Biomedical subjects
F A Hoffman
Publications and source records attributed to F A Hoffman.
Effects of intravenous hyperalimentation during treatment in patients with small-cell lung cancer.
One hundred nineteen patients were entered onto a randomized trial of the role of intravenous hyperalimentation (IVH) in patients with small-cell lung cancer. IVH was given during the first 30 days of induction chemotherapy to 54 patients. IVH did not effect any improvement in response or survival from therapy. In view of the lack of benefits from IVH, an analysis was made of the toxicities suffered by the 54 patients receiving IVH as well as any effects IVH might have made on chemotherapy-induced toxicity. Toxicities observed included mechanical difficulties with the catheter leading to temporary or permanent discontinuation of the IVH (11 patients), subclavian vein thrombosis (one patient), sepsis in nine patients v none of the 62 control patients, fluid overload (27 patients), hyponatremia (25 patients), and hyperglycemia requiring insulin (13 patients). Patients receiving IVH had higher granulocyte counts on days 14 and 21 of the first cycle of chemotherapy. Analysis shows that this difference is likely caused by fever and infection associated with IVH rather than any nutritional effect on granulopoiesis. In this population of patients, IVH had significant complications but did not ameliorate chemotherapy-induced toxicity and it did not effect any clinical benefit. Future studies of adjunctive nutritional therapy must consider the significant risk in this older population and must limit IVH volume or exclude patients with even mild compromise in cardiovascular functions. Further, any new trial must have a significant rationale for adjunctive use to justify the potential risks.
Effect of adjuvant central iv hyperalimentation on the survival and response to treatment of patients with small cell lung cancer: a randomized trial.
The effect of central iv hyperalimentation (IVH) as an adjunct to aggressive antineoplastic therapy for small cell carcinoma of the lung was evaluated in a randomized trial with 119 evaluable patients. IVH was given over a 28-day period with higher caloric and protein intake for patients nutritionally depleted on entry in the study; all patients were escalated in caloric and protein intake to maximize nutritional repletion. Combination chemotherapy and radiation therapy induced a 45.5% complete response rate and an overall response rate of 92.8%. Median survival for patients with limited disease was 18 months; median survival for patients with extensive disease was 11 months. Patients randomized to receive IVH did not have a better response rate (P = 0.97) or survival (P = 0.78) than control patients. IVH did not significantly alter the survival for patients who at baseline had greater than 5% pretreatment weight loss, low caloric intake, decreased serum albumin, or reduced total iron-binding capacity. Significantly more febrile episodes were seen in IVH patients than in control patients (P less than 0.001). Short-term IVH to patients with this malignancy who are capable of enteral alimentation cannot be routinely recommended as adjunctive therapy.
Production of and response to interleukin-2 by cultured T cells: effects of lithium chloride and other putative modulators.
Immunomodulating substances may be useful as host-modifying adjuvants in patients receiving immunosuppressive therapies or as probes for studying the immune system. Detection of interleukin-2 (IL-2) is possible via a microassay, enabling investigation of the effects of immunomodulating agents on T cell production of and response to IL-2 in vitro. Four such agents were examined: lithium chloride, Bestatin, Azimexon, and muramyl dipeptide (MDP). All four agents increased the response of cultured T cells to IL-2 over control populations supplied with IL-2 alone. Lithium chloride, Bestatin, and MDP enhanced the production of IL-2 in standard mixed lymphocyte cultures over control cultures receiving media alone. These results suggest that several immunomodulators may produce their effects by the modulation of IL-2 or other lymphokines. Additionally, microassay systems may prove useful as probes to elucidate the function of putative immunoregulatory substances.