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Mononuclear cell accumulation and plasma protein extravasation (PPE) during induction, remission and re-challenge of experimental allergic encephalomyelitis in the rat.

Plasma protein extravasation (PPE) and cell accumulation have been studied in the CNS of rats during experimental allergic encephalomyelitis (EAE) using radioisotopic techniques. Use of such techniques makes it possible to study objectively and conveniently the rate of cell infiltration and PPE during the disease process in relation to clinical signs and time after immunization. The following observations have been made: After the first immunization, the number of rats showing increased PPE in the CNS correlated well with the severity of EAE. Mononuclear cell infiltration into brain and spinal cord during EAE did not parallel one another; infiltration being of earlier onset and shorter duration in the spinal cord, in comparison with brain. Animals re-challenged with encephalitogenic antigen showed considerably increased cellular infiltration into the brain but failed to exhibit comparable infiltration in the spinal cord. In this case infiltration of cells is not accompanied by increased PPE, in contrast to what is seen during primary disease. Increased infiltration into the brain of re-challenged animals appears, therefore, unrelated to gross damage of vascular endothelium.

Animals↗

Addition of etoposide to cyclophosphamide, doxorubicin, and vincristine for remission induction and survival in patients with small cell lung cancer.

A total of 116 patients with small cell lung cancer were randomized to receive either: cyclophosphamide, 750 mg/m2, doxorubicin, 50 mg/m2, and vincristine, 2 mg iv (Regimen A), or the same drugs plus etoposide, 100 mg/m2 iv daily for 2 days (Regimen B) every 3 weeks. Complete responders received whole-brain radiation therapy. The overall response rates were 50% for Regimen A and 65% for Regimen B (P less than 0.05). The complete response rates were 18% for Regimen A and 44% for Regimen B (P less than 0.01). For patients with limited disease, the complete responders were 35% on Regimen A and 52% on Regimen B (P = 0.26); for those with extensive disease, the complete responders were 0% on Regimen A and 35% on Regimen B (P = 0.002). The median survival for complete responders was 17 months on Regimen A and 20 months on Regimen B. The difference is not statistically significant. Toxicity was tolerable for both groups; however, it was greater for the etoposide arm. We conclude that although etoposide improves the overall response rates in patients with small cell lung cancer, especially those with extensive disease, the addition of this drug does not lead to improved survival.

Actuarial Analysis↗