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Biomedical subjects

K Hoekman

Publications and source records attributed to K Hoekman.

At least 19 recordsLinked to original sources
PubMed1995

[Favorable results of paclitaxel (Taxol) in patients with ovary carcinoma pretreated with platinum].

OBJECTIVE: To assess the anti-tumour and side effects of paclitaxel in patients with ovarian carcinoma, after prior treatment with al least one platinum-containing chemotherapy regimen. DESIGN: Phase II study. SETTING: Academic Hospital of the Free University, Amsterdam. METHOD: Fourteen of 55 patients with progressive ovarian carcinoma were treated with 135 mg/m2 and 41 with 175 mg/m2 paclitaxel. 9 patients by 24-hour and 46 by 3-hour intravenous infusion. RESULTS: In 9/55 (16%) patients an objective tumour response was obtained, which was complete in 1 patient. In 19/55 (35%) patients the disease stabilised. The serum CA 125 level was increased in 52 patients. In 33% of the patients the course of the serum CA 125 was an indication of the tumour response. The median duration of response was 8 months (range 4.1-13.1) and the median duration of survival was 11.3 months (range 0.3-28.2). Side effects of paclitaxel treatment were hair-loss, arthralgia and myalgia and neutropenia of short duration. In 76% of patients pre-existing neurosensory symptoms increased mildly or developed de novo. The neurotoxic effect appeared reversible in most instances after discontinuation of the paclitaxel treatment. CONCLUSION: In this rather unfavourable patient population, paclitaxel induced only 16% objective response. However, more than 50% of the patients did benefit from paclitaxel treatment, as a much larger group had long lasting disease stabilisation without symptoms or had reduction of symptoms. The treatment was well tolerated by most patients.

Adult↗
PubMed1994

Arginine supplementation in the prevention and treatment of osteoporosis.

Oral administration of L-arginine in pharmacological doses induces growth hormone and insulin-like growth factor-I responses and stimulates nitric oxide synthesis. Growth hormone and insulin-like growth factor-I are important mediators of bone turnover and osteoblastic bone formation, while nitric oxide is a potent inhibitor of osteoclastic bone resorption. Because of this dual effect on physiological regulators of bone remodeling, L-arginine could potentially increase bone formation over bone resorption, and, consequently, increase bone mass. It is, therefore, hypothesized that oral supplementation of L-arginine may be a novel strategy in the prevention and treatment of osteoporosis. Studies of this simple, safe, and inexpensive therapy seem warranted.

Administration, Oral↗
PubMed1993

Effects of interleukin-3 on myelosuppression induced by chemotherapy for ovarian cancer and small cell undifferentiated tumours.

Two clinical studies were undertaken to study the toxicity profile and effects of interleukin-3 (rhIL-3) on chemotherapy-induced myelosuppression. Fifteen patients with recurrent ovarian carcinoma were treated with high dose carboplatin (800 mg m-2). All patients received 5.0 micrograms/kg/d rhIL-3 subcutaneously but timing and duration of rhIL-3 treatment differed. Constitutional symptoms were the major toxicity and in addition to the carboplatin-induced nausea and vomiting the combination was poorly tolerated. In 5/15 patients receiving high dose carboplatin rhIL-3 administration was discontinued due to nephrotoxicity (2 x), hypotension, severe malaise and bone pain. In this study, rhIL-3 ameliorated chemotherapy-induced neutropenia as well as thrombocytopenia and reduced the requirement for platelet transfusions in the second cycle of chemotherapy. However, rhIL-3 failed to prevent cumulative platelet toxicity. In the second study 12 patients with small cell undifferentiated cancers were treated with carboplatin, etoposide and ifosfamide. Three dose levels of rhIL-3 were explored (0.125, 5.0 and 7.5 micrograms/kg/d). In this study, toxicity of the treatment was mild, however, no beneficial haematologic effects of rhIL-3 could be demonstrated. In conclusion, the haematological effects of rhIL-3 were modest and dependent on the chemotherapeutic regimen, timing and duration of rhIL-3 treatment (in relation to the expected nadir). In general rhIL-3-induced toxicity was mild, but combination with high dose carboplatin could be hazardous if rhIL-3 is initiated at 24 h after the cytostatic agent.

Adult↗
PubMed1992

Secretory diarrhea in villous adenoma of rectum: effect of treatment with somatostatin and indomethacin.

The effects of treatment with the synthetic long-acting somatostatin analogue SMS-201-995 were studied in a patient with a fluid and electrolyte secreting villous adenoma of the rectum. The effects of SMS-201-995 on rectal fluid volume and electrolyte loss, and local and general prostanoid production were compared with those of treatment with indomethacin. During treatment with the somatostatin analogue iso-osmolar rectal fluid production increased about 25%; the quantity of prostaglandin E2 in the rectal fluid rose almost 20-fold. Prostaglandin F2 alpha, 6-keto-prostaglandin F1 alpha and 13,14-dihydro-15-keto-prostaglandin F2 alpha output showed similar, though less impressive increments during somatostatin treatment. The somatostatin analogue did not affect urinary prostanoid excretion except for levels of 2,3-dinor-thromboxane B2, which doubled. With indomethacin treatment diurnal rectal fluid production dropped by about 50% and all prostanoids measured in urine and rectal fluid decreased below control values. It appears that the somatostatin analogue SMS-201-995 has a marked stimulatory effect on the in vivo prostanoid production by the villous adenoma. Perhaps this stimulation is not confined to the tumor only, but also affects thromboxane synthesis.

Adenoma↗
PubMed1992

The effect of tissue type plasminogen activator (tPA) on osteoclastic resorption in embryonic mouse long bone explants: a possible role for the growth factor domain of tPA.

Osteoblasts produce proteolytic enzymes and their production is regulated by osteotropic agents. It has been suggested that these proteases play a role in bone resorption by removing the superficial collagenous layer from the bone matrix and indirectly inducing migration of osteoclast precursors towards the bone matrix. We examined the effect of the plasminogen activator tPA on osteoclastic resorption using 17-day-old mouse embryonic long bone explants representing different stages of osteoclast development, that is, radii containing already mature osteoclasts and metacarpals containing no mature osteoclasts but only osteoclast precursors/progenitors which are still confined to the periosteum. Tissue type PA stimulated osteoclastic resorption (measured as 45Ca-release) in 17-day-old fetal metacarpals but not in radii of the same animal. Blocking the enzymatic activity of tPA did not inhibit its effect on osteoclastic resorption. Plasmin, the direct product of PA enzymatic activity, did not induce osteoclastic resorption. However, a tPA-mutant missing the growth-factor-like domain of the molecule, failed to stimulate 45Ca-release from the metacarpals. In addition, in both systems tPA and transforming growth factor alpha had similar effects on osteoclastic resorption. The finding that tPA stimulated 45Ca-release only in the metacarpals suggests that tPA has an effect on osteoclast formation rather than on the activity of already mature osteoclasts. Under the experimental conditions used this effect seems to be mediated by the growth factor domain of tPA rather than by the enzymatic activity of the molecule.

Amino Acid Chloromethyl Ketones↗
PubMed1992

Regulation of parathyroid hormonelike protein production in cultured normal and malignant keratinocytes.

We have recently demonstrated that parathyroid hormone-like protein (PLP) production by cultured human squamous carcinoma cells (SCC) can be modulated by co-culture with fibroblasts. The interaction of SCC with fibroblasts, possibly occurring during the invasive phase of SCC, may be the stimulus for enhanced PLP production, thus contributing to the genesis of humoral hypercalcemia of malignancy in this type of cancer (Cancer Res 50:3589-3594, 1990). In the present study we show that the fibroblast-induced increase in PLP level in the medium of SCC-4 cells is paralleled by an increase in PLP messenger ribonucleic acid (mRNA) expression in these cells. We also found that the inhibition of secretion of PLP by monensin for 2 h resulted in a marked increase in immunodetectable PLP intracellularly, suggesting that secretion of PLP was a fast process. The modulation of the production of PLP by calcium and hydrocortisone was further examined in SCC-4 cells and was compared to that in normal keratinocytes and in SCC-9 cells. PLP levels in conditioned media were highest in poorly differentiating SCC-4 cells, intermediate in moderately differentiating SCC-9 cells, and lowest in normal keratinocytes showing high differentiating capacity. Furthermore, in each of the cell types used, PLP production was highest in cultures grown under low calcium conditions; at both calcium concentrations used, the presence of hydrocortisone reduced the PLP release into the medium. This reduction was probably due to a direct effect of hydrocortisone on PLP synthesis because the expression of PLP mRNA was also reduced in the presence of hydrocortisone when tested in SCC-4 cells. In conclusion, our findings indicate that the induction of differentiation in both normal and malignant keratinocytes is associated with the inhibition of PLP production.

Carcinoma, Squamous Cell↗
PubMed1991

Effects of recombinant human granulocyte-macrophage colony-stimulating factor on myelosuppression induced by multiple cycles of high-dose chemotherapy in patients with advanced breast cancer.

In this study, 18 patients with advanced breast cancer were treated with multiple cycles of doxorubicin (75 or 90 mg/m2) plus cyclophosphamide (750 or 1000 mg/m2) every 21 days. Granulocyte-macrophage colony-stimulating factor (GM-CSF) (250 micrograms/m2 per day) was administered by continuous infusion during 10 days (days 2-12), starting in the first or second cycle of chemotherapy. Sixteen (89%) of 18 patients (95% confidence interval, 65%-99%) achieved an objective remission, five (28%) of which were complete. The median duration of response was 7 months. When GM-CSF was used for the first time, it had an effect on the kinetics of all blood cells, including neutrophils, lymphocytes, thrombocytes, and reticulocytes. However, in subsequent cycles of chemotherapy, the stimulatory effect of GM-CSF on hematopoiesis was substantially diminished. World Health Organization grade 3 and 4 neutropenia and thrombocytopenia necessitated dose reductions of doxorubicin and cyclophosphamide from cycle 2 onward in all patients treated with the highest dose. Side effects of GM-CSF included fever, general weakness, and hypotension. These toxic effects mimicked sepsis, and hospital admission for treatment with intravenous antibiotics was required for 73 days in 61 cycles of chemotherapy that included GM-CSF. Dose-intensive chemotherapy produced a high response rate in patients with advanced breast cancer. However, GM-CSF administered from day 2 to day 12 at a dose of 250 micrograms/m2.

Adolescent↗
PubMed1991

Reversible thyroid dysfunction during treatment with GM-CSF.

To investigate whether autoimmunity against thyroid antigens is induced or exacerbated by granulocyte-macrophage colony-stimulating factor, thyroid function and thyroid autoantibodies were studied in 14 patients with advanced breast cancer and 11 with soft-tissue sarcoma who received several cycles of doxorubicin and cyclophosphamide plus GM-CSF 250 micrograms/m2 intravenously daily for 10 days in every 21 day cycle. All patients had normal thyroid function before treatment. In 2 patients with pre-existing thyroid antibodies, thyroid dysfunction developed but disappeared after cessation of GM-CSF. No other autoimmune abnormalities appeared. Stimulation of antigen-presenting cells by GM-CSF may bring about this phenomenon.

Adult↗
PubMed1991

The role of 1,25-dihydroxyvitamin D in the maintenance of hypercalcemia in a patient with an ovarian carcinoma producing parathyroid hormone-related protein.

The syndrome of humoral hypercalcemia of malignancy (HHM) is thought to be mainly a result of the production of parathyroid hormone-related protein (PTHRP) by malignant tumors. Serum 1,25-dihydroxyvitamin D (1,25-DHD) concentrations are generally low in such patients, which contrasts with the findings in animal studies. A patient is reported with HHM from a clear cell ovarian carcinoma and elevated serum immunoreactive PTHRP (about five times the upper limit of normal) in whom serum 1,25-DHD concentrations were abnormally high (200 pmol/l) and associated with increased intestinal calcium absorption. Treatment with two different nitrogen-containing bisphosphonates (pamidronate and [3-dimethyl-amino-1-hydroxypropylidene]-1,1-bisphosphonate) did not normalize serum and urinary calcium despite effective inhibition of bone resorption. These observations suggested an additional intestinal contribution to the maintenance of hypercalcemia. Tumor removal was followed by decreases in serum immunoreactive PTHRP and 1,25-DHD concentrations to their respective normal ranges and normocalcemia. Separating HHM into Types I and II, according to the prevailing serum 1,25-DHD concentrations, can provide a basis for a better understanding of the pathogenesis of hypercalcemia, and it also may have practical use in the successful management of these patients.

Aged↗
PubMed1991

[The hematopoietic growth factor GM-CSF in chemotherapy for advanced breast carcinoma].

A non-randomized study was carried out in the Free University Hospital, Amsterdam, to investigate the (hematologic) toxicity and antitumor response of patients with advanced breast cancer treated with intensive chemotherapy in combination with granulocyte-macrophage colony-stimulating factor (GM-CSF). Of 11 patients with an inoperable or metastasized breast cancer, 5 were treated with doxorubicin 75 mg/m2 + cyclophosphamide 750 mg/m2 intravenously every 3 weeks and 6 patients with 90 and 1000 mg/m2 respectively. When in a preceding cycle a significant hematologic toxicity was observed, this patient was treated in the subsequent cycle with the same dose of chemotherapy in combination with GM-CSF 250 micrograms/m2/day from day 2-12 as a continuous infusion. Bone marrow depression was diminished in the presence of GM-CSF. This was apparent from a milder decline of the number of neutrophilic granulocytes, reduction of the neutropenic period and a more rapid recovery of the neutrophil number. A transient eosinophilia and a mild monocytosis were also observed. GM-CSF did not improve erythrocyte and thrombocyte counts. The efficacy of GM-CSF was less pronounced in the group of patients with the highest dose of chemotherapy. GM-CSF was associated with malaise, fever and a small decrease of blood pressure, which in combination with a frequently occurring anemia and the side-effects of high dose chemotherapy, resulted in a substantial toxicity. In 9/11 patients an objective tumor regression was noted. GM-CSF stimulated the recovery of granulocytes after intensive chemotherapy. Treatment of a small group of patients with advanced breast cancer with intensive chemotherapy resulted in a high antitumor response.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Regulation of the production of plasminogen activators by bone resorption enhancing and inhibiting factors in three types of osteoblast-like cells.

Production of proteolytic enzymes by osteoblasts is considered to be important for the initiation of osteoclastic bone resorption. We examined the production of tissue-type (tPA) and urokinase-type plasminogen activator (uPA) activity by three types of osteoblast-like cells (normal rat osteoblasts, rat and human osteosarcoma cells) using a quantitative spectrophotometric assay and a qualitative gel overlay technique. All 3 types of cells released both types of PA-activity into the medium, but normal rat osteoblasts released uPA probably in an inactive form. Treatment with different concentrations of the bone resorbing factors bovine Parathyroid Hormone [1-84], synthetic human Parathyroid Hormone-Like Protein [1-34]. Prostaglandin E2, Interleukin-1 beta, Tumor Necrosis Factor alpha and 1,25-dihydroxyvitamin D3 increased in general the production of both PA's by all three cell types. However, there were differences in the relative potencies of these factors. In contrast, Transforming Growth Factor beta, which inhibits bone resorption, decreased PA-activity in osteoblast-like cells. In all three types of cells, under control as well as under stimulated conditions, a high molecular weight form of PA was demonstrated by the gel overlay technique, most likely a complex of tPA with the PA-inhibitor PAI-1. The uniform increase in production of PA's by osteoblast-like cells in response to bone resorbing factors and its decrease by TGF beta supports the notion that PA's are involved in bone resorption. The exact mechanism however, remains to be elucidated.

Animals↗
PubMed1990

Modulation of the production of a parathyroid hormone-like protein in human squamous carcinoma cell lines by interaction with fibroblasts.

Normal human keratinocytes as well as human squamous cell carcinomas produce a parathyroid hormone-like protein (PLP). However, PLP production by these cells is not a constant phenomenon. Since nothing is known about factors which regulate the production of PLP, in vitro studies were performed with normal keratinocytes and squamous carcinoma cell lines in order to establish conditions under which PLP production may vary. PLP was measured as cyclic AMP production in parathyroid hormone target cells (osteoblasts) which could be inhibited by a parathyroid hormone antagonist. The presence of PLP was confirmed using a radioimmunoassay specific for PLP. Results from the bioassay correlated very well with the data obtained by radioimmunoassay for PLP. The results confirm that human squamous carcinoma cells and normal keratinocytes produce PLP. PLP production appeared to be very sensitive to modulation of coculture of squamous carcinoma cells with fibroblasts. The effect of fibroblasts was not mediated by an effect on squamous carcinoma cell viability. Murine transformed fibroblasts (3T3 cells) as well as human normal foreskin fibroblasts were equally effective in inducing PLP production in these cells. The fibroblastic factor was apparently present in a soluble form in the coculture system which prevented direct cell-cell contact but allowed communication through the medium. Nevertheless, conditioned medium from 3T3 cells failed to induce PLP production by squamous carcinoma cells. This suggests a more complicated interaction between the two cell types than a one way message from fibroblasts to keratinocytes. Production of PLP by a number of squamous carcinoma cell lines was variable and not evidently correlated with the ability of these carcinoma cells to differentiate. Production of parathyroid hormone-like protein not only is the expression of a disturbed metabolism of a specific cell type but also reflects the cell-cell interaction in tumor tissue.

Animals↗