Use of CA-125 to predict survival of patients with ovarian carcinoma. North Thames Cooperative Group.

The prognostic value of serum CA-125 measurements was assessed in 54 patients with advanced ovarian adenocarcinoma. All patients received a minimum of two courses of carboplatin as part of the North Thames Cooperative Group trial. With a minimum follow-up of 6 months, 37 patients (69%) have clinical evidence of progressive disease and 28 have died.

Lumbar pain in stage 1 testicular germ cell tumours: a symptom preceding radiological abnormality.

In a series of 114 stage 1 testicular tumour patients managed by a surveillance policy there have been 26 relapses. Three of these patients presented with lumbar pain as the first sign of relapse. All 3 were tumour marker non-producers and the onset of pain pre-dated radiological abnormality by up to 4 months.

Phase II trials of flavone acetic acid in advanced malignant melanoma and colorectal carcinoma.

Flavone acetic acid (FAA), 8.6 gm-2 has been administered by 6h intravenous infusion to 19 patients with advanced colorectal carcinoma and 15 patients with advanced malignant melanoma. The drug associated toxicity was generally mild and as predicted from the phase I study.

The role of low-dose methotrexate and folinic acid in gestational trophoblastic tumours (GTT).

Between 1964 and 1986, 487 patients with gestational trophoblastic tumour (GTT) were treated with methotrexate and folinic acid. The patients comprise two groups: between 1964 and 1974, 126 patients were treated but were not systematically stratified using a prognostic score before the start of treatment. These patients formed part of the 317 women who were analysed to identify a number of prognostic variables (Bagshawe 1976).

Weekly alternating etoposide, methotrexate, and actinomycin/vincristine and cyclophosphamide chemotherapy for the treatment of CNS metastases of choriocarcinoma.

Twenty-five patients with CNS metastases of choriocarcinoma were treated with a regimen incorporating etoposide, methotrexate, and actinomycin (EMA) alternating weekly with vincristine and cyclophosphamide (CO). The dose of methotrexate was increased to 1 g/m2. Eighteen patients presented with CNS metastases, or developed them on inappropriate treatment started elsewhere.

EMOP/CA chemotherapy for the treatment of aggressive non-Hodgkin's lymphomas.

From October 1983 to June 1987, 32 patients with aggressive non-Hodgkin's lymphomas (diffuse centroblastic, lymphoblastic and Burkitt type) were treated with the weekly alternating EMOP/CA schedule, total duration 12 weeks. There were six bulky stage II, nine stage III and 17 stage IV patients, median age 54 years (range 19-75). The complete remission rate was 59% (95% confidence limits 40-76%) and the partial remission rate 28% providing an overall response rate of 87%.

The effect of intensity of administered treatment on the outcome of germ cell tumours treated with POMB/ACE chemotherapy.

In order to assess the importance of the intensity of administration of chemotherapy in the management of advanced germ cell tumours we have calculated indices of chemotherapy. These have been used to compare the treatment given to patients who subsequently relapsed with matched controls who did not relapse. Two of these indices (alpha and beta) are derived from the doses of drugs whose dose is varied (cisplatinum, methotrexate and etoposide).

Long-term outcome in patients with germ cell tumours treated with POMB/ACE chemotherapy: comparison of commonly used classification systems of good and poor prognosis.

We analysed outcome in 206 consecutive male patients treated for metastatic non-seminomatous germ cell tumour (NSGCT) of testicular or extragonadal origin treated with the POMB/ACE (cisplatin, vincristine, methotrexate, bleomycin, actinomycin D, cyclophosphamide, etoposide) regimen after division into prognostic groups by commonly used clinical classification systems and definitions of adverse prognosis. The adverse prognostic groups of all classification systems and definitions examined showed similar, but only moderate, sensitivity (71-81%) and specificity (52-56%) in predicting death. A simple definition of poor prognosis based on raised initial levels of serum tumour markers alpha fetoprotein (aFP) and human chorionic gonadotrophin (hCG) proved at least as useful (sensitivity 80%, specificity 55%) as other more complicated systems in predicting failure to achieve long-term survival.

Tumour markers: from carcinoembryonic antigen to products of hybridoma technology.

Measurements of carcinoembryonic antigen (CEA) concentrations in serum provide a system for monitoring patients with colorectal cancer. The serum tumour marker, CA19-9, recognized by a monoclonal antibody, appears to be the only new marker to add usefully to information from CEA. Their value is in assessing response to therapy and in detecting early surgically resectable relapses.

Treatment of small cell lung cancer by eight weeks chemotherapy.

Eighty-two patients with small cell lung cancer (SCLC), 32 with limited disease, were treated with alternating chemotherapy. Eight courses were administered at weekly intervals, and responding patients received radiotherapy to sites of bulk disease. Overall response rate was 76.

Carcinoembryonic antigen levels in germ cell tumours.

Elevated serum carcinoembryonic antigen (CEA) prior to specific treatment was noted in 3% (7/258) of assessable patients with testicular, extragonadal or ovarian germ cell tumours (GCT). In addition, persistently raised CEA was documented in 7% (26/385) of patients during or after cisplatin-based chemotherapy for metastatic GCT. Raised CEA did not appear associated with adverse prognosis.

Bone disease in testicular and extragonadal germ cell tumours.

Of 297 patients with metastatic testicular and extragonadal germ cell tumours (GCT), bone involvement was detected clinically in 3% (7/251) of those at first presentation and in 9% (4/46) of relapsed cases. This difference was not statistically significant (95% confidence limits -2%; +14%). Concurrent systemic metastases, commonly involving lung (7/11 cases) and para-aortic lymph nodes (6/11), were present in all patients with bone disease.

Phase I-II study of carboplatin vincristine methotrexate and bleomycin (COMB) in carcinoma of the cervix.

Platinum based combination chemotherapy has been associated with a high response rate in patients with cervical carcinoma. To determine whether the toxicity could be reduced but the efficacy maintained carboplatin 200 mg m-2 was substituted for cisplatin in a regimen that was repeated two weekly and also contained vincristine, methotrexate and bleomycin. Twenty-four patients with squamous cell carcinoma of the cervix of whom 17 had relapsed following radiotherapy were studied.

Single agent activity of methotrexate in advanced non-seminomatous testicular germ cell tumours.

The single agent activity of methotrexate in non-seminomatous germ cell tumours (NSGCT), and thus the rationale for its inclusion in combination regimens, has never been documented clearly. We have therefore reviewed all patients with NSGCT treated in this hospital from 1967 to 1970. Seventeen patients were identified who had a rising HCG excretion and who were treated with methotrexate alone as first line chemotherapy.

Single agent etoposide in gestational trophoblastic tumours. Experience at Charing Cross Hospital 1978-1987.

Two hundred and two patients with gestational trophoblastic tumours (GTT) were treated using single agent etoposide. Patients were divided into low, medium and high risk groups using a prognostic index. Initial chemotherapy commenced with etoposide in 101 patients and 94 were accessible.

Treatment of advanced malignant melanoma with interferon alpha and etretinate.

The combination of recombinant human interferon alpha A 9 MU daily intramuscularly and etretinate 50 mg daily orally was given to 25 patients with progressive advanced, metastatic melanoma. The treatment was well tolerated. Partial responses were seen in three (12%) patients lasting from 2 to 8 months.

Safety of surveillance in the management of stage I anaplastic germ cell tumours of the testis.

A study was made of 46 patients with anaplastic germ cell tumours of the testis with no evidence of disease elsewhere as judged by computed tomography (CT) of thorax and abdomen, ultrasound and tumour marker measurements. A repeat CT 3 months after the first and clinical examination with chest X-ray and tumour marker measurements ensured that the 30.7% of patients who relapsed were detected promptly enough for them all to enter complete remission.

Therapy of advanced ovarian cancer with D-Trp-6-LH-RH (decapeptyl) microcapsules.

Forty-one patients with advanced ovarian cancer (FIGO stage III or IV) who had relapsed following conventional treatment were treated with long acting depot preparation of D-Trp-6-LH-RH once a month. There were no exclusion criteria and patients of any age or performance status were eligible. Thirty patients continued to progress following therapy.

Cisplatin, vincristine, methotrexate and bleomycin (POMB) as initial or palliative chemotherapy for carcinoma of the cervix.

Chemotherapy was given as initial therapy to 12 women with very advanced squamous cell carcinoma of the cervix and to 19 women with recurrent disease. They received a median of four courses of POMB which comprised vincristine 1.0 mg/m2 and methotrexate 300 mg/m2 followed by folinic acid rescue, bleomycin 30 mg as a 48-h infusion or intramuscular injection and cisplatin 100 mg/m2 as a 12-h infusion.