nodes at primary diagnosis, the occurrence of metastases in the mediastinum, and the presence of visceral metastases. Moreover, a positive bone scintigraphic scan at the time of first recurrence and abnormal biochemical analyses from serum also were associated significantly with a shortened time to MBD. Micrometastases in the bone marrow, as detected by monoclonal antibodies against epithelial markers (epithelial membrane antigen and cytokeratin), were present in 18% of the patients. The presence of such tumor cells was not associated with development of radiologic MBD. Cox analyses revealed that the result of bone scintigraphic scanning and the presence of visceral metastases were the most important and independent predictors of the time of MBD. Four distinct prognostic groups were identified based on the status of these two variables. The recognition of these prognostic groups has several implications for clinical and therapeutic management of patients with recurrent breast cancer.

Aged↗