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S Fetscher

Publications and source records attributed to S Fetscher.

36 records · Page 2Linked to original sources
PubMed1998

Multimodality treatment including early high-dose chemotherapy with peripheral blood stem cell transplantation in limited-disease small cell lung cancer.

Combined-modality treatment for limited-disease small cell lung cancer using conventional chemotherapy and chest irradiation achieves high response rates, but most patients relapse over a period of 12 to 16 months. To improve current results, we performed a phase II trial including high-dose chemotherapy and peripheral blood progenitor cell transplantation (PBPCT) as part of an early intensification strategy after two cycles of induction therapy. Moreover, to reduce the risk of local recurrence, the protocol included surgical resection in stages I to IIIA patients as well as chest irradiation. Between January 1991 and July 1994, 16 consecutive patients (median age, 50 years; age range, 30 to 59 years) were treated in this single-center trial. The patients received two cycles of conventional chemotherapy consisting of etoposide 500 mg/m2, ifosfamide 4 g/m2, cisplatin 50 mg/m2, and epirubicin 50 mg/m2 plus granulocyte colony-stimulating factor 5 microg/kg at a 3-week interval, followed by PBPC collection and subsequent high-dose etoposide 1,500 mg/m2, ifosfamide 12 g/m2, carboplatin 750 mg/m2, and epirubicin 150 mg/m2 with PBPCT. The duration of the entire chemotherapy program was 9 weeks. Six of 10 patients in stages I to IIIA and one of six patients in stage IIIB received neoadjuvant or adjuvant surgery before high-dose chemotherapy, followed by thoracic (50 Gy) and prophylactic (30 Gy) cranial irradiation. Hematopoietic reconstitution after high-dose chemotherapy occurred within 11 days (range, 9 to 17 days) for both neutrophils (>0.5 x 10(9)/L) and platelets (>20 x 10(9)/L). Oral mucositis (World Health Organization grade 2 to 4) was the predominant nonhematologic toxicity, which was observed in 12 of 16 patients. One patient developed neutropenic septicemia with fatal multiorgan failure. At a median follow-up of 44 months (range, 32 to 77 months) after PBPCT, nine patients are alive and well, resulting in a disease-free and overall survival rate of 56.3% +/- 12.4%. The median overall survival has not yet been achieved. None of the patients who had surgery relapsed or died after therapy. All relapses occurred within the first 12 months after PBPCT. Patients in stages I to IIIA (10 patients) had a 70% +/- 14% overall survival rate at 4 years, while patients in stage IIIB (six patients) had a 33% +/- 19% survival rate at 4 years, with a median survival of 17 months posttransplant. These data demonstrate that a multimodality treatment including early high-dose chemotherapy with PBPCT may lead to a prolonged disease-free survival in the majority of patients. A randomized phase III study has now been initiated to prospectively investigate the role of high-dose chemotherapy, surgery, and chest irradiation in the multidisciplinary approach to limited-disease small cell lung cancer.

Adult↗
PubMed1997

Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high-dose chemotherapy.

Loss of physical performance is a universal problem of cancer patients undergoing chemotherapy. We postulated that this impairment can be partially prevented by aerobic exercise. In a randomized study, 33 cancer patients receiving high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (training group, T) performed an exercise program consisting of biking on an ergometer in the supine position after an interval-training pattern for 30 minutes daily during hospitalization. Patients in the control group (C, n = 37) did not train. Maximal physical performance was assessed with a treadmill test by admission and discharge. Physical performance of the two groups was not different on admission. The decrement in performance during hospitalization was 27% greater in the control group than in the training group (P = .05); this resulted in a significantly higher maximal physical performance at discharge in the trained patients (P = .04). Duration of neutropenia (P = .01) and thrombopenia (P = .06), severity of diarrhea (P = .04), severity of pain (P = .01), and duration of hospitalization (P = . 03) were reduced in the training group. We conclude that aerobic exercise can be safely carried out immediately after high-dose chemotherapy and can partially prevent loss of physical performance. Based on the potential significance of the observed outcomes, further studies are warranted to confirm our results.

Adult↗
PubMed1997

Early-onset secondary malignancies after high-dose chemotherapy and autologous hematopoietic stem cell transplantation.

We treated 500 patients with high-dose chemotherapy (HDC) and autologous bone marrow (ABMT) or autologous peripheral blood stem cell transplantation (PBSCT). Treated conditions included leukemia, lymphomas, breast cancer, lung cancer, germ-cell carcinomas, and other solid tumors. In order to assess relapse of primary malignancy or occurrence of new neoplasms, routine screening after ABMT or PBPCT was performed at regular and close intervals. With a total follow-up of 1358 person-years and a median follow-up of 34 months (range 9-91), 10/500 (2%) patients developed second malignancies after PBSCT or ABMT; i.e., one new cancer occurred every 136 person-years. All malignancies were detected at routine follow-up examinations; and 7/10 diagnoses were made in an asymptomatic phase; 6/10 neoplasms were amenable to complete surgical resection, five of which remain in CR at a median of 23+ months after autotransplantation. We conclude that regular and close follow-up examination of patients after autologous hematopoietic stem cell transplantation may be beneficial, since successful treatment of second malignancies is possible in selected cases after early detection.

Adult↗
PubMed1997

High-dose chemotherapy and autologous hematopoietic stem cell transplantation in patients with second primary malignancies.

We treated 500 patients with high-dose chemotherapy and autologous bone marrow or autologous peripheral blood stem cell transplantation. Treated conditions included leukemia, lymphoma, breast cancer, lung cancer, germ-cell carcinoma, and other solid tumors. 10/500 (2%) of patients were treated for a second malignancy diagnosed 12 months to 25 years after their initial neoplasm. Four of these ten patients are in complete remission (CR) of both malignancies at a median follow-up of 29+ months after high-dose chemotherapy and autotransplantation. None of these patients would have been eligible for high-dose chemotherapy and autotransplantation by conventional selection criteria which usually excluded patients with a history of prior malignancies. Conclusion. Conventional exclusion criteria for high-dose chemotherapy and autotransplantation may not adequately reflect the prognosis of patients with second or secondary malignancies treated with this therapeutic modality. High-dose chemotherapy and autologous hematopoietic stem cell transplantation may be of true benefit in selected cases of secondary malignancies.

Adult↗
PubMed1997

Acute myelomonocytic leukemia secondary to synchronous carcinomas of the breast and lung, and to metachronous renal cell carcinoma.

We describe a patient in whom synchronous breast cancer and small-cell lung cancer, and metachronous renal cell carcinoma were diagnosed within an 11 months period. All three tumors were treated surgically, followed by administration of tamoxifen, adjuvant chemotherapy with etoposide (2.8 g/m2 total) and vindesine, and administration of interferon alpha and flutamide. The patient developed acute myelomonocytic leukemia 26 months after discontinuation of etoposide-containing chemotherapy. This pattern of multiple neoplasms fits the wider disease spectrum associated with germline mutations of the p53 gene; however, analysis of p53 exons 5-8 did not disclose any sequence abnormalities in this patient. In conclusion, clustering of four (synchronous and metachronous) malignancies may on rare occasions occur in an individual patient and in the absence of a family history of cancer; the sequence during which treatment of primary malignancies may result in treatment-related acute myelocytic leukemia is discussed.

Breast Neoplasms↗
PubMed1997

Dose-intense therapy with etoposide, ifosfamide, cisplatin, and epirubicin (VIP-E) in 107 consecutive patients with limited- and extensive-stage non-small-cell lung cancer.

BACKGROUND: We conducted a phase I/II trial to assess the feasibility and activity of combination chemotherapy with etoposide, ifosfamide, cisplatin, and epirubicin in limited-stage (LS, stage I-IIIB) and extensive-stage (ES, stage IV) non-small-cell lung cancer (NSCLC). End-points were treatment-related morbidity and mortality, response rate, duration of response, and survival. PATIENTS AND METHODS: Chemotherapy followed by granulocyte colony-stimulating factor was given at a dose of etoposide (500 mg/m2), ifosfamide (4000 mg/m2), cisplatin (50 mg/m2), and epirubicin (50 mg/m2) (VIP-E) to 107 patients with NSCLC. Twenty-five patients with qualifying responses proceeded to high-dose chemotherapy with autologous peripheral blood stem cell transplantation after etoposide (1500 mg/m2), ifosfamide (12,000 mg/m2), carboplatin (750 mg/m2) and epirubicin (150 mg/m2) (VIC-E) conditioning. RESULTS OF CONVENTIONAL-DOSE VIP-E: 35 of 102 (34%) evaluable patients responded (2 CR's, 33 PR's), 33/102 patients (33%) showed no change (NC); the remainder of patients progressed with therapy (PD). Objective response rate was 68% (4% CR, 64% PR) in LS-NSCLC and 23% (1.4% CR, 21.4% PR) in ES-NSCLC. Median duration of survival was 13 months in LS-NSCLC and 5.5 months in ES-NSCLC. Two-year survival was 26% in LS and 2% in ES-NSCLC. RESULTS OF HIGH-DOSE VIC-E: 23 of 24 evaluable patients improved or maintained prior responses (92%), I patient showed NC. Treatment mortality was 4%. Median duration of survival was 17 months in LS-NSCLC and 10 months in ES-NSCLC. Two-year survival was 30% in LS and 8% in ES-NSCLC. CONCLUSION: Response-rates and survival after conventional-dose VIP-E chemotherapy are comparable to other published trials of combination chemotherapy in NSCLC. Toxicity and mortality is acceptable in limited stage, but unacceptably high in extensive stage NSCLC. Although better response-rates were achieved in the high-dose arm, they did not translate into improved survival. Most stage IV NSCLC-patients will neither benefit from VIP-E conventional dose, nor from VIC-E high dose chemotherapy. Whether selected LS-patients with partial or complete responses to VIP-E induction chemotherapy could benefit from dose intensification in an adjuvant or neo-adjuvant setting remains to be determined.

Adult↗
PubMed1997

Dose-intense therapy with etoposide, ifosfamide, cisplatin, and epirubicin (VIP-E) in 100 consecutive patients with limited- and extensive-disease small-cell lung cancer.

BACKGROUND: We conducted a phase I/II trial to assess the feasibility and activity of VIP-E chemotherapy in small-cell lung cancer. End-points were treatment-related morbidity and mortality, response to treatment. duration of response, and survival. PATIENTS AND METHODS: Two cycles of combination chemotherapy followed by granulocyte colony-stimulating factor (G-CSF) were given at a dose of etoposide (500 mg/m2), ifosfamide (4000 mg/m2), cisplatin (50 mg/m2), and epirubicin (50 mg/m2) to 100 consecutive patients with SCLC. Thirty patients (19 with LD, and 11 with ED SCLC) proceeded to VIC-E high-dose chemotherapy with autologous peripheral blood stem cell transplantation (PBSCT) at a cumulative dose of etoposide 1500 mg/m2, ifosfamide 12,000 mg/m2, carboplatin 750 mg/m2 and epirubicin 150 mg/m2 (VIC-E). Surgical resection of primary tumor was attempted at the earliest feasible point. Thoracic irradiation was given after completion of chemotherapy. RESULTS of conventional-dose VIP-E: 97 patients were evaluable for response. Objective response rate was 81% in LD-SCLC (33% CR, 48% PR; excluding patients in surgical CR) and 77% in ED-SCLC (18% CR, 58% PR). Treatment mortality was 2%. Median survival was 19 months in LD-SCLC and 6 months in ED-SCLC. Two-year survival was 36% in LD and 0% in ED SCLC. RESULTS OF HIGH-DOSE VIC-E: All 30 patients improved on or maintained prior responses. Four patients (13%) died of treatment-related complications. Median survival was 26 months in LD-SCLC and 8 months in ED-SCLC. Two-year survival was 53% in LD and 9% in ED SCLC. CONCLUSION: VIP-E chemotherapy is an effective induction therapy for SCLC. Compared with traditional protocols such as ACO or carboplatin/etoposide, response rates are slightly improved, while survival is not different. In the LD SCLC subgroup, high-dose chemotherapy improved response rates and survival, especially for patients in surgical CR prior to high-dose therapy. In ED SCLC, however, higher response-rates did not translate into improved survival. Selected LD-SCLC patients with good partial or complete remissions after prior therapy may benefit from HDC and PBSCT.

Adult↗
PubMed1997

Correlation between physical performance and fatigue in cancer patients.

BACKGROUND: Fatigue and a reduction in physical ability are common and often severe problems of cancer patients regardless of disease stage and modality of treatment. However, while physical performance can be assessed objectively with laboratory tests, fatigue is a subjective phenomenon whose perception is influenced by past experience and expectations for the future. PATIENTS AND METHODS: To evaluate the correlation between fatigue and physical impairment, we assessed maximal physical performance with a treadmill test, and mental state with two questionnaires, the Profile of Mood States (POMS) and the Symptom Check List (SCL-90-R), in a successive series of 78 cancer patients with solid tumors or hematological malignancies. RESULTS: A weak association between fatigue and maximal physical performance was found (r = -0.30; P < 0.01). However, intensity of fatigue showed a strong correlation with several indicators of psychological distress such as depression (r = 0.68), somatization (r = 0.64) and anxiety (r = 0.63; P for all < 0.001). Furthermore, patients with lower levels of physical performance had significantly higher scores for depression (P = 0.005), somatization (P = 0.03) and anxiety (P = 0.08), and significantly lower scores for vigor (P = 0.05) than their counterparts whose physical performance was higher. CONCLUSIONS: We conclude that fatigue in cancer patients may be related to mood disturbance but appears to be independent of physical performance. Moreover, low physical performance can be viewed as an independent predictor of mental distress in cancer patients.

Adolescent↗
PubMed1997

Treatment of relapsed non-Hodgkin's lymphoma after BEAM chemotherapy and autologous transplantation by BU/CY chemotherapy and salvage transplantation.

We report a patient with centroblastic non-Hodgkin's MALT lymphoma of the stomach treated initially with surgery and post-operative chemotherapy and radiotherapy. First relapse was treated with high-dose BEAM chemotherapy and autologous peripheral blood stem cell transplantation (PBSCT). Second, systemic relapse was treated with high-dose BU/CY and second PBSCT. Today, the patient is in complete remission at 27+ months. The case indicates a curative potential for high-dose BU/CY chemotherapy as salvage therapy for relapsed high-grade lymphoma after BEAM and autologous PBSCT. This may have implications for the prevention as well as for the management of lymphoma relapse after high-dose chemotherapy (HDC) and autologous PBSCT.

Adult↗
PubMed1997

High-dose chemotherapy with autologous peripheral blood stem cell transplantation for metastatic gastric leiomyosarcoma.

We report a case of metastatic gastrointestinal leiomyosarcoma treated with high-dose combination chemotherapy and autologous peripheral blood stem cell transplantation. After incomplete surgical resection, enteral, peritoneal and hepatic involvement remained. Postoperatively, standard-dose chemotherapy with etoposide, ifosfamide, cisplatin and epirubicine, and high-dose chemotherapy with the same agents (carboplatin replacing cisplatin) was given. Treatment was well tolerated and the patient remains in complete remission at 36+ months. We conclude that high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation may be of use as treatment for inoperable residual disease after resection of the primary lesion in gastrointestinal and other soft tissue sarcomas.

Adult↗
PubMed1997

Supportive care in hematologic malignancies, including hematopoietic growth factors, transfusions, and infectious complications.

This review focuses on some of the recent developments in the field of supportive care in hematologic malignancies. The increasingly important role of hematopoietic growth factors in modern treatment modalities for hematologic disorders is clear. Newer developments in transfusional therapy and in the management of infectious complications are also discussed.

Blood Transfusion↗
PubMed1997

[New medical care models in the USA and their effect on the therapeutic freedom of the American physician].

Managed care and quality control have markedly changed American medicine. After describing some of the more important features of the recent activities in the American health care reform, this article describes the methods used by managed care corporations in improving pharmaceutical treatment quality and pharmaceutical treatment costs. The advantages of newer methods to improve pharmacotherapy (eg. pharmaceutical benefits management) are then balanced against their potential dangers (eg. loss of physician autonomy or manipulation of drug prescription and consumption by health care corporations).

Cost Control↗
PubMed1996

Mobilization of peripheral blood progenitor cells for allogeneic transplantation: efficacy and toxicity of a high-dose rhG-CSF regimen.

Mobilization of PBPC was investigated in 19 healthy matched sibling donors using two different rhG-CSF regimens. Five donors (median age 39 years, range 17 to 57 years) received 10 micrograms rhG-CSF/kg bw once daily subcutaneously (s.c.), while 14 donors (median age 34 years, range 19 to 56 years) were treated with 10-12 micrograms rhG-CSF/kg bw twice daily s.c.. Leukapheresis was started on day 4 of rhG-CSF administration. Cytokine priming as well as collection of PBPCs were well tolerated. Application of twice daily rhG-CSF resulted in a higher yield of CD34+ cells in leukapheresis products than injection of once daily rhG-CSF. This high-dose twice daily rhG-CSF regimen is well tolerated and results in reliably high numbers of progenitor cells in the leukapheresis product in healthy donors, therefore collection as well as subsequent selection has been facilitated.

Adolescent↗
PubMed1996

An aerobic exercise program for patients with haematological malignancies after bone marrow transplantation.

We describe the effects of an aerobic exercise program designed to improve the physical performance of patients undergoing bone marrow transplantation. Twenty patients entered the rehabilitation program, consisting of walking on a treadmill, and carried it out for 6 weeks. Patients started the training program 30 +/- 6 days (range 18-42) post-BMT. By the end of the program we observed a significant improvement in maximal physical performance and maximum walking distance, and a significant lowering of the heart rate with equivalent workloads (P for all significances < 0.001). All participants of the program reached a peak performance (calculated in metabolic equivalents, METs) more than sufficient for carrying out all basic activities of daily living. These results contrast with literature reports indicating that spontaneous recovery of physical functioning after BMT can take many months and that about 30% of patients experience long-lasting impairment of physical performance. We conclude that that fatigue and loss of physical performance in patients undergoing BMT can be corrected with adequate rehabilitative measures.

Adult↗