Biomedical subjects

P C Hoffman

Publications and source records attributed to P C Hoffman.

At least 19 recordsLinked to original sources

PubMed2006

Utility of near-infrared reflectance spectroscopy to predict nutrient composition and in vitro digestibility of total mixed rations.

Total mixed ration (TMR) samples (n = 110) were analyzed for dry matter (DM), crude protein (CP), soluble CP, neutral detergent fiber (NDF), NDF CP, starch, ash, fat, total ethanol-soluble carbohydrate, and nonfiber carbohydrate (NFC). Rapidly and slowly degraded and undegraded in situ CP fractions and in vitro DM, organic matter, and NDF digestibility were determined on each TMR. The TMR were scanned using near-infrared reflectance spectroscopy (NIRS); spectra were retained with NIRS calibration and cross-validation statistics were determined using partial least squares regression methods. The CP, NDF, starch, in vitro DM, and in vitro indigestible NDF contents of TMR were predicted by NIRS with good degrees (R2 >0.85) of accuracy with proportionally low standard errors of prediction. Moderate utility of NIRS to predict the NFC (R2 = 0.83) and fat content (R2 = 0.81) of TMR was observed. Rapidly, slowly, and undegraded in situ CP fractions in TMR were not well predicted by NIRS. Similarly, soluble CP, NDF CP, total ethanol-soluble carbohydrate, and in vitro NDF digestibility (% of NDF) were not well predicted by NIRS. Ratios of nutrient range to reference laboratory method error were calculated and found to be positively related (R2 = 0.84) to NIRS predictability of a given TMR nutrient, suggesting some laboratory procedures were not precise enough to yield suitable NIRS predictions. Data suggest that NIRS has utility to predict basic nutrients such as CP, NDF, starch, NFC, and fat in TMR. However, difficulty was observed using NIRS in predicting key biological nutrients in TMR such as in situ CP fractions and in vitro NDF digestibility. Difficulty of NIRS in predicting these nutrients is related to the level of reference method error in relationship to the range of nutrient values in TMR, but other sources of prediction error may exist.

Animal Feed↗

PubMed2006

Changes in conception rate, calving performance, and calf health and survival from the use of crossbred Jersey x Holstein sires as mates for Holstein dams.

Differences in conception rates in matings of Holstein sires or F1 Jersey x Holstein sires to Holstein dams in the University of Wisconsin-Madison experimental herd were evaluated, as were differences in birth weight, dystocia, serum protein, serum IgG, fecal consistency, respiratory disease, and perinatal and pre-weaning mortality among the resulting calves. When mated to randomly chosen, lactating Holstein cows, Holstein sires (n = 74) and crossbred sires (n = 7) did not differ in male fertility. Calves from Holstein sires and multiparous Holstein dams (n = 99) were 1.9 kg heavier than calves from crossbred sires and multiparous Holstein dams (n = 211), leading to greater likelihood (odds ratio of 1.24) of dystocia. Furthermore, calves from crossbred sires and multiparous Holstein dams had higher serum protein and serum IgG levels between 24 and 72 h of age, as well as lower rates of perinatal and preweaning morality than calves from Holstein sires and multiparous or primiparous Holstein dams. Mean fecal consistency scores from birth to 7 d of age and number of days with scours also tended to be lower among calves from crossbred sires, compared with calves from Holstein sires. No differences were observed in the incidence or severity of respiratory disease. Results of this study suggest that introduction of Jersey genes via crossbreeding may lead to a reduction in dystocia and improvements in calf health and survival in Holstein herds. Future studies should address other traits related to dairy farm profitability, including milk composition, female fertility, longevity, feed efficiency, and resistance to infectious and metabolic diseases.

Animals↗

PubMed2004

A phase II study of oxaliplatin and paclitaxel in patients with advanced non-small-cell lung cancer.

PURPOSE: To evaluate the efficacy and toxicity of oxaliplatin and paclitaxel as first-line therapy for patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: The treatment regimen was given as defined in a phase I investigation in patients with previously treated ovarian cancer. It consisted of paclitaxel 175 mg/m(2) (1-h infusion) and oxaliplatin 130 mg/m(2) (2-h infusion) given every 21 days. Eligible patients had stage IIIB (pleural effusion)/IV NSCLC, measurable disease, no prior chemotherapy, Eastern Cooperative Oncology Group performance status 0-2, and adequate hematological, renal and hepatic function. RESULTS: A total of 38 patients were enrolled with the following characteristics: 29% male (n = 11); 71% female (n = 27); median age 64.5 years (range 37-78); performance status of 0-1 84% (n = 32); stage IIIB 8% (n = 3); stage IV 92% (n = 35). One hundred and eighty-one cycles were administered, with a median of four per patient (range one to 12). The overall objective response rate for all 38 patients was 34.2% [95% confidence interval (CI) 19.6% to 51.4%]. This response rate includes 13 patients who met criteria for a partial response. No complete responses were observed. Median overall survival time was 9.2 months (95% CI 6-12.4) and median progression-free survival time was 4.3 months (95% CI 2.1-6.5). The 1- and 2-year overall survival rates were 37% and 21%, respectively. Hematological toxicity included six patients with grade 4 neutropenia. Non-hematological toxicity consisted mainly of grades 1 and 2 neurosensory toxicity. Laryngodysesthesia was observed in two patients following oxaliplatin infusion. No grade 4 non-hematological toxicities were encountered. CONCLUSION: This regimen is well tolerated, and demonstrates activity in patients with advanced NSCLC.

Adult↗

PubMed2003

Phase I/II investigation of paclitaxel, ifosfamide and carboplatin for advanced non-small-cell lung cancer.

BACKGROUND: The aim of this study was to evaluate feasibility and tolerability of the three-drug combination of paclitaxel, ifosfamide and carboplatin (TIC) in patients with advanced non-small-cell lung cancer. The specific objectives of the study were: (i) to define the dose-limiting toxicities (DLTs) and the maximum-tolerated dose of ifosfamide administered as part of the combination; and (ii) to determine the overall response rate and overall survival of patients treated with this regimen. PATIENTS AND METHODS: Patients with untreated, stage IIIB (pleural effusion) or stage IV non-small-cell lung cancer were enrolled in one of three cohorts. Patients received paclitaxel 200 mg/m(2) as a 1-h infusion on day 1 with carboplatin at an area under the concentration-time curve (AUC) of 6 mg.min/ml on day 2. For dose level I, ifosfamide was administered at a dose of 2 g/m(2) on days 1 and 2. For dose levels II and III, the dose of ifosfamide was decreased to 1.5 g/m(2) on days 1 and 2 and the dose of carboplatin was decreased to AUC 5 mg.ml/min. Therapy for dose levels I and III included filgrastim support (5 micro g/kg/day), which was initiated on day 3 and continued until after day 11 or until an absolute neutrophil count >10 000/ micro l. Treatment cycles were repeated every 21 days. Once the phase II dose was established, a full cohort of patients received therapy at this dose level to examine further the regimen's activity and tolerability. RESULTS: Neutropenia was the DLT encountered for dose levels I and II. No DLT was encountered in the initial six patients treated at dose level III, and therefore this dose level was declared the recommended phase II dose. A total of 49 patients were treated at the recommended phase II dose. The predominant non-hematological toxicity encountered with this triplet regimen was cumulative peripheral neuropathy. Of the 65 eligible patients enrolled in this study, 17 (26%) responded. There were 15 patients with partial responses (23%), two with regression, and 26 with stabilization of disease (40%). Median progression-free and overall survival were 4.8 and 9.4 months, respectively. CONCLUSIONS: The combination TIC is well-tolerated. This triplet regimen produced response and survival rates in advanced non-small-cell lung cancer similar to those of other current combination chemotherapy regimens.

Adult↗

PubMed2001

A phase I trial of the oral platinum analogue JM216 with concomitant radiotherapy in advanced malignancies of the chest.

JM216 is an orally administered platinum analogue. We undertook this study to determine the maximally tolerated dose (MTD) of JM216 when administered with concomitant radiotherapy to the chest (200 cGy daily, 5 x/week) in patients with locoregionally advanced non-small cell lung (NSCLC) or esophageal cancer. Patients were excluded for inadequate bone marrow reserve, prior radiotherapy to the primary tumor or previous treatment with platinum drugs. A dose-limiting toxicity (DLT) was defined using the National Cancer Institute (NCI) Common Toxicity Criteria (CTC) and consisted of grade > or = 2 renal, hepatic, cardiac, or pulmonary toxicity or grade > or = 3 hematologic, neurological, or gastrointestinal toxicity. A total of 23 patients were registered; two never received treatment and are excluded from analyses. Six patients were treated at a dose of 30 mg/m2/day for 5 days with two grade 2 DLT's: cough (1 pt) and elevated trans-aminases (1 pt). Seven evaluable patients were treated at 60 mg/m2/day and seven experienced grade 3 or 4 toxicity, five related to myelosuppression. The dose was then reduced to 45 mg/m2/d. Eight patients were evaluable for toxicity, of which 5 experienced DLT: myelosuppression (3 pts), esophagitis (2 pts), dyspnea (1 pt), and elevated creatinine (1 pt). Fourteen patients were evaluable for efficacy, of which 6 had an objective response, including one complete response. The recommended phase II dose of JM216 with concurrent radiation therapy is 30 mg/m2/d for 5 days. The major DLT is myelosuppression with only limited increased toxicity within the field of radiation. This conceivably may limit the use of JM216 as a radiation sensitizer.

Administration, Oral↗

PubMed2001

A phase II trial of 9-aminocaptothecin (9-AC) as a 120-h infusion in patients with non-small cell lung cancer.

In a previous phase II trial of the synthetic topoisomerase I inhibitor, 9-aminocamptothecin (9-AC), given as a 72-h infusion, we identified modest single agent activity of 9% in patients with previously untreated advanced non-small cell lung cancer (NSCLC). Preclinical studies suggested that a more prolonged continuous infusion of the drug might lead to greater antitumor activity. A phase I study recommended a phase II dose of 25 microg/m2/hr for 120 h (3000 microg/m2 over 5 days), administered for 2 consecutive weeks of a 3-week cycle. We utilized this schedule and enrolled 13 chemotherapy-naïve patients with Stage IIIB and IV NSCLC in this trial: median age 67 (range 57-74); 46% male; 92% stage IV; and median performance status 1. Twelve patients are available for response and toxicity evaluation after 2 cycles of therapy. One patient achieved a partial response. Four patients had stable disease while seven patients had progressive disease. Patients with stable or progressive disease after two cycles received no additional 9-AC, and were offered conventional chemotherapy. The median survival time was 10.2 months and the one-year survival rate 28% (95% confidence interval, 5-58%). Significant toxicities included myelosuppression, fatigue, and anorexia. One patient had grade 4 neutropenia following the first week of cycle 2, and did not receive additional therapy. There were no neutropenia-related infections. These data suggest that this prolonged schedule is unlikely to increase 9-AC's very modest activity in NSCLC above that seen with the simpler 72-h administration schedule. Further evaluation of 9-AC in NSCLC is not recommended.

Aged↗

PubMed2001

Short communication: Effect of dietary protein on growth and nitrogen balance of Holstein heifers.

A growth study and a companion N balance study were conducted to evaluate the effect of dietary protein on growth and N utilization of postpubertal Holstein heifers. Forty heifers (398 +/- 9.4 kg) were fed one of four diets containing 8, 11, 13, or 15% crude protein (CP) for 121 d. Body measurements were taken at the beginning and end of the experimental period. Blood was collected via jugular vein every 28 d and evaluated for serum protein, albumin, and urea nitrogen. Curvilinear relationships were observed between dietary CP and gains in wither height and hip width, with maximal gains occurring at 13% CP. Feeding heifers higher amounts of dietary CP resulted in linear increases in heart girth gain, serum protein, albumin, and blood urea nitrogen. In the companion N balance study, feeding increasing amounts of dietary CP to heifers resulted in linear increases in N intake, fecal-N, urinary-N, and absorbed-N. There was a numerical trend towards maximal N retention in heifers fed diets containing 13% CP. Curvilinear relationships also were observed between dietary CP and dry matter, organic matter, and CP digestibility with maximal nutrient digestibilities occurring when heifers were fed diets containing 13% CP. Data suggest 13% dietary CP was optimal for postpubertal (400 kg) Holstein heifers.

Albumins↗

PubMed2000

Lung cancer.

Lung cancer remains a major worldwide health problem, accounting for more than a sixth of cancer deaths. The proportion of cancers that are adenocarcinomas is increasing in North America and to some degree in Europe, leading to a changing clinical picture characterised by early development of metastases. Newer diagnostic techniques have allowed for more accurate tumour staging and treatment planning. In patients with non-small-cell cancer, surgical resection offers substantial cure rates in early-stage cases. Combined chemotherapy plus radiation therapy has clearly improved the treatment results for patients with locally advanced cancers, and patients with metastatic disease are now candidates for newer chemotherapy regimens with more favourable results than in the past. Small-cell lung cancer is highly responsive to chemotherapy, and recent advances in radiation therapy have improved the prospects for long survival. New techniques for screening, and innovative approaches to both local and systemic treatment offer hope for substantial progress against this disease in the near future.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2000

Sex-associated differences in survival of patients undergoing resection for lung cancer.

BACKGROUND: The increasing incidence of lung cancer among women prompted us to assess whether sex-associated differences exist in the presentation and survival of patients who undergo major lung resection for lung cancer. METHODS: We performed a retrospective review of patients who had major lung resection for lung cancer from January 1980 to June 1998. RESULTS: There were 265 men and 186 women. Women were younger (60.7+/-0.8 versus 63.6+/-0.6 years; p = 0.005). Adenocarcinoma was more common among women (48% versus 40%; p = 0.001). Pathologic stages for men were: I = 43%, II = 26%, IIIA = 25%, IIIB or IV = 6%, and for women: I = 52%, II = 20%, IIIA = 22%, IIIB or IV = 6% (p = 0.146). Median survival was better for women (41.8 versus 26.9 months; p = 0.006). This was due both to a difference in stage at presentation and to a better median survival rate for adenocarcinoma compared with squamous cell cancer. The data suggest an association between sex and survival, although this failed to reach statistical significance. Sex influenced survival with a relative risk for women of 0.67 (95% confidence interval 0.35 to 1.29; p = 0.231 adjusted for stage, cell type, age, and spirometry). CONCLUSIONS: There are sex-associated differences in the presentation and possibly in the survival of patients with lung cancer. This finding has possible implications regarding the selection of patients for therapy and for the design of randomized therapeutic trials.

Adenocarcinoma↗

PubMed2000

Short communication: a novel system to estimate protein degradability in legume and grass hays.

Previous research from our laboratory has demonstrated that near-infrared reflectance spectroscopy has utility in predicting rumen-undegradable protein (RUP) contents of legume and grass silages. This study was conducted to evaluate whether application of previous research techniques could yield a useful near-infrared reflectance spectroscopy RUP prediction system for legume and grass hays. Legume and grass hays (n = 106) were evaluated for RUP content by in situ techniques in four ruminally cannulated cows. In situ RUP for legume and grass hays averaged 25.9% CP and ranged from 14.6 to 45.5% CP, respectively. We developed a near-infrared reflectance spectroscopy RUP calibration equation for the legume and grass hay data set using in situ RUP contents as base data. This procedure resulted in an acceptable (R2 = 0.87, SE = 2.46% CP) near-infrared reflectance spectroscopy equation to predict RUP content of legume and grass hays. Data suggest that near-infrared spectroscopy predicts RUP contents of legume and grass hays with accuracies similar to legume and grass silages.

Animals↗

PubMed2000

A phase I study of STEALTH cisplatin (SPI-77) and vinorelbine in patients with advanced non small-cell lung cancer.

STEALTH cisplatin (SPI-77) is a liposomal formulation of cisplatin that has activity in animal models of non small-cell lung cancer (NSCLC). Vinorelbine has documented clinical activity in NSCLC. The purpose of this study was to determine the dose-limiting toxicity (DLT) and maximum tolerated dose (MTD) of SPI-77 when administered in combination with a fixed dose of vinorelbine to patients with stage IIIB or IV NSCLC refractory to or recurrent following previous chemotherapy. SPI-77 was given on day 1 in combination with vinorelbine at a fixed dose of 25 mg/m2 on days 1 and 8 of a 3-week treatment cycle. Dose escalation of SPI-77 progressed as follows: 20, 40, 80, 100, 120, and 140 mg/m2. Twenty patients were entered (11 men and nine women; median age, 63 years). Sixty-four complete cycles of therapy were administered, and 19 of 20 patients completed at least 1 cycle of combination chemotherapy. Neutropenia was dose limiting at a SPI-77 dose of 140 mg/m2. Neuropathy and nephrotoxicity were minimal and not dose related. A partial response was observed in three of 17 patients eligible for a response evaluation and response duration ranged from 6 weeks to 5 months. In conclusion, treatment with combination SPI-77 and vinorelbine was well tolerated, and our recommended phase II dose is 120 mg/m2 of SPI-77 in combination with vinorelbine at 25 mg/m2. Activity was observed in this patient population, and additional phase II testing of this regimen in a less extensively pretreated cohort of patients with NSCLC is indicated.

Journal Article↗

PubMed1999

First two cases of immune hemolytic anemia associated with ceftizoxime.

BACKGROUND: Second- and third-generation cephalosporins have been associated with immune-mediated hemolytic reactions. This report discusses two patients who developed clinically significant extravascular hemolysis while receiving the third-generation cephalosporin ceftizoxime (Ceftizox). This is believed to be the first time hemolysis has been described in patients receiving this drug. STUDY DESIGN AND METHODS: Immunologic workup of drug-dependent antibodies was performed on blood samples using drug-coated and immune complex methodologies. Antibody classes and titers were analyzed. RESULTS: Both the patients' sera contained anti-ceftizoxime that reacted with red cells only when ceftizoxime was added to the sera ("immune complex" method). The patients recovered without complications following discontinuation of the drug. Each patient had IgM and IgG drug-dependent antibodies. The drug-induced antibodies from each patient cross-reacted with cefotaxime, which is structurally similar to ceftizoxime, but cross-reacted either weakly or not at all with ceftriaxone, which has a more complex side chain. CONCLUSION: This report describes the first cases of immune hemolytic anemia associated with ceftizoxime. In drug-induced hemolytic reactions, prompt recognition and discontinuation of the drug may be important factors in reducing the chance of serious sequelae.

Adult↗

PubMed1999

Predicting the effect of proteolysis on ruminal crude protein degradation of legume and grass silages using near-infrared reflectance spectroscopy.

Two studies were conducted to assess whether routine applications of near infrared reflectance spectroscopy could predict the effects of silage proteolysis on ruminal crude protein (CP) degradation of legume and grass silages. A preliminary study was conducted to assess the effect of laboratory drying method on ruminal CP degradation of silages. Thirty legume and grass silages were freeze-, oven-, or microwave-dried and incubated in situ in the ventral rumen of three ruminally cannulated cows for 24 h. Freeze-drying was considered least likely to alter ruminal CP degradation of the silages; therefore, oven- and microwave-drying were compared using first-order regression with freeze-drying. Oven-drying for 48 h at 55 degrees C compared favorably (R2 = 0.84) with freeze-drying. Microwave-drying resulted in a large bias (2.84 g/10(-1) kg of CP) and was poorly related (R2 = 0.48) to freeze-drying. In a second study, alfalfa and timothy were cut at three maturities and allowed to wilt for 0, 10, 24, 32, 48, and 54 h. Forages were ensiled in triplicate cylindrical mini silos and allowed to ferment for 120 d. After fermentation, silages were oven-dried, ground, and scanned on a near-infrared reflectance spectrophotometer. Duplicate, dried, 2-mm ground silage samples were incubated in the ventral rumen of three ruminally cannulated cows for 24 h. Forage species, maturity, and wilting time significantly affected 24-h ruminal CP degradation of the silages. Near-infrared reflectance spectroscopy accurately predicted (R2 = 0.91) 24-h ruminal CP degradation of silages. Data suggest near-infrared reflectance spectroscopy can accurately assess the effects of forage species, maturity, and wilting time (proteolysis) on 24-h ruminal CP degradation of legume and grass silages.

Animals↗

PubMed1999

Prediction of laboratory and in situ protein fractions in legume and grass silages using near-infrared reflectance spectroscopy.

Legume and grass silage samples (n = 121) were collected from commercial forage testing laboratories (trial 1). Samples were dried at 55 degrees C for 48 h, ground, scanned on a near-infrared reflectance spectrophotometer, and analyzed for crude protein (CP), soluble CP, acid detergent fiber (ADF) CP, and neutral detergent fiber (NDF) CP by wet chemistry methods. Sixty samples were selected for calibration development, and the remaining samples were used for equation validation. Near-infrared reflectance spectroscopy accurately predicted the CP content of the silages (R2 = 0.96), but prediction of soluble CP, ADF CP, and NDF CP was markedly less accurate. The coefficients of determination and standard errors of calibration for CP, ADF CP, NDF CP (percentage of DM), and soluble CP (percentage of CP) were as follows (0.96 and 0.80, 0.77 and 0.24, 0.72 and 0.71, and 0.82 and 4.40). In a second study, legume and grass silage samples (n = 32) were dried at 55 degrees C and ground (2 mm). Duplicate dacron bags containing 5 g of silage were incubated in the ventral rumen of three ruminally cannulated cows for 0, 3, 6, 12, 24, 48, and 72 h. In situ protein fractions, including rapidly degraded protein, slowly degraded protein, undegradable protein, degradation rate, and rumen-undegradable protein, were determined. Original samples were reground (1 mm) and scanned. Previously defined near-infrared spectroscopy calibration procedures were conducted. Coefficients of determination for in situ CP fractions were R2 > 0.92 with the exception of degradation rate (R2 = 0.87). Data suggest that in situ protein fractions are better predicted by near-infrared reflectance spectroscopy than by laboratory protein fractions.

Animals↗

PubMed1999

Development of a novel system to estimate protein degradability in legume and grass silages.

Five trials were conducted to develop a system to estimate rumen-undegradable protein (RUP) of legume and grass silages using near infrared reflectance spectroscopy. In situ procedures were the reference method used to determine silage RUP content. Trials 1, 2, and 3 were devoted to improving in situ procedures. In trial 1, alfalfa silage with and without heat treatment was incubated ruminally in 30 cows. The standard deviation of in situ RUP attributable to cow and diet was 0.82 and 3.80 g/10(-1) kg of crude protein (CP) for the unheated and heated alfalfa, respectively. Based on trial 1, it was determined that 8 cows would be required to establish RUP standards. In trial 2, low (13.3 g/10(-1) kg of CP) and high (44.5 g/10(-1) kg of CP) RUP standards were developed using eight ruminally cannulated cows. In trial 3, 11 new RUP standards were developed by mixing trial 2 RUP standards together. The RUP standards were used to employ a calibration curve technique in ruminally cannulated cows. The technique was employed in four ruminally cannulated cows to estimate RUP contents of 121 silages, and RUP values were used for near-infrared reflectance spectroscopic analysis in trial 4. Trial 4 procedures yielded a calibration for RUP content of silages with an R2 of 0.84 and a standard error of calibration of 1.55 g/10(-1) kg of CP. In trial 5, the equation was tested on 300 silage samples. The mean predicted RUP content was 21.8 g/10(-1) kg of CP. Data suggest near-infrared reflectance spectroscopy can predict RUP content of silages.

Animals↗

PubMed1999

Relationship between megakaryocyte mass and serum thrombopoietin levels as revealed by a case of cyclic amegakaryocytic thrombocytopenic purpura.

Cyclic amegakaryocytic thrombocytopenic purpura is a rare syndrome characterized by periodic failure of megakaryocytopoiesis. In this report we describe a patient with cyclic amegakaryocytic thrombocytopenic purpura associated with a megakaryocyte specific serum IgG antibody, who responded to cyclosporin A therapy. Serial serum thrombopoietin assays during an episode of platelet cycling demonstrated a reciprocal relationship between serum thrombopoietin level and megakaryocyte mass, suggesting that megakaryocytes have an important role in the regulation of thrombopoietin metabolism.

Adult↗

PubMed1998

A phase I-II study of paclitaxel, ifosfamide, and vinorelbine with filgrastim (rhG-CSF) support in advanced non-small-cell lung cancer.

PURPOSE: We designed a phase I-II trial of three active agents, paclitaxel, ifosfamide, and vinorelbine, in advanced non-small-cell lung cancer (NSCLC) to: 1) define the dose-limiting toxicities (DLT) and maximum tolerated dose (MTD) of paclitaxel with filgrastim (G-CSF) support; and 2) determine the overall response rate and median survival of patients treated on this regimen. PATIENTS AND METHODS: We treated cohorts of patients with stage IIIB or IV NSCLC with ifosfamide 1.2-1.6 g/m2/day x 3 and vinorelbine 20-25 mg/m2/day x 3 and escalating doses of paclitaxel at 100-175 mg/m2 on day 2 with G-CSF support on a 21-day cycle. One prior experimental single-agent chemotherapy regimen was allowed. RESULTS: Fifty-six patients, were enrolled on this trial: 27 on the phase I portion of the study and an additional 29 at the recommended phase II dose (RPTD). Thirteen patients had received prior chemotherapy. Paclitaxel doses of 175 mg/m2 and 150 mg/m2 produced dose-limiting myelosuppression, and the RPTD was determined to be paclitaxel 135 mg/m2 with ifosfamide 1.2 g/m2/day on days 1-3 and vinorelbine 20 mg/m2/ day on days 1-3 with G-CSF support. The overall response rate was 18%, with a median survival of 6.1 months. Six of 35 patients (17%) treated at the RPTD achieved a partial response to therapy. Grade IV neutropenia was observed in 19 of 35 patients at this dose, with eight patients suffering febrile neutropenia. CONCLUSIONS: This non-cisplatin-containing three-drug regimen has substantial toxicity and low activity in advanced NSCLC, and does not seem to improve on prior regimens. It is unclear whether the lack of efficacy relates to an antagonistic reaction between the specific drugs, administration schedule, or to subtherapeutic doses of the individual agents.

Adult↗

PubMed1998

Induction chemotherapy, surgery, and concomitant chemoradiotherapy for carcinoma of the esophagus: a long-term analysis.

PURPOSE: To define the activity and toxicity of preoperative chemotherapy and postoperative concomitant chemoradiotherapy in patients with carcinoma of the esophagus, and to determine the effect on survival in patients treated with this approach. PATIENTS AND METHODS: Patients were treated with two 21-day cycles of induction chemotherapy with cisplatin 100 mg/m2 on day 1, 5-fluorouracil (5-FU) 800 mg/m2/day continuous infusion on days 1-5, and leucovorin 100 mg/m2 every four hours on days 1-5. Surgical resection was performed if feasible (and could also be performed prior to chemotherapy). Patients then received radiotherapy (50 to 60 Gy) every other week x five to six weeks, concomitantly with 5-FU 800 mg/m2 continuous infusion daily and hydroxyurea 1 g twice daily x five days. RESULTS: Forty-six patients were treated. With a minimum follow-up of 58 months, the median survival for the entire group was 16 months; the median survivals for patients with squamous carcinoma and adenocarcinoma were 29 months and 12 months, respectively. Toxicities of induction chemotherapy were severe neutropenia and mucositis; there was one toxic death. Toxicities of concomitant chemoradiotherapy were neutropenia, mucositis and esophagitis. There were five cases of radiation pneumonitis, one fatal. CONCLUSION: Induction chemotherapy and postoperative concomitant chemoradiotherapy can be added to surgical resection for carcinoma of the esophagus. Combined modality therapy, as reported here, produces long-term survival benefit, particularly in patients with squamous carcinoma. However, similar outcome results have been reported with less toxic and shorter treatment regimens as tested in randomized studies.

Adult↗