RESUMEN
Dihydropyrimidine dehydrogenase (DPD) is the initial, rate-limiting enzyme in the catabolism of 5-fluorouracil (5-FU), one of the most widely used chemotherapeutic agents in the treatment of breast cancer. The objective of this study was to determine the population characteristics of DPD activity in patients with breast cancer as well as the frequency of DPD deficiency in this population. DPD activity in peripheral blood mononuclear cells (PBM-DPD) was determined in 360 patients with breast cancer, with the mean PBM-DPD (0.26 +/- 0.01 nmol/min/mg protein) being significantly lower than that observed in female controls (0.44 +/- 0.02 nmol/min/mg protein; P < 0.01). ANOVA analysis examining the significance of differences in DPD activity among various groups indicated that only disease difference (breast cancer versus normal subjects) was significant after adjustments for race and age. In the present study, 21 (5.8%) patients were considered to be DPD deficient, indicating that this pharmacogenetic syndrome may be more common than anticipated (no DPD-deficient individual was found in the controls). Significantly lower DPD activity in patients with breast cancer may predispose to 5-FU-associated toxicity. These results provide further rationale for individualizing the 5-FU dose, thus reducing the risk of toxicity and/or improving therapeutic efficacy in patients with breast cancer.
Asunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/enzimología , Fluorouracilo/uso terapéutico , Oxidorreductasas/sangre , Adulto , Factores de Edad , Anciano , Antimetabolitos Antineoplásicos/administración & dosificación , Población Negra , Neoplasias de la Mama/sangre , Dihidrouracilo Deshidrogenasa (NADP) , Femenino , Fluorouracilo/administración & dosificación , Humanos , Leucocitos Mononucleares/enzimología , Persona de Mediana Edad , Oxidorreductasas/deficiencia , Población BlancaRESUMEN
The clinical presentation and characterization of the mutation in members of a large kindred with von Hippel-Lindau disease (VHLD) and pheochromocytoma were examined. Twenty-five proven cases of VHLD occurring in four generations of a large kindred have been followed since 1964, and pheochromocytoma has occurred in 17. Symptoms of pheochromocytoma developed at an early age, on average at 12.5 +/- 1.3 yr, and definitive diagnosis and treatment of pheochromocytoma occurred at 19.9 +/- 2.6 yr. Significantly higher urine catecholamine concentrations were observed in younger patients than in older ones. Mutation analysis was performed in 14 family members, and a new mutation in the VHLD gene was identified in 11; this mutation is a G to T change at nucleotide 658 that results in the substitution of a serine for an alanine residue at position 149 of the polypeptide chain. Seven of the 11 patients with the mutation have VHLD; four, all 10 yr old or less, are asymptomatic and have no evidence of disease, but are at high risk for developing VHLD. These children are being followed closely for clinical and biochemical manifestations. The characterization of this new mutation has permitted identification of family members who are likely to develop VHLD.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/genética , Feocromocitoma/genética , Mutación Puntual , Enfermedad de von Hippel-Lindau/complicaciones , Enfermedad de von Hippel-Lindau/genética , Adenoma/epidemiología , Adenoma/genética , Adolescente , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/epidemiología , Neoplasias de las Glándulas Suprarrenales/terapia , Adulto , Edad de Inicio , Anciano , Carcinoma de Células Renales/epidemiología , Carcinoma de Células Renales/genética , Catecolaminas/orina , Niño , Preescolar , Femenino , Hemangioma/epidemiología , Hemangioma/genética , Humanos , Lactante , Neoplasias Renales/epidemiología , Neoplasias Renales/genética , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/epidemiología , Neoplasias Pancreáticas/genética , Linaje , Fenotipo , Feocromocitoma/diagnóstico , Feocromocitoma/epidemiología , Feocromocitoma/terapia , Neoplasias de la Retina/epidemiología , Neoplasias de la Retina/genética , Factores de Riesgo , Sensibilidad y EspecificidadAsunto(s)
Antibióticos Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Antibióticos Antineoplásicos/farmacología , Neoplasias de la Mama/mortalidad , Quimioterapia Adyuvante , Supervivencia sin Enfermedad , Relación Dosis-Respuesta a Droga , Resistencia a Medicamentos , Femenino , Humanos , Metástasis Linfática , Tasa de SupervivenciaRESUMEN
PURPOSE: Contrast venography is the gold standard for diagnosis in deep venous thrombosis (DVT); however, this technique is invasive and requires the use of potentially hazardous contrast agents. Although duplex Doppler ultrasonography is accurate in the evaluation of lower extremity DVT, it is less accurate in the assessment of the pelvic and intraabdominal veins. Magnetic resonance venography (MRV) has recently been developed, and our purpose was to determine whether MRV could accurately demonstrated DVT when compared with duplex scanning and contrast venography. METHODS: Eighty-five patients underwent contrast venography and MRV from the inferior vena cava to the popliteal veins to rule out DVT. Thirty-three of these patients also underwent duplex scanning. Blinded readings of these studies were compared for the presence or absence and extent of venous thrombosis. RESULTS: DVT was documented by contrast venography in 27 (27%) venous systems. Results of MRV and contrast venography were identical in 98 (97%) of 101 venous systems, whereas results of duplex scanning and contrast venography were identical in 40 (98%) of 41 venous systems. All DVTs identified by contrast venography were detected by MRV and duplex scanning. The discrepancies were due to false-positive MRV (3) and duplex scanning (1) results. When compared with contrast venography, MRV had a sensitivity of 100%, specificity of 96%, positive predictive value of 90%, and negative predictive value of 100%. For duplex scanning the sensitivity was 100%, specificity was 96%, positive predictive value was 94%, and negative predictive value was 100%. CONCLUSIONS: It is concluded that MRV is an accurate noninvasive venographic technique for the detection of DVT.
Asunto(s)
Imagen por Resonancia Magnética , Flebografía , Tromboflebitis/diagnóstico , Humanos , Pierna/irrigación sanguínea , Estudios Prospectivos , Tromboflebitis/diagnóstico por imagen , UltrasonografíaRESUMEN
OBJECTIVE: To report on data collected during on-site audits of source documents in the Cancer and Leukemia Group B (CALGB). DESIGN: A retrospective review of audit reports in four audit cycles. SETTING: A cooperative group of institutions conducting clinical trials in cancer treatment. PARTICIPANTS: Patients taking part in clinical trials at collaborating CALGB institutions, members of the CALGB Data Audit Committee, and group chairmen of CALGB. MAIN OUTCOME MEASURE: The results of 691 institutional audits conducted by the CALGB in 1982 through 1992 with comparisons of main CALGB institutions vs affiliates. RESULTS: In four full reviews of all participating institutions in the CALGB, 3787 patients have had their on-site medical records compared with data submitted to the CALGB Data Management Center. Compliance with federal regulations for oversight by an institutional review board improved from a deficiency rate of 28.0% among the main institutions and 49.6% of the affiliate institutions in the first audit cycle to respective figures of 13.3% and 28.2% in the fourth cycle. Consent form deficiencies also dropped overall from 18.5% in the first cycle to 3.9% in the fourth. Patient eligibility was verified by auditors in 94.5%, and assessment of tumor changes in response to treatment was verified in 96.4% in the fourth cycle; both figures were only slightly lower in the first cycle. Two instances of scientific impropriety were discovered for a rate of only 0.28% of all audits. Both occurred prior to 1984, and none have occurred since. Major protocol deviations in drug dosing have held steady at about 11% over four audit cycles. Over the 11-year period of audits, three main institutions and 96 affiliate institutions have discontinued CALGB membership due solely, or at least partly, to unfavorable audit results. CONCLUSION: Scientific improprieties have occurred very rarely in clinical trials conducted by the CALGB. Protocol compliance in assessing patient eligibility and tumor responses has been high. Attention to administrative matters of consent forms, institutional review board approval, and ancillary data submission has measurably improved in the CALGB, which is at least partly due to the pressure from this on-site peer review of investigator performance.
Asunto(s)
Ensayos Clínicos como Asunto/normas , Auditoría Médica , Registros Médicos/normas , Neoplasias/terapia , Ensayos Clínicos como Asunto/estadística & datos numéricos , Recolección de Datos/normas , Humanos , National Institutes of Health (U.S.) , Estudios Retrospectivos , Mala Conducta Científica/estadística & datos numéricos , Estados UnidosRESUMEN
In a prospective study of 622 women with breast cancer, those with one to three histologically positive axillary lymph nodes were randomised after mastectomy to receive cyclophosphamide 100 mg/m2 orally on days 1-14, methotrexate 40 mg/m2 intravenously on days 1 and 8, and fluorouracil 600 mg/m2 intravenously on days 1 and 8 every 28 days for six cycles (CMF x six), or for twelve cycles of the same chemotherapy (CMF x 12). Those with > or = four positive nodes were randomised to one of these two groups or to 5000 cGy of postmastectomy regional radiotherapy (RT) followed by six cycles of the same chemotherapy (RT + CMF x six). With about 10 years median follow-up, there was no significant difference in survival or disease-free survival among the three groups. There was evidence of decreased locoregional recurrence in patients with > or = four nodes who received RT + CMF x six (relative risk 0.53, P = 0.067). Multivariate analysis indicated that the presence of > or = four positive nodes (negatively) and the percentage of ideal (full) dose of CMF received (positively) were the strongest factors predictive of survival. This study shows no advantage for 12 over six cycles of CMF chemotherapy in women with breast cancer and positive axillary nodes. There was a suggestion of decreased locoregional recurrence but no improvement in survival with radiotherapy for women with > or = four positive nodes.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Axila , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Neoplasias de la Mama/radioterapia , Quimioterapia Adyuvante , Terapia Combinada , Ciclofosfamida/administración & dosificación , Femenino , Fluorouracilo/administración & dosificación , Humanos , Metástasis Linfática , Mastectomía , Metotrexato/administración & dosificación , Recurrencia Local de Neoplasia , Estudios Prospectivos , Análisis de SupervivenciaRESUMEN
This study describes the inheritance of a defect in pyrimidine catabolism and its association with drug-induced toxicity in a patient receiving 5-fluorouracil (FUra) as adjuvant chemotherapy for breast carcinoma. The study population included the affected patient (proband), nine of her blood relatives, and seven healthy volunteers. The activity of dihydropyrimidine dehydrogenase (DPD), the initial enzyme of pyrimidine (and FUra) catabolism, in peripheral blood mononuclear cells was measured in each subject by a specific radiometric assay using FUra as the substrate. The proband had no detectable DPD activity. When enzyme levels in the proband and relatives were compared with that in controls, an autosomal recessive pattern of inheritance was demonstrated. This is the third patient with severe FUra toxicity secondary to an alteration in pyrimidine catabolism and the second from our clinic population suggesting that the frequency of this genetic defect may be greater than previously thought. Monitoring DPD activity may be important in the management of patients experiencing severe toxicity secondary to FUra chemotherapy.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Intraductal no Infiltrante/tratamiento farmacológico , Fluorouracilo/efectos adversos , Oxidorreductasas/deficiencia , Adulto , Neoplasias de la Mama/genética , Neoplasias de la Mama/metabolismo , Carcinoma Intraductal no Infiltrante/genética , Carcinoma Intraductal no Infiltrante/metabolismo , Terapia Combinada , Ciclofosfamida/administración & dosificación , Dihidrouracilo Deshidrogenasa (NADP) , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/farmacocinética , Humanos , Recuento de Leucocitos/efectos de los fármacos , Masculino , Metotrexato/administración & dosificación , Monocitos/enzimología , Linaje , Receptores de Progesterona/análisisRESUMEN
A 72-year-old man was diagnosed with epithelioid hemangioendothelioma involving liver, bone, and lungs characterized by low attenuation and irregular margins on CT. It is postulated that long exposure to vinyl chloride could predispose to development of such a rare tumor of low-grade malignancy.
Asunto(s)
Hemangioendotelioma/diagnóstico por imagen , Neoplasias Primarias Múltiples/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Cloruro de Vinilo/efectos adversos , Acetábulo , Anciano , Neoplasias Óseas/inducido químicamente , Neoplasias Óseas/diagnóstico por imagen , Exposición a Riesgos Ambientales , Hemangioendotelioma/inducido químicamente , Humanos , Neoplasias Hepáticas/inducido químicamente , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Pulmonares/inducido químicamente , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Neoplasias Primarias Múltiples/inducido químicamente , Sarcoma de Ewing/inducido químicamente , Sarcoma de Ewing/diagnóstico por imagenRESUMEN
Available information suggests that individuals with breast cancer gain weight during adjuvant treatment and that this weight gain may be associated with poor prognosis. Exploration of the factors which affect weight gain may aid in developing weight control interventions for these patients. To determine the factors which are associated with weight gain, 32 women undergoing adjuvant chemotherapy were followed over 2 years from the beginning of adjuvant treatment. Measures of psychologic functioning and self-reports of exercise levels and eating were assessed every 2 months during the course of treatment. Sixty-nine percent of the women gained weight over treatment, resulting in a significant weight gain for the group as a whole. Weight gain was correlated positively with several psychologic measures but not with assessed biologic measures. A multiple-regression equation using psychologic/behavioural measures of emotional discharge, logical analysis, affective regulation, interpersonal sensitivity, average number of symptoms, and obsessive compulsiveness accounted for 58% of the variance in overall weight gain. At 2 years of follow-up, 27 women had gained weight for an average of 6.03 kg. The coping style of logical analysis emerged as a significant predictor of disease recurrence, accounting for 28% of the variance in weight gain at 2 years. The results are discussed in terms of identification of women likely to gain weight during adjuvant treatment, directions for future research, and development of interventions to control weight gain.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Aumento de Peso/fisiología , Adaptación Psicológica , Adulto , Anciano , Neoplasias de la Mama/psicología , Terapia Combinada , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Femenino , Fluorouracilo/administración & dosificación , Estudios de Seguimiento , Humanos , Melfalán/administración & dosificación , Metotrexato/administración & dosificación , Persona de Mediana Edad , Prednisona/administración & dosificación , Recurrencia , Análisis de Regresión , Apoyo Social , Vinblastina/administración & dosificaciónRESUMEN
Using serial examination and oral cytology, 50 adult patients undergoing induction therapy for acute leukemia were studied for oral colonization with candida species. Ninety percent of patients were found to be colonized with Candida, with most of these colonizations present by day 14. The 30 patients exhibiting colonization with pseudohyphae received ketoconazole 400 mg daily by mouth. Of 20 patients in this group treated for 5 or more days, Candida organisms were eradicated in nine. Sixteen patients from the above group with persistent colonization on ketoconazole were treated by independent clinical decision for sustained fever and neutropenia with Amphotericin B, but only one responded by elimination of colonization. Seven of the 15 patients who did not initially receive ketoconazole developed Candida dissemination in contrast to two of 30 who received ketoconazole initially (P = 0.003, Fisher's exact test). No patient who initially had or acquired a negative cytology developed oral or disseminated candidiasis. Clinical oral candidiasis occurred in three patients, all of whom were receiving amphotericin B. Approximately 90% of these patients have or develop oral colonization with Candida organisms as identified by oral cytology. Those with colonization, both with and without pseudohyphae present, are at risk for dissemination. Amphotericin B does not eliminate colonization remaining after treatment with 400 mg of ketoconazole daily. More effective diagnostic and therapeutic strategies are needed to identify and eliminate Candida organisms and to prevent disseminated candidiasis in this population of patients.
Asunto(s)
Candidiasis Bucal/etiología , Leucemia/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anfotericina B/uso terapéutico , Candida/aislamiento & purificación , Candidiasis Bucal/tratamiento farmacológico , Femenino , Humanos , Cetoconazol/uso terapéutico , Masculino , Persona de Mediana EdadRESUMEN
The antiemetic effectiveness of haloperidol plus dexamethasone was compared with that of prochlorperazine plus dexamethasone in a prospective study of patients receiving chemotherapy for breast cancer. Chemotherapy consisted of cyclophosphamide, doxorubicin or methotrexate, and fluorouracil in all patients. Patients who received the doxorubicin-containing combination experience significantly more nausea and vomiting than those who received the chemotherapy combination containing methotrexate. There was no significant difference between the two antiemetic regimens in the overall incidence of post-chemotherapy nausea and vomiting, but patients who received haloperidol and dexamethasone did have a lower incidence of severe vomiting. Neither regimen is highly effective, especially for the combination containing doxorubicin, and cannot be recommended as standard antiemetic therapy for this population of patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Dexametasona/uso terapéutico , Haloperidol/uso terapéutico , Náusea/tratamiento farmacológico , Proclorperazina/uso terapéutico , Vómitos/tratamiento farmacológico , Ensayos Clínicos como Asunto , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Quimioterapia Combinada , Femenino , Fluorouracilo/administración & dosificación , Humanos , Metotrexato/administración & dosificación , Persona de Mediana Edad , Estudios Prospectivos , Distribución AleatoriaRESUMEN
Nineteen patients with locoregional non-small-cell lung cancer (NSCLC) were treated with two courses of cisplatin/VP-16/MGBG, followed by involved field radiotherapy and, subsequently, the same chemotherapy alternating with mitomycin-C/vinblastine. Five of 17 patients obtained a response (CR + PR) after induction chemotherapy. Following radiotherapy, an additional two patients responded. The median survival was 7.5 months, with the two longest survivors at 30 and 32 months. Hematologic toxicity was severe, with two deaths from severe neutropenia. Renal and gastrointestinal toxicities were moderate. This program of aggressive therapy did not increase the response rate or median survival compared with those of comparable patients treated in recent trials using radiotherapy alone or combined radiotherapy plus chemotherapy.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Terapia Combinada , Evaluación de Medicamentos , Etopósido/administración & dosificación , Etopósido/efectos adversos , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/radioterapia , Masculino , Persona de Mediana Edad , Mitoguazona/administración & dosificación , Mitoguazona/efectos adversos , Mitomicinas/administración & dosificación , Mitomicinas/efectos adversos , Vinblastina/administración & dosificación , Vinblastina/efectos adversosRESUMEN
The Southeastern Cancer Study Group performed a Phase II study of teniposide in previously treated patients with metastatic breast cancer. No responses were observed in 11 evaluable patients who received teniposide 60 mg/m2 by IV infusion for five consecutive days every three weeks. Toxicity was primarily gastrointestinal and hematologic and was frequently severe. This study demonstrated no therapeutic activity for teniposide when given in this dose and schedule to patients with heavily pretreated metastatic breast cancer.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Podofilotoxina/análogos & derivados , Tenipósido/uso terapéutico , Adulto , Anciano , Neoplasias de la Mama/patología , Evaluación de Medicamentos , Resistencia a Medicamentos , Femenino , Humanos , Persona de Mediana Edad , Metástasis de la Neoplasia , Tenipósido/efectos adversosAsunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Progestinas/uso terapéutico , Femenino , Humanos , Medroxiprogesterona/análogos & derivados , Medroxiprogesterona/farmacología , Acetato de Medroxiprogesterona , Megestrol/análogos & derivados , Megestrol/farmacología , Acetato de Megestrol , Noretindrona/análogos & derivados , Noretindrona/farmacología , Acetato de Noretindrona , Progestinas/efectos adversos , Progestinas/farmacologíaRESUMEN
Severe neurotoxicity due to 5-fluorouracil (FUra) has previously been described in a patient with familial pyrimidinemia. We now report the biochemical basis for both the pyrimidinemia and neurotoxicity in a patient we have recently studied. After administration of a "test" dose of FUra (25 mg/m2, 600 microCi[6-3H]FUra by intravenous bolus) to a patient who had previously developed neurotoxicity after FUra, a markedly prolonged elimination half-life (159 min) was observed with no evidence of FUra catabolites in plasma or cerebrospinal fluid and with 89.7% of the administered dose being excreted into the urine as unchanged FUra. Using a sensitive assay for dihydropyrimidine dehydrogenase in peripheral blood mononuclear cells, we demonstrated complete deficiency of enzyme activity in the patient and partial deficiency of enzyme activity in her father and children consistent with an autosomal recessive pattern of inheritance. Patients who are deficient in this enzyme are likely to develop severe toxicity after FUra administration.
Asunto(s)
Fluorouracilo/efectos adversos , Oxidorreductasas/deficiencia , Errores Innatos del Metabolismo de la Purina-Pirimidina/metabolismo , Adulto , Cromatografía Líquida de Alta Presión , Dihidrouracilo Deshidrogenasa (NADP) , Femenino , Fluorouracilo/líquido cefalorraquídeo , Fluorouracilo/farmacocinética , Humanos , Leucocitos Mononucleares/enzimología , Oxidorreductasas/sangre , Oxidorreductasas/genética , Linaje , Errores Innatos del Metabolismo de la Purina-Pirimidina/líquido cefalorraquídeo , Errores Innatos del Metabolismo de la Purina-Pirimidina/genéticaRESUMEN
This study (Alabama Breast Cancer Project) reports the ten-year surgical results of a prospective randomized trial comparing Halsted radical mastectomy (RM) with modified radical mastectomy (MRM) for breast cancer. We entered 311 patients in the study between 1975 and 1978. Patients with histologically positive axillary lymph nodes were randomized after operation to receive melphalan or intermittent intravenous cyclophosphamide, methotrexate, and fluorouracil for one year. After a median follow-up of ten years, there was no significant difference in the survival of the two groups (RM, 71%; MRM, 64%). Local recurrence after RM was significantly lower than after MRM. A subset of patients with more advanced cancers (T3 and T2 with clinically positive axillary nodes) experienced significantly better survival at ten years following RM compared with MRM (59% vs 38%, respectively). These results indicate that overall survival is similar for patients treated by either RM or MRM. However, there is subset of patients with more advanced cancers whose ultimate survival can be favorably influenced by RM.
Asunto(s)
Neoplasias de la Mama/cirugía , Mastectomía/métodos , Carcinoma/cirugía , Carcinoma Intraductal no Infiltrante/cirugía , Ensayos Clínicos como Asunto , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Pronóstico , Estudios Prospectivos , Distribución AleatoriaRESUMEN
Breast cancer is the leading cause of cancer death in women in the United States. Western cultural factors, such as high socioeconomic status, early age of menarche, and late age at first pregnancy, may be risk factors in the development of breast cancer. A strong positive correlation exists worldwide between fat consumption and breast cancer. Case-controlled studies also support an association of a high-fat diet and breast cancer. Animal studies using rats or mice have verified that fat is a promoter of breast cancer after exposure to a known chemical carcinogen. A high-fat diet resulted in a higher incidence of breast tumors than a low-fat diet. Recent rodent studies further suggest that a reduction in calories alone reduces breast cancer incidence. Furthermore, studies reveal that the 5-year survival is about 80% after appropriate therapy (surgery, radiation, and/or chemotherapy) for breast cancer, with early detection by self-examination as the first step to improve outcomes. Excision of the breast tumor (segmental mastectomy) and some surrounding normal tissue followed by radiation therapy can be as effective therapy for most small breast cancers as total or radical mastectomy. The authors strongly recommend obtaining medical evaluation for any lump or thickening in the breast and following good dietary practices.
Asunto(s)
Neoplasias de la Mama , Grasas de la Dieta/efectos adversos , Animales , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/etiología , Neoplasias de la Mama/terapia , Grasas de la Dieta/metabolismo , Humanos , Estados UnidosRESUMEN
Gallium nitrate was administered as a 700-mg/m2 iv bolus infusion over 15-30 minutes every 2 weeks to 138 patients with malignant lymphoproliferative diseases. Responses occurred in patients with well-differentiated lymphomas (five responses among eight patients), but the drug produced few responses in any other group of patients. Toxic effects were primarily gastrointestinal and reversible renal abnormalities and anemia. As a single agent, bolus gallium nitrate has little activity in lymphoproliferative diseases.
Asunto(s)
Antineoplásicos/uso terapéutico , Galio/uso terapéutico , Linfoma/tratamiento farmacológico , Adolescente , Adulto , Anciano , Antineoplásicos/efectos adversos , Ensayos Clínicos como Asunto , Evaluación de Medicamentos , Galio/efectos adversos , Humanos , Persona de Mediana EdadAsunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Arabinonucleotidos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Fosfato de Vidarabina/uso terapéutico , Neoplasias de la Mama/patología , Ensayos Clínicos como Asunto , Evaluación de Medicamentos , Femenino , Enfermedades Gastrointestinales/inducido químicamente , Enfermedades Hematológicas/inducido químicamente , Humanos , Persona de Mediana Edad , Metástasis de la Neoplasia , Fosfato de Vidarabina/análogos & derivadosRESUMEN
A total of 97 women with good-risk metastatic breast cancer received therapy with cyclophosphamide, doxorubicin, and 5-FU; half of these patients were randomly allocated to receive levamisole, 2.5 mg/kg, 2 days of each week in addition to chemotherapy, while the other half received an identical placebo. Good-risk patients consisted of those with bone-only metastasis, or local chest wall recurrence with or without bone metastasis. No significant difference in response rate, duration of disease control, or survival was observed between the groups. No major toxicity was associated with levamisole.