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PubMed1987

Active specific immunotherapy of renal cell carcinoma patients: a prospective randomized study of hormono-immuno-versus hormonotherapy. Preliminary report of immunological and clinical aspects.

Early results of a prospective, randomized trial of active, specific immunotherapy adjunctive to nephrectomy in all stages of RCC are presented. Forty-three patients with median followup of 30 m, who were randomly allocated to either immuno-hormonotherapy arm (IMT), or hormonotherapy alone (HT), are evaluated in terms of progression-free interval (PFI) and overall survival by life table method. Immunotherapy consisted of autologous irradiated tumor cells (AITC), admixed with bacillus Calmette-Guérin (Glaxo) administered by the intradermal and endolymphatic route. Clinical results of this study show only a trend for advantage of the experimental (IMT) arm over the control (HT) arm, this trend did not reach statistical significance level: prolongation of disease free period in stages I-III with localized disease (p less than 0.1) and prolongation of survival in patients with metastatic disease (p less than 0.07). A correlation was established between induction of cutaneous delayed hypersensitivity (DTH) to AITC and prolonged PFI and survival: patients with positive DTH had a significantly better course of disease than those who could not be converted to positivity after repeated immunizations. Positive in vitro leukocyte migration inhibition against autologous tumor preparations correlates well with positive in vivo cutaneous DTH. Some immunological aspects of active immunization with autologous tumor cells are discussed.

BCG Vaccine↗

PubMed1988

Prevention of puerperal lactation by a single oral administration of the new prolactin-inhibiting drug, cabergoline.

To evaluate the efficacy of a single oral administration of the new ergot derivative Cabergoline in the prevention of post-partum lactation, we compared the effects of three different doses of the drug with those of placebo in 32 puerperal women. In a controlled, double-blind trial, the subjects were randomly allocated to four treatment groups receiving either placebo or 400, 600, or 800 micrograms Cabergoline (N = 8 in each group) within 24 hours after delivery. Treatment efficacy was assessed clinically by physical examination before (day 0) and at one, two, three, four, and 14 days after treatment. Plasma prolactin (PRL) concentrations were measured in blood samples collected before and at one, two, three, and four days after treatment. Lactation was prevented in four of the eight subjects (50%) who received 400 micrograms Cabergoline and in all subjects who received 600 or 800 micrograms Cabergoline. By contrast, only one of the eight subjects (12.5%) receiving placebo showed no signs of spontaneous lactation within the 14 days after delivery. No effects of placebo administration on plasma PRL levels were observed. Plasma PRL concentrations were significantly reduced starting from one day after Cabergoline administration, however, and the amount of inhibition of PRL secretion induced by different doses of the drug was not statistically different. These preliminary data demonstrate that Cabergoline has a dose-related effect in the prevention of postpartum lactation, and milk secretion can be prevented completely by a single oral administration of 600 or 800 micrograms of the drug.

Administration, Oral↗

PubMed1987

Evaluation of the addition of cromolyn sodium to bronchodilator maintenance therapy in the long-term management of asthma.

Three hundred ninety-seven patients, aged 5 to 63 years, took part in a year-long international multicenter, double-blind, placebo-controlled trial. The patients, whose asthma was considered not adequately controlled, were divided into two groups according to their principal medication at entry (group A, oral and/or inhaled beta 2-bronchodilators; group B, methylxanthines, with or without beta 2-agonists) and randomly allocated to additional treatment with cromolyn sodium (metered-dose inhaler, 2 mg, four times a day, or capsules, 20 mg, four times a day) or matching placebo. A 2-month baseline preceded 10 to 12 months of treatment. After 4 to 8 weeks of treatment, patients were encouraged to reduce bronchodilator usage. Patients used diary cards to record asthma severity, sleep difficulty, morning and evening peak expiratory flow rates, days of disruption of normal activity, use of test treatments, and concomitant medication. Significant differences favoring cromolyn sodium (p less than 0.05 and better) were observed for most of the treatment period in respect to (1) asthma severity, (2) morning and evening peak expiratory flow rates, and (3) days of disruption of normal activity. Patients receiving cromolyn sodium experienced fewer exacerbations and tended to use less concomitant medication than patients receiving placebo. Patients' opinions of treatment significantly favored cromolyn sodium. These results demonstrate the value of the addition of cromolyn sodium to existing therapy in the long-term management of asthma and endorse its use as a first-line treatment.

Adolescent↗

PubMed1987

Parenteral nutrition via peripheral veins: a feasibility study.

Twenty patients who had undergone uncomplicated surgery of moderate severity were randomly allocated to two groups (both n = 10) who were fed using a peripheral vein for up to six days. Group I received, each day, a nutrient solution providing 10 grams of nitrogen as Perifusin (E Merck Ltd) and 1400 calories as dextrose and Intralipid (Kabivitrum Ltd) with an osmolality of 490 mosmol/kg. Group II received only 15 grams of nitrogen per day as Perifusin with an osmolality of 376 mosmol/kg. The mean (+/- s.e. mean) nitrogen balance over the study was similar in both groups, in Group I being -1.23 +/- 0.89, and in Group II being -1.05 +/- 1.08 g (P greater than 0.05 Mann-Whitney U test). The nutrient mixture given to Group I resulted in elevated levels of serum 3-hydroxybutyrate and lower levels of serum non-esterified fatty acids. These data suggest that lipolysis and ketogenesis were suppressed. There was no significant difference in serum lactate levels in either group. Venous thrombophlebitis at the infusion site was assessed daily using Maddox's criteria, with a minimal degree of inflammation occurring in either group. This preliminary study suggests that a total parenteral feeding regimen may be designed for peripheral vein infusion. Further studies are indicated.

Adult↗

PubMed1988

Antihypertensive and hemodynamic effects of slow-release nicardipine.

The antihypertensive efficacy, the hemodynamic effects and the tolerability of a new slow-release nicardipine (SR-Nic) formulation, capsules containing 40 mg of active drug, have been tested in a randomized, double-blind placebo (P)-controlled study. Thirty mild-to-moderate essential hypertensives were enrolled and after a one-week single-blind placebo run-in period randomly allocated to SR-Nic or P twice-day for six weeks. Blood pressure (BP) was measured after 1, 2, 4 and 6 weeks of treatment. Hemodynamic parameters were evaluated non-invasively by the impedance cardiography technique, using the Noninvasive Continuous Cardiac Output Monitor (NNCOM 3, BoMed Medical Manufacturing Ltd), after 2 and 4 weeks of treatment. All the determinations were made before the morning administration, i.e., 12-14 h after evening intake of SR-Nic or P. The blood pressure (p less than .01) and hemodynamic response (p less than .01 for the systemic vascular resistances) in the SR-Nic group significantly differed from those in the P group. At the end of the study, there were decreases in mean systolic/diastolic BP values of 17/12 in the sitting and of 18/12 mmHg in the standing position in the SR-Nic group; in the P group, the changes were +2/-2 in the sitting and +2/-1 mmHg in the standing position. Systemic vascular resistances were reduced by 17.3% in the SR-Nic and by 1.9% in the P group after 4 weeks of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗

PubMed1988

The Bristol third stage trial: active versus physiological management of third stage of labour.

OBJECTIVE: To compare the effects on fetal and maternal morbidity of routine active management of third stage of labour and expectant (physiological) management, in particular to determine whether active management reduced incidence of postpartum haemorrhage. DESIGN: Randomised trial of active versus physiological management. Women entered trial on admission to labour ward with allocation revealed just before vaginal delivery. Five months into trial high rate of postpartum haemorrhage in physiological group (16.5% v 3.8%) prompted modification of protocol to exclude more women and allow those allocated to physiological group who needed some active management to be switched to fully active management. Sample size of 3900 was planned, but even after protocol modification a planned interim analysis after first 1500 deliveries showed continuing high postpartum haemorrhage rate in physiological group and study was stopped. SETTING: Maternity hospital. PARTICIPANTS: Of 4709 women delivered from 1 January 1986 to 31 January 1987, 1695 were admitted to trial and allocated randomly to physiological (849) or active (846) management. Reasons for exclusion were: refusal, antepartum haemorrhage, cardiac disease, breech presentation, multiple pregnancy, intrauterine death, and, after May 1986, ritodrine given two hours before delivery, anticoagulant treatment, and any condition needing a particular management of third stage. INTERVENTIONS: All but six women allocated to active management actually received it, having prophylactic oxytocic, cord clamping before placental delivery, and cord traction; whereas just under half those allocated to physiological management achieved it. A fifth of physiological group received prophylactic oxytocic, two fifths underwent cord traction and just over half clamping of the cord before placental delivery. ENDPOINT: Reduction in incidence of postpartum haemorrhage from 7.5% under physiological management to 5.0% under active management. MEASUREMENTS AND MAIN RESULTS: Incidence of postpartum haemorrhage was 5.9% in active management group and 17.9% in physiological group (odds ratio 3.13; 95% confidence interval 2.3 to 4.2), a contrast reflected in other indices of blood loss. In physiological group third stage was longer (median 15 min v 5 min) and more women needed therapeutic oxytocics (29.7% v 6.4%). Apgar scores at one and five minutes and incidence of neonatal respiratory problems were not significantly different between groups. Babies in physiological group weighed mean of 85 g more than those in active group. When women allocated to and receiving active management (840) were compared with those who actually received physiological management (403) active management still produced lower rate of postpartum haemorrhage (odds ratio 2.4;95% CI1.6 to 3.7). CONCLUSIONS: Policy of active management practised in this trial reduces incidence of postpartum haemorrhage, shortens third stage, and results in reduced neonatal packed cell volume.

Breast Feeding↗

PubMed1985

Objective evaluation of the role of vincristine in induction and maintenance therapy for myelomatosis. Medical Research Council Working Party on Leukaemia in Adults.

In the Medical Research Council's IVth trial in Myelomatosis the possible benefit of adding vincristine to first line treatment with intermittent melphalan and prednisone has been assessed. This was analysed in 530 patients who were randomly allocated to receive vincristine or not. Survival was not improved by the addition of vincristine. A total of 268 patients reached plateau phase on first line therapy. Of these 226 patients were rerandomised either to continue receiving first line therapy for a further year or to cease therapy. At the present time there is a slight but not significant survival advantage in the group which received no further treatment on reaching plateau.

Adult↗

PubMed1988

Effect of lumbar epidural anaesthesia on plasma cortisol levels in children.

The cortisol response to surgery was studied in two groups of children one to eight years old during the first 24 hours after lower abdominal or peripheral surgery. The children were randomly allocated to a control (C) group (n = 6) or an epidural (E) group (n = 7). In Group C, surgery was performed under general anaesthesia and postoperative pain relief was achieved by using non-narcotic analgesics only. In Group E, lumbar epidural anaesthesia was combined with light general anaesthesia and postoperative pain relief was achieved by intermittent doses of bupivacaine administered through an epidural catheter. Cortisol levels were assessed before surgery (C), at the end of surgery (H0), at the 3rd, 6th, 12th and 24th postoperative hours (H3, H6, H12, H24). In Group C, cortisol levels increased significantly at H0, H3 and H6, whereas in Group E, a significant decrease was observed at H0 and a significant increase at H12. Mean cortisol values at H0 and H24 were significantly lower in Group E, when compared with those measured in Group C. In Group E, all postoperative cortisol values remained within the normal range, despite the low level of sensory blockade achieved. This suggests that minimal doses of epidural bupivacaine are effective in decreasing the endocrine stress response to surgery in children. This could be of clinical relevance in high-risk children with poor nutritional status. In Group C, the cortisol response remained altered for a longer period of time.

Anesthesia, Epidural↗

PubMed1988

A randomized trial of quality assurance in nursing homes.

Sixty nursing homes were randomly allocated to receive or not to receive a quality assurance intervention. The experimental intervention included the use of predeveloped quality assurance packages, the services of a quality assurance consultant, and the process of working through the quality assurance cycle with one of two principal indicator conditions. Two prevalent health problems, hazardous mobility and constipation, were selected as the principal indicator conditions. To detect co-intervention, one of two hidden secondary indicator conditions (potential skin breakdown and urinary incontinence) was assessed in each facility. In the control nursing homes, both the principal and secondary indicator conditions were hidden from staff. The care for 1,525 residents was examined before and after the intervention using a retrospective record review initiated for the study purposes. Improvement in management of the principal conditions, hazardous mobility and constipation, was greater in the experimental group (P less than 0.03 and P less than 0.005, respectively). Neither group changed its management of the hidden conditions. Behavior change was achieved using quality assurance-linked interventions. Further research should focus on refining quality assurance interventions that provide staff education and motivational strategies.

Accidental Falls↗

PubMed1989

Magnesium supplementation during pregnancy: a double-blind randomized controlled clinical trial.

Four hundred young normotensive primigravid women between 13 and 24 weeks' gestation were randomly allocated to one of two study groups. One group received placebo tablets and the other group received 365 mg of elemental magnesium daily (as magnesium aspartate hydrochloride). Three hundred seventy-four patients completed the study, 189 in the placebo group and 185 in the treatment group. There were no significant differences between the two groups regarding serum calcium, uric acid, or electrolyte levels. However, the magnesium-supplemented group had significantly higher magnesium levels at delivery (1.68 +/- 0.03 mg/dl vs. 1.56 +/- 0.03 mg/dl, p less than 0.01). There were no significant differences in either systolic or diastolic blood pressures between both groups either at time of enrollment or at subsequent gestational ages later during pregnancy. Analysis of variance for repeated measurements and Fisher's least significant difference testing indicated a significant increase (p less than 0.01) in blood pressure from the level at the time of enrollment to the level achieved at or beyond 37 weeks' gestation in each group. There were no significant differences between the two groups regarding any of the following parameters: incidences of preeclampsia, fetal growth retardation, preterm labor, birth weight, gestational age at delivery, or number of infants admitted to the special care unit. Magnesium supplementation during pregnancy did not improve pregnancy outcome in our population.

Blood Pressure↗

PubMed1987

Preoperative myocardial ischaemia: its relation to perioperative infarction.

One hundred consecutive patients undergoing coronary artery bypass surgery were randomly allocated to a preoperative (24 h) intravenous infusion of isosorbide dinitrate (1.5-15 mg/hr) (50 patients) or to placebo (50 patients). The characteristics of the two groups were similar. Evidence of acute myocardial ischaemia was sought by continuous electrocardiographic Holter recordings and acute myocardial infarction by the appearance of new Q waves and increased activity of the creatine kinase MB isoenzyme. Episodes of acute myocardial ischaemia were found in 18% of patients in the control group and in none of those who received isosorbide dinitrate. None the less, the frequency of perioperative myocardial infarction was similar (22% and 18% respectively) in the two groups. Perioperative infarction was significantly more common in women, in patients with unstable angina or poor left ventricular function, in those who had coronary endarterectomy, and in those in whom the aortic clamping time was greater than 50 minutes. These factors may have obscured any effect that prevention of preoperative ischaemia had on perioperative infarction. Preoperative infusion of isosorbide dinitrate eliminated preoperative ischaemia but did not influence the occurrence of perioperative infarction. The probable benefits of prevention of preoperative ischaemia on postoperative left ventricular function, which is a determinant of long term survival, remain to be established.

Acute Disease↗

PubMed1986

Lack of clinical exacerbations in adults with chronic asthma after immunization with killed influenza virus.

The effects of immunization with killed influenza virus vaccine were assessed by comparison with placebo in a double-blind study of 318 adult patients with chronic asthma. The patients were randomly allocated to active vaccine and placebo. No difference was observed in peak expiratory flow rate or in clinical symptoms of bronchial obstruction between the groups receiving active vaccine and placebo during the first week after immunization. The data were analyzed separately for age, sex, duration of the disease, hypersensitivity to aspirin (acetylsalicylic acid), atopic status, patients with a history of attacks of asthma induced by viral infections, patients with a diurnal variation of baseline peak expiratory flow of 20 percent or more, and patients receiving continuous oral steroid medication, but none of these factors seemed to predict any short-term adverse effects of vaccination. Follow-up for eight months after the vaccination revealed no differences in asthmatic symptoms between the patients treated with active vaccine and those receiving placebo. The antiviral antibody response to vaccination was normal. The possible protection provided by the vaccination against exacerbation of asthma induced by influenza could not be evaluated, since the influenza epidemic expected during the season failed to occur in Finland. It is concluded that immunization with killed influenza vaccine is safe and is not associated with any significant side effects in adult patients with chronic asthma.

Adult↗

PubMed1982

Multicenter evaluation of mepindolol and of mepindolol plus hydrochlorothiazide in essential hypertension.

The effect on systolic (SAP) and diastolic (DAP) arterial blood pressure of 5 mg mepindolol daily vs 12.5 mg hydrochlorothiazide daily vs 5 mg mepindolol plus 12.5 mg hydrochlorothiazide daily was evaluated in this multicenter study. After a 2-week washout period with placebo, 138 patients with mild to moderate essential hypertension (WHO Class I and II), homogeneous for age and blood pressure values, were randomly allocated to one of the three treatment groups. Arterial blood pressure and heart rate were obtained at the beginning and at the end of the washout placebo period, and after 2, 4, and 6 weeks of active treatment. At the beginning and at the end of the study, all patients underwent a thorough clinical and laboratory evaluation, including blood chemistry, electrocardiogram, and chest roentgenogram. A trend toward normalization of blood pressure was defined as a lowering of DAP to 90 mmHg or at least a 10-mmHg decrease from the control value. Statistical analysis was performed on all the data. After 6 weeks of treatment, SAP and DAP values were significantly reduced in 67% of the patients in all groups. In 71% of patients on mepindolol plus hydrochlorothiazide a particularly more marked decrease in DAP was observed. Mepindolol was well tolerated: side effects were generally mild and inconsequential. The results show that mepindolol, given as a single oral dose of 5 mg, is an effective agent in the treatment of mild to moderate essential hypertension. Because of its efficacy, the advantage of single daily administration, and lack of important side effects, it can increase compliance to therapy. Moreover the association of mepindolol plus hydrochlorothiazide appears to be safe and effective.

Blood Pressure↗

PubMed1987

Treatment of bronchial asthma with terfenadine; a randomized controlled trial.

1. Terfenadine, a histamine H1-receptor antagonist, was studied in 52 patients with stable mild perennial asthma with an allergic basis. 2. After a placebo run-in period, patients were randomly allocated to either terfenadine 120 mg twice daily or placebo. After 2 weeks they were crossed over to the other treatment. Forty-six patients completed the study. 3. Terfenadine was significantly more effective than placebo as measured by peak expiratory flows and by symptom scores. 4. These results suggest that histamine may play a more significant role in asthmatic bronchoconstriction than is currently recognised.

Adolescent↗

PubMed2001

Effect of omeprazole on the pharmacokinetics of moclobemide according to the genetic polymorphism of CYP2C19.

BACKGROUND: Moclobemide, an antidepressant with selective monoamine oxidase-A inhibitory action, is known to be metabolized by CYP2C19 and is also reported to be an inhibitor of CYP2C19, CYP2D6, and CYP1A2. To confirm the involvement of CYP2C19, we performed a pharmacokinetic interaction study. METHODS: The effect of omeprazole on the pharmacokinetics of moclobemide was studied in 16 healthy volunteers. The volunteer group comprised 8 extensive metabolizers and 8 poor metabolizers of CYP2C19, which was confirmed by genotyping. Subjects were randomly allocated into two sequence groups, and a single-blind, placebo-controlled, two-period crossover study was performed. In study I, a placebo was orally administered for 7 days. On the eighth morning, 300 mg of moclobemide and 40 mg of placebo were coadministered with 200 mL of water, and a pharmacokinetic study was performed. During study II, 40 mg of omeprazole was given each morning instead of placebo, and pharmacokinetic studies were performed on the first and eighth day with 300 mg of moclobemide coadministration. RESULTS: The inhibition of moclobemide metabolism was significant in extensive metabolizers even after a single dose of omeprazole. After daily administration of omeprazole for 1 week, the pharmacokinetic parameters of moclobemide and its metabolites in extensive metabolizers changed to values similar to those in poor metabolizers. In poor metabolizers, no remarkable changes in the pharmacokinetic parameters were observed. CONCLUSION: Our results show that CYP2C19 is an important enzyme in the elimination of moclobemide and that it is extensively inhibited by omeprazole in extensive metabolizers, but not in poor metabolizers.

Adult↗

PubMed1982

A controlled clinical trial in advanced ovarian cancer.

Thirty-eight patients with an advanced ovarian cancer (FIGO stage III and IV) were randomly allocated to treatment, either with melphalan (M) or a combination of adriamycin, 5-fluorouracil and cyclophosphamide (CAF) to determine the effect on survival. Actuarial survival of the two treatment groups was the same but the combination was more toxic.

Antineoplastic Agents↗

PubMed1986

A prospective evaluation of the Björk-Shiley, Hancock, and Carpentier-Edwards heart valve prostheses.

From 1975 to 1979, 540 patients undergoing valve replacement were entered into a randomized trial and received either a Björk-Shiley (273 patients) or a porcine heterograft prosthesis (initially a Hancock valve [107 patients] and later a Carpentier-Edwards prosthesis [160 patients]). Two hundred and sixty-two patients required mitral valve replacement, 210 required aortic valve replacement, 60 required mitral and aortic valve replacement, and eight also required associated tricuspid valve replacement (six mitral valve replacement; two mitral plus aortic valve replacement). Analysis of 34 preoperative and operative variables showed the treatment groups to be well randomized. In-hospital mortality was not significantly different among patients receiving the three prostheses for aortic valve replacement (7.6% overall) and mitral plus aortic valve replacement (10% overall), but there was a higher in-hospital mortality for patients undergoing mitral valve replacement with the Carpentier-Edwards prosthesis (15.5% compared with 8.8% overall; p = .03). This difference could not be explained on the basis of any preoperative or operative variable. Median follow-up was 5.6 (range 2.8 to 8.3) years. Actuarial survival after mitral valve replacement was 56.7 +/- 7.0% at 7 years, that after aortic valve replacement was 69.6 +/- 9.6% at 7 years, and that after mitral plus aortic valve replacement was 62.5 +/- 20.0% at 7 years. There was no significant difference in actuarial survival of patients receiving the three prostheses within the mitral, aortic, and mitral plus aortic valve replacement groups, nor was there a difference when these groups were amalgamated. Thirty-seven patients required reoperation for valve failure (15 with Björk-Shiley, 12 with Hancock, and 10 with Carpentier-Edwards valves; p = NS) and 11 died at reoperation (four with Björk-Shiley, four with Hancock, and three with Carpentier-Edwards valves; overall operative mortality 29.7%). Up to 7 years after surgery, there was no significant difference in the incidence of thromboembolism in patients with different prostheses undergoing mitral or aortic valve replacement. There were too few patients undergoing mitral plus aortic valve replacement for meaningful comparison. There was no significant beneficial effect of anticoagulants in patients undergoing mitral or aortic valve replacement with porcine prostheses, but patients were not randomly allocated to anticoagulant treatment. All patients with Björk-Shiley prostheses received anticoagulants.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗

PubMed1988

A randomized trial of two dose levels of cyclophosphamide, methotrexate, and fluorouracil chemotherapy for patients with metastatic breast cancer.

This study was designed to assess the role of dosage of chemotherapy for treatment of metastatic breast cancer. One hundred thirty-three patients without prior chemotherapy for metastatic disease were randomly allocated to receive two different dose levels of cyclophosphamide (C), methotrexate (M), and fluorouracil (F), administered intravenously (IV) every 3 weeks. Patients were stratified by sites of disease (visceral, bone, or soft-tissue dominant) and by interval from primary surgery to first recurrence. Doses on the higher-dose arm were 600 mg/m2 (C,F) and 40 mg/m2 (M) with escalation if possible; doses on the lower-dose arm were 300 mg/m2 (C,F) and 20 mg/m2 (M) without escalation. Patients who failed to respond to lower-dose CMF were crossed over to the higher-dose arm. Patients randomized to the higher-dose arm had longer survival measured from initiation of chemotherapy (median survival, 15.6 months v 12.8 months, P = .026 by log-rank test), but the effect of dose was of borderline significance (P approximately 0.12) when adjusted for a chance imbalance between the two arms in the time from first relapse to randomization, using the Cox proportional hazards model. Response rates (International Union Against Cancer [UICC] criteria) for patients with measurable disease were higher-dose arm: 16/53 (30%) and lower-dose arm: 6/53 (11%), (P = .03). Only one of 37 patients responded on crossover from the lower- to the higher-dose arm. Patients experienced more vomiting, myelosuppression, conjunctivitis, and alopecia when receiving higher doses of chemotherapy. A series of 34 linear analogue self-assessment scales were used to make detailed quality of life assessments on a subset of 49 patients. These scales confirmed greater toxicity in the immediate posttreatment period, but also a trend to improvement in general health and some disease-related indices, in patients receiving higher-dose chemotherapy. This trial suggests that better palliation is achieved by using full-dose chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗