PubMed Health⌕ Search

Biomedical subjects

R Westberg

Publications and source records attributed to R Westberg.

9 recordsLinked to original sources
PubMed1998

Dacarbazine-vindesine versus dacarbazine-vindesine-cisplatin in disseminated malignant melanoma. A randomised phase III trial.

In a multicentre phase III study of disseminated malignant melanoma performed in Sweden and Norway, 326 patients were randomised to receive treatment with the combination dacarbazine [DTIC] (D) and vindesine (V) with or without the addition of cisplatin (P). D was given intravenously (i.v.) at a dose of 250 mg/m2 days 1-5 every 4 weeks and V was given i.v. at a dose of 3.0 mg/m2 day 1 weekly. P was given i.v. at a dose of 100 mg/m2 day 1 every 4 weeks. There was no statistically significant difference in overall survival between the treatment arms (P = 0.22). Increased toxicity was observed in the treatment arm containing P of which leucopenia, alopecia and nausea/vomiting were the most pronounced. The median time to progression was significantly longer in patients treated with DVP (4.2 versus 2.2 months, P = 0.007). In conclusion, adding P to DV did not change overall survival but did significantly increase toxicity.

Adolescent↗
PubMed1998

Long-term results from a phase II study of single agent paclitaxel (Taxol) in previously platinum treated patients with advanced ovarian cancer: the Nordic experience.

BACKGROUND: Owing to the wide spread perception of a possible benefit from paclitaxel in the second-line situation the Nordic Gynecologic Oncology Group (NGOG) conducted two prospective phase II studies of paclitaxel single agent treatment (175 mg/m2, three-hour i.v. infusion with standard pre-medication every third week) in patients with relapsing or progressing epithelial ovarian cancer following platinum. PATIENTS AND METHODS: Between 1992-1994 138 patients in total were enrolled of whom 136 received paclitaxel and were included in the toxicity and survival analysis, while 112 were evaluable for response. RESULTS: The overall response rate (CR + PR) was 28% with 16 patients achieving a CR (14%). The estimated median (range) time to progression was 4.1 (0.7-60.7) months. The projected four-year overall survival was 7%, with a median (range) of 9.6 (0.3-60.7) months. A multivariate logistic regression analysis showed that platinum resistance, and WHO performance status at baseline, independently correlated with survival at all three time points (median survival time 9.6, 18, and 24 months). Patients with platinum sensitive tumors and WHO performance status 0 had a median survival of 25.6 months compared to 7.0 months for the rest of the patients (P < or = 0.0001). No serious toxicity was registered. CONCLUSION: Paclitaxel could safely be administered in an outpatient setting using this schedule. Patients with platinum sensitive tumors and a good performance status were most likely to survive. However, these patients are also most likely to respond to re-treatment with a platinum compound. With reference to the reasonably good tumor control and limited toxicity observed in this study, we conclude that paclitaxel single agent therapy is a viable option in the salvage situation, which in some patients can give long-lasting responses. However, although responses can be induced in a significant number of patients, the survival figures remain poor.

Adult↗
PubMed1996

Radiotherapy and neoadjuvant chemotherapy for cervical carcinoma. A randomized multicenter study of sequential cisplatin and 5-fluorouracil and radiotherapy in advanced cervical carcinoma stage 3B and 4A.

BACKGROUND: The locoregional failure rate remains high in advanced cervical carcinoma. Chemotherapy (CT) was added to radiotherapy (RT) in order to increase disease control and to improve 5-year survival. METHODS: CT + RT included cisplatin administered 100mg/m2, d.1 plus 5-fluorouracil 1000 mg/m2 D.1 to 5, ci (120 hrs), q every 3rd week for 3 cycles, followed by RT. RT included external beam irradiation 64.8 Gy in 1.8 Gy fractions, five days a week, by 4-field box technique. The median follow-up was 46 months. Ninety-four patients were evaluable for survival, 47 in the CT + RT group and 47 in the RT group. Ninety-two patients were evaluable for response. Known prognostic factors were equally distributed between the two groups. RESULTS: Of the 43 patients evaluable before RT, 31 (72%) achieved a partial or complete response after CT alone. After RT, 52 patients attained a complete response, 25 in the CT + RT group and 27 in the RT-group. Sixty-three patients developed distant metastases or local relapse, 30 in the CT + RT group and 33 in the RT group. In the CT + RT group 6 of the 9 patients with metastases also had local progression at relapse, in the RT group, 7 of 17 patients. The survival rates for the two groups are not statistically different. Thirty-seven patients are alive, 29 have no evidence of disease. Fifty-seven have died, 29 in the CT + RT group and 28 in the RT group. Fifty-four deaths were related to cancer, and 3 to therapy. CONCLUSIONS: Sequential CT and RT did not improve the survival, local control, or metastasis rate compared with RT alone.

Adult↗
PubMed1996

Correlation of DNA ploidy and S-phase fraction with chemotherapeutic response and survival in a randomized study of disseminated malignant melanoma.

DNA ploidy and S-phase fraction were measured by flow cytometry in the tumour tissue of 87 patients with disseminated malignant melanoma, who had been classified either as responders or with progressive disease in a study of the effects of 2 chemotherapeutic regimens. The patients had been randomized to receive treatment with dacarbazine (DTIC) and vindesine (Eldesine) with or without addition of cisplatin (Platinol). Tumour tissue was obtained from both the primary tumours and the last histologically verified metastases, but in some cases only the primary tumours or the last metastases could be evaluated. There was a significantly higher mean S-phase value in melanoma metastases from patients with complete or partial responses compared with patients with progressive disease. Neither the S-phase fraction of the primary tumour, nor the DNA ploidy of the primary tumour or of the last histologically verified metastases taken before inclusion into the study were associated with therapeutic response. In the multivariate analysis, both the anatomical location of the metastases and the S-phase fraction measured on the last metastases remained significant prognostic factors of response. In the univariate survival analysis, there was an association between high S-phase fractions of the metastases and longer survival. In the multivariate survival analysis, the S-phase fraction, the number of involved metastatic sites and the treatment response were independent predictive factors. We conclude that, in disseminated melanoma treated with chemotherapy, a high S-phase fraction measured in the last histologically verified metastases is associated with a higher response rate and a longer survival. Our results clearly support the role of S-phase measurement as a potential tool for selecting patients for treatment.

Adolescent↗
PubMed1996

A randomized prospective study comparing long-term intravesical instillations of mitomycin C and bacillus Calmette-Guerin in patients with superficial bladder carcinoma.

PURPOSE: We compared the efficacy and toxicity of long-term mitomycin C versus bacillus Calmette-Guerin (BCG) instillation in patients at high risk for recurrence and progression of superficial bladder carcinoma. MATERIALS AND METHODS: Our randomized comparison study included 261 patients with primary dysplasia, or stage Tis, stage T1, grade 3 and multiple recurrent stage Ta/T1, grade 1 or 2 disease. Mitomycin C (40 mg.) or Pasteur strain BCG (120 mg.) was instilled weekly for 6 weeks, then monthly for up to 1 year and every 3 months during year 2. RESULTS: After a median followup of 39 months 49% of the patients given BCG and 34% given mitomycin C were disease-free (p < 0.03), compared to 48 and 35%, respectively, of those with stage Ta or T1 disease, and 54 and 33%, respectively, of those with dysplasia or stage Tis tumor. Tumor progressed in 13% of patients, with no statistically significant difference observed regarding progression between the mitomycin C and BCG groups. Side effects were more common after BCG instillation, with 5 cases of severe side effects compared to 1 in the mitomycin C group. Treatment was stopped due to toxicity in 10% of the patients. CONCLUSIONS: The majority of patients tolerated long-term intravesical therapy well. BCG instillation was hampered by more frequent side effects. BCG was superior regarding recurrence prophylaxis, since patients given BCG had fewer recurrences and a significantly longer time to treatment failure compared to those treated with mitomycin C. No statistically significant difference was observed regarding progression.

Adjuvants, Immunologic↗
PubMed1995

Carboplatin in combination with epirubicin and cyclophosphamide in patients with advanced ovarian cancer. A phase II study.

Seventy-one patients with epithelial ovarian cancer stage III (n = 56) or IV (n = 15) were treated with carboplatin 300 mg/m2, epirubicin 50 mg/m2 and cyclophosphamide 400 mg/m2 every fourth week. Patients clinically free of tumour after six courses (n = 58) underwent a second-look laparotomy. Seventeen patients were microscopically tumour-free (24% of all) and an additional 10 (14%) had only microscopic cancer. Median time to progression was 19 months. The median survival was 33 months and the estimated 5-year survival 27%. The toxicity was mainly haematological, with leukopenia WHO grade 3-4 seen in 88% and thrombocytopenia grade 3-4 in 42% of the patients. The gastrointestinal toxicity was mild and no renal toxicity was seen. This chemotherapy regimen was effective with acceptable toxicity and could be given on an out-patient basis. The possibility of increasing the efficacy and decreasing the toxicity was discussed.

Adult↗
PubMed1994

A phase II study of intraperitoneal carboplatin as adjuvant treatment in early-stage ovarian cancer patients.

In a previously reported phase I study of carboplatin administered ip to patients with ovarian cancer at our clinic, it was determined that the recommended dose for phase II was 500 mg/m2. In this study, this dose was given to 47 patients with the purpose of determining the relapse-free interval and toxicity. Four courses were given with a 28-day interval in an escalated fashion. Median age of patients was 55 years. Karnofsky index was 100 in 98% of the patients. Thirty-one patients had FIGO stage I and 16 patients had FIGO stage II ovarian cancer. Median time to recurrence has not yet been reached among 43 evaluable patients after a median (range) follow-up time of 26.2 (5.5-45.9) months. Recurrent disease was documented in 10 patients (23%). The relapse site was intraabdominal in 7 and extraabdominal in 1 patient. Two patients had combined intra- and extraabdominal relapse sites. Thirty-six of 43 patients went through second-look surgery. The total number of treatment cycles given to evaluable patients was 154. In the patient group with relapsed tumor, > or = 3 courses were administered to 60%, whereas nonrelapsed patients had > or = 3 courses in 94% (P = 0.019). The reason for this distribution was higher toxicity and more frequent catheter-related problems in patients with relapsed tumor. Median (range) disease-free interval for relapsed patients was 11.5 (5.5-26.6) months. Myelosuppression, especially thrombocytopenia, was the dose-limiting systemic toxicity. The overall hematologic toxicity (all courses) was median (range) WBC 3.9(0.3-25.0) x 10(9)/liter, PLTC 212(7-961) x 10(9)/liter, and Hb 109(75-153) g/liter. WHO grade 4 toxicity for WBC was observed in 6.7%, for PLTC in 17.8%, and for Hb in 0% of the patients. Day to nadir values for WBC, PLTC, and HB were in median (cycle 1-4) 18, 16, and 18 days, respectively. Subjective toxicity was mild. In conclusion, ip carboplatin as a single-agent drug in first-line adjuvant chemotherapy of early-stage ovarian cancer has shown moderate activity. The administered dose in this study was safe, with acceptable toxicity.

Adult↗
PubMed1994

Dose intensity of the CAVE regimen in small cell lung cancer correlates to response rate.

Sixty-three patients with limited or extensive small cell lung cancer (SCLC), were treated in the Department of Respiratory Diseases, Huddinge Hospital, between 1985 and 1990, with chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine and etoposide (CAVE). The patients were analyzed retrospectively concerning dose intensity (DI) of the chemotherapy actually delivered during induction treatment, the response rate, toxicity and survival. The mean combined relative DI (CRDI) of the induction treatment, consisting of three chemotherapy courses, was 0.7 (projected CRDI = 1.0). The overall response rate was 57% and the median survival time was 291 days. We found a correlation between the combined relative DI (all four drugs together) and the response rate. Increasing the CRDI from the range of 0.28-0.6 to 0.76-0.90 resulted in an increase in the response rate from 35 to 90%. Toxicity was scarce, suggesting that the actual delivered chemotherapy had low intensity. No correlation was found between DI and toxicity or between the response rate and toxicity. A correlation between DI of this induction treatment and survival could not be established. Our findings suggest the utility of reporting the actual DI of chemotherapy trials in SCLC.

Adult↗