PubMed Health⌕ Search

Biomedical subjects

J M Extra

Publications and source records attributed to J M Extra.

70 records · Page 4Linked to original sources
PubMed1989

[Cancer of the breast: intensive treatment with bone marrow autografts].

High dose chemotherapy with autologous bone marrow transplantation has been proposed in metastatic and inflammatory breast cancer. Data in the literature reported an improvement of the quality and of the rate of response. However, the impact on survival remains to be demonstrated. Since 1985, a pilot study in inflammatory and directly metastatic breast cancer has been started in order to determine the impact of high dose chemo-radiotherapy. Patients were treated with an induction regimen consisting of cyclophosphamide 1,200 mg/m2 and 4'epi-adriamycin 75 mg/m2 every 15 days x 4. Mastectomy was performed associated for patients younger than 50 years with bone marrow collection and cryoconservation. In this group, late intensification with cyclophosphamide 2.2 g/m2 day 1 and 2, TBI and autologous bone marrow transplantation was performed. Fourteen patients have been treated: 9 inflammatory breast cancers T4 b N1 M0, 5 metastatic cancers at presentation including 3 with inflammatory breast cancer T4 b N1 M1 and 2 metastatic T2 N1 M1. Relapses had occurred in 7 patients, of them 4 were metastatic. Five patients died from their disease, and one from CMV interstitial pneumonitis. Six patients are alive free of disease but only one was metastatic. On this limited number of patients, survival of metastatic breast cancers does not seem to benefit from this regimen.

Adult↗
PubMed1989

Advances in vinca-alkaloids: Navelbine.

Vinorelbine (Navelbine) is a new semisynthetic vinca alkaloid which chemically differs from vinblastine by substitutions on the catharantine moiety of the molecule. It has shown promising experimental antitumor activity against experimental murine tumors as well as continuous cell lines of human neoplastic origin and human tumor xenografts in nude mice. Acute subacute and chronic toxicity extensively studied in rodents, dogs and primate has shown that hematotoxicity was almost the sole side-effect; neurotoxicity appears very limited. Almost exclusive affinity of NVB for mitotic tubulin and tubulin associated protein accounts for this pattern of toxicity. Phase I and II studies have been conducted in humans. Dose limiting side-effect appears to be neutropenia: the drug is slightly emetogenic, induces little alopecia, almost no neurotoxicity, and no other toxicity. Although preliminary, results of phase II studies already suggest significant activity of NVB in non small lung cancer (33% response rate in 78 evaluable patients), advanced breast cancer (53% response rate in 33 pts without significant chemotherapy for the target progression) and Hodgkin's disease (90% response rate after 4 weekly courses in 31 pts). Thus extensive pharmacological studies and ongoing clinical studies confirm that chemical modifications of the catharantine moiety of vinca alcaloid can lead to active agents with broader spectrum of activity and easily manageable side effects.

Animals↗
PubMed1988

[Organoplatinum compounds. 1987 update].

Cisplatin is one of the best available cytotoxic agents particularly in testicular, ovarian and head and neck cancer. However gastrointestinal and renal toxicities preclude greater utilisation. High dose cisplatin (200 mg/m2) has serious neurological side effects. Carboplatin gives the same therapeutic results as cisplatin in ovarian, small cell lung and head and neck cancers with a better tolerance, the main toxicity being haematological. Iproplatin seems to have no advantage over carboplatin. New derivates such as diaminocyclo-hexane-platinum seem to be promising in preclinical and phase I studies.

Carboplatin↗
PubMed1988

[Isolated internal breast adenopathy. Late recurrence of breast cancer].

Invasion of the internal mammary lymph nodes is common in tumoral pathology of the breast, but an isolated internal mammary lymphadenopathy occurring long after treatment of the primary tumour is a rare event. The authors report one case and discuss the prognostic and therapeutic factors involved.

Adenocarcinoma↗
PubMed1987

Treatment of adult acute lymphoblastic leukemia. Preliminary results of a trial from the French Group.

We present here the results of a cooperative trial in 244 adult patients with acute lymphoblastic leukemia. Induction therapy with vincristine, cytoxan, and prednisone (VCP) gave the same complete remission rate after one course as more aggressive induction with vincristine, rubidazone, araC, and prednisone (VRAP) due to increased toxic death in the aggressive arm. Because of high efficacy of salvage therapy with VRAP regimen in patients failing to achieve CR with VCP regimen, patients initially randomized to receive VCP had a significantly higher CR rate than patients initially receiving VRAP (87% vs. 73%, p = 0.01). Patients randomized to receive postremission consolidation using adriamycin, araC, and asparaginase (AAA) prior to maintenance had a significantly longer remission than patients not receiving consolidation (p less than 0.005). At the time of analysis allogeneic bone marrow transplantation does not significantly increase disease-free survival when compared with intensive consolidation chemotherapy.

Adult↗
PubMed1987

[Improved results in the treatment of acute monoblastic leukemia: analysis of 91 patients treated in the 01 AM 81 protocol].

A total of 91 patients with acute monoblastic leukemia (AML) were treated following two induction regimens (ARA-C + RBZ, with of without CPA), and a unique maintenance therapy (CNS prophylaxis and reinductions every 6 weeks, for 36 months). Complete remission (CR) was obtained in 84% of patients. The only prognostic factor significantly influencing the CR rate was age, with 92% for the less than 40 years group and 75% for the greater than or equal to 40 years group. CR was not influenced by sex, tumoral syndrome, leukocytosis, cytological subclassification (M5A, M5B), or induction regimen with or without CPA. The duration of CR in these forms which have a traditionally poor prognosis, was no different from other forms of AML (21 months), and the disease-free survival at 50 months was 45%. These results, pertaining to the largest published series treated by the same protocol, are the best reported in literature and confirm the role of induction and maintenance therapy in CR.

Adult↗
PubMed1987

[Acute myelomonocytic leukemia with abnormal eosinophils].

A total of 32 patients with acute myelomonocytic leukemia and abnormal bone marrow eosinophils (LAM4 Eo) have been treated at this Institute since 1977. Abnormalities of chromosome 16 have been noted in 14 of 22 evaluable cases. After a median follow-up of 4 years, median duration of complete remission was 46 months and median duration of survival had not been reached; 8 patients have been receiving no therapy for between 1 and 6 years. These results compare favorably with LAM4 without abnormal bone marrow eosinophils (median duration of complete remission: 12 months; median duration of survival: 14 months). LAM4 Eo constitute a particular entity, with a special hematological presentation, the incidence of abnormalities of chromosome 16, and a particularly good prognosis.

Adolescent↗
PubMed1986

Cell-cycle prognostic value in adult acute myeloid leukemia. The choice of the best variables.

Flow cytometry with simultaneous analysis of DNA and protein content allows a most exhaustive study of cell-cycle for the prognostic evaluation of acute myeloid leukemia (AML). Sixty-seven cases of AML were studied before any form of chemotherapy had been undertaken. We determined the following cell-cycle variables: S, S + G2 + M, low protein content fraction (LPC-fraction) and high protein content fraction of G1 (HPC-G1). Patients were stratified according to age: S and S + G2 + M phases were higher for patients over 50 who did not achieve a complete remission. LPC-fraction was significantly lower for patients older than 50 who did not achieve a complete remission not only compared to the complete remission group of patients over 50, but also compared to the younger non responder group. The duration of survival was significantly longer when LPC-fraction was higher than 26% and HPC-G1 lower than 70%. Length of survival was also better when S + G2 + M was longer than 5.75%. Analysis of the therapy failure showed that S + G2 + M and LPC-fraction were significantly different between the complete remission group and the group of patients dying in aplasia. Overall, patients older than 50 with a proliferative leukemia had a worse prognosis.

Adolescent↗
PubMed1986

Intensive and sequential combination chemotherapy for aggressive malignant lymphomas (protocol LNH-80).

Ninety-seven patients with aggressive malignant lymphoma (ML) were treated with an intensive and sequential chemotherapy (protocol LNH-80). There were 42 patients with intermediate grade ML, 53 patients with high-grade ML, and two patients with true histiocytic ML. Most of the patients were in advanced stage: 21 stage III and 61 stage IV. The LNH-80 protocol schedule comprised three phases: (1) induction with three courses of an intensified CHOP-Bleo (cyclophosphamide, doxorubicin, vindesine, methylprednisolone, and bleomycin); (2) consolidation with cytarabine, followed by high-dose methotrexate and folinic acid rescue, then asparaginase; and (3) final intensification with two courses of CVAP-Bleo (cyclophosphamide, teniposide, cytarabine, methylprednisolone, and bleomycin). CNS prophylaxis included one injection of methotrexate during each induction course and the drugs of the consolidation phase. In cases of initial CNS localization, cranial radiotherapy was added. Eighty-four patients (87%) went into complete remission (CR), 18 (21%) of whom relapsed, usually during the phase of treatment or within 6 months of completing chemotherapy. Sixty-three patients are alive with an overall median follow-up of 24 months. The median survival time and the median disease-free survival have not been reached, and the survival curve seems to have plateaued at above 60%. There was no statistical difference between intermediate-grade ML (CR 90%, relapse 18%) and high-grade ML (CR 84%, relapse 24%). The toxicity of this treatment is mainly encountered during the induction phase: almost all patients had short-term neutropenia, less than 0.500 g/L in 57, with a documented infection in 25. Overall treatment-related mortality was 6%, with four patients dying during the induction phase.

Adolescent↗
PubMed1986

Intensive timed chemotherapy protocol for 37 resistant or relapsing acute myeloid leukemias.

Thirty-seven patients with acute myeloid leukemia in relapse or at initial diagnosis but resistant to conventional induction regimen have been treated by single-cycle timed sequential chemotherapy, including continuous infusion of cytarabine over 72 hours on Days 1-3 and 8-10 and short injections of daunorubicin on Days 1-3. There were 21 complete remissions (56%), 11 failures, and five early deaths. For responders, median durations of complete remission and survival were 7 and 12 months, respectively.

Adult↗
PubMed1982

[An empirical combination of antibiotics used in aplasias during chemotherapy for acute malignant hemopathies (author's transl)].

Continuous infusion of amikacin, cotrimoxazole and carbenicillin was the second empirically established combination of antibiotics used when fever occurred during the induction phase of chemotherapy in sixty-five patients (58 acute myeloid leukemias, 5 acute lymphoid leukemias, 2 non Hodgkin lymphomas). Clinical evidence of infection was available in 25 cases and the infection was bacteriologically documented in 19 cases. Therapy was successful in 57 patients (89%). When infection was clinically or bacteriologically documented tha success rates were 92 and 82% respectively. The average length of treatment was ten days. In 25 patients receiving 2 g of amikacin in continuous infusion, the mean serum concentration was 15,9 micrograms/ml; in 17 patients receiving 3 g, the mean serum concentration was 19,4 micrograms/ml.

Adult↗
PubMedDate not supplied

[The role of autografts in severe or metastatic breast cancers].

Intensive treatment of poor prognosis breast cancer has included bone marrow autografts. A multicentric study was conducted from 1988 to 1992, including 105 patients with a minimal follow-up of 2 years after the autograft. Inclusion criteria were: age < 55 years, measurable metastasis, inflammatory breast cancer, breast cancer with major lymph node invasion (> 8 N+). Chemotherapy (6 to 8 cycles) was used initially. In responders, bone marrow was harvested and frozen. Medullary invasion had to be absent for bone marrow harvesting. Management then included cyclophosphamide: 60 mg/kg, D-7, D-6; mitoxantrone: 12 mg/m2, D-9 to D-5; alkeran: 140 mg/m2, D-2 followed D0 for bone marrow autograft. For the 105 patients, mean age was 40 years; inflammatory breast cancer: 33 patients; > or = 8 N+: 11 patients; metastasis: 61 patients. For the cases with metastasis, the main sites were: liver: 24 patients, lung: 14 patients, bone: 22 patients, central nervous system: 4 patients. Nineteen patients had at least two metastasis localizations. Responders alone were included although 7 patients had been stabilized before the autograft. For the metastatic forms, median survival was 41 +/- 9 months from the onset to diagnosis of metastasis, with 8 patients surviving over 5 years. Median survival without progression was 12 months with a 4-year probability of 17%. For inflammatory breast cancers, the probability of survival was 50% and survival without progression was 42%. For patients with lymph node invasion > or = 8 N+, it was 72%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Prescription of diphosphonates in ambulatory oncology. A study of the health insurance medical services].

OBJECTIVES: As requested by the Health Ministry, the Agricultural (Mutualité Sociale Agricole) and Independant Professions (Assurance Maladie des Professions Indépendantes) Health Insurances carried out a survey to analyse the use of second generation oral biphosphonates. METHODS: The data, from 3,414 prescriptions, gathered over the twelve months from May '93, showed that clodronate is prescribed mainly for breast cancer (35%), prostate cancer (23%), multiple myeloma (19%) and carcinoma of the lung (7%). The other prescriptions (16%) were either related to various malignant diseases (18 types encountered) or non-malignant diseases (mainly osteoporosis, but also Paget's disease of bone and hyperparathyroidism). The initial prescriber was most often a cancerologist (49%) but also quite frequently (17%) a general practitioner. The treatment was prescribed for an average of 41 days. 1600 mg daily was the most frequent dose (79%). However, in non-authorised indications, especially osteoporosis, the dose was lower, generally 800 mg a day. Altogether 14% non-authorised indications were linked either to non-metastatic malignant diseases (for the prevention of metastases) or with osteo-condensing type metastases (prostate cancer: 43%) or non-malignant diseases (osteoporosis, Paget's disease of bone, hyperparathyroidism, chronic renal insufficiency, sympathetic algodystrophy, bedbound decalcification, etc.). The prescription for these cases was motivated by the expected beneficial effect on bone mineralisation. Such treatment authorised was more often initiated by a general practitioner (23%) than a specialist (12%). CONCLUSION: These data raise the problem of limiting the possibility of prescribing second generation biphosphonates as initial treatment to a specialist. They also reaffirm the need to have precise guidelines in the field of medical prescription controls.

Aged↗
PubMedDate not supplied

Phase II trial of a combination of vinorelbine, cyclophosphamide and 5-fluorouracil in the treatment of advanced breast cancer.

PURPOSE: The aim of this study was to assess the efficacy and tolerance of a combination (CT) chemotherapy of Vinorelbine (VNB), Cyclophosphamide (CPA) and 5-Fluorouracil (FU) for the treatment of advanced breast cancer. PATIENTS AND TREATMENT: Forty five women with measurable or evaluable metastatic, locoregionally advanced or relapsing breast cancer have entered the study. Thirty eight patients were not exposed to treatment other than adjuvant CT while 5 were heavily pretreated. Treatment consisted of VNB 25 mg/m2 by rapid i.v. infusion d1 and d3, CPA 600 mg/m2 i.v. as VNB, d2 and 5FU 750 mg/m2/d 1-3 in continuous i.v. infusion. The treatment was repeated every 21 days up to 6 courses if response or stability were obtained. RESULTS: Forty three patients (38 in first line for advanced disease) were evaluable for response and tolerance. The overall response rate (UICC criteria) was 51% (95%; CI: 36-65%) with 12 and 39% CR and PR respectively, while an additional 33% had stable disease. The response and stability rate were similar in first and second line treated patients. Responses were observed in all sites while a well documented 50% partial response rate of bone metastases was noted. Median time to progression in first line treated patients was 10.5+ months Median overall survival has not yet been reached; however 61% of patients are alive after a 26 months median follow-up. A total of 236 courses has been administered. The main toxicity was neutropenia (88%) with only 3 cases with dose reduction and one withdrawal. Serious non-hematologic toxicity was limited to 3 cases of GIII mucositis. Digestive toxicity (88% G I-II), diarrhea (7% GI), constipation (19% G I-III), peripheral neuropathy (14% GI-II) and alopecia (42% GI-IV) were also noted but remained controllable. No toxic deaths were registered. CONCLUSION: The combination of VNB, CPA and SFU in advanced or metastatic breast cancer yields a response rate, response duration and survival rate comparable to anthracycline--as well as VNB-containing combinations while maintaining a low toxicity profile. Although CPA seems to be a minor contributor to the efficacy of this regimen, further evaluation should identify the value of this combination, particularly in candidates for heavy chemotherapy breast cancer patients.

Adult↗