Biomedical subjects
Publications and source records attributed to M L Gershanovich.
Patients with stage III Hodgkin's disease (110) received 2-3 courses of combination chemotherapy followed by total or subtotal irradiation, or exposure of primarily involved lymph nodes. The study did not include patients with persistent symptoms of intoxication. Overall 5- and 10-year survival rates were 78 and 68%, recurrence-free--75 and 74% respectively.
Therapy of anemia raises hemoglobin (Hb) level which in turn improves quality of life. Venofer was tested in 20 anemic (grade 1) patients with various malignancies. The drug was administered in 3 courses, i/v, 200 mg at a 4-5 week interval during chemotherapy. Hb levels rose or remained unchanged in 75%; they fell mostly in cases of tumor progression. There was no correlation between Hb concentration and chemotherapy regimen--with or without platinum. Venofer treatment was followed by improvement in quality of life or by stabilization only in 73.3%. Quality of life improved by 9,3% (FACT-An) after an 1g/dl increase in Hb level. Venofer treatment prevented further anemia.
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The relevance of certain factors in therapy of Hodgkin's disease was evaluated in patients with stage III A (232) and III B (97). Among them were age above 45 years, an increase of more than 50% in blood-serum alkaline phosphatase, presence of at least five lesions, lymph node clusters of 5 cm in diameter and more, and male sex, when two introductory courses of combination chemotherapy were used in stage III A or 2-4 courses (stage III B), followed by total or subtotal irradiation of lymph nodes. The prognostic relevance of either factor was further demonstrated by its increased significance when their different combinations were used.
The efficacy and tolerability of therapy with gemcitabine plus cisplatin were evaluated in 49 patients with disseminated breast cancer refractory to anthracyclines, docetaxel and capecitabine. Gemcitabine 600-750 mg/m2 and cisplatin 30 mg/m2 were injected intravenously, dropwise, on days 1 and 8 of a 3-week course. Overall response rate was 27%; median response duration - 8.0 months, median mediation time until tumor progression--3.2 months, and median survival time--10.3 months. Untoward side-effects were moderate, reversible and, therefore, did not require dosage to be corrected or cut down.
The multi-center non-randomized clinical study included 38 patients, aged 31-70, with morphologically (histologically and/or cytologically) verified diagnosis of disseminated cutaneous melanoma established objective response in 18.5% and clinically significant effect (55.5%) following first-line treatment with fotemustine in conjunction with cisplatin and tamoxifen. Fotemustine as a first-line component of combination chemotherapy retarded metastatic spread to the brain. Since side-effects incidence was not high, the regimen may be used under outpatient hospital conditions.
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Aranoza and dacarbazine (DTIC) monotherapy and in combinations with aranoza and interferon-alpha (IPHN-alpha) as well as DTIC and IPHN-alpha was given to 175 patients (89 males and 86 females, aged 23-78) with disseminated skin melanoma. The effectiveness of aranoza and DTIC monotherapy was practically identical. Total response to DTIC used in combination with IPHN-alpha increased insignificantly: 25.6%--in combination vs. 19.5% DTIC alone (p > 0.05). IPHN-alpha was most effective when used with aranoza (total objective response--31.7% vs. aranoza alone--16%). The best results were reported in cases heretofore untreated with cytostatic drugs. Total response (complete or partial remission) was recorded in 63% vs. 4.5% (p < 0.05) of patients who had received chemotherapy. In cases of aranoza+ IPHN-alpha treatment, complete and partial remission was reported in metastasis of the skin, subcutaneous fat, peripheral, retroperitoneal and abdominal (mesenteric) lymph nodes and lungs. There was no relapse of metastasis of the liver, intestinal tract, bones, breast or ovary.
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The investigation involved 50 patients (fludarabin+cyclophosphamide+prednisolone (FCP)--30; fludarabin+mitoxanthrone+prednisolone (FMP)--17; fludarabin+cyclophosphamide--3). FMP proved the most effective (60%). Yet, FCP results were clinically significant (29%). The efficacy of all the procedures was determined by morphological pattern and was reported in low- and intermediategrade non-Hodgkin's disease alone. Insignificant differences in partial remission duration and stabilization were observed between FMP and FCP, e.g. FMP's effect lasted 1 month longer. No complete remissions were reported; tolerance was reasonable. Tentative findings point to the marked efficacy of fludarabin, particularly, in combination with mitoxanthrone, cyclophosphamide and prednisolone for relapse or refractory low- and intermediate-grade non-Hodgkin's disease.
Patients with stage III (A,B) Hodgkin's disease (366) received chemoradiotherapy consisting of 2-4 courses of combined modality treatment followed by total or subtotal irradiation of lymph nodes. Overall 10-year (84%) and 15-year (79%) and relapse-free 10-year (85%) and 15-year (82%) survival was reported in stage IIIA cases. Subtotal exposure proved relatively more effective in such patients without iliac and inguinal lymph node involvement. If, following combined modality therapy, intoxication symptoms were aborted in stage IIIB patients; fairly good results were obtained after total and subtotal irradiation of lymph nodes or involved areas (10-year (70%) and 15-year (65%) overall and 10-year (75%) and 15-year (75%) relapse-free survival.
A clinical appraisal of efficacy and tolerability of taxol (T) and a generic drug--paclitaxel--LANCE (P)--was carried out in two groups of patients with recurrences (9) or platinum-refractory ovarian carcinoma (17). In group I, patients aged 19-71 (mean age--47 yrs) had received 6-7 courses, while, in group II, patients aged 44-72 (mean age--52 yrs) who suffered tumor progression--15.0 courses of various chemotherapeutic regimens. Following standard premedication, T and P were injected 135 mg/sq., intravenously, dropwise, during 3 hrs, as a rule, either concurrently with platinum drugs or with hemzar. In the final analysis, there was no clinically significant difference in overall response--44-30% and 44-48%, respectively, nor any significant difference in side-effect incidence was reported.
The effectiveness and tolerability of xeloda (capecitabine), a tumor-reactivated oral fluoropyrimidine, alone were investigated in 19 patients, aged 39-79, with relapsing and cisplatin-resistant ovarian tumors. Unfavorable prognosis of chemotherapy was in 11 cases (57.8%): cisplatin-resistant tumors (7) and early relapse--before month 6 (4). Xeloda was administered orally, 1,250 mg/m2, twice a day, for two weeks at an interval of one week. A total of 68 cycles (an average of 3.6 cycles) were evaluated. Complete response was registered in 1, partial--4, and stabilization--4 cases. Total response was in 26.3%, clinically significant effect--47.3% (9 out of 19). Toxic side-effects generally persisted with in stage I-II (palm-and-sole syndrome, leukopenia, neutropenia, sickness, vomiting, diarrhea) without interfering with the treatment.
Thirty-eight patients with disseminated skin melanoma received chemotherapy in conjunction with laser coagulation or interstitial hyperthermia of intra- or subcutaneous metastases. Use of combination therapy was followed by a rise to 37% in total response and 16%--complete regression, respectively. Most effectiveness was attained when the dacarbazine + cisplatin + BCNU + tamoxifen regime was employed. In this group of 16 patients (46%), total response was 56% and, what is most significant, 31% in complete regression. In all cases of apparent response, polychemotherapy was administered both before and after laser coagulation or interstitial hyperthermia.