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Biomedical subjects

Z Tomasević

Publications and source records attributed to Z Tomasević.

15 recordsLinked to original sources
PubMed2001

Survival advantage for carboplatin substituting cisplatin in combination with vindesine and mitomycin C for stage IIIB and IV squamous-cell bronchogenic carcinoma: a randomized phase III study.

This communication represents the definitive report of a randomized phase III study comparing cisplatin and carboplatin, in combination with vindesine and mitomycin C in stage IIIB and IV squamous-cell bronchogenic carcinoma. A total of 221 patients entered the study and were randomized into two arms. Of these, 114 patients (109 evaluable for activity) were randomized to arm A, receiving cisplatin 120 mg/m(2), mitomycin C 8 mg/m(2) and vindesine 3 mg/m(2) per cycle; 107 patients (101 evaluable for activity) were randomized to arm B receiving carboplatin 500 mg/m(2) with the same doses of mitomycin C and vindesine per cycle. Patients with progressive disease (PD) were excluded from the study after the 2nd cycle, and those with stable disease (SD), partial response (PR) and complete response (CR) received six cycles of chemotherapy (or less in case of early progression). Patients were stratified according to the clinical stage (IIIB vs. IV), performance status (0+1 vs. 2+3) and tumor histological grade (I+II vs. III). In the cisplatin arm two patients (1.9%) achieved a CR, 38 (34.9%) a PR, 45 (41.2%) a SD and 24 (22.0%) had PD; the overall response rate was 40/109 (36.8%). In the carboplatin arm five patients (5.0%) achieved a CR, 31 (30.7%) a PR, 40 (39.6%) a SD, and 25 (24.7%) had PD; the overall response rate was 36/101 (35.7%). No statistically significant difference in response rate was present between the two arms, and the response rate was not influenced by performance status, histological grade or clinical stage. The Kaplan-Meyers curves displayed a significant advantage both for time to progression (P=0.005) and overall survival (P=0.008) for patients in the carboplatin arm. The advantage for patients receiving carboplatin instead of cisplatin appeared evident in univariate setting for patients with a good performance status and clinical stage IV, and occurred irrespectively of tumor histological grade; response duration and survival of responders was identical in the two arms. Patients achieving a stable disease survived longer in the carboplatin than in the cisplatin arm (P=0.012). Thus, substitution of cisplatin by carboplatin in the combination chemotherapy regimen, although more hematologically toxic (but less emetogenic) resulted in a similar response rate, but a significantly longer time to progression and overall survival.

Adult↗
PubMed2000

Circulating immune complexes in advanced Hodgkin's disease: qualitative analysis and prognostic significance.

The level of circulating immune complexes (CIC) may be a reflection of the underlying malignancy and appears to be related to the stage of disease, tumor burden and prognosis. Prognostic factors at diagnosis, clinical response, survival and CIC were analyzed in 89 patients with Hodgkin's disease. All patients were newly diagnosed, in advanced stage and treated with MOPP regimen. The median follow-up was 41 months. CIC were estimated by the polyethylene glycol precipitation test. The median age was 40 years and 52% were under the age of 45. Nodular sclerosis and mixed cellularity were the most common histologies, 36 and 35% respectively. "B" symptoms were present in 65%, bulky disease in 29% and bone marrow involvement in 4% of the total. The erythrocyte sedimentation rate (ESR) was over 30 in 72% of patients and 27% had one or two extranodal localizations. Complete remission (CR) was obtained in 69 patients (77%). The only factor influencing the CR rate was the number of extranodal localizations (p<0.05). The ten-year relapse-free survival (RFS) and overall survival (OS) were 63 and 83%, respectively. RFS was adversely influenced by lymphocyte depletion histology (p=0.009) and by performance status over 1 (p=0.003). Elevated CIC levels were detected in 58% of the total. Patients with ESR over 30 had significantly higher values of CIC (p<0.05). Qualitative analysis of the CIC showed high levels of positivity to immunoglobulin G and M. C-reactive protein (CRP) was identified in 42% of all samples. CRP is an acute phase protein which shows conformational similarity to the immunoglobulin molecule. There were no significant correlations between levels of CIC and the other prognostic factors. Survival was not influenced by the CIC level.

Adult↗
PubMed1999

Comparison of two non-anthracycline-containing regimens for elderly patients with diffuse large-cell non Hodgkin's lymphoma--possible pitfalls in results reporting and interpretation.

Age over 65 years is a risk factor per se for doxorubicin administration, and coexisting diseases pose additional problems. There is still controversy whether chemotherapy regimens for elderly patients with aggressive NHL should be full-dose doxorubicin containing or whether development of non-anthracycline containing regimens is warranted. In this prospective study, 47 patients aged over 65 years with diffuse large cell NHL clinical Stage I/IE bulky-IV and no other initial exclusion criteria were randomized to receive either BCNU 120 mg/m2 d. l, VP 16 60 mg/in2 d.2-4, procarbazine 85 mg/m2 d. 2-8 (arm A, 27 patients) or mitoxantrone 6 mg/m2 d. l. with VP16 and procarbazine in the same dosage and schedule (Arm B, 20 patients). Partial responders received additional irradiation treatment if feasible. Arms were well balanced according to age, sex, clinical stage and performance status. Ten patients from arm A and 13 from arm B had PS 2 or 3; 14 patients from arm A and 8 from arm B had clinically significant antecedent and/or concomitant disease (SACD: cardiac, vascular, cerebrovascular, neurological, renal or other). On the intent-to-treat basis, the results were the following. ARM A: median number of cycles 3 (range 1--6); early death 3 patients; 16/27 responses (59%), 7 complete (30%). ARM B: median number of cycles 3 (range 1-6); early death 4 patients; 12/20 responses (60%), 3 complete (15%). There was no difference either in response rate or survival between the two arms, and pooled results from the two arms displayed a plateau on the survival curve from the 20-th month onwards on the probability level of 0.40. Clinical stage of NHL, bulky disease, age and sex did not influence survival. Initial performance status did influence survival at the significance level of p = 0.045. Although presence of SACD did not influence initial performance status, it had a strong negative impact on survival p = 0.0004). The results point to the existence of two prognostic categories of elderly patients with large cell NHL, one with a poor survival, the other achieving a significant response rate and relapse free survival. Comorbidity (SACD) apparently accounts for the poor survival in a subpopulation of elderly patients. Clinical trials with elderly patients with NHL with PS 0 or 1 and no serious coexisting disease as inclusion criteria, analyzed on an evaluable patients basis, target only to a prognostically better subpopulation among these patients.

Aged↗
PubMed1999

Epirubicin 150 mg/m2-cisplatin versus epirubicin 180 mg/m2-cisplatin for advanced soft tissue sarcoma.

We have previously reported the superiority of the epirubicin 180 mg/m2-cisplatin combination over single drug epirubicin 180 mg/m2 for advanced soft tissue sarcoma both in terms of response (54% vs. 29%, p = 0.025) and survival (p = 0.001). The aim of the present study was to establish whether decreasing the dosage of epirubicin to 150 mg/m2 would result in the same activity but with less hematological toxicity. One hundred fifty-nine patients with advanced soft tissue sarcoma were randomized for either epirubicin 150 mg/m2-cisplatin 120 mg/m2 (group A) or epirubicin 180 mg/m2-cisplatin 120 mg/m2 (group B). The results were as follows: group A: 79 patients were evaluated. Overall response rate was 24/79 (30%) (95% CI 21-41%). Median survival was 11 months and probability of survival at 1 year was 0.46. Grade IV granulocytopenia was present in 111/274 cycles and febrile neutropenia in 22/274. Group B: 73 patients were evaluated. The overall response rate was 39/73 (53%), (95% CI 42-64%). Median survival was 14 months and probability of survival at 1 year was 0.58. Grade IV granulocytopenia was present in 136/295 cycles and febrile neutropenia in 30/295. The differences were as follows: for overall response rate p = 0.004; power (for p = 0.05) 85%; for survival p = 0.09; for grade IV granulocytopenia p = 0.3; and for febrile neutropenia p = 0.61. A survival advantage (p = 0.043) was evident for patients randomized to group B and with performance status 0 or 1 compared with similar patients from group A. A plateau-like formation on the probability level of 0.26 on the survival curve started from month 26 onwards. In conclusion, both regimens share the same toxicity but epirubicin 180 mg/m2-cisplatin seems more active in soft tissue sarcoma, possibly indicating a breakthrough for activity between an epirubicin dosage of 150 mg/m2 and 180 mg/m2 in combination with cisplatin. The superiority of the epirubicin 180 mg/m2-cisplatin regimen appears evident both in terms of response and survival.

Adolescent↗
PubMed1996

Pilot study of enhancement of cisplatin activity by high dose cytarabine in advanced gastric and colorectal (G3/G4) cancer.

The response rate of advanced gastric cancer to cisplatin monotherapy averages 20% and in colorectal cancer no activity of cisplatin monotherapy has been detected in initial studies. Cytarabine is ineffective in gastric cancer and displays borderline activity in colorectal cancer. In vitro studies on cell lines from human digestive cancers have demonstrated a dose and timing dependent enhancing effect of cytarabine on cisplatin antitumor activity. The aim of the present study was to investigate whether this enhancing activity can also be demonstrated in vivo. We have treated 37 patients with advanced gastrointestinal cancer (21 gastric and 16 colorectal), poorly differentiated G3-G4. The treatment included-Day 1: cytarabine 500 mg/m2 0 h and 12 h, cisplatin 15 mg/m2 6 h and 18 h. Day 2-4:cisplatin 30 mg/m2. Cycles were repeated every 4 weeks. Thirty four patients were evaluable for objective response. The overall response rate was 16.7% (CR 2/18, PR 1/18, SD 5/18, PD 10/18) for patients with gastric cancer and 25% (CR 1/16, PR 3/16, SD 7/16, PD 5/16) for patients with colorectal cancer. Grade 4 anemia (WHO criteria) occurred in 1/37 and thrombocytopenia in 1/37 patients. These patients had previous adjuvant chemotherapy. Vomiting grade 3 occurred in 4/37 and hepatotoxicity grade 3 in 1/37 patients. There were no toxic deaths. Our study did not demonstrate any enhancement of cisplatin activity by high dose cytarabine in advanced gastric cancer. There appears to be an enhancing activity on colorectal cancer although true synergism can not be ruled out since cytarabine has a borderline activity in this type of human cancer.

Aged↗
PubMed1996

[A pilot study of high-dose zorubicin in advanced stages of soft tissue sarcoma in adults].

High-dose anthracyclines, doxorubicin 75 mg/m2 and epirubicin 150-180 mg/m2, are the most active drugs in the treatment of advanced soft tissue sarcoma. These dosages are associated with significant hematological toxicity for both drugs and a high risk of cardiotoxicity for doxorubicin. The aim of this pilot study was to investigate the activity of zorubicin in advanced soft tissue sarcoma, with a dosage supposed to be equihematotoxic to epirubicin 180 mg/m2. Twenty of 21 patients who had been included in the study were evaluable for response, 15 males and five females, median age 41 (range 20-67) years. All patients received zorubicin 600 mg/m2 per cycle divided in 3 days, the intercycle interval being 4 weeks. The cardiac function was monitored by determinations of left ventricular ejection fraction before each cycle. Therapeutic response was the following: 2/20 patients (10%) complete response, 6/20 (30%) partial response, 6/20 (30%) stable disease and 6/20 (30%) progressive disease, the overall response rate being 8/20 (40%). Complete responses were observed in a patient with undifferentiated sarcoma of the mediastinum and in a patient with unresectable angiosarcoma of subcutaneous tissues. The major toxicity was hematological, with granulocytopenia grade 4 occurring in 42/66 cycles, and the nadir on day 10 of the treatment cycle. Nine of 66 cycles were complicated by febrile neutropenia and stomatitis of any grade was recorded in only 1/66 cycles. No cumulative cardiotoxicity was observed up to a total cumulative zorubicin dose of 3,000 mg/m2.

Adult↗
PubMed1994

A pilot study to assess the efficacy of salmon calcitonin in the relief of neuropathic pain caused by extraskeletal metastases.

Although the pain-relieving activity of salmon calcitonin has been mainly demonstrated for painful bone metastases it has been postulated that the drug possesses a central analgesic activity which is independent of the opiate receptor system. Thus, 16 patients with neuropathic cancer pain due to radicular compression by extraskeletal metastases, and without the possibility of any specific anticancer treatment, entered the study. Of the 16, 11 were pretreated with opiate-type analgesics. Salmon calcitonin was applied once daily at a dose of 200 IU in 500 ml 0.9% NaCl infused over 1 h. The total duration of the treatment was 20 days. The pain-relieving effect was classified as very good, good, moderate and bad; in 10 patients it was described as bad, in 2 as moderate in 2 as good and in 2 as very good. The drug failed in 9/11 opiate-pretreated patients. It is suggested that salmon calcitonin pain-relieving activity might depend on the tumor type, previous pain-relieving drug intake and site of metastatic disease.

Administration, Intranasal↗
PubMed1994

[Therapeutic possibilities of recombinant interferon alfa-2b (Intron A) in non-AIDS Kaposi sarcomas and angiosarcomas].

Data concerning treatment of vascular neoplasia with biological response modifiers are still scanty, but encouraging results have been observed with alpha-2b interferon in AIDS related Kaposi sarcoma. In this study five treatment naive patients with Kaposi sarcoma and four heavily pretreated patients with angiosarcoma with still evolutive disease were treated with Etopozid 120 mg/m2/24h, days 1, 3 and 5, and recombinant alpha-2b interferon 6.000.000 U/24h, days 1-15, the intercycle interval being 21-28 days. All patients were negative for anti-HIV 1, anti-HIV 2 and anti-HTLV 1 antibodies; one patient had a high titer of IgG anti-chlamydia antibodies amounting to 1/4.194.304. This group differed from similar HIV 1 positive patients by having a normal CD4/CD8 ratio. In the Kaposi sarcoma group 1/5 achieved a complete response lasting 24+ months and 3/5 achieved a good partial response lasting 5+, 12+ and 35+ months. In the angiosarcoma group 1/4 patient achieved a complete response but relapsed after 18 months and one patient experienced stable disease lasting for 15+ months. These findings could be understood in two different ways. Since an infective etiology has been proposed for Kaposi sarcoma, the positive effect of alpha-2b interferon could be related to its "antiinfective" effects observed in viral disorders. However, similar activity in angiosarcoma points to the possibility that the positive effect of alpha-2b interferon in this group of disorders is related to interfering effects of the drug with factors implicated in neoplastic angiogenesis.

Adult↗
PubMed1990

High-dose epirubicin-cisplatin chemotherapy for advanced soft tissue sarcoma.

A chemotherapy regimen with epirubicin (60 mg/m2, days 1, 2 and 3) and cisplatin (30 mg/m2, days 2, 3, 4 and 5) was started for 35 patients with advanced soft tissue sarcoma (28 males and 7 females; median age, 50 years). All patients were chemotherapy-naive and with an expected survival of more than 2 months. All patients were evaluable for activity and toxicity. The intercycle interval was 4 weeks. Median number of cycles applied was 4 (range, 2-8). The overall response rate was 20/35 (57.1%). A complete response (CR) was achieved in 7/35 patients (20%), lasting for 26+, 26+, 13+, 13+, 9+, 9+ and 5 months; 13/35 patients (37.1%) entered a partial remission (PR), 9/35 patients (25.7%) had stable disease (SD), and 6/35 (17.1%) had progressive disease (PD). In non-responders (SD + PD), the median survival was 4 months; the median survival of responders (CR + PR) was 9+ months (the median has not yet been reached). Hematologic toxicity of grade 4 was present at least in one cycle for hemoglobin in 6/35 patients, for leukocytes in 22/35, and for platelets in 13/35. No hemorrhagic syndrome was observed. The leukopenia was usually of short duration (nadir on days 10-12). Febrile episodes were present in 18 patients during the nadir of leukopenia. No other significant toxicity was noted (apart from grade III alopecia in all patients), and specifically, there was neither acute nor cumulative cardiotoxicity.

Adult↗
PubMedDate not supplied

High-dose anthracyclines in the treatment of advanced primitive neuroectodermal tumors in adults--a single institution experience.

Primitive neuroectodermal tumors (PNET) are rare malignancies of presumed neural crest origin, most often presenting as bone or soft tissue masses in the trunk or axial skeleton, in children and young adults. Treatment of advanced PNET in adults is not clearly defined in the literature. Data concerning dose-intensive chemotherapy regimens for poor-risk patients with those tumors are sparse, due to rarity of PNET in adults, their diverse presentation, the variable treatment procedures applied and the absence of direct comparisons. On the other hand, the role of anthracyclines in the treatment of advanced soft tissue sarcomas is well known and substantial. Six advanced PNET patients were treated at the Institute for Oncology and Radiology of Serbia, during last five years, with high-doses of doxorubicin or epidoxorubicin combined with cisplatin. The paper reviews each of our patients, discussing how does chemotherapy influence the outcome in these patients, in context of the feasibility of high-doses of anthracyclines in advanced settings. High dose anthracyclines (epidoxorubicin 150 mg/m2) in combination with cisplatin 120 mg/m2 induced a complete response lasting for 63+ months in a patient with desmoplastic medulloblastoma of the cerebellum metastatic to bones and bone marrow. The same treatment but with the epidoxorubicin dose of 180 mg/m2 induced a complete response in a patient with olfactory neuroblastoma. Administration of high dose Doxorubicin (75 mg/m2) seems feasible in association with irradiation treatment in patients with extraosseal Ewing sarcoma/PNET but the place of high dose chemotherapy within this setting remains to be determined.

Adult↗
PubMedDate not supplied

[Cervical pregnancy treated by conization].

Cervical pregnancy in a 23-year-old patients is presented. The local finding corresponded to criteria for the diagnosis of cervical pregnancy. The diagnosis was confirmed by an immunological test (Gonavislide) and ultrasound. Conization was applied, and in the conization material the pathologist found chorial villi with a great many trophoblasts in direct contact with the muscular cervical layer.

Adult↗
PubMedDate not supplied

[Levels of immune complexes in fresh and frozen serum and plasma detected by precipitation with polyethylene glycol in patients with malignant diseases].

INTRODUCTION: Immune complexes are macromolecules consisting of immunoglobulins (antibodies) bound to different antigens [1]. Determination of circulating immune complexes in patients with malignant diseases can be of some interest for prognosis and follow-up of a disease [2, 3]. According to certain data the immune complexes concentration varies in dependence of disease stage [4] and it is not affected by therapy [5]. Precipitation with polyethylenglycol is a physical method for determination of circulating immune complexes, based on the ability of high molecular polymers to precipitate macromolecules from sera [6]. This mechanism of precipitation is not yet well understood, but it is probably based on steric exclusion of water molecules that affects insolubility of immune complex molecules [7]. Repeatedly frozen sera demonstrated rapid decrease in detected concentration of circulating immune complexes [8] by polyethylenglycol. The presence of complement affects solubility of circulating immune complexes [7]. While there are no data about the influence of other proteins in sera or plasma, the aim of this study was to find out if there are any significant differences between the circulating immune complexes levels, determined by polyethylenglycol, in sera, plasma or in only once frozen sera. MATERIAL AND METHODS: Eighteen samples of plasma and sera from patients with malignancy (10 males and 8 females) were examined. Eight of them had non-Hodgkin lymphoma, 4 were with Hodgkin lymphoma, 4 with breast carcinoma and 2 with lung carcinoma. All samples were taken before starting chemotherapy. The circulating immune complexes determination was carried out immediately after the separation of plasma and sera and also in sera frozen for 10 days at -35 degrees C. Circulating immune complexes were determined spectrophotometrically. The absorbance (A450) of serum or plasma in 3.75% of polyethylene glycol, polyethylenglycol (M = 6000) solution was used as the measure of the circulating immune complexes level [9]. The standard for circulating immune complexes determination in g/l was aggregated IgG at 36 degrees C for 30 minutes from the serum of healthy volunteers. RESULTS: The mean value and the range of circulating immune complexes level (A450) are given in Table 1. The values in g/l are presented in Graph 1. The values of circulating immune complexes in plasma were significantly lower than those in fresh sera (t = 2.8125; p < 0.02). There was no significant statistic difference between levels in circulating immune complexes (A450) in fresh and frozen sera (t = 1.3261; p > 0.1). DISCUSSION: In dependence on its concentration polyethylenglycol shows the ability to precipitate proteins selectively [10]. The selectivity was tested mainly towards immunoglobulins and the complement. Results obtained in this study show statistically significant lower circulating immune complexes level in plasma than in serum or frozen serum. The main difference between sera and plasma is in complete absence of fibrinogen, factors V and VIII in sera and in presence of Ca++ ions. Besides that plasma contains an anticoagulant [11]. It is possible that the presence of fibrinogen and some coagulation factors disturb the polyethylenglycol precipitation mechanism. According to this, it might be, that mechanism, based on steric exclusion of water molecules, selectively influences polyethylenglycol precipitation of circulating immune complexes in plasma. It is difficult to say how much Ca++ ion and anticoagulant, as well as the activity of some plasma enzymes, and possible dissociation of circulating immune complexes influence the formation of precipitate. In any case, there is a significant difference between concentration of circulating immune complexes according to substrate. For that reason, it is necessary to detect circulating immune complexes by polyethylanglycol always in the same medium for exact clinical evaluation. (ABSTRACT TRUNCATED)

Antigen-Antibody Complex↗