Changes in criteria for tumor response.
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Biomedical subjects
Publications and source records attributed to D J Perry.
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Five cases of hypersensitivity reactions to amsacrine are reported. These five cases are compared to the three cases previously published. Sixty-two reports on the clinical use of amsacrine in a variety of solid tumors and hematological malignancy were reviewed. Nine cases of hypersensitivity were described in the 2095 patients reported in these clinical trials. The approximate incidence of hypersensitivity to amsacrine is 0.4%.
A case of Hodgkin's disease presenting as idiopathic thrombocytopenic purpura in a 23-year-old male is reported. This is a rare presentation of Hodgkin's disease having been previously described in only two cases.
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Post-gamma globulin previously isolated and partially sequenced in this laboratory was used for production of polyclonal and monoclonal (hybridoma) antibodies. A radioimmunoassay method was developed for quantitation of post-gamma globulin with either antibody. The titration curves obtained were treated statistically and found practically indistinguishable. The sensitivity of the method adopted for the quantitation of post-gamma globulin in a variety of biological fluids was 0.13 ng/ml and the upper limit of precision was 2.5 ng/ml. The following results were obtained (mean +/- 1 SD): normal sera, 0.96 +/- 0.20 microgram/ml; pregnancy sera, 1.08 +/- 0.28 micrograms/ml; cord blood 2.08 +/- 0.33 micrograms/ml; hospitalized patient's sera, 1.3 +/- 0.54 micrograms/ml; geriatric subjects' sera 2.26 +/- 1.10 micrograms/ml; cerebrospinal fluid, 5.37 +/- 3.36 micrograms/ml; saliva, 1.22 +/- 0.67 micrograms/ml; synovial fluid, 1.27 +/- 0.41 micrograms/ml and urine, 0.11 +/- 0.125 microgram/ml. To shed light on the catabolism of post-gamma globulin the levels of beta 2-microglobulin were also measured radiometrically. Correlative statistical analysis of all the data have shown that renal handling of post-gamma globulin and beta 2-microglobulin may be very similar but not necessarily identical.
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The results of induction chemotherapy with vinblastine, bleomycin, and cis-platinum II are reported. No survival advantage was seen when the entire treatment group was compared with an historical control group. Special attention is directed to the meaning of complete response and the potential treatment options and survival advantages of the complete responders subgroup.
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Forty patients with metastatic colorectal carcinoma who had received no prior chemotherapy were entered onto a trial of methyl-CCNU, 5-fluorouracil, vincristine, and streptozocin (MOF-STREP). Ten of 40 (25%) responded. Two patients (5%) achieved a complete response and eight patients (20%) a partial response. In addition, 10 patients previously treated with chemotherapy received the MOF-STREP regimen; 1 of 10 (10%) responded. The duration of the complete responses were 5 and 16 mo, respectively. The median duration of the partial responses was 4 mo with a range of 1-16 mo. The median survival of the 11 responders was 14 mo. Median survival of the 39 nonresponders was 5 months. Responders lived significantly longer than nonresponders (p = 0.03, log-rank). Toxicity was severe with nausea and vomiting common after streptozocin and myelosuppression requiring dose reductions in 70% of patients. We compare our findings using this regimen to those of two previously reported trials.
We used mitoguazone (500 mg/m2 iv weekly, with 50-mg/m2 escalations weekly as tolerated) to treat 22 patients with squamous cell carcinoma of the head and neck which recurred after initial therapy. Nine of 22 (11%) patients responded: two had complete responses and seven had partial responses. Gastrointestinal toxicity and anemia were commonly seen. We conclude that mitoguazone is active in squamous cell carcinoma of the head and neck and should be incorporated into phase III trials.
Six patients with Hodgkin's disease who failed MOPP (mechlorethamine, vincristine, prednisone, and procarbazine) chemotherapy, with recurrences confined to lymph node areas, are reported. All patients were treated with tumoricidal doses of irradiation in mantle, inverted Y, or whole-abdominal fields. All six patients achieved complete remission, with minimal toxicity. Disease-free survival ranged from 3 to 38 months, with four patients remaining in complete remission at 9, 15, 27, and 38 months. Radiation therapy should be considered in patients failing MOPP chemotherapy with lymph node disease.
Forty-two patients with recurrent or metastatic squamous cell carcinoma of the head and neck were treated with vinblastine, bleomycin, and cisplatin. All patients had received prior surgery, radiation or chemotherapy and all had measurable disease. Forty-five percent of the patients responded with a median duration of response of eight months and median survival of nine months. Six patients (14%) were complete responders and had a median duration of response of 12 months and median survival of 24+ months. Thirteen patients (31%) were partial responders and had a median duration of response of seven months and survival of 13 months. Toxicity was mild with nausea and vomiting occurring in all patients after cisplatin. There were two cases of bleomycin-induced pulmonary fibrosis and two cases of mild renal insufficiency (creatinine clearance level, 45 cc/min). This regimen compares favorably with other published regimens for advanced head and neck cancer.
Two cases of documented T-cell lymphoma occurring in the oropharynx are described. Both patients presented with cervical lymphadenopathy and involvement of oropharyngeal tissues. Although classification of these patients' lesions in relation to other known T-cell lymphomas was difficult, the location of the lesions in both cases and certain morphologic features in one case at least suggested that the malignant cells may have arisen from peripheral T-lymphocytes. In both patients, the neoplastic cells showed a tendency to impinge upon the oral epithelium, in keeping with the pattern of involvement of epithelial tissues seen in several varieties of T-cell lymphoproliferative disorders. The possibility that these oropharyngeal T-cell lymphomas may represent a distinct type of T-cell neoplasm is raised.
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