Biomedical subjects

J L Grem

Publications and source records attributed to J L Grem.

113 records · Page 7Linked to original sources

PubMed1985

Augmentation of 5-fluorouracil cytotoxicity in human colon cancer cells by dipyridamole.

The effect of dipyridamole (DP), an inhibitor of nucleoside transport, on the uptake and toxicity of 5-fluorouracil (FUra) was examined in a human colon cancer cell line (HCT 116). DP substantially increased the cytotoxicity of FUra in cell growth experiments and in viability assays measuring colony formation. The augmentation by DP was dose and time dependent. Several possible mechanisms by which DP enhanced FUra toxicity were investigated. DP did not alter the uptake of FUra into the acid-soluble and -insoluble fractions of HCT 116 cells. While DP did not affect the uptake of FUra, it did inhibit the transport of the nucleoside analogues, fluorouridine and fluorodeoxyuridine, of FUra. Although DP effectively inhibited the uptake of thymidine and uridine in a dose-dependent manner, several lines of evidence suggested that inhibition of nucleoside salvage was not the critical effect. (a) The toxicity of FUra was not prevented by thymidine, uridine, or the combination of thymidine and uridine. Thymidine triphosphate pools, decreased by 50% during the initial 8 h of exposure to FUra, were not further depleted by the addition of DP. The shrinkage in deoxythymidine triphosphate pools produced by FUra was prevented by concomitant exposure to thymidine; however, this did not translate into protection from FUra lethality. The use of dialyzed serum, which greatly diminished the availability of nucleic acid precursors, did not increase the toxicity of FUra. DP increased the cytotoxicity of FUra as effectively in experiments utilizing dialyzed serum as when nondialyzed serum was used. Surprisingly, however, the addition of sufficient thymidine to overcome the DP block did prevent the augmentation of FUra toxicity produced by DP. DP may provide a novel means of enhancing the cytotoxicity of FUra.

Cell Division↗

PubMed1985

Massive skeletal muscle invasion by lymphoma.

Three patients had diffuse enlargement of skeletal muscle of the thigh as the result of infiltration by diffuse large-cell lymphoma. One case presented de novo as diffuse lymphoma, but the other two had previous diagnoses of nodular lymphoma and Hodgkin's disease. Computed tomographic scanning disclosed an enhancing mass in the thigh with infiltration of skeletal muscle groups; abnormal medullary cavities were noted in the adjacent long bones. Muscle biopsy established the diagnosis in two of the patients.

Adult↗

PubMedDate not supplied

The role of interferon-alpha as a modulator of fluorouracil and leucovorin.

Several preclinical studies have demonstrated that interferon-alpha (IFN-alpha) may enhance the cytotoxicity of fluoropyrimidines in a greater-than-additive manner in a variety of human cancer cell lines. The underlying mechanism(s) have varied in different cancer cell lines, and include increased fluorouracil anabolism to fluorodeoxyuridine monophosphate, further inhibition of thymidylate synthase, stimulation of thymidine and uridine phosphorylase activities, greater DNA damage, and enhanced natural killer cell-mediated lysis of tumour targets. These preclinical studies stimulated clinical evaluation of IFN-alpha in combination with 5-fluorouracil (5-FU) with and without leucovorin (LV), and the initial clinical results appeared promising. We summarise preclinical research concerning the interaction of 5-FU and IFN-alpha. The rationale for combining 5-FU with IFN-alpha and LV is discussed, and we describe our clinical experience with the combination of 5-FU, LV and IFN-alpha-2a. The insights and unresolved questions concerning the clinical application of this combination are also discussed.

Antidotes↗

PubMedDate not supplied

The utility of monitoring carcinoembyronic antigen during systemic therapy for advanced colorectal cancer.

To determine if pre-treatment serum carcinoembryonic antigen (CEA) levels or changes in CEA values during treatment have prognostic value, we reviewed five prior fluorouracil/leucovorin-based trials and identified 125 colorectal cancer patients with no prior chemotherapy for metastatic disease in whom CEA values were available. Although pre-treatment serum CEA values did not predict for clinical response or time to progression, serial monitoring of CEA appeared to be useful in patients with an elevated pre-treatment CEA, particularly when a decrease in CEA occurred in concert with radiographic evidence of disease response. The CEA nadir was a strong prognostic variable with respect to time to disease progression. A consistent rise in CEA values over the minimum value signals the need for radiographic re-assessment of the patient's disease status to rule out disease progression.

Adult↗

PubMedDate not supplied

Thymidylate synthase protein expression: Association with response to neoadjuvant chemotherapy and resection for locally advanced gastric and gastroesophageal adenocarcinoma.

PURPOSE: A phase II study of neoadjuvant fluorouracil, leucovorin, and interferon alpha-2a was conducted to determine the feasibility of this regimen's use and the response rates in patients undergoing resection for locally advanced gastric or gastroesophageal adenocarcinoma. Also, tumor protein expression of free, total, or bound thymidylate synthase before and after initial exposure to fluorouracil was quantitated to determine if thymidylate synthase expression is associated with response in this treatment setting. PATIENTS AND METHODS: Twenty-two patients with T3-4N0-2M0 gastric or gastroesophageal adenocarcinoma were treated with three cycles of neoadjuvant fluorouracil (370 mg/m2 intravenously on days 2 through 6), leucovorin (500 mg/m2 intravenously on days 2 through 6), and interferon alpha-2a (5x106 U/m2 subcutaneously days 1 through 7), followed by resection and three cycles of consolidation therapy. Endoscopic tumor biopsies were done in 13 patients before therapy and during cycle 2 of the 5-fluorouracil/leucovorin/interferon regimen, and total thymidylate synthase, free thymidylate synthase, bound thymidylate synthase, and percent complexed thymidylate synthase were quantitated by Western blot. Tumor protein expression was evaluated for its association with response to neoadjuvant therapy and patient survival. RESULTS: Eight of 21 (38%) evaluable patients had a partial response, and another 5 of 21 (24%) had a minor response (25% to 49% tumor reduction) after three cycles of neoadjuvant fluorouracil/leucovorin/interferon. The pretreatment total thymidylate synthase level was significantly higher in five nonresponders than in eight responders. After exposure to fluorouracil, levels of free thymidylate synthase were significantly lower and the percent bound thymidylate synthase was higher in responders than in nonresponders. The median potential follow-up period is 24 months, and 11 of 21 patients have died from disease. CONCLUSIONS: These preliminary results indicate that a response to neoadjuvant fluorouracil-based therapy may be associated with decreased levels of total thymidylate synthase before therapy and free thymidylate synthase after exposure to fluorouracil in patients with locally advanced gastric cancer. Quantification of thymidylate synthase protein expression before and after exposure to fluorouracil may provide a method to select patients for fluorouracil therapy in the neoadjuvant, adjuvant, or advanced-disease setting based upon the fundamental sensitivity of the tumor.

Adenocarcinoma↗