PubMed Health⌕ Search

Biomedical subjects

J Lokich

Publications and source records attributed to J Lokich.

9 recordsLinked to original sources
PubMed1992

Controversial issues in 5-fluorouracil infusion use. Dose intensity, treatment duration, and cost comparisons.

BACKGROUND: The use of ambulatory infusions of 5-fluorouracil (5-FU) improves the therapeutic index of this drug and is superior to the traditional schedule of bolus administration weekly or daily for 5 days at 5-week intervals. The infusion schedules that have been used vary as follows: (1) 24-hour infusion weekly; (2) 48-hour infusion weekly or biweekly; (3) 120-hour infusion at 4-5-week intervals; (4) 14-day infusion; and (5) protracted infusions continuously for 10 weeks or more. The relationship of dose intensity to infusion duration and the analysis of costs of chemotherapy were reviewed. METHODS: Selected clinical trials of infusional 5-FU were analyzed regarding infusion duration and dose intensity in relationship to response rates (RR). Chemotherapy cost was analyzed distinguishing "cost" definitions. RESULTS: The response rates for the infusion durations studied in Phase II and III trials were: (1) 24 hours, 25%; (2) 48 hours, 30%; (3) 120 hours, 3%; (4) 14-day, 12%; and (5) 10 weeks, 30%. The corresponding DI for each infusion duration was (1) 24 hours, 2.6 g/m2/week; (2) 48 hours, 2.4 g/m2/week; (3) 120 hours, 1.25 g/m2/week; (4) 14-days, 1.225 g/m2/week; and (5) 10 weeks, 2.1 g/m2/week. Cost analysis by actual reimbursement was compared for 5-FU infusion and bolus 5-FU with leucovorin (high and low dose) and 5-FU with interferon. Monthly reimbursement for each is $1400, $2000, and $1150, and up to $3000, respectively. CONCLUSIONS: DI and infusion duration have a complex interaction that may contribute meaningfully to the therapeutic index, but this issue can only be resolved by randomized clinical trials. The cost of 5-FU infusion is comparable to that of bolus therapy when leucovorin or interferon are added in combination. Considering the relative absence of patient toxicity, the costs of 5-FU infusion are substantially less than bolus delivery.

Costs and Cost Analysis↗
PubMed1992

A review of the stability and compatibility of antineoplastic drugs for multiple-drug infusions.

It is important that the stability of reconstituted parenteral antineoplastic agents be established, particularly in the context of ambulatory infusion systems for delivery. The stability of selected agents within each of the five classes of compounds (antimetabolites, alkylating agents, antibiotics, alkaloids and glycosides, and metals) is reviewed from the literature together with additional data from studies carried out using high-performance liquid chromatographic (HPLC) technology in clinically applicable volumes and concentrations for ambulatory infusion. The stability of reconstituted drugs varies from a few minutes (mecloethamine) to many months (FU). Compatibility data on two- and three-drug admixtures of cytotoxic agents are reported for a number of common multidrug regimens. Tabular presentation of the drug-drug compatibilities and incompatibilities is included along with a discussion of the mechanisms for drug-drug interaction. The use of a broad spectrum of compatible cytotoxic drugs is possible, including fluoropyrimidine-, anthracycline-, and platinum-based combinations, providing the capability of carrying out multidrug infusions for 4-7 days in an ambulatory delivery system.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Etoposide plus carboplatin admixture. Phase I study of five- or seven-day continuous infusion.

Thirty-five patients were entered in a Phase I trial of an admixture infusion of etoposide (VP-16) and carboplatin (CBDCA) administered continuously for 5 or 7 days. Because of the compatibility and solubility of the two agents, the treatment program could be administered on an outpatient basis. The dose rate of VP-16 was fixed at 30 mg/m2/day (total dose 150 mg/m2 for 5 days or 210 mg/m2 for seven days) for each cycle. Carboplatin was evaluated at three dose rates: 50, 60, and 75 mg/m2/day on the 5-day infusion and 40, 50, and 60 mg/m2/day on the 7-day infusion with cycles repeated at 28 to 42 days. The dose limiting toxicity was hematologic and followed a pattern typical for carboplatin, that is, delayed neutropenia and/or thrombocytopenia with a protracted leukocyte recovery. Renal toxicity was observed in three patients. The optimum total dose for the infusional carboplatin component was 300 mg/m2 (5-day) and 420 mg/m2 (7-day). The total etoposide dose was 150 mg/M2 and 210 mg/M2, which did not appear to contribute to the hematologic toxicity. Delivery of the admixture of VP-16 and CBDCA was feasible, although cumbersome, as a result of the portable delivery system. Extending the duration of infusion increases the total cumulative dose of carboplatin and etoposide that can be administered without increasing adverse effects.

Aged↗
PubMed1979

Epidermoid carcinoma of the breast.

Two patients with squamous cell carcinoma of the breast are described. In one patient the lesion represented a primary breast tumor; in the second, a metastases from primary bonchogenic carcinoma. Neither lesion possessed estrogen receptor protein. This report emphasizes the rarity of epidermoid lesions of the breast and the importance of identifying an extramammary primary source of metastases to the breast.

Aged↗
PubMed1978

Randomized phase II clinical trial of adriamycin, methotrexate, and actinomycin-D in advanced measurable pancreatic carcinoma: a Gastrointestinal Tumor Study Group Report.

Sixty-six patients with advanced pancreatic carcinoma were randomized to receive single agent chemotherapy with either adriamycin, methotrexate, or actinomycin-D using conventional dose, route and schedule of administration. All patients had measurable lesions which were used to objective assessment of response. For adriamycin, 2 of 25 patients (8%) evidenced a partial response (2 of 15 (13%) previously untreated patients). One of 25 patients treated with methotrexate and one of 28 received actinomycin-D responded. The duration of responses ranged from 43-64 days for those patients with no chemotherapy prior to study entry. The median survival of patients who received adriamycin as initial treatment was 12 weeks compared to 8 weeks for methotrexate and 6 weeks for actinomycin-D therapy.

Adult↗
PubMed1978

Circulating immune complexes in patients following clinically curative resection of colorectal cancer.

Sixty-nine patients have been followed prospectively after curative resection of Dukes-Kirklin B-2 or C colorectal cancer. Serial plasma samples were studied in selected patients to determine changes in circulating immune complex concentrations (CIC) following primary tumor resection, and to compare serial plasma CIC and carcinoembryonic antigen (CEA) levels. CIC was determined in an average of seven serial samples per patient by inhibition of antibody-dependent cell-mediated cytotoxicity (ADCC). CEA assays were performed by the Hanson Z-gel method. Two distinct patterns of serial CIC have emerged. In seven patients with no known tumor recurrences, serial CEA levels and CIC oscillated regularly and were inversely related. In seven of eight patients whose tumors recurred, both CEA and CIC rose together. In three patients with elevated plasma CEA levels due to inflammatory bowel disease, serial Ag-Ab complex concentrations did not vary, nor did separated Ag or Ab fractions inhibit ADCC. These data suggest that, in patients following curative resection of colorectal cancer, serial changes in circulating immune complexes may discriminate between transient CEA elevations which occur despite no known tumor recurrence and tumor recurrence which is beyond the capacity of adequate host antitumor defense.

Adenocarcinoma↗
PubMed1975

Percutaneous aspiration biopsy of the pancreas under ultrasonic guidance.

Fine-needle aspiration biopsy for cytologic diagnosis was performed on seven patients suspected of having pancreatic tumors. A 23-gauge biopsy needle was accurately placed in the suspicious lesion under ultrasonic guidance. Six patients had tumors; of these, five had a definite cytologic diagnosis, and the sixth was suspicious of tumor. There was no morbidity associated with the procedure in these patients. Although fine-needle biopsy is not expected to prolong life in patients with pancreatic tumors, it does eliminate the need for more complicated, expensive, uncomfortable and hazardous diagnostic procedures. In many cases exploratory surgery may be obviated.

Biopsy, Needle↗