PubMed Health⌕ Search

Biomedical subjects

J H Mulder

Publications and source records attributed to J H Mulder.

At least 19 recordsLinked to original sources
PubMed1987

Three tumor sensitivity tests evaluated with mouse tumors.

The predictive value of three types of tumor sensitivity tests was evaluated using mouse tumors. Sensitivities of osteosarcoma C22LR, Lewis lung and M2661 carcinoma were determined for the following drugs: DNA interacting or alkylating agent (doxorubicin, cisplatin, 1,3-bis(2-chloroethyl)-1-nitrosourea, melphalan), antimetabolite (5-fluorouracil, methotrexate) and microtubule inhibitor (vinblastine, vincristine). Volume measurements of the subcutaneously growing tumors after treatment with the same drugs were considered to be the traditional reference system with which the results of the in vitro clonogenic assay, the labeled precursor incorporation assay and the subrenal capsule assay were compared. Results obtained with the in vitro clonogenic assay were highly reproducible. With the 1-h drug exposure technique the predictive accuracy was 71%. This result is in the same range as those found by others for human tumors. Predictive accuracy after continuous drug exposure was only 25%. Vinblastine, vincristine and cisplatin caused no inhibition of labeled precursor incorporation. However, the assay is too unreliable to use, due to the extreme variability when used with the other drugs. From 31 consecutively performed duplicate tests in the subrenal capsule assay, nine showed opposite results. This degree of disagreement between duplicate test results was considered too high to make reliable predictions of tumor sensitivity with this assay.

Animals↗
PubMed1987

Adriamycin versus epirubicin in advanced soft tissue sarcomas. A randomized phase II/phase III study of the EORTC Soft Tissue and Bone Sarcoma Group.

The objective of this randomized phase II/phase III study was to investigate the efficacy and toxicity of equimolar doses of adriamycin (ADM) and 4-epiadriamycin (EPI) in patients with locally advanced and/or metastatic soft tissue sarcoma. Doses of ADM and EPI were 75 mg/m2 given as an i.v. bolus injection every 3 weeks. Two hundred and ten patients were entered into the study by 18 institutions. Twenty-eight patients were ineligible and 15 were non-evaluable, leaving 167 evaluable patients. The two treatment groups were well balanced for sex, performance status, age, prior radiotherapy, extent and site of disease. Rates of response were similar, 25% in the ADM group compared to 18% in the EPI group (P = 0.33), and there were no significant differences between the ADM and EPI groups with respect to median duration of response (45 weeks vs. 77 weeks, P = 0.08), time to progression (15 weeks vs. 12 weeks, P = 0.945), and median survival (41 weeks vs. 48 weeks, P = 0.363). Myelotoxicity as shown by leucopenia was significantly more pronounced in the ADM treated patients (P = 0.002). Other toxicities such as alopecia and nausea/vomiting were also more severe in the ADM group (P = 0.02 and 0.06, respectively). In conclusion, the use of equimolar doses of ADM and EPI in advanced soft tissue sarcoma produced response rates which did not differ significantly and were only slightly in favour of ADM. However, this was achieved at the expense of higher toxicity.

Adolescent↗
PubMed1986

Phase II study of low-dose methotrexate in advanced osteosarcoma followed by escalation after disease progression: a study of the Soft Tissue and Bone Sarcoma Group of the European Organization for Research on Treatment of Cancer.

Twenty-seven patients with osteosarcoma and measurable metastases were treated with low-dose methotrexate (LDMTX) (80 mg/m2), followed by high-dose methotrexate (HDMTX) (7.5 g/m2) after disease progression in 14 patients. LDMTX was administered on Days 1, 8, and 15; if response or stable disease occurred, it was repeated on Days 29 and 43. If response occurred by Day 57, LDMTX was continued every 2 weeks until disease progression. If stable disease occurred by Day 57, the patient crossed over (optional) to HDMTX. HDMTX was given weekly during the first 3 weeks and continued once every 14 days until disease progression. Twenty-five of the patients were evaluable for response. Three patients (12%) achieved complete remission, with durations of 5, 14, and 34 weeks, respectively. The time to disease progression from the start of treatment was 19, 28, and 42 weeks. Twelve patients (48%) had stable disease, with a median duration of 7.5 weeks (range, 6-20). Ten patients (40%) had disease progression. In general, toxicity with LDMTX was mild. The most frequent toxic effect was stomatitis. Twelve of 14 patients who crossed over to HDMTX were evaluated for response. Six patients had stable disease and six had disease progression. We conclude that the results achieved with LDMTX seem inferior to the results achieved with HDMTX described in the literature.

Adolescent↗
PubMed1984

Combination chemotherapy with cisplatin and VM-26 in advanced transitional cell carcinoma of the bladder.

Forty-one evaluable patients with bidimensionally measurable metastases of transitional cell carcinoma of the bladder were treated with cisplatin 70 mg/m2 i.v. on day 1 and VM-26 100 mg/m2 i.v. on days 1 and 2, every 3 weeks. Response was evaluated after 2 treatment cycles. Complete response (CR) was achieved in 4 patients (10%) and partial response (PR) in 17 (41%). The median response duration was 6 months. In this group of previously untreated patients the combination of cisplatin and VM-26 did not appear to yield better response rates than would be expected from cisplatin alone.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Carminomycin vs adriamycin in advanced soft tissue sarcomas: an EORTC randomised phase II study.

Eighty-three patients with advanced soft tissue sarcoma who had received no prior chemotherapy entered a randomised phase II study comparing carminomycin (CMM) 20 mg/m2 with adriamycin (ADM) 75 mg/m2, both administered i.v. bolus every 3 weeks. Six patients were ineligible and response could not be evaluated in 6 additional patients. Thirty-eight evaluable patients received ADM and 33 received CMM. There was one complete response to ADM and 10 partial responses, an overall response rate of 29%. CMM showed significantly (P = 0.01) lower antitumour activity--one partial response (3%). Stabilisation of disease was similar in both arms (47 and 45%), but fewer patients progressed on ADM (24 compared to 52%). Durations of response dating from the start of chemotherapy were 5 months for complete remission on ADM, a median of 7 months (range 4-17) for partial response on ADM and 14 months for the one partial remission on CMM. Although the median time to progression for all patients receiving CMM (2 months) was significantly (P = 0.001) shorter than for those receiving ADM (5 months), patients on ADM had only a marginally significant longer duration of survival (P = 0.06) than the patients receiving CMM. A leucocyte nadir less than 2.0 X 10(9)/l occurred in 38% of patients receiving ADM and 43% receiving CMM. Anaemia and thrombocytopoenia were uncommon. Other toxicities such as nausea, vomiting, anorexia and alopecia were more severe in the ADM group. There was one infective death secondary to leucopoenia in the ADM arm, and one patient who had received 109 mg/m2 CMM + 255 mg/m2 ADM developed progressively fatal cardiomyopathy.

Adolescent↗
PubMed1983

Model studies in adjuvant chemotherapy.

We have focused on three aspects of adjuvant chemotherapy applied to mice with one of the metastasizing tumors: Lewis lung carcinoma (LL) or mammary carcinoma 2661 (M2661). The first aspect concerned the timing of adjuvant chemotherapy. To investigate this, tumor-bearing mice were treated postoperatively with cyclophosphamide using a standard regimen. In M2661, adjuvant therapy was marginally effective in contrast to the clearly significant results obtained in LL. Any delay in the initiation of adjuvant therapy decreased the efficacy of the treatment. The effect of administering chemotherapy before surgery was also studied; normally, marginally effective adjuvant therapy was found to become effective when started preoperatively in M2661. In LL, effective adjuvant therapy was found to become less effective when started preoperatively. The second aspect considered was the comparability between the increase in relapse-free survival time and the increase in cure rate as alternate goals of adjuvant therapy. To study this, mice with small, medium, or large residual tumor loads were subjected to surgery and subsequently treated with cyclophosphamide. While the effect of adjuvant therapy on the cure rate increased proportionally with decreasing tumor load, the increase in lifespan in nonsurvivors was not related to tumor load. The final aspect of study was the selection procedure for drugs to be applied in adjuvant treatment in our models. Taking the volume response of large tumors as being predictive for the successful use of the same agent in adjuvant therapy, we obtained both false-negative and false-positive results in our tumor lines.

Amputation, Surgical↗
PubMed1982

N-(phosphonacetyl)-L-aspartate (PALA) in advanced malignant melanoma: a phase II trial of the EORTC Malignant Melanoma Cooperative Group.

Thirty-nine patients with measurable advanced malignant melanoma were entered in a phase II trial with PALA. Among the 36 evaluable patients there were 18 men and 18 women, with a median age of 53 yr (29-73) and a median performance status (Karnofsky) of 100 (50-100). Indicator lesion consisted essentially of soft tissue lesions (29 patients) and/or lung metastases (9 patients). Only three patients had received prior chemotherapy. PALA was given as a 60-min i.v. infusion at a daily dose of 2.5 g/m2 for two consecutive days. Courses were repeated every two weeks. A median number of 3 courses (2-8) were administered. Partial response (greater than 50%) was obtained in 4 patients for 6-17 weeks. Eight patients had stable disease after 3 courses of PALA and 24 had progressive disease. Toxic effects were generally mild to moderate and mainly included cutaneous toxicity, nausea and vomiting, stomatitis, and diarrhea. Myelosuppression was rare and negligible. It is concluded that PALA given at the dose schedule selected for this trial is fairly well tolerated and has borderline antitumor activity in good-risk patients with advanced malignant melanoma.

Adult↗
PubMed1982

Cisplatin and vindesine combination chemotherapy in advanced malignant melanoma: an EORTC phase II study.

Sixty-one evaluable patients with measurable advanced malignant melanoma received 4-week courses of a combination of cisplatin 100 mg/m2 as a 24-hr i.v. infusion on day 1 and vindesine 3 mg/m2 as an i.v. bolus on days 1, 8, 15 for two courses and every other week thereafter. Two patients achieved complete response for 46 and 81+ weeks respectively, eleven patients achieved partial response for a median of 17 weeks (range 8-26) and three patients had no change for 24 weeks or more. The overall response rate of 21% did not seem to be affected by prior chemotherapy or site of indicator lesions, soft tissue vs visceral. Myelosuppression, consisting essentially of leucopenia, required dose schedule modifications in 41% of the first two courses and 12% of the remaining courses, but never produced major complications. Non-hematologic toxic effects were prominent, especially nausea and vomiting, which were universal. Alopecia was seen in 71% of the patients, neuromuscular manifestations in 39%, diarrhea in 30%, renal impairment in 25%, mucositis in 12%, ototoxicity in 7% and phlebitis in 3%. These results do not suggest striking additive or synergistic antitumor activity of cisplatin and vindesine in advanced malignant melanoma, at least with the method of drug administration selected for this trial.

Adult↗
PubMed1982

The influence of intramedullary nailing on the development of metastases in the treatment of an impending pathologic fracture: an experimental study.

An experimental model was developed to study the effects of a pathologic fracture and intramedullary nailing on metastatic spread. The end point used was the production of lung metastases in rats inoculated intracortically with a rat rhabdomyosarcoma. We found that a pathologic fracture markedly increases the incidence of lung metastases and that intramedullary nailing, by decreasing the incidence of fractures, decreases this incidence. The surgical procedure itself does not increase the incidence significantly. It is concluded that in metastatic disease prophylactic nailing of an impending pathologic fracture is the treatment of choice.

Animals↗
PubMed1980

Malignant melanoma: an androgen-dependent tumour?

Of 688 melanoma patients registered during 1956--78, 267 developed metastatic spread of the disease. Sex differences in the course of the disease in this subset were studied. Intervals between subsequent stages of melanoma activity were longer, but not significantly so, in female than male patients. Survival times from initial distant metastasis were significantly longer in women than in men. Tumour doubling time of pulmonary secondaries revealed a clear tendency to a slower growth rate in female patients. Our analysis suggests that malignant melanoma might be an androgen-dependent tumour. Therapy with anti-androgens or orchidectomy deserves consideration in male patients with metastatic melanoma.

Androgens↗
PubMed1980

Cell kinetic factors, single drugs and combination.

This communication focuses on the problems that exist in the application of cell kinetic information in cancer chemotherapy. From selected historical work, the following conclusions can be drawn. 1) Theoretically optimal drug sequences may fail to show the expected effect. 2) Similar drug sequences cause different effects in different tumors, even when the tumors have similar proliferation characteristics. The unpredictability and the heterogeneity in response make the extrapolation to clinical cancer chemotherapy very difficult. Better prediction may be made from the integration of results from studies combining cell kinetic factors, cellular pharmacokinetics, and biochemistry of drug exposure.

Animals↗