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Biomedical subjects

K Christman

Publications and source records attributed to K Christman.

7 recordsLinked to original sources
PubMed1996

A phase I trial of a modified, dose intensive FAMTX regimen (high dose 5-fluorouracil+doxorubicin+high dose methotrexate+leucovorin) with oral uridine rescue.

BACKGROUND: Dose intensification of 5-fluorouracil (5-FU) is complicated by increased toxicity. 5-FU is a fluorine-substituted pyrimidine analog of uracil. In preclinical studies, administration of oral uridine (Ur) has been shown to allow for dose intensification of 5-FU with enhancement of its antitumor activity. Therefore, a Phase I trial was designed aimed at dose intensification of 5-FU as a component of a modified 5-FU-doxorubicin-methotrexate (FAMTX) regimen using oral Ur rescue. METHODS: Methotrexate (MTX) was administered to all patients at a fixed dose of 1.5 g/m2. MTX was followed 24 hours later by escalating doses of 5-FU starting at 800 mg/m2 with leucovorin rescue. Cycles of 5-FU and MTX were repeated every 15 days. Every other cycle, patients received doxorubicin. "Adria cycles") at a dose of 30 mg/m2. Oral Ur was administered at a dose of 8 gm/m2 every 6 hours for 12 doses. In the first phase of the study, patients received Ur only if they developed Grade 3 or 4 hematologic toxicity. In the second phase, all patients received Ur 24 hours after 5-FU on all cycles. RESULTS: Without Ur rescue, the maximum tolerated dose (MTD) of 5-FU was 900 mg/m2 on the Adria cycles and 1.1 gm/m2 on the non-Adria cycles. With Ur, the MTD of 5-FU increased to 1.2 gm/m2 on the Adria cycles and to 1.6 gm/m2 on the non-Adria cycles. CONCLUSIONS: In this modified FAMTX regimen, oral Ur administration allowed for dose-intensification of 5-FU, with a 33% increase in the MTD of 5-FU on the Adria cycles and a 45% increase in the MTD of 5-FU dose on the non-Adria cycles.

Administration, Oral↗
PubMed1995

Cancer chemotherapy in the elderly.

Gastrointestinal malignancies are very common in the elderly of the U.S. There is controversy about the role of chemotherapy in these elderly patients because of the impression that this population experiences greater toxicity while deriving lesser benefit. Though definitive data is lacking regarding many aspects of chemotherapy in the elderly, some general observations can be made: (a) most chemotherapy agents do not have increased toxicity in the elderly; (b) dosing and regimen should be based more on functional parameters rather than chronologic age; (c) chemotherapy for advanced gastrointestinal malignancies is in general of marginal efficacy and can be potentially toxic, regardless of age; and (d) better prospective studies focusing on the efficacy, toxicity, and quality of life effects of chemotherapy in the elderly should be performed. We review the literature regarding chemotherapy pharmacology, efficacy, and organ-specific toxicity of agents used in gastrointestinal malignancies in the context of these principles.

Aged↗
PubMed1994

Phase II trial of gemcitabine in patients with advanced gastric cancer.

BACKGROUND: Approximately 22,000 new cases of gastric cancer are diagnosed each year in the United States, most of which are advanced disease and thus are not curable by surgery. Chemotherapy has had little impact on patient survival. Consequently, the evaluation of new agents is needed. Gemcitabine, a cytosine arabinoside analogue, was evaluated in a Phase II trial to assess its efficacy in previously untreated patients with advanced gastric cancer. METHODS: Patients were treated with weekly gemcitabine, 800 mg/m2, for 3 consecutive weeks, followed by a 1-week rest period. Eighteen patients were enrolled. Fifteen patients were evaluable for response; 2 patients refused therapy before the completion of one cycle of treatment, and one patient was found to have nonmeasurable disease. RESULTS: No major objective responses were seen. Two minor responses occurred. One patient with a minor response was removed from the study at his request after ten cycles of treatment. The other patient remains on the study with stable disease at more than 17 months. Toxicities on this study were mild. Median leukocyte count and platelet nadirs were 5.0 (range, 2.2-51.0) and 234,000/microliters (range, 59,000-554,000/microliters), respectively. CONCLUSION: Gemcitabine at this dose and schedule has no significant antitumor activity in gastric cancer.

Adenocarcinoma↗
PubMed1994

Desert Shield deployment and social problems on a U.S. Army combat support post.

We undertook a study of selected mental health-related services at a combat support post to determine if stress levels surrounding Operations Desert Shield/Desert Storm had an effect on the utilization of these services. Our measure was the problem rate formed by adding the visits to the alcohol and drug service and the social work service. The findings (not all of which reached statistical significance in our small study) were that the problem rates were higher in those units which deployed, both before and after deployment. The pre-deployment differences in age, rank, and race between those soldiers deployed and not deployed is a finding which may help to account for the difference between units. There was a transient, but not sustained, problem rate increase immediately following return home for those units which deployed. Implications for mental health-related services staffing and directions for further research are discussed.

Adult↗
PubMed1992

Chemotherapy of metastatic breast cancer in the elderly. The Piedmont Oncology Association experience [see comment].

OBJECTIVE: To determine the effect of age on treatment outcome in women with metastatic breast cancer treated with chemotherapy. DESIGN: Case-comparison study of patients with metastic breast cancer treated in five clinical trials of the Piedmont Oncology Association. SETTING: University and private practice physicians participating in the Piedmont Oncology Association clinical trials in the southeastern United States. PATIENTS: Seventy patients 70 years of age or older were compared with 60 patients aged 50 through 69 years and 40 patients less than 50 years of age. All patients were ambulatory or capable of self-care, with adequate hematologic, renal, and hepatic function. INTERVENTIONS: Treatment with multidrug chemotherapy regimens. MAIN OUTCOME MEASURES: Response to treatment, time to disease progression, survival, and toxic effects. RESULTS: Pretreatment characteristics including race, performance status, disease-free interval, prior therapy, sites of metastatic disease, and number and dominant sites of metastases were similar for the three age groups. The response rates for the younger-than-50, 50-through-69, and 70-or-older age groups were 40%, 31%, and 29%, respectively (P = .53). There were no significant differences in time to disease progression or survival for patients in the three age groups. Estimates for time to progression and survival were 9.1 and 17.9 months, 6.2 and 12.8 months, and 7.2 and 14.2 months, respectively. Toxic effects, dose delivery, and dose delays were also similar for all three age groups. CONCLUSIONS: Women 70 years of age or older who were enrolled in these trials were similar to their younger counterparts in response rates, time to disease progression, survival, and toxic effects. Women in this age group should not be excluded, based on age alone, from clinical trials involving chemotherapy for advanced breast cancer.

Age Factors↗