Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:2.7.10.1 (ERK)
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Women with breast carcinoma and four or more involved ipsilateral axillary lymph nodes were randomly assigned to receive an induction course and 2 yr of maintenance chemotherapy with cyclophosphamide, methotrexate and 5-fluorouracil (CMF, 150 patients), CMF plus vincristine and prednisone (CMFVP, 166 patients), or chemoimmunotherapy with CMF plus the methanol extraction residue of BCG (CMF-MER, 85 patients). After 5 yr of accrual and a median follow-up of 34 mo, CMFVP is superior to CMF (p less than 0.01) with disease-free survival estimates at 4 yr of 60% for CMFVP compared to 45% for CMF. The disease-free survival advantage of CMFVP over CMF was greater in postmenopausal (p = 0.02) than in premenopausal patients (p = 0.09). CMF-MER was similar to CMF alone. CMF related side effects were similar in each regimen (see text), except for a greater incidence of leukopenia during induction with CMF than with CMFVP (p less than 0.01).
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PMID:A randomized trial of five and three drug chemotherapy and chemoimmunotherapy in women with operable node positive breast cancer. 636 33

Intradermal, interlesional and intravenous MER/BCG have been reported to possess immunostimulatory properties and combined with chemo-radiotherapy an anti-neoplastic effect. Due to local and systemic side effects of the methanol extraction residue of BCG therapy a new approach to oral administration was investigated. Seventeen patients with inoperable non-oat cell lung cancer were given oral MER for 30 days. Skin tests to 5 recall antigens and various concentrations of MER, lymphocyte stimulation by PHA were done before and repeated during therapy. The initial group of patients received a dose of 1.25 mg per day and when no side effects were detected the dose was gradually escalated in subsequent groups of patients up to 5 mg. Oral MER was well tolerated even at the higher dose with no clinical or laboratory side effects. No regression in tumor size was seen. In 6 of 17 patients the disease remained stationary for a mean of 6 months (Range 6-14 months). In the remainder, disease progressed after a mean of 15 weeks. Two patients had cutaneous PPD reactivity converted from negative to positive, in one it became negative, while the remaining patients maintained their original responsiveness. No major changes could be observed in the in vivo immune tests performed following the course of treatment. In view of the reported relative efficacy of oral BCG administration, and considering the very low toxicity with oral MER, further studies employing considerably higher doses of this nonviable vaccine are now justified.
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PMID:Oral administration of the methanol extraction residue of BCG (MER/BCG): a phase I study in non-oat cell lung cancer patients. 662 93

One-hundred-ninety-six patients with Stage III and IV Hodgkin's disease were prospectively randomized to receive either treatment with the methanol extraction residue of Bacillus Calmette-Guerin (MER/BCG) or no immunotherapy. Prior to the MER/BCG randomization, patients received six courses of induction and two years of maintenance chemotherapy so that a group with a presumptively low tumor burden could be established. Only patients achieving a complete remission were evaluated. During the first two years of immunotherapy, the MER/BCG group had a relapse frequency twice that of controls. The overall crude relapse frequency and disease-free survival were similar between the two treatment groups. The MER/BCG dose schedule used in this study was associated with a high frequency of unacceptable toxicity. Ulcerations of greater than 1 cm occurred in one-third of the patients with associated pain, fever, and occasional lymphadenopathy. A high degree of patient noncompliance (36%) was observed. Age (P = 0.002), prior radiotherapy (P = 0.032), and chemotherapy (P = 0.044) were prognostic factors found to significantly influence remission duration. These factors were balanced between patients treated with immunotherapy and those who were not. MER/BCG therapy did not significantly delay or prevent relapse.
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PMID:Effect of methanol extraction residue of Bacillus Calmette-Guerin in advanced Hodgkin's disease. 680 82

One hundred fifty-six evaluable patients with metastatic breast cancer were treated with vincristine, Adriamycin and cyclophosphamide alternating at fixed intervals with 5-FU and methotrexate. Immunotherapy with BCG or MER-BCG was administered to all patients in two consecutive treatment programs. Overall objective response rate and complete response rate were 67% and 20%, respectively. These were not significantly different between the two immunotherapeutic groups. The median time to progression was sixteen-and-a-half months from initiation of therapy. The median survival of all patients was 21 months and that of responders was 26 months. Response rates, time to progression, and survival showed no significant advantage over a recent historical control group treated with FAC-BCG. Toxicity related to the gastrointestinal tract and bone marrow was considerably higher in this protocol than in the FAC combinations. MER at the dose, route, and schedule administered in this protocol caused excessive local and systemic toxic reactions. The alternate use of these noncross-resistant combinations in advanced breast cancer is not superior to combination chemotherapy used in the traditional manner.
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PMID:Alternating noncross-resistant combination chemotherapy and active nonspecific immunotherapy with BCG or MER-BCG for advanced breast carcinoma. 698 70

The effects of chemotherapy and chemoimmunotherapy in previously treated advanced Hodgkin's disease were evaluated in a randomized study of 167 patients by CALGB. Combination chemotherapy consisted of treatment with one of three regimens with further randomization of MER (methanol extraction residue BCG) immunotherapy or no MER during chemotherapy. CVPP (CCNU, vinblastine, procarbazine, prednisone) was compared to a new combination, BAVS (bleomycin, Adriamycin, vincristine, streptozotocin), and to a third regimen consisting of alternating cycles of CVPP and BAVS. At the current analysis there is no significant difference in complete responses among the chemotherapy regimens. MER did not improve complete response frequency and was associated with significantly poorer survival for patients previously treated with chemotherapy. There was also no benefit with MER for patients with at least one pretreatment positive skin test. Because of the documented lack of therapeutic benefit and the morbidity of painful ulcers, MER treatment has been discontinued.
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PMID:MER immunotherapy and combination chemotherapy for advanced, recurrent Hodgkin's disease. Cancer and Leukemia Group B study. 701 26

Surgery alone does not cure breast cancer, and adjuvant chemotherapy has changed the management of this disease. Data obtained in 81 premenopausal women with operable breast cancer, treated at our clinic, are presented. Patients with axillary node disease were treated on three different protocols: cyclophosphamide + methotrexate + fluoro-uracil + vincristine + prednisone (CMFVP), cyclophosphamide + methotrexate + fluoro-uracil (CMF), and CMF + immunotherapy with methanol extract residue of BCG (CMF + MER). Patient discriminants and treatment regimens are discussed. Analysis of the results obtained in 49 patients in one study showed an extension of disease-free survival to 4,25 years, that CMFVP was superior to CMF with or without MER, and that immunotherapy was not beneficial. The literature is briefly reviewed and the motivation for our newer studies stated.
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PMID:Adjuvant chemotherapy for operable breast cancer in premenopausal women. 704 53

Seventy-three patients with Dukes' B2 and C colorectal cancer were randomized to adjuvant therapy after radical surgery. One group was treated with chemotherapy either alone or in combination with radiotherapy (RC). The second group was treated by chemotherapy (with or without radiotherapy) plus MER/BCG (RCM). In patients with Dukes' C disease, the survival at 54 months and the disease-free interval up to 24 months were significantly better in the RCM than in the RC subgroup. There were no significant differences in the survival and disease-free interval between RC- and RCM-treated patients with Dukes' B2 disease. Entry of additional patients and further follow-up are needed before we can decide whether the combination of RCM increases the cure rate in Dukes' C cancer or merely delays recurrence and prolongs survival.
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PMID:Combined adjuvant therapy of radically operated colorectal cancer patients. (chemotherapy, radiotherapy, and MER-BCG). 709

Two hundred patients with metastatic breast cancer who were treated with combination chemotherapy and nonspecific immunotherapy with BCG or MER were skin tested prior to, and at regular intervals during the administration of chemotherapy with a battery of six antigens (Dermatophytin, Varidase, candida, mumps, PPD, and KLH). Delayed-type hypersensitivity responses to this battery of antigens were analyzed to assess whether they correlated with ability to respond to chemotherapy, length of survival, and a number of other host and tumor characteristics of known prognostic significance. Responsiveness to individual recall antigens or the number of positive skin test responses did not correlate with overall or complete response rates. The correlation did exist with KLH, a primary antigen. A positive response to two or more antigens correlated with a longer survival. Inability to mount a skin test response to any antigen correlated with poor survival. PPD conversions during serial BCG administration did not correlate with a better prognosis. Serial skin testing with a battery of antigens did not correlate with prognosis. Skin test responsiveness to the antigens used in this study did not correlate with the other pretreatment factors of prognostic importance such as tumor burden, absolute lymphocyte count, performance status, prior radiation therapy, menopausal status, and age. Therefore, responsiveness to skin testing with these antigens appears to be an independent prognostic variable and should be incorporated in the planning and analysis of systemic treatment programs in metastatic breast cancer.
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PMID:Prognostic value of prechemotherapy skin tests in patients with metastatic breast carcinoma. 722 61

Mycobacterial antigens including BCG stimulate human peripheral blood mononuclear cells resulting in cellular proliferation and the release of inflammatory cytokines such as TNF-alpha. However, the signal transduction mechanisms responsible for the BCG-induced cell activation are not completely understood. In this study, we investigated the role of PTK as a signal transduction pathway in BCG-induced cell activation, with the use of two PTK inhibitors (genistein and tyrphostin). Our results indicated that genistein significantly inhibited BCG-induced cell growth determined by thymidine uptake in a dose-dependent manner. BCG-induced TNF-alpha secretion was completely suppressed by genistein in a dose-dependent manner, producing 92% inhibition at a concentration of 50 microM. In addition, strong inhibition (81%) of BCG-induced TNF-alpha secretion was observed with tyrphostin (30 microM), another specific protein tyrosine kinase with a different mechanism of action. These inhibitory effects were not attributed to an alteration in cell viability as judged by trypan blue staining, and were not due to LPS contamination. On the other hand, monoclonal antibodies directed against HLA-DR and DQ inhibited the BCG-induced secretion of TNF-alpha. Taken together, these findings suggest that PTK may play an essential role in BCG-induced cellular activation.
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PMID:Cellular activation induced by BCG is a PTK-dependent event. 866 Aug 50

At present, the most efficacious and used immunostimulant agent in the superficial bladder cancer immunotherapy field, is the BCG, even if its mechanism of action is still partly unknown. The therapeutic effects of BCG don't seem to depend exclusively on local immune response, so that according to this assertion, this immunohistochemical study had been conducted on 14 patients affected by superficial bladder cancer (pTa-pT1) which aimed to value both the apoptosis and proliferation indexes and the expression of the genetic product p53 and EGFR before and after the exposition of the vesical mucosa to the BCG. The BCG treatment can reduce the proliferation index of the normal urothelial cells in a statistically significant way whereas it would exclude a cytostatic effect mediate by negative modulation of EGFR from the cytokinins induced by BCG itself. The index of apoptosis of the urothelium does not increase after BCG and decreased expression of p53 associated after the treatment, although statistically not significant, it would seem to bear, the prophylactic efficacy of BCG according to the follow up of the patients included in the study.
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PMID:[Cellular proliferation, expression of p53, EGFR and apoptosis index of healthy mucosa of the bladder with TCC; pre- and post-intravesical BCG immunohistochemical study]. 941 99


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