周剂量紫杉醇联合替吉奥治疗晚期胃癌(英文)

Objective:There remains no standard first-line chemotherapeutic regimen for advanced gastric cancer (AGC).The aim of this study was to evaluate the efficacy and safety of combination regimen with weekly paclitaxel and S-1 as a first-line chemotherapy for AGC. Methods:Forty-six patients with AGC were included in this study. Paclitaxel was administered weekly at a dose of 60 mg/m2 on days 1, 8 and 15, S-1 was administered orally twice daily at 80 mg/m2/day for 2 weeks. The regimen was repeated every four weeks. Results:The results showed that the overall response rate was 45.7%, with 3 patients achieved complete response and 18 patients had a partial response, the disease control rate was 76.1%. The median progress free survival was 7.2 months 95% confidence interval (CI):6.3-8.1 months and the median overall survival was 11.6 months (95% CI:10.6-12.6 months) after treatment with paclitaxel and S-1. Neutropenia occurred in 25 patients (54.3%) and grade 3/4 neutropenia was observed in 8 patients (17.4%), gastrointestinal reactions were the most common non-hematologic toxicities, while severe gastrointestinal toxicities were uncommon. Conclusion:The regimen of weekly paclitaxel and S-1 demonstrated activity and acceptable toxicity for AGC as a first-line chemotherapy.     

Clinical Research on Use of Oxaliplcrtin in Combination with HCPT, LV and 5FU in a Regimen for Advanced Gastric Cancer

OBJECTIVE To observe the effects and adverse reactions of a OXA-HCPT LV/5FU 3 regimen for patients with advanced gastric cancer.METHODS OHLF3 regimen: OXA 130 mg/m^2iv d 1, HCPT6 mg/m^2, iv d 1-5, LV 200 mg/m2iv 2 h followed by a 5FU 400 mg/m2 iv bolus and 5FU 600mg/m2 iv d 1-3, were given, every 21 days as 1 cycle. Assessment of the tumor was conducted after 3 cycles and the effective cases were confirmed after 4 weeks.RESULTS Among 39 patients, 36 were actually evaluable. Overall response rates (CR PR} were 50%‘ the major adverse reactions were mild hematological toxicity, nausea and vomiting and peripheral nerve abnormalities.CONCLUSION The OHLF 3 regimen using OXA and HCPT is effective and results in mild toxicity when used in combined chemotherapy for advanced gastric cancer.     

Pemetrexed in Previously Treated Non-small Cell Lung Cancer Patients with Poor Performance Status

Background and objective Pemetrexed have been approved for the treatment of patients affected by advanced non-small cell lung cancner(NSCLC) in progression after first-line chemotherapy.We evaluated the activity and feasibility of pemetrexed in previously treated NSCLC.Methods Patients with histologically or cytologically confirmed NSCLC were evaluated from April 2007 to March 2009.The patients had relapsed or progressed after prior chemotherapy treatment.Pemetrexed(500 mg/m2) was administered intravenously once every 3 weeks after progression to prior chemotherapy.The tumor response was evaluated according to RECIST criteria by chest CT at every 2 cycles of chemotherapy.Results A total 61 patients were eligible for analysis.Performance status of them(100%) was over 2.The response rate and disease control rate were 14.7% and 37.7% respectively.Non-squamous cell carcinoma histology was significantly associated with a superior response rate(P=0.045) and disease control rate(P=0.008).The median survival time and the median progression free survival(PFS) time were 6.11 months and 2.17 months,respectively.Comparing the efficacy of pemetrexed in these two settings [second-line versus(12/61) more than third(49/61)],there was no significant difference in regard to median survival(11.18 months vs 11.46 months,P=0.922,5),but PFS was more longer in third-or further-line groups than second-line group(1.39 months vs 2.25 months,P=0.015,3).Conclusion Pemetrexed is a feasible regimen in previously treated NSCLC with poor performance status.     

The effect of pirarubicin chemotherapeutic regimen on osteosarcoma associated with lung metastasis and myocardial function assessment北大核心

Objective: To evaluate the clinical effect of pirarubicin (THP) chemotherapeutic regimen on osteosarcoma with lung metastasis, detect the heart function, and evaluate the adverse reactions induced by THP. Methods: For the 32 patients THP 50 mg/m2 was given on day 1 and cisplatin (DDP) was given for 2-3 d with total dosage of 80 mg/m2 or ifosfamide (IFO) was given for 4 d with total dosage of 8 g/m2. A color Doppler ultrasound echocardiography was used to measure the ejection ratio of left ventricle and the heart function parameters such as E/A value. Results: The survival time was (31.00 ±7.98) months and the disease free time was (13.00 ± 2.46) months. The objective remission rate was 46. 88% and the partial remission rate was 40.63 % in osteosarcoma patients with lung metastasis after combined THP chemotherapy. The side effects induced by THP treatment mainly involved gastrointestinal reaction and bone marrow depression. The left ventricular ejection fraction showed no significant difference between the groups who received various THP cumulative dosages. The E/A value was significantly decreased in high THP cumulative dosage group after chemotherapy (P < 0.05). Conclusion: The THP chemotherapeutic regimen is effective and safe in the treatment of osteosarcoma with lung metastasis, which could be served as a salvage chemotherapeutic regimen. Two dimensional and color Doppler echocardiography may be valuable to assess the early cardiotoxicity induced by anthracyclines.     

Clinical observation of capecitabine monotherapy in elderly patients with advanced breast cancer

Objective The aim of the study was to evaluate the safety and efficacy of capecitabine mono-chemotherapy in elderly patients with advanced breast cancer. Methods The data from 36 cases of capecitabine monotherapy in elderly patients with advanced breast cancer were retrospectively analyzed. Oral administration of capecitabine 2000 mg/m2 twice daily(D1–14) for 21 days constituted a cycle. The effect of the disease and main adverse reactions were evaluated every 2 cycles. Results The data from 36 elderly patients were studied. The median number of chemotherapy cycles was 4. The total effective rate was 30.6%(11/36) and the disease control rate was 72.2%(26/36). The number of patients with clinical complete remission was 2, clinical partial response was 9, stable disease was 15, and progressive disease was 10. Where treatment was effective, the median time to progression was 6 months and the median overall survival was 9.5 months. The main adverse events were gastrointestinal reactions, bone marrow suppression, and oral mucositis; most of the reactions were grade 1 to 2. Grade 3 to 4 adverse reactions included granulocytopenia in 2 patients(12.5%) and hand-foot syndrome in 1 patient(6.7%).Conclusion Capecitabine monotherapy was effective in controlling disease progression, and adverse reactions were tolerated by elderly patients with advanced breast cancer.     

艾迪注射液对晚期非小细胞肺癌NP方案化疗的影响

Objective:To evaluate the effects of Aidi injection on vinorelbine plus cisplatin(NP) chemotherapy for advanced non-small cell lung cancer(NSCLC).Methods:Ninety eight patients with advanced NSCLC were randomized to receive either NP alone or NP plus Aidi injection every 3 weeks.The primary endpoint was overall survival;secondary endpoints included overall response rate,time to progression,and safety.Results:The median overall survival time was 11.6 months in NP plus Aidi-treated patients and 10.1 months in NP alone-treated ones,and 1-and 2-year survival rates were higher in the former(47% and 22%) than the latter(42% and 15%).The overall response rates in Aidi injection plus NP-treated patients tended to be higher but not statistically significant compared with NP alone-treated ones.The occurrence rates of grades 3 or 4 toxicities,e.g.fatigue,nausea,vomiting,appetite loss,leucopenia,thrombocytopenia and anemia,were lower in Aidi injection plus NP-treated patients than NP alone-treated ones,although not significantly different between them.Conclusion:Aidi injection promotes NP chemotherapeutic effects,reduces the toxicities,and improves the patients' tolerance to chemotherapy as well.It may be an effective adjunct to chemotherapy in patients with NSCLC.     

小剂量CHG预激方案治疗老年人急性髓系白血病的临床研究

Objective To explore the efficacy and side effect of inductive chemotherapy with lowdose,cytarabine,homoharringtonine and granulocyte colony-stimulating factor(CHG) in elderly acute myeloid leukemia(AML). Methods Thirty-five elderly patients (age＞60 years) with AML were enrolled for the initial treatment with CHG regimen,The CHG regimen consisted of cytarabine 10 mg/m2 per 12 h by subcutaneous injection,days 1-14,homoharringtonine 1 mg/m2 per day by intravenous continuous infusion,days 1-14,and G-CSF 200 μg/m2 per day by subcutaneous injection 12 h before chemotherapy,days 0-14. G-CSF only was used when white blood cell count(WBC) was less than 20×109/L during the whole course. Results After the first course,12 patients achieved complete response (CR),15 patients achieved partial response(PR),and 8 patients had no response(NR). After the second course,5 of 15 PR patients achieved CR,2 of 8 NR patients achieved PR. The total effective rate was 82 % (29/35). Of those 17 CR patients,eleven patients continued maintenance therapy and remained in remission for 12-34 months with a median CR duration of 18 months,the other 6 patients relapsed and were treated with original regimen,including one achieved CR again,4 achieved PR,and 1 achieved NR. The CHG regimen had mild hematologic toxicities and no severe nonhematologic toxicities. Conclusion CHG regimen is effective and well tolerated in remission for elderly AML.     

Influence of tumor response on the survival of patients with extensive-stage small-cell lung cancer treated with the etoposide plus cisplatin chemotherapy regimen

Objective In this study, we evaluated the difference of progression-free survival(PFS) and overall survival(OS) between extensive-stage small-cell lung cancer(ES-SCLC) patients who acquired partial response(PR) or complete remission(CR) after two cycles of first-line chemotherapy with the etoposide plus cisplatin(EP) regimen and those who acquired PR or CR after four or six cycles.Methods A total of 106 eligible patients treated with the EP chemotherapy regimen for two to six cycles, at The General Hospital of Shenyang Military Region(China) between November 2004 and May 2011, were enrolled in this study. RECIST version 1.1 was used for the evaluation of chemotherapy efficiency. We followed up all eligible patients every 4 weeks. All statistical data were analyzed by using SPSS 21.0 statistical package for Windows.Results After a median follow-up of 293 days(range, 62–1531 days), all patients had died by the cutoff date. Fifty-one patients acquired PR or CR after two cycles of chemotherapy; the median PFS reached 6.0 months(95% CI, 5.1–6.9), and the median OS was 10.5 months(95% CI, 8.6–12.4). Twenty-eight patients acquired PR or CR after four or six cycles; the median PFS was 4.8 months(95% CI, 4.4–5.2), and the median OS was 7.5 months(95% CI, 6.8–8.2). Both PFS and OS showed a statistical difference between the two groups. Conclusion ES-SCLC patients who acquired PR or CR after two cycles of the EP regimen as first-line therapy had longer PFS and OS than those who acquired PR or CR after four or six cycles.     

Nab-paclitaxel(abraxane)-based chemotherapy to treat elderly patients with advanced non-small-cell lung cancer:a single center,randomized and open-label clinical trial

Background:The purpose of this study is to evaluate the clinical efficacy and safety of abraxane-based chemotherapy with/without nedaplatin in elderly patients with non-small-cell lung cancer(NSCLC).Materials and methods:From October 2009 to January 2013,48 elderly patients(>65 years) with NSCLC were investigated in this clinical trial.The patients were randomized and equally allocated into arms A and AP:(A) abraxane(130 mg/m~2,days 1,8);(B) abraxane + nedaplatin(20 mg/m~2 days 1-3,q3w).The parameters of objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS),overall survival(OS) and side effects were evaluated between two arms.Results:Over 80%of the patients completed four cycles of chemotherapy.The total ORR was 21.3%,DCR was 55.3%,PFS 4.5 months and OS 12.6 months.No significant difference was found between arms A and AP in terms of ORR(16.7%vs.26.1%,P=0.665) or DCR(55.3%vs.56.5%,P=0.871).The median PFS in arm A was 3.3 months[25-75%confidence interval(CI):3.1-7.2]and 5.5 months(25-75%CI:3.2-7.0) in arm AP with no statistical significance(P=0.640).The median OS in arm A was 12.6 months(25-75%CI:5.7-26.2) and 15.1 months(25-75%CI:6.4-35.3) in arm AP with no statistical significance(P=0.770).The side effects were mainly grade 1-2.The incidence of grade 3-4 toxicities was 29.1%in arm A and 62.5%in arm AP with a statistical significance(P=0.020).Conclusions:Compared with combined therapy,abraxane alone chemotherapy was beneficial for elderly NSCLC patients with better tolerability and less adverse events,whereas did not significantly differ in terms of ORR,DCR,PFS or OS.     

偏小剂量的硼替佐米联合地塞米松治疗初发多发性骨髓瘤疗效观察

目的每次1.75 mg(0.8～1.0 mg/m2)的硼替佐米联合地塞米松对初发多发性骨髓瘤疗效观察。方法17例初发患者接受硼替佐米+地塞米松的方案治疗。硼替佐米每次1.75 mg(0.8～1.0 mg/m2),第1、4、8、11天,3～5秒内静脉推注完成;地塞米松20 mg/d,第1、2、4、5、8、9、11、12天静脉滴注,同时地塞米松0.75mg/d,口服,第1～12天。21天为1个疗程。完成4个疗程。结果完成4个疗程偏小剂量硼替佐米结合地塞米松治疗的初发多发性骨髓瘤患者的有效率为88.23%。高于传统VAD化疗方案的有效率(44.74%),且两者有统计学差异;不低于推荐剂量(1.3 mg/m2)的硼替佐米方案治疗的有效率。结论偏小剂量硼替佐米联合地塞米松对初发多发性骨髓瘤治疗仍有较好疗效,但其对疗效维持的长久性尚需进一步随访观察。     

硼替佐米联合阿霉素、地塞米松治疗初治多发性骨髓瘤的疗效观察

目的　比较硼替佐米联合阿霉素、地塞米松方案（ＰＡＤ方案）与长春新碱联合阿霉素、地塞米松方案（ＶＡＤ方案）治疗初治多发性骨髓瘤（ＭＭ）的疗效和不良反应。方法　ＰＡＤ方案组４１例患者给予硼替佐米１.３ｍｇ／ｍ２静推,第１、４、８、１１天;阿霉素１０ｍｇ／ｄ静滴,第１～４天;地塞米松２０ｍｇ／ｄ静滴,第１～４天,３周为１个周期,每例接受２～６个周期化疗。４０例ＶＡＤ方案组患者予长春新碱０.５ｍｇ／ｄ静滴,第１～４天;阿霉素１０ｍｇ／ｄ静滴,第１～４天;地塞米松２０ｍｇ／ｄ静滴,第１～４天,４周为１个周期,每例接受２～８个周期化疗。化疗２个周期后评价两组患者的疗效和不良反应。结果　两组患者均可评价疗效和不良反应。化疗２个周期后,ＰＡＤ方案组获显效２２例（５３.７％）,ＶＡＤ方案组获显效１０例（２５.０％）,差异有统计学意义（Ｐ＜０.００１）。两组主要不良反应包括消化道症状、周围神经炎、血小板减少、白细胞减少和感染,多为１～２级,经对症治疗后均可缓解。结论 ＰＡＤ方案治疗初治ＭＭ的显效率明显高于ＶＡＤ方案,不良反应可耐受。     

T - VAD 方案联合自体外周血造血干细胞移植治疗多发性骨髓瘤的疗效观察

目的：观察 T - VAD 方案联合自体外周血造血干细胞移植（ autologous peripheral blood hematopoietic stem cells，APBSC）治疗多发性骨髓瘤（multiple myeloma，MM）的临床疗效及不良反应。方法：选取2010年1月-2014年12月采用 T - VAD 方案联合自体外周血造血干细胞移植治疗的30例多发性骨髓瘤患者的临床资料进行回顾性研究。T - VAD 方案：沙利度胺起始剂量为50mg/晚，每周增加50～100mg/晚，最大剂量200mg/晚，若无明显不适，持续服用。长春新碱0.4mg/ d，静脉滴注，第1～4d；多柔比星10mg/（m2·d），静脉滴注，第1～4d；地塞米松40mg/ d，静脉滴注，第1～4d，第9～12d，28d 为一个疗程，共4个疗程。T - VAD 方案4个疗程诱导治疗后给予自体外周血造血干细胞采集、移植术。结果：患者移植术后，造血功能均顺利重建，无移植相关的死亡发生。30例患者在移植后3个月，完全缓解10例（33.3%），高质量缓解（非常好的部分反应，VGPR）16例（53.3%），部分反应2例（6.6%），无变化2例（6.6%）。不良反应主要有不同程度的恶心、呕吐、脱发及骨髓抑制等。结论：T - VAD 联合自体外周血造血干细胞移植治疗多发性骨髓瘤疗效明显，患者耐受性好。     

A Phase II trial of pegylated liposomal doxorubicin,vincristine, and reduced-dose dexamethasone combination therapy in newly diagnosed multiple myeloma patients

BACKGROUND: Patients with multiple myeloma (MM) have increased bone marrow angiogenesis, a low plasma cell labeling index, and multidrug resistance (the primary cause of chemotherapy failure). MM patients receiving the vincristine, doxorubicin, and dexamethasone (VAD) regimen develop resistance and cardiac and steroid toxicity. Pegylated liposomal doxorubicin (Doxil/CAELYX) could potentially extend the duration of malignant plasma cell exposure to therapeutic levels of doxorubicin. This Phase II study evaluates combination pegylated liposomal doxorubicin, vincristine, and reduced-dose dexamethasone in MM patients. METHODS: Thirty-three newly diagnosed patients with MM received intravenous pegylated liposomal doxorubicin (40 mg/m(2)), vincristine (2.0 mg, Day 1), and oral or intravenous dexamethasone (40 mg per day for 4 days) every 4 weeks for six or more cycles and/or for two cycles after the best response. RESULTS: The overall response rate was 88%: 4 (12%) patients achieved a complete response, 18 (55%) a major response, and 7 (21%) a minor response. Three patients (9%) had stable and one (3%) had progressive disease. The median time to progression was 23.1 months, with 2-year and 3-year progression-free survival rates of 42% and 23%, respectively. The patient survival rate at 3 years was 67%. No patients discontinued treatment due to adverse events. Myelosuppression was manageable. The most common toxicities were Grade 3 palmar-plantar erythrodysesthesia, mucositis, and neutropenia. Only one patient experienced cardiotoxicity. CONCLUSIONS: Substituting pegylated liposomal doxorubicin for doxorubicin in the VAD regimen and reducing the dose of dexamethasone in patients with MM improve the safety profile and convenience of the treatment regimen without compromising efficacy.     

沙利度胺联合地塞米松诱导治疗初诊多发性骨髓瘤

背景与目的:沙利度胺是治疗复发、难治性多发性骨髓瘤(multiple myeloma,MM)的有效药物,但其在初诊MM诱导治疗中的作用仍不清楚.本研究目的是评价沙利度胺联合地塞米松(thalidomide and dexamethasone,TD)在初诊MM诱导治疗中的治疗效果和不良反应.方法:应用TD方案诱导治疗39例初诊MM.沙利度胺100～300 mg/d,持续口服;地塞米松20～40 mg/d,在奇数疗程的第1～4天、第9～12天和第17～20天口服;在偶数疗程的第1～4天使用,28天为1疗程.并以36例接受VAD方案诱导治疗的临床资料匹配的初诊MM作为历史对照,比较两组的疗效、生存情况和不良反应.结果:TD方案诱导治疗初诊MM的总有效率为71.8%,VAD组为61.1%(P＞0.05).TD组中位无疾病进展生存时间(progression-free survival,PFS)为14个月,VAD组的中位PFS为9个月,两组相比差异无统计学意义(P＞0.05).TD组的中位总生存时间(overall survival,OS)尚未达到,VAD组中位OS为29个月.TD组常见的不良反应有便秘、乏力、头晕、嗜睡等,多为2级以下.VAD组3级以上白细胞减少和血小板降低明显多于TD组(P＜0.05),各种感染的发生率也高于TD组(P＜0.05).结论:TD方案是对初诊MM有效的治疗方案,可以代替VAD方案作为初诊MM的诱导治疗方案.     

低剂量硼替佐米联合沙利度胺及化疗治疗多发性骨髓瘤35例

 目的　观察低剂量硼替佐米联合沙利度胺及化疗治疗多发性骨髓瘤（MM）患者的疗效及安全性。方法　35例初治及难治复发MM患者,硼替佐米1.1 mg／m2,第0、3、7、10天,静脉注射;沙利度胺从50 mg／d开始逐渐加量至150 mg／d或患者能够耐受的最大剂量;化疗方案根据每疗程患者情况选择MP、VAD或AD方案。28 d为1个疗程,每例患者至少接受2个疗程以上治疗。达到部分缓解（PR）及以上疗效的患者应用沙利度胺150 mg／d或患者能够耐受的最大剂量维持治疗。采用2006年MM国际统一疗效标准观察疗效,根据国际癌症研究中心不良事件通用命名标准评估不良反应。结果　中位随访20个月,35例患者治疗总有效率82.8 ％,其中完全缓解（CR）率48.6 %,良好的部分缓解（VGPR ）率17.1 %,PR率17.1 %。3年预计无进展生存（PFS）和总生存（OS）率分别为60.92 %和72.41 %。达PR以上疗效患者的OS率高于未达PR患者,差异有统计学意义（P＝0.004）。初治及难治复发患者客观缓解率（ORR）及OS率差异无统计学意义。Ⅲ～Ⅳ度非血液学毒性主要包括乏力（3／35）、恶心、呕吐（8／35）、便秘（4／35）和周围神经病变（3／35）。Ⅲ～Ⅳ度血液学毒性为粒细胞缺乏（10／35）和血小板减少（8／35）。结论　低剂量硼替佐米联合沙利度胺及化疗治疗MM具有较好的疗效及安全性,沙利度胺维持治疗可延长患者PFS时间。     

小剂量沙利度胺联合含单周地塞米松的VAD方案治疗多发性骨髓瘤42例

目的观察小剂量沙利度胺联合含单周地塞米松的VAD方案治疗多发性骨髓瘤（MM）的临床疗效及不良反应。方法给予42例MM患者小剂量沙利度胺（150～200）mg／d联合含单周地塞米松（40mg,口服,第1天至第4天）的VAD方案治疗,28d为1个疗程。4个疗程后进行总体评估。结果总有效率为80．95％（34／42）;其中完全缓解6例,部分缓解20例,进步8例,无效8例。不良反应轻微,患者治疗前后血红蛋白、骨髓浆细胞比例、β2微球蛋白、Karnofsky评分、血肌酐、血免疫球蛋白差异均有统计学意义（均P〈0．001）。结论小剂量沙利度胺联合含单周地塞米松的VAD方案治疗MM有效率高,不良反应轻微,值得临床进一步研究和推广应用。     

Pegylated liposomal doxorubicin, vincristine, and reduced-dose dexamethasone as first-line therapy for multiple myeloma

In patients with multiple myeloma (MM) who may ultimately receive active therapy, the combination of VAD (vincristine, doxorubicin, and dexamethasone) has been shown to be effective. However, the use of VAD is complicated by inherent risks that result from the use of central venous catheters, steroid toxicity, and by doxorubicin-associated adverse events such as cardiotoxicity and alopecia. To address these issues, a phase II trial investigating the combination of vincristine, pegylated liposomal doxorubicin, and reduced-schedule oral dexamethasone in the first-line treatment of patients with MM has been conducted. Patients with symptomatic, newly diagnosed MM were treated with intravenous (i.v.) pegylated liposomal doxorubicin 40 mg/m2 and vincristine 2 mg on day 1, along with dexamethasone 40 mg/day given either i.v. or orally for 4 days, every 4 weeks for a minimum of 6 cycles. Responses were reported in 29 patients (88%), and an additional 3 patients achieved stable disease. The median time to maximal response was 5.8 months (range, 0.7-13.6 months), and median overall survival time is estimated to be 60 months. This treatment regimen was well tolerated, and the most common grade 3/4 adverse events included hand-foot syndrome (21%), neutropenia (30%), anemia (21%), and mucositis (12%). Based on these results, the vincristine/liposomal doxorubicin/dexamethasone regimen appears to be effective and well tolerated in the first-line treatment of MM.     

Temozolomide for the treatment of brain metastases associated with metastatic melanoma: a phase II study.

PURPOSE: Temozolomide is a well-tolerated oral alkylating agent with activity in the CNS. A multicenter, open-label, phase II study was conducted to assess the safety and efficacy of temozolomide in patients with brain metastases from metastatic melanoma (MM) who did not require immediate radiotherapy. PATIENTS AND METHODS: Eligible patients had histologically confirmed MM to the brain, and no prior radiotherapy or radiosurgery for brain metastases. Previously untreated patients received temozolomide at 200 mg/m(2)/d x 5 days; previously treated patients received 150 mg/m(2)/d x 5 days every 28 days. Treatment continued for 1 year or until disease progression or unacceptable toxicity. RESULTS: Of 151 patients enrolled, 117 had received no prior systemic chemotherapy, and 34 had received prior chemotherapy for MM. Among previously untreated patients, 25% had more than four brain lesions, eight (7%) achieved an objective response (one complete and seven partial), and 34 (29%) had stable disease in brain metastases. Median overall survival was 3.5 months. Among previously treated patients, 21% had more than four brain lesions, one had a partial response, and six (18%) had stable disease in brain metastases. Median overall survival was 2.2 months. Temozolomide was well tolerated, with four (3%) patients discontinuing because of adverse events. Grade 3/4 hematologic toxicities included thrombocytopenia (3%), neutropenia (2%), and leukopenia (1%). Headache (9%) and vomiting (8%) were the most common nonhematologic grade 3/4 adverse events. CONCLUSION: Temozolomide was well tolerated and demonstrated activity in the treatment of brain metastases from MM. Further evaluation of temozolomide combination therapy is warranted.     

Maintenance with pamidronate following first-line MP or VAD therapy in multiple myeloma

We investigated the anti-tumor effect of pamidronate after obtaining a decrease of serum monoclonal immunoglobulin (Ig) level by conventional chemotherapy in patients with multiple myeloma (MM) in order to evaluate whether the drug is useful as maintenance therapy for MM. Eight patients with MM received 60 mg/d pamidronate every third week for 6-18 months without chemotherapeutic agents or corticosteroids after the treatment with melphalan and prednisolone, or vincristine, adriamycin and prednisolone. Serum Ig and beta2-microglobulin (b2MG) levels were maintained at the levels obtained after the termination of chemotherapy in six and four out of eight patients, respectively. Hemoglobin levels were maintained at, or increased to more than, the levels observed at the end of chemotherapy in six patients. Decreased plasma cells in the bone marrow after the chemotherapy were evident in five patients. Two patients were categorized as non-responders, because Ig and b2MG increased and anemia progressed after treatment with the drug. Despite the very small numbers, the results suggest that pamidronate may have anti-tumor activity and be useful for treatment after the conventional chemotherapy in some cases of MM.