RESUMEN
Indicine N-oxide is a pyrrolizidine alkaloid isolated from Heliotropium indicum, one of the widely used herbs in Ayurvedic medicine. Thirty-seven patients with solid tumors received the drug: 15 men and 22 women (mean age, 53 years). All had had prior chemotherapy, and 25 had had prior radiotherapy. Eighty-four percent had a performance status of 0-3 (Cancer and Leukemia Group B criteria). The drug was given as a short infusion over 15 minutes and repeated with a median interval of 4 weeks. Doses were escalated from 1 to 9 g/m2. A total of 55 courses were evaluable. Dose-limiting toxic effects were leukopenia and thrombocytopenia, and the toxicity was cumulative with repeated doses. Other toxic effects included nausea and vomiting, anemia, and hepatic dysfunction. The hematologic toxicity tended to be more pronounced in patients with hepatic dysfunction, poor marrow reserve, and heavy prior chemotherapy and radiotherapy. There were no complete or partial responses. One patient with skin melanoma and another with ovarian carcinoma had improvement lasting 2 months. The maximally tolerated dose is 9 g/m2 in our population. A recommended dose for therapeutic study is 7 g/m2. High-risk patients should be started at a dose of 5 g/m2. The treatment may be repeated at 4-week intervals with close monitoring of wbc and platelet counts. Dose reductions may be necessary for repeated courses.
Asunto(s)
Antineoplásicos Fitogénicos/toxicidad , Óxidos N-Cíclicos/toxicidad , Neoplasias/tratamiento farmacológico , Alcaloides de Pirrolicidina/toxicidad , Adulto , Anciano , Óxidos N-Cíclicos/uso terapéutico , Evaluación de Medicamentos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Alcaloides de Pirrolicidina/uso terapéuticoRESUMEN
Twenty-four patients who had stage III or IV ovarian adenocarcinoma and had failed prior chemotherapy were treated with cyclophosphamide, adriamycin, and cis-dichlorodiammineplatinum(II) every 3 weeks. Twelve patients had objective responses and an additional six had subjective improvement. The median duration of survival for responders is 9 months. There were no instances of nephrotoxicity. Fluid management consisted of 1000-2000 ml of iv fluid without Lasix- or mannitol-induced diuresis. Patients responded after having failed radiotherapy or multiple-drug chemotherapy, including some who were 70-75 years of age or were greater than 50% bedridden. Patients with one- or two-drug prior chemotherapy had a higher response rate (ten responses among 17 patients) than those previously treated with three or more drugs (two responses among seven patients).
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Cisplatino/administración & dosificación , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Neoplasias Ováricas/tratamiento farmacológico , Adulto , Anciano , Evaluación de Medicamentos , Quimioterapia Combinada , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Forty patients with disseminated malignant melanoma were treated with triple combination chemotherapy consisting of Imidazole Carboxamide, BCNU and Vincristine. Seventeen of 40 patients (42.5%) showed significant responses including three complete responses. Responses were seen in cutaneous, lymph node and pulmonary metastases. Nine instances of hepatic metastases were unaffected by therapy but 68% of the skin and nodal patients responded. The median response duration was only 4 months and the median survival of responders was 9.5 months compared to a 2 month median survival of non-responders. Half of the responders died of CNS metastases. The short duration of response, the resistance of hepatic metastasis and the high incidence of cerebral recurrence necessitate additional therapeutic approaches to this disease.