Summary:The purpose of this trial was to study feasibility and tolerance of a dose-intensive multicyclic alternating induction chemotherapy with repeated stem cell support in a series of 43 metastatic breast cancer patients. ades. Extensive literature reviews by Hryniuk et al 1,2 have found dose intensity to be correlated with response rate and survival. This effect has been considered in the rationale of many clinical trials that attempted to improve long-term survival in metastatic BC by delivering single courses of high-dose chemotherapy (HDC). Despite some promising data derived from phase II trials, results of the randomized studies published thus far have failed to show a sound clinical benefit for single autografts. [3][4][5] There might be other ways to take advantage of the doseintensity principle. In vitro, repeated doses of chemotherapy cause more cell kill than single doses, even though the total amount of drug administered is the same. 6 The classical model of Gompertzian kinetics provides a possible explanation for this fact through rapid compensatory re-growth of the resistant clones not eradicated by HDC. 7 The spread of the cytotoxic effect over a longer period of time might increase cell kill and reduce the probability of drug resistance. 8 Multicyclic treatment schemes appear to take advantage of the inherent time-dependant responsiveness of most cancer tissues.Autologous peripheral blood stem cell infusions have been extensively used to support single courses of HDC. Nonetheless, their possible use in programs of multicyclic non-myeloablative dose-intense chemotherapy has been little explored. [9][10][11][12] In November 1995, the Department of Oncology of University of Navarra, Spain, initiated a feasibility study that included a biweekly, alternating, doseintensive chemotherapy regimen. The results observed in the first 43 patients with metastatic BC are presented in this report.
Materials and methodsWomen with histologically proven metastatic BC were evaluated for study entry. An ECOG performance status of 0-1, age less than 65 years, and no evidence of cardiac, pulmonary, liver or renal impairment were required. All patients gave written informed consent according to institutional policy before entering the study. Patients presenting with brain metastases, leptomeningeal disease, or bone marrow involvement, as well as patients previously
Dose intensity has been related to clinical outcome in several solid tumors. We studied the influence of clinical and cellular parameters on dose intensity received in a series of 53 patients with metastatic breast cancer or advanced ovarian cancer. They received courses of cisplatin 120 mg/m2 plus etoposide 600 mg/m2 alternating every 14 days with ifosfamide 8 g/m2 plus paclitaxel 200–350 mg/m2. Blood stem cell support was administered after every course except for the first one. Patients with excellent mobilization underwent immunomagnetic selection of CD34+ cells. We found a significant inverse correlation between the CD34+ cell dose infused and the delay for the administration of the next cycle. A CD34+ cell dose between 1.5 and 5 × 106/kg per cycle was found to be feasible and was followed by a median delay of 1day (not different from doses above 5 × 106/kg). Three factors independently predicted the actually received dose intensity in a multiple regression model (R2 = 0.4): previous autologous transplantation, eligibility for immunomagnetic selection (excellent response to mobilization) and median CD34+ cell dose received along the treatment.
Se presenta un nuevo caso de regresión tumoral espontánea (RTE) en un paciente con el diagnóstico establecido de mieloma múltiple que alcanza remisión histológica tras infección de la herida quirúrgica por Staphylococcus Aureus.
Este caso cumple los criterios de RTE exigidos por la definición de Everson y Cole, al remitir el tumor sin tratamiento o con terapia inadecuada para ejercer acción significativa sobre la enfermedad tumoral. Los mecanismos de acción de la RTE permanecen oscuros. Este es el quinto caso comunicado en nuestro centro.
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