amphotericin-b and Carcinoma--Small-Cell

Esophagitis is an important side effect in thoracic radiotherapy, no preventive drug therapy has been established yet. The aim of the present study was to prospectively evaluate the effectiveness of prophylactic antimycotic treatment with amphotericin B lozengers.. 40 consecutive patients with high-dose thoracic radiotherapy for lung cancer were investigated in a nonrandomized study. 20 patients receiving a median maximal esophageal dose of 67 Gy (range 61-80 Gy) were treated with amphotericin B lozengers four times daily from day 8 to the end of radiotherapy. Another 20 patients with a lower median maximal esophageal dose of 60 Gy (range 51-67.5 Gy) constituted the control group. Length of the irradiated esophagus and dose-length indices were evaluated. Side effects were prospectively scored according to the RTOG/EORTC criteria. There was a trend toward higher esophageal volumes in the prophylaxis group; furthermore, patients in this group were older, had a worse median Karnofsky Index and had more often received induction chemotherapy.. In the prophylaxis group, 15 patients remained free from esophagitis and five patients developed esophagitis grade 1. In the control group, four patients remained free from symptoms, 14 patients showed esophagitis grade 1 and two patients grade 2. The difference between the two groups was statistically significant (p < 0.05). The start of symptoms was delayed in the prophylaxis group in comparison to the control group: day 21 (median, range 14-44) and day 18 (median, range 10-32) respectively. Amphotericin B lozengers were tolerated without side effects by all patients.. Prophylactic administration of amphotericin B lozengers seems to effectively prevent radiation-induced esophagitis.

Topics: Administration, Oral; Adult; Aged; Amphotericin B; Antifungal Agents; Candidiasis; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Esophagitis; Esophagus; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Prospective Studies; Radiation Injuries; Radiotherapy, High-Energy

The rate of objective response to second-line chemotherapy with cyclophosphamide, adriamycin and vincristine increased from 13% to 55% in two consecutive series of patients with small-cell lung cancer when the therapy was potentiated by amphotericin B (2 mg/kg i.v.) entrapped in liposomes (= ampholiposomes). Patients who received ampholiposomes had a rapid and significant (p less than 0.01) increase of serum TNF alpha concentrations (median value: from less than 10 to 261 pg/mL) followed by a rise in serum neopterin and CRP. No major side effects were observed. Administration of ampholiposomes appeared to be a safe method for obtaining relatively high serum levels of TNF alpha that could potentiate anticancer chemotherapy.

Topics: Adult; Aged; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Biopterins; C-Reactive Protein; Carcinoma, Small Cell; Cyclophosphamide; Doxorubicin; Drug Carriers; Drug Synergism; Humans; Liposomes; Lung Neoplasms; Male; Middle Aged; Neopterin; Tumor Necrosis Factor-alpha; Vincristine

Topics: Adult; Aged; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Small Cell; Cyclophosphamide; Doxorubicin; Female; Humans; Liposomes; Lung Neoplasms; Male; Middle Aged; Vincristine

The invasive aspergillus pneumonias have been described particularly in chemotherapy for patients with haematological disorders. In respiratory disorders such cases are exceptional. The authors report a case of invasive aspergillus pneumonia, occurring during treatment of a small cell cancer; the rapid commencement of anti-fungal treatment by Amphotericin "B" and Flucytosine enabled an apparent cure of the tumour by radiotherapy and chemotherapy. The authors stress the difficulty of definitive diagnostic criteria at the beginning of the disorder and also the need to start anti-fungal treatment as soon as possible.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Aspergillus fumigatus; Carcinoma, Small Cell; Drug Therapy, Combination; Flucytosine; Humans; Lung; Lung Diseases, Fungal; Lung Neoplasms; Male; Middle Aged; Radiography; Radioisotope Teletherapy; Sputum

Eighteen patients with unresectable bronchogenic carcinoma were treated with amphotericin B (7.5 mg/m2 on day 1, 15 mg/m2 on day 2, and 30 mg/m2 on days 3 and 4) plus BCNU (250 mg/m2 on day 4 following amphotericin B) with courses of therapy repeated every 8 weeks. All patients had metastatic disease, and 5 had received prior chemotherapy. Antitumor responses were observed in 8 patients. Six patients had partial responses (greater than 50% decrease in tumor area): 1 of 3 with small cell undifferentiated carcinoma, 1 of 4 patients with large cell undifferentiated carcinoma, 2 of 7 patients with adenocarcinoma, and 2 of 4 patients with epidermoid carcinoma. Two patients had objective improvement (25--50% decrease in tumor area): 1 with small cell undifferentiated carcinoma and 1 with epidermoid carcinoma. The median duration of remission was 3 months. The median duration of survival was 7 months for patients achieving partial response, and only 2 months for other patients. Myelosuppression was the dose limiting toxicity. One patient died with hepatocellular dysfunction, possibly related to BCNU. Transient hypotension was observed in 2 patients. We conclude that amphotericin B plus BCNU produced an encouragingly high response rate in patients with bronchogenic carcinoma, and that a randomized phase III trial is warranted to determine whether amphotericin B enhances the antitumor effects of nitrosoureas or other known antitumor agents.

Topics: Adenocarcinoma; Adult; Aged; Amphotericin B; Bone Marrow; Carcinoma, Bronchogenic; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Carmustine; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Lung Neoplasms; Male; Middle Aged