Digital Clubbing and Lung Cancer Sridhar, Kasi S.; Lobo, Christopher F.; Altman, Roy D.
Chest,
12/1998, Letnik:
114, Številka:
6
Journal Article
Recenzirano
Odprti dostop
To determine the relative frequency of clubbing in small cell lung carcinoma (SCLC) versus non-small cell lung carcinoma (NSCLC).
Examine patients with lung cancer for digital clubbing and relate the ...findings to the histopathologic subtype of lung cancer.
Cancer center at a tertiary teaching hospital.
One hundred and eleven consecutive patients with a pathological diagnosis of lung cancer examined by one physician (KSS).
None.
Clubbing was present in 32 (29%) of the 111 patients with lung cancer. Clubbing was more common in women (40%) than in men (19%; χ2 test p = 0.011), and was more common in patients with NSCLC (35%) than those with SCLC (4%; χ2 test p = 0.0036).
In a prospective study, digital clubbing was less frequently observed in men than women and in patients with SCLC than NSCLC. These clinical observations may assist in the initial evaluation of patients for planning workup and therapy.
Pyrazoloacridine (NSC 366140, PD115934, PZA) is a new class of acridine anticancer agents under investigation in Phase II
clinical trials in patients with advanced cancers. Although poor responses in ...patients to the treatment with PZA alone have
been observed, this class of agents remains of interest because of its distinct mechanism of action from other topoisomerase
poisons. Therefore, the combination of PZA with conventional anticancer agents presents an attractive approach to treat drug-resistant
human tumors. In the present study, the cytotoxic effects of PZA combined with doxorubicin, topotecan, and etoposide were
determined using paired parental and doxorubicin-resistant human colon carcinoma (SW-620 and SW620/AD-300) and breast cancer
cell lines (MCF-7 and MCF-7/TH). Cytotoxicity was measured by soft agar clonogenic assays. Dose effect and combination effects
were analyzed by the method of Chou and Talalay. The combination of PZA with doxorubicin, topotecan, and etoposide in fixed
ratios demonstrated synergistic cytotoxicity on both SW-620 and SW620/AD-300 cell lines. The combination of PZA with doxorubicin
also exhibited synergistic cytotoxicity against both MCF-7 and MCF-7/TH cell lines. The mechanism of synergism appeared independent
of topoisomerase I and II inhibition, and interference with protein-DNA complexes. Strategies to define optimal drug combinations
are proving to be of significant value when considering potential clinical applications of new and established agents.
Gemcitabine is a pyrimidine analog of deoxycytidine with activity against nonhematologic and hematologic malignancies. Its pulmonary toxicity is usually mild and self-limiting. We describe a male ...patient with lung cancer in whom severe dyspnea and interstitial infiltrates developed after the administration of gemcitabine.
Lung cancer infrequently may be associated with human immunodeficiency virus (HIV) infection. This retrospective case-control study was undertaken to determine if there were differences in age, sex, ...and stage distribution and in survival between HIV-positive and HIV-indeterminate lung cancer patients. We compared 19 patients with both pathologically verified lung cancer and HIV infection proved by serologic study with lung cancer patients with an indeterminate HIV status. Ail 19 HIV-positive lung cancer patients were men. This was significantly (p=0.004) different from the 69 percent male preponderance in 1,335 HIV-indeterminate lung cancer patients. Median ages of HIV-positive and HIV-indeterminate patients were 48 and 61 years, respectively. HIV-positive patients were significantly (p=0.0139) younger. Stage distribution was similar in both groups. Histologic features and smoking were not significantly different between the two groups. Survival data that were available in 16 HIV-positive patients were compared with 32 HIV-indeterminate control subjects matched for stage, age, sex, and race. The median survival was three months in the HIV-positive group and ten months in the HIV-indeterminate cohort. The survival was significantly different (p=0.002). There were no one-year survivors in HIV-positive lung cancer patients.
Incubation
of drug-resistant human tumor cells with a combination of
prochlorperazine and dipyridamole has additive/synergistic effect on
the cellular retention and cytotoxicity of doxorubicin. In ...patients
administered a fixed dose of doxorubicin and prochlorperazine with
escalating doses of dipyridamole, mean plasma levels of dipyridamole
and prochlorperazine achieved were as high as 3.01 ± 0.41 μm
and 0.94 ± 0.09 μm, respectively. Plasma samples from patients
were analyzed in an in vitro assay to monitor the effect
on the cellular retention of tritium-labeled daunorubicin in
MDR 1 -transfected P388 cells. In 22 of 49 of the
plasma samples analyzed, the daunorubicin in efflux blocking activity
was one-half or greater than that of cells incubated with 12.5μ
m verapamil, a well-known efflux blocker. These
observations suggest that a combination of prochlorperazine and
dipyridamole may enhance cellular doxorubicin retention by blocking
efflux while reducing normal tissue toxicity and unwanted side effects
in vivo .
Somatostatin receptor expression, which was not a previously described marker for Hürthle cell cancer of the thyroid, was demonstrated by in vivo imaging with (111)In-pentetreotide in three patients. ...This phenomenon not only adds another imaging technique to the nuclear medicine armamentarium for detecting recurrent and metastatic cancer in patients with Hürthle cell cancer but also opens up an alternative therapeutic avenue with somatostatin analogs or their radiolabeled compounds.
Three patients developed clinical congestive heart failure after cumulative doxorubicin doses of 264, 440, and 450 mg/m2, respectively, despite serial monitoring of systolic cardiac function by ...resting gated radionuclide scanning. All three patients had depressed diastolic function, as shown by a decreased peak filling rate preceding a change in systolic function, which was assessed by left ventricular ejection fraction prior to the development of clinical congestive heart failure. We recommend serial monitoring of the peak filling rate, in addition to left ventricular ejection fraction. If broader experience confirms our impression that the peak filling rate is more sensitive than the current standard assessment of left ventricular ejection fraction, new guidelines may need to be drawn to monitor cardiotoxicity of anthracyclines and anthraquinones.
To determine whether combination chemotherapy is superior to single agents for recurrent/metastatic head and neck cancer, we compared the efficacy and toxicity of cisplatin (CP) and fluorouracil ...(5-FU), alone and in combination in a phase III trial.
Two hundred forty-nine patients with recurrent head and neck cancer were randomized to one of three treatments: CP (100 mg/m2) and 5-FU (1 g/m2 x 4), CP, or 5-FU every 3 weeks.
The overall response rate to the combination (32%) was superior to that of CP (17%) or 5-FU (13%) (P = .035). Response was associated with good performance status (PS) but not with primary site, site of recurrence, histology, prior irradiation, or relative dose intensity. Median time to progression was less than 2.5 months, and there was no significant difference in median survival (5.7 months) among the groups. By multivariate analysis, patients with better PS and poorly differentiated tumors had superior survival. Hematologic toxicity and alopecia were worse in the combination arm.
Although the response rate to the combination of CP plus 5-FU was superior to that achieved with single agents, survival did not improve.
Nausea and vomiting occur in a majority of patients receiving cisplatin chemotherapy despite prophylactic single agent antiemetic therapy. Three potent antiemetics, metoclopramide, droperidol and ...dexamethasone, and diphenhydramine to prevent potential extrapyramidal reactions, were combined in prophylaxis of 67 patients receiving cisplatin chemotherapy. Of the patients studied, 76.1% experienced complete protection from both nausea and vomiting in their first course and 62.7% in all their courses of treatment. In 73.3% of 161 evaluable courses, there was neither nausea nor vomiting. Vomiting did not occur in 79.5% of courses. There was no evidence to suggest tachyphylaxis. The efficacy in preventing nausea and vomiting was independent of primary disease site, age, sex, performance status, prior chemotherapy, and prior vomiting. Toxicities were mild and infrequent. Reversible transient extrapyramidal reactions, sweating or twitches occurred in 5.6% of courses. The combination of metoclopramide, diphenhydramine, droperidol and dexamethasone was highly efficacious in preventing nausea and vomiting in moderate or high‐dose cisplatin chemotherapy with little toxicity.
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