Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cisplatin has played a major role in the treatment of germ cell tumors. However, it causes renal damage, severe nausea and vomiting. It is also neurotoxic and ototoxic. Carboplatin is an analog of cisplatin which, does not cause renal damage at therapeutic doses. It is not neurotoxic or ototoxic and it produces less gastrointestinal toxicity than cisplatin. We used carboplatin alone as an initial chemotherapy in a 36-year-old man with stage IIB seminoma. Following left radical orchiectomy the patient received 4 courses of carboplatin chemotherapy. After the first course of chemotherapy, tumor markers (LDH, beta-HCG) returned to the normal range. After 4 courses, the size of the retroperitoneal metastases was significantly reduced. The toxicity of 4 courses of carboplatin chemotherapy was generally milder than that of cisplatin-based combination chemotherapies such as PVB or VAB-6. There were no episodes of septicemia, thrombocytopenic bleeding or renal deterioration. The patient did not suffer from alopecia, neuropathy, symptomatic hearing loss, severe nausea or vomiting. Nine months after the completion of carboplatin chemotherapy, the patient remains well and free from disease progression. This case strongly suggests that single agent carboplatin therapy could be an effective and less-toxic treatment for advanced seminoma.
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PMID:[A case of advanced seminoma treated effectively with single agent carboplatin therapy]. 156 62

Episodes of septicemia (114) in patients with solid cancers at Nagoya Memorial Hospital were analyzed from April 1985 to June 1986. The underlying malignancies were predominantly gastric and colon cancers. Almost all the cancers were in advanced stages, the most frequent patient performance status being 4. Hypogammaglobulinemia and granulocytopenia were not, however frequent among these patients. The major microbes detected from blood cultures were Candida sp., Staphylococcus aureus and Staphylococcus epidermidis. Preceding chemotherapies were mainly combination chemotherapies containing Cisplatin (CDDP). The major pathogen, Candida sp., was detected frequently from Hickman's catheter. Thirty-one percent of patients died within 14 days of the septicemia diagnosis (two were cases of septic shock).
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PMID:Septicemia in patients with solid cancers in a Japanese cancer hospital--the significance of candidemia for cancer patients. 206 21

Of 19 patients with advanced transitional bladder cancer (T2-T4, N0-N+, M0) who received two or three cycles of pre-emptive MVC (Methotrexate, Vinblastine, Cisplatin), pathological partial (PR) and complete (CR) remissions were observed in 67% (50% and 17% respectively). The toxicity of chemotherapy was generally acceptable but 5 patients required hospitalization for neutropenia and thrombopenia . In one of them chemotherapy was stopped for severe sepsis. No death was observed. In 11 patients follow-up is greater than 12 months. In this group, 10 patients are actually alive and disease-free, while the other one was dead owing to brain metastasis, after eight months from surgery.
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PMID:[Neoadjuvant chemotherapy with MVC (methotrexate, vinblastine, cisplatin)in the treatment of infiltrating transitional carcinoma of the bladder]. 214 7

Cisplatin, vinblastine and bleomycin (PVB) is very effective therapy in disseminated testicular cancer, but toxicity is severe. A further reduction of vinblastine might reduce the acute toxicity of PVB without compromising the response rate in good-risk patients. Starting in March 1982, 42 consecutive patients with minimal or intermediate advanced disease (lymph node metastases less than 10 cm, lung nodules less than 5 cm) began a 0.2-mg/kg vinblastine PVB regimen, provided that serum alpha-fetoprotein (AFP) levels were not greater than 1000 ng/ml and human chorionic gonadotropin (HCG) values were not greater than 50,000 mIU/ml. Only 9 patients (21.4%) had leukocyte counts less than 1000/mm3, 6 (14%) had infections, but none had documented sepsis. Gastrointestinal and neuromuscular toxicities were mild. Of the 42 patients, 41 (97.6%) entered complete remission (CR), 8 with surgery. After a median follow-up period of 26 months (range, 19-40 months), 35 patients (83.3%) are continuously disease-free. Of the 6 patients with AFP levels greater than 400 ng/ml and/or HCG values greater than 1000 mIU/ml, only 2 (33.3%) entered continuous CR, versus 33 (91.6%) of the 36 patients with normal or less elevated markers (P less than 0.01). PVB with a 0.2-mg/kg vinblastine dosage is very effective and well-tolerated therapy in selected good-risk patients with disseminated germinal testis cancer.
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PMID:Successful treatment of good-risk disseminated testicular cancer with cisplatin, bleomycin, and reduced-dose vinblastine. 242 65

Thirty-six of 39 previously untreated evaluable patients with advanced metastatic seminoma (stage greater than or equal to IIb) obtained a complete response (CR) and three a partial response (PR) after cisplatin-based combination chemotherapy with or without surgery/radiotherapy (group 1). After a median observation time of 36 months, 33 patients are alive with no evidence of disease (NED). Fifteen additional patients received cisplatin-based chemotherapy due to relapsing seminoma after initial radiotherapy (group 2). Thirteen patients obtained a CR, and two a PR. Patients from group 1 lived significantly longer after the start of chemotherapy than those from group 2. The rate and severity of the treatment-related complications were comparable in both groups. The most frequent nonfatal side effects of cisplatin-based combination chemotherapy were Raynaud-like phenomena, polyneuropathy, and myelosuppression. Four patients developed fatal complications (septicemia, bone marrow aplasia). In three of 12 patients with evaluable postchemotherapy histology, vital malignant seminoma was found. Cisplatin-based combination chemotherapy in advanced seminoma patients is highly effective, but includes a significant risk of severe complications. Less toxic treatment regimens should be explored, at least for patients who have less advanced tumors (stage IIb/limited stage IIc).
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PMID:The treatment of advanced metastatic seminoma: experience in 55 cases. 243 60

Forty-nine evaluable patients with advanced or recurrent endometrial carcinoma who were no longer controllable with surgery, radiotherapy, and hormonal therapy and who had not received prior chemotherapy were treated with cisplatin 50 mg/m2 intravenously every 3 weeks. Two complete responses (4%) and eight partial responses (16%) were observed among the 49 patients. Twenty-two (45%) exhibited stable disease for at least 2 months, while 17 patients (35%) progressed less than 2 months after initiating chemotherapy. Adverse effects included mild leukopenia (31%), nausea and vomiting (72%), and mild azotemia (51%). Only 2 patients experienced life-threatening toxicity; one related to renal failure and the other to sepsis and shock. Cisplatin thus has definite activity when given at the dose and schedule tested to patients with endometrial carcinoma who have not received prior chemotherapy.
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PMID:Phase II trial of cisplatin as first-line chemotherapy in patients with advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group Study. 270 69

A randomized clinical study of patients with advanced epithelial ovarian cancer after debulking surgery showed that high-dose (120 mg/m2) cis-platinum (DDP) in combination with cyclophosphamide (600 mg/m2) had a significantly higher response and survival rate than the low-dose DDP (60 mg/m2) and cyclophosphamide combination. The 3-year actuarial survival rate of the high-dose group was 60% and that of the low-dose group was 30%. Though moderate to severe marrow toxicity was evident in 80% of the patients in the high-dose group and 40% of the low-dose group, no serious sepsis or death developed as a result of the marrow depression. Mild neurotoxicity was observed in 55% of the patients in the high-dose group and only 20% in the low-dose group. Mild nephrotoxicity was seen in 25 and 17% of patients in the high- and low-dose groups, respectively. It was concluded that the 120 mg/m2 dose DDP and cyclophosphamide combination should be used in the treatment of carcinoma of the ovary in spite of its toxicities. However, it should only be used in institutions with supportive facilities in the management of patients with severe marrow depression.
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PMID:A randomized study of high-dose versus low-dose cis-platinum combined with cyclophosphamide in the treatment of advanced ovarian cancer. Hong Kong Ovarian Carcinoma Study Group. 276 62

Of 133 patients with advanced urothelial tract cancer given methotrexate (MTX), vinblastine (VBL), Adriamycin (ADR) (doxorubicin; Adria Laboratories, Columbus, OH), and cisplatin (DDP) (M-VAC regimen), significant tumor regression occurred in 72% +/- 8% of 121 with transitional cell carcinoma (TCC) evaluable for response. Complete remission (CR) was achieved in 36% +/- 9% of patients, of whom 11% required the addition of surgical resection of residual disease. Although 68% of CR patients have relapsed, CR median survival will exceed 38 months compared with 11 months for partial (36%) and minor (6%) responders, and 8 months for nonresponders: 2-year and 3-year survivals were 68% and 55%, respectively, versus 0% to 7% for the remaining patients. Sixteen percent of responders developed brain lesions, half of whom had no systemic relapse at the time of progression. Three patients with non-TCC histologies did not respond. In 32 patients who had pathologic restaging, the clinical (T) understaging (T less than pathologic [P] restaging) error was 35%. Although all metastatic sites showed evidence of tumor regression, CR was noted more frequently in lung, in intraabdominal lymph nodes and masses, and in bone (24% to 35%); the rate for hepatic lesions was 15%. There were 52% of 21 N3-4M0 patients who achieved CR versus 33% of 100 with N0-+M+ lesions. Toxicity was significant with 4 (3%) drug-related deaths, 25% incidence of nadir sepsis, 58% greater than or equal to 3+ myelosuppression, and 49% with mucositis. Responsiveness of metastasis in various sites, patterns of relapse, and the usefulness of the new CR response criteria are reported, as is the current status of cisplatin and methotrexate combination regimens.
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PMID:Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced transitional cell carcinoma of the urothelium. Efficacy and patterns of response and relapse. 281 54

The compatibility of etoposide (VP-16-213) and cisplatin (CDDP) in an admixture solution was established by High Pressure Liquid Chromatography (HPLC) studies in vitro at room temperature. A Phase I dual-dose escalation study of the admixture was subsequently carried out utilizing a 24-hour continuous infusion schedule administered for 3 consecutive days and repeated at 3 to 4 week intervals. Twenty-seven patients received a total of 42 treatment courses. The daily dose rates for VP-16-213 were 50, 75, and 100 mg/m2/day. Cisplatin was delivered at 20, 30, and 40 mg/m2/day for each dose level of VP-16-213. Dose-rate limiting toxicity was observed first at the VP-16 dose of 50 mg/m2/day and CDDP at 30 mg/m2/day. At 100 mg/m2/day for VP-16-213, six of 17 courses were associated with life-threatening leukopenia and four of six patients died with sepsis. All but one of the patients developing severe or life-threatening leukopenia had associated acute renal failure with serum creatinine levels greater than 2 mg/dl. The optimal dose rate of delivery for VP-16 and CDDP administered as a 72-hour infusion admixture is 75 mg/m2/day and 30 mg/m2/day, respectively.
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PMID:Etoposide admixed with cisplatin. Phase I clinical investigation of 72-hour infusion. 291 88

Methotrexate, Cisplatin, and Vinblastine (MCV) was followed by Cisplatin plus radiation therapy in 19 patients with muscle-invading clinical Stage T2-4NXM0 transitional cell carcinoma of the urinary bladder (including cystectomy candidates), to achieve local control and prevent distant metastases. Radical cystectomy was recommended for all patients who failed to reach a complete response (CR = biopsy negative and cytology not positive) following MCV and Cisplatin X 2 plus 4000 cGy. Completely responding patients, and those partially responding patients unsuited for cystectomy, were selected for bladder conservation treated with additional irradiation to the bladder tumor volume (total 6,480 cGy) plus one additional Cisplatin treatment. Dose reductions were required for stomatitis in 26%, mild bone marrow depression in 58%, and renal toxicity in 5% of the patients. During the Cisplatin/4000 cGy, mild dysuria occurred in 68% of patients and 36% had mild bowel hyperactivity. Serious complications have occurred in two patients to date. One patient had recurrent pulmonary emboli, marked reduction in bladder capacity, and diarrhea. A second had bladder perforation during cystoscopic evaluation after MCV and a small bowel obstruction after Cisplatin and 4000 cGy. There was no treatment-related sepsis. Three patients had initial complete transurethral resection of their tumors and therefore 16 patients are evaluable for tumor responsiveness to this protocol. Four patients (25%) were biopsy negative and cytology negative, whereas three additional patients (19%) were biopsy negative but cytology positive following initial MCV. Six patients (38%) were biopsy negative and cytology negative whereas three additional patients (19%) were biopsy negative and cytology positive following MCV and Cisplatin X 2 plus 4000 cGy pelvic radiation. Of the entire group, 9 patients were treated with full-dose radiotherapy. All of these patients are alive without evidence of tumor on rebiopsy of the original tumor site, but one has a persistent positive cytology. Seven patients had a radical cystectomy and 6 are disease free. The treatment of 3 patients deviated from the protocol. Overall, only one patient has developed distant metastases and currently 84% of the patients are disease-free, although follow-up is short. To date, this feasibility study has been clinically practical and well tolerated. The proportion of CR's suggests that this program may prove to be an organ-sparing and curative approach for a significant number of patients, but more experience and follow-up are required.
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PMID:Invasive bladder carcinoma: preliminary report of selective bladder conservation by transurethral surgery, upfront MCV (methotrexate, cisplatin, and vinblastine) chemotherapy and pelvic irradiation plus cisplatin. 318 28


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