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Biomedical subjects

M Al-Sarraf

Publications and source records attributed to M Al-Sarraf.

At least 91 records · Page 5Linked to original sources

Factors that affect response to chemotherapy and survival of patients with advanced head and neck cancer.

A review of 164 patients with far advanced head and neck cancer, treated by a cytotoxic chemotherapy over a ten year period, at WAyne State University, Detroit, Michigan, was done in an attempt to determine factors that may influence the response to chemotherapy and subsequent survival. Response rate to methotrexate was 28%, 5-FU 31%, and porfiromycin 13%. Improved responses were noted with combination chemotherapy. Patients who failed to first line therapy rarely responded to other single agent or combination chemotherapy. Those who did not have prior surgery and/or radiotherapy had better results from drug therapy. Patients with good performance status at the time of initial chemotherapy, had better response to treatment (32% vs. 13% PR & CR) and longer survival (28 weeks vs. 9 weeks, p = 0.01) when compared to those with poor status. Patients who responded to chemotherapy have better survival compared to nonresponders (29 weeks vs. 16 weeks, p = 0.002). This information may prove helpful in future planning of multidisciplinary approach in the treatment of patients with head and neck cancer.

Adolescent↗

The value of serial carcinoembryonic antigen (CEA) in predicting response rate and survival of patients with gastrointestinal cancer treated with chemotherapy.

Elevated serum levels of carcinoembryonic antigen (CEA) were found in 70% of 141 patients with advanced gastrointestinal (GI) cancers. Serial CEA measurements were performed on 70 patients before and during chemotherapy. The majority were treated with 5-FU and Methyl-CCNU (33 patients), 5-FU (19 patients), or 5-FU and mitomycin-C (8 patients). In 49 patients with colorectal carcinoma who had elevated serum CEA prior to chemotherapy, 18 had objective partial tumor remission, 16/18 (89%) showed definite decrease in CEA level, one had no change, and one had an increase CEA titer. Thirty-one patients had either stable disease (10 patients) or increasing disease (21 patients) while on chemotherapy. Of these patients four showed decrease in CEA, eight had no change, and 19 had increase in CEA levels as compared to pretreatment value. The survival of patients with a decrease in CEA during chemotherapy was statistically significant (p = .03) as compared to survival of those with no change or increasing CEA levels. In 21 patients with other GI cancers, the correlation between the clinical response and change in CEA level observed was not as definite as in patients with colorectal carcinoma.

Adenocarcinoma↗

Transfer factor.

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Animals↗

Combination of adriamycin and cyclophosphamide in the treatment of metastatic prostatic carcinoma: a phase II study.

A prospective trial of Adriamycin and cyclophosphamide was undertaken in the treatment of patients with hormonally refractory prostatic carcinoma. Of the 20 patients evaluable, three (15%) had a partial remission and five (25%) had stable disease for a total response of 40%. All patients who responded had subjective improvement consisting of weight gain (greater than or equal to 10% of body weight), improvement of performance status (greater than or equal 10% in Karnofsky index), and a decreased need for pain medication.

Aged↗

Phase II trial of dianhydrogalactitol in metastatic malignant melanoma: a Southwest Oncology Group study.

Dianhydrogalactitol given iv in a schedule of 30 mg/m2/day for 5 consecutive days every 4 weeks was administered to 27 patients with metastatic malignant melanoma. All patients had received extensive prior therapy including chemotherapy and had progressive disease at the start of the study. Of 24 patients evaluable for response, 21 demonstrated progressive disease and three had stable disease for periods of from 4 to 11 months. No objective responses were observed. Two of the remaining three patients died 6 and 10 days after entry in the study, while the third refused to return after one drug course. Adverse effects included myelosuppression in eight patients, nausea and vomiting in five patients, and alopecia in one patient. Dianhydrogalactitol is considered to be insignificantly active in the secondary treatment of metastatic malignant melanoma at the dose and schedule studied.

Adult↗

Clinical presentation, natural history and prognostic factors in advanced malignant melanoma.

A retrospective study of the clinical findings and natural history of 140 patients with disseminated malignant melanoma treated at Wayne State University over a ten year period was done. Multiple organ metastases were diagnosed clinically in 78 per cent of all patients and seen at all autopsies. Routine roentgenograms of the chest did not diagnose metastases to the lung in 27 per cent of the patients. The concimitant elevation of alkaline phosphatase, serum glutamic-oxalacetic transaminase and serum glutamic-pyruvic transaminase enzymes is suggestive of underlying metastases to the liver even with a negative liver scan or normal liver size. Electroencephalography was found to be sensitive in predicting and confirming metastases to the central nervous system prior to clinical manifestation with a 97 per cent accuracy rate in clinically confirmed instances as compared with a 60 per cent accuracy rate with brain scan. Age, sex and primary site of melanoma did not influence the survival once the disease became disseminated. Patients with a disease-free interval of more than six months statistically have a better chance of survival from the onset of systemic metastases, p = 0.001. Patients with a poor performance status of less than or equal to 40 per cent had a median survival period of one month as compared with six months with 90 per cent performance, p = 0.001. Patients who initially presented with metastases to the skin or lymph nodes without other visceral involvement had a 14 month median survival rate as compared with eight months in patients with metastases to the central nervous system only, four months with metastases to the liver and only one month in patients with multiple organ involvement, p = 0.0001.

Adolescent↗

Monoclonal gammapathy, multiple myeloma and cancer.

Seventeen cancer patients with monoclonal gammapathy on serum protein electrophoresis are described. Thirteen of these patients were proved to have multiple myeloma, while four patients had "benign" monoclonal gammapathy. In all the cases where bone marrow aspiration was done, an increase in plasma cells was revealed. A majority of the myeloma patients had osteolytic lesions, while all the patients with "benign" monoclonal gammapathy had normal bone survey. A relationship between the solid tumors and monoclonal gammapathy is discussed. The difficulty of detecting multiple myeloma in patients who are previously known to have cancer is presented.

Aged↗

Piperazinedione in patients with advanced malignant melanoma: a Southwest Oncology Group study.

Piperazinedione was administered in doses of 9 or 12 mg/m2 by iv infusion every 3 weeks in 28 patients with previously treated malignant melanoma. Of the 25 evaluable patients, 72% had drug-induced toxicity: 40% had leukopenia, 56% had thrombocytopenia, 40% had anemia, and 16% had nausea and vomiting. None of these patients had partial remission, two had stable disease, and the remaining 23 had definite progression of their disease in spite of adequate trial with this agent.

Adult↗

Evaluation of VP-16-213 in malignant lymphoma and melanoma.

Phase II studies utilizing VP-16-213 in the treatment of 56 patients with malignant lymphoma and 29 patients with malignant melanoma were carried out by the Southwest Oncology Group. All patients had received extensive prior therapy. The initial dose of VP-16-213 administered was 45 mg/m2 by iv infusion over 30-60 minutes on Days 1-5 every 3 weeks but, because, of severe myelosuppression in the lymphoma group, the dose was subsequently reduced to 35 mg/m2. Only three partial regressions lasting 6, 2, and 1 months were noted in 17 patients with Hodgkin's disease. No favorable responses were noted in 35 patients with non-Hodgkin's lymphoma including 16 with the diffuse histiocytic type. No responses were noted in patients with melanoma. The major toxic effect was myelosuppression. VP-16-213 appears to lack significant effectiveness in these previously treated disease.

Adult↗

cis-platinum and 5-fluorouracil as initial therapy in advanced epidermoid cancers of the head and neck.

A total of 44 patients with previously untreated Stage IV squamous cell carcinomas of the head and neck were treated with a combination of cis-platinum (100 mg/sq m) and 96-hour infusion of 5-fluorouracil (5-FU) (1,000 mg/sq m/day) in two courses or with cis-platinum (100 mg/sq m) and 120-hour infusion of 5-FU (1,000 mg/sq m/day) in three courses. In the 26 patients receiving the two course regimen, the tumor response rate was 88.5%. In five of the 26 patients complete disappearance of the tumor was achieved; partial remission was obtained in 18 of 26 patients. The main side effects were nausea and vomiting (70%), leukopenia (27%), and mild-to-moderate renal toxicity (27%). In the 18 patients who received the three course regimen of 5-FU and cis-platinum, there were 11 (61%) complete responses, 6 (33%) partial responses, and 1 (6%) minimal response. The incidence of complete response was increased with each course given. No added toxicity was observed with surgery or radiotherapy.

Adult↗

Significance of alkaline phosphatase and chemotherapy for head and neck carcinoma.

As an adjunct to surgical treatment and radiation therapy, chemotherapy is becoming another major treatment for head and neck malignancies. While response rates have reached as high as 75% in some series, chemotherapy is time-consuming, expensive, and not without risk to the patient. If a subpopulation that would benefit from its use could be identified, this new modality could be applied on a more rational and selective basis. Recent work has suggested a prognostic role for serum alkaline phosphatase in carcinoma of the head and neck. In an attempt to verify this work, a study of 101 patients treated with an induction chemotherapy protocol for squamous cell carcinoma of the head and neck was undertaken. Alkaline phosphatase and other variables possibly related to alkaline phosphatase were studied in detail. We are unable to verify a prognostic role for alkaline phosphatase.

Alkaline Phosphatase↗

Platinum analogs in recurrent and advanced head and neck cancer: a Southwest Oncology Group and Wayne State University Study.

Cisplatin combinations are active in patients with epidermoid cancer of the head and neck. Because of the incidence of dose-limiting toxicity and the need for hospitalization for iv hydration and mannitol diuresis, the search for active analog(s) with less of such toxicity has been intensive. In a limited institution study of Wayne State University and the Southwest Oncology Group, a clinical trial of carboplatin (CBDCA) and iproplatin (CHIP) in patients with recurrent head and neck cancer was carried out. Sixty-four patients were entered and 63 were evaluated, 29 receiving CBDCA and 34 receiving CHIP therapy. These patients were stratified according to important prognostic factors. The response rate to CBDCA was 24% (seven responses among 29 patients; three complete responses and four partial responses), and to CHIP was 12% (four responses among 34 patients; one complete response and three partial responses). Both drugs were administered without prior hydration or mannitol diuresis on an outpatient basis. The major side effect was myelosuppression, which was reversible but cumulative and dose-limiting. Less severe vomiting occurred as compared to the incidence of this toxicity with cisplatin and no significant renal or hearing loss occurred. It was concluded that further evaluation of these agents with other active drug(s) in patients with head and neck cancer is warranted.

Adult↗

cis-Dichlorodiamminepltinum(II) in adult patients: Southwest Oncology Group Studies.

In addition to cis-dichlorodiammineplatinum(II) studies in lymphomas and testicular cancer and a broader phase II study of all genitourinary malignancies, the Southwest Oncology Group is currently conducting eight other studies which examine the effectiveness of this drug in adult patients with a variety of tumor types. This report will give preliminary analyses of the five studies for which there are early data, plus briefly describe the design of the three remaining protocols for which there are no data as yet.

Adult↗

Phase II ftorafur therapy in previously treated squamous cell cancers of the head and neck.

A prospective study was carried out to determine the effectiveness and tolerance of ftorafur (2.25 g/m2 daily for 5 days, repeated every 4 weeks) in previously treated patients with advanced squamous cell cancers of the head and neck. Seventeen patients were entered in the study; 15 were evaluable for drug toxicity, and 14 were evaluable for response. Three patients had mild nausea, three had mild-to-moderate lethargy, two had nonspecific generalized weakness, and two had severe stomatitis. Of 15 patients three experienced leukopenia (causing death in one) and four had thrombocytopenia (life-threatening to one). Response to treatment included: progressive disease (nine patients), stable disease (four), and complete response (one with no previous radiotherapy or chemotherapy).

Adult↗