melphalan and Uterine-Neoplasms

To examine the perioperative and survival outcomes in women with disseminated peritoneal uterine leiomyosarcoma (uLMS) who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).. A comprehensive systematic review of literature was conducted using multiple public search engines, PubMed, Scopus, and the Cochrane Library, in compliance with the PRISMA guidelines. Women with disseminated peritoneal uLMS treated with CRS-HIPEC were analyzed. Perioperative morbidity and mortality rate as well as oncologic outcomes related to CRS-HIPEC were assessed.. Ten studies met the inclusion criteria from 2004 to 2020, including 8 case series (n=28) and 2 original articles (n=47). Of the 75 patients, 68 (90.7%) were women with uLMS whereas 7 women were non-uLMS. Of these, 64 (85.3%) had recurrent disease, and 39 (52.0%) received chemotherapy or radiotherapy prior to CRS-HIPEC. The perioperative mortality rate was 4.0% (intraoperative 1.3%, and postoperative 2.7%), and postoperative complications (grade ≥3) rate ranged 21.4-22.2%. With regard to HIPEC regimens (n=75), cisplatin was most frequently used (n=55, 73.3%) followed by melphalan (n=17, 22.7%) and others (n=3, 4.0%). Among the two observational studies, the median overall survival after CRS-HIPEC treatment was 29.5-37 months. In one limited comparative effectiveness study (n=13), albeit statistically non-significant CRS-HIPEC was associated with higher progression-free survival versus CRS alone (3-year rates, 71.4% versus 0%, P=0.10). When the HIPEC regimens were compared, melphalan use was associated with decreased uLMS-related mortality compared to a cisplatin-based regimen, but the association was not statistically significant (hazard ratio 0.35, 95% confidence interval 0.04-3.05, P=0.35).. Effectiveness of CRS-HIPEC for disseminated peritoneal uLMS is yet to be determined. As interpretation of the available data on survival is limited due to small sample sizes or the lack of an active comparator, further study is warranted to examine the safety and survival effect of CRS-HIPEC in disseminated peritoneal uLMS.

Topics: Antineoplastic Agents, Alkylating; Clinical Trials, Phase III as Topic; Cytoreduction Surgical Procedures; Female; Humans; Hyperthermic Intraperitoneal Chemotherapy; Leiomyosarcoma; Melphalan; Randomized Controlled Trials as Topic; Treatment Outcome; Uterine Neoplasms

Topics: Carcinoma; Chlorambucil; Cyclophosphamide; Female; Genital Neoplasms, Female; Humans; Hysterectomy; Lymph Node Excision; Melphalan; Ovarian Neoplasms; Progestins; Radiotherapy, High-Energy; Thiotepa; Uterine Cervical Neoplasms; Uterine Neoplasms

Fifty consecutive patients with recurrent and metastatic endometrial carcinoma were treated with melphalan, 5-fluorouracil, and medroxyprogesterone acetate with or without tamoxifen as first-line chemotherapy. The objective response rate was 48%, with 20% complete responses. The estimated median progression-free survival time was only five months (0.5 to 65 months) with estimated two- and five-year progression-free survival rates of 16 and 13%, respectively. The estimated median progression-free survival time was 24 months for complete responders; the progression-free survival times were significantly longer than the survival times (median = four months) for all other patients (P = .0002). Whether or not the addition of cytotoxic chemotherapy to progesterone hormonal therapy for metastatic endometrial carcinoma lengthens survival time is still open to question.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma; Female; Fluorouracil; Humans; Medroxyprogesterone; Melphalan; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Prospective Studies; Random Allocation; Tamoxifen; Thrombocytopenia; Uterine Neoplasms

A patient with gestational trophoblastic disease failed to respond to all standard multiple-agent chemotherapy and had progressive uterine disease. Total hysterectomy also proved ineffective. We therefore administered high-dose cyclophosphamide, etoposide, and melphalan with autologous bone marrow support. Severe marrow suppression followed but a complete remission was achieved and the patient remains free of disease 3 years after the completion of therapy. This result seems to confirm the value of using high-dose multiagent therapy to optimize the dose-effect of therapy regimens on drug-refractory gestational trophoblastic disease.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Choriocarcinoma; Combined Modality Therapy; Cyclophosphamide; Dose-Response Relationship, Drug; Etoposide; Female; Humans; Hysterectomy; Melphalan; Pregnancy; Transplantation, Autologous; Trophoblastic Tumor, Placental Site; Uterine Neoplasms

The clinical and pathologic findings in a 53-year-old woman who developed a uterine adenosarcoma following an adenomyoma are described. During the interval between the diagnosis of adenomyoma and the subsequent diagnosis of adenosarcoma, the patient developed breast carcinoma and received adjuvant chemotherapy that included tamoxifen. The possible stimulatory effects of this drug upon the patient's pre-existing adenomyoma are discussed in view of reports of tamoxifen-associated endometrial carcinoma and uterine sarcomas developing in the setting of estrogen excess.

Topics: Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Cell Transformation, Neoplastic; Combined Modality Therapy; Doxorubicin; Endometriosis; Female; Fluorouracil; Humans; Melphalan; Menopause; Middle Aged; Tamoxifen; Uterine Neoplasms; Wilms Tumor

The ATP bioluminescence assay has demonstrated a strong potential to become a clinical assay for chemosensitivity testing. Currently, chemotherapy of gynecologic cancers remains controversial and empirical. To optimize the patient's chance of survival and to justify related toxicities, the chemoregimen should be individualized and based on the patient's chemosensitivity profiles. This study was performed to identify a panel of active drugs against uterine cancer cell lines for possible use in future chemosensitivity testing. We used the ATP chemosensitivity assays to screen 12 common cytotoxic agents against six uterine cancer cell lines. Drug concentrations required for a 50% surviving fraction were defined as IC50s. When using an IC50 of 0.21 PPC (peak plasma concentration) as a cutoff value for sensitivity, the following 8 drugs were considered effective for uterine cancer cell lines: actinomycin D, Adriamycin, vinblastine, etoposide, 5-fluorouracil, methotrexate, cytosine arabinoside, and mitomycin-C. Meanwhile, 4 drugs, cisplatin, 4OH-Cytoxan, bleomycin, and Alkeran with mean IC50s of 2.1 +/- 0.7, 0.8 +/- 0.1, greater than 5.0, and 0.75 +/- 0.36 PPC, respectively, were considered inactive or partially active with higher IC50s than peak plasma concentrations. In conclusion, the above panel of promising drugs can be further tested in animal models or human cancer specimens for possible use in chemosensitivity testing of uterine cancer patients.

Topics: Adenocarcinoma; Adenosine Triphosphate; Alkaloids; Antineoplastic Agents; Cisplatin; Cyclophosphamide; Drug Screening Assays, Antitumor; Endometrial Neoplasms; Female; Humans; Intercalating Agents; Kinetics; Luminescent Measurements; Melphalan; Mitomycin; Tumor Cells, Cultured; Uterine Neoplasms

A retrospective evaluation of 87 cases of uterine sarcoma treated during 1965-1980 at two Swedish hospitals has been made. Adjuvant postoperative radiotherapy has been compared with adjuvant chemotherapy. Various types of combination treatments were also evaluated. Both types of adjuvant therapy seem to reduce the failure rate, both locally in the pelvis and at distant sites, although survival, studied by the life table technique, was unaffected. Radiotherapy appears to reduce the number of pelvic failures when used as combination therapy and chemotherapy tends to prevent distant recurrences when used together with surgery. Further prospective and randomized studies are needed, however, to answer the question of the long-term value of adjuvant radiotherapy and/or chemotherapy in the treatment of uterine sarcomas.

Topics: Adult; Age Factors; Aged; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cyclophosphamide; Dacarbazine; Doxorubicin; Female; Humans; Leiomyosarcoma; Melphalan; Middle Aged; Parity; Postoperative Care; Prognosis; Radiotherapy Dosage; Retrospective Studies; Sarcoma; Uterine Neoplasms; Vincristine

The case of a 74-year-old female with an IgD kappa plasma cell leukemia is presented. In contrast to the majority of the cases in the literature, this patient responded rather well to melphalan and prednisolone and survived for 20 months after starting treatment. Another remarkable feature was the simultaneous occurrence of a double uterine neoplasm, a malignant mixed Müllerian tumor of the homologous variety (also called carcinosarcoma).

Topics: Adnexa Uteri; Aged; Allopurinol; Ampicillin; Carcinosarcoma; Female; Gentamicins; Humans; Hysterectomy; Immunoglobulin D; Immunoglobulin kappa-Chains; Leukemia, Plasma Cell; Melphalan; Pneumonia; Prednisolone; Uterine Neoplasms

Serum vitamin A and retinol-binding protein (RBP) concentrations were measured in patients comprising 53 myeloma and 28 epithelial cell cancer cases. Vitamin A levels in these patients were found to be significantly lower than those in the 30 healthy subjects, the effect being more marked in the patients with cancer of epithelial origin. The serum concentrations of retinol-binding protein (RBP) fell in parallel with vitamin A in the epithelial cancer patients, while the RBP concentrations remained unaffected in the patients with myeloma, suggesting that the underlying factor for resulting low vitamin A levels may be different in these two groups of patients.

Topics: Adult; Aged; Breast Neoplasms; Female; Humans; Lung Neoplasms; Male; Melphalan; Middle Aged; Multiple Myeloma; Retinol-Binding Proteins; Urinary Bladder Neoplasms; Uterine Neoplasms; Vitamin A

In patients with advanced uterine corpus carcinoma treated with the combination chemotherapy of megestrol, cyclophosphamide, and doxorubicin (MCA) or with this combination and 5-fluorouracil (MCAF), the overall response rate was 22%. There was no significant difference in response rates between the two regimens. There is some indication that survival was longer in ambulatory patients who were treated with MCA, but this combination produced more hematologic toxicity than MCAF. Patients unsuitable for treatment with doxorubicin received megestrol, 1-phenylalanine mustard, and 5-fluorouracil (MLF), which produced objective responses in 2 of 12 patients.

Topics: Antineoplastic Agents; Cyclophosphamide; Doxorubicin; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluorouracil; Humans; Megestrol; Melphalan; Uterine Neoplasms

Two patients with measurable recurrent endometrial adenocarcinoma achieved complete remission proven by second-look operation. Both patients were treated with a combination of melphalan, 5-fluorouracil and medroxyprogesterone acetate.

Topics: Adenocarcinoma; Aged; Drug Therapy, Combination; Female; Fluorouracil; Humans; Medroxyprogesterone; Melphalan; Middle Aged; Uterine Neoplasms

Topics: Adenocarcinoma; Bundle-Branch Block; Doxorubicin; Female; Humans; Melphalan; Middle Aged; Postoperative Care; Uterine Neoplasms

The purpose of this study was to evaluate therapy with melphalan, 5-fluorouracil (5-FU), and medroxyprogesterone acetate combination (MFP) in women with metastatic or recurrent endometrial carcinoma not amenable to surgery or radiation therapy, as compared to progesterone therapy alone. Previously, the authors have treated 114 women with progesterone therapy and achieved a 15.8% objective response rate; 7.0% were complete responders. Thirteen women with documented recurrent or metastatic endometrial carcinoma were entered into the MFP study. Thirteen were evaluable for toxicity and 11 for response (2 had no measureable parameter). Treatment consisted of melphalan 0.2 mg/kg/day for 4 days every 4 weeks; 5-FU 15 mg/kg/day for 4 days every 4 weeks; and medroxyprogesterone acetate 1.0 g intramuscularly weekly. Two of the first 3 patients who were treated with this regimen developed severe thrombocytopenia (platelets, 25,000 and 17,000/mm3). Therefore, the remaining 10 patients received 5-FU at a dose of 10 mg/kg/day for 4 days every 4 weeks. Except for 1 patient who devloped thrombophlebitis, there was no other significant toxicity in the 90 courses of therapy received by the 13 women. Of the 11 women evaluable for respone, 6 (54.5%) responded (2 complete responders, 4 partial responders), 2 for stationary disease, and 3 progressed after having had stationary disease for 3, 6, and 9 months, respectively. Of special interest was that the 2 women with adenosquamous carcinoma responded and 1 additional patient with adenocarcinoma maintained a complete response with 5-FU therapy alone.

Topics: Adenocarcinoma; Antineoplastic Agents; Drug Therapy, Combination; Female; Fluorouracil; Humans; Medroxyprogesterone; Melphalan; Neoplasm Metastasis; Neoplasm Recurrence, Local; Uterine Neoplasms

Topics: Adult; Antineoplastic Agents; Cyclophosphamide; Dactinomycin; Drug Resistance; Drug Therapy, Combination; Female; Humans; Hydroxyurea; Leucovorin; Melphalan; Methotrexate; Pregnancy; Trophoblastic Neoplasms; Uterine Neoplasms; Vincristine

Combination chemotherapy can produce a rapid and frequent therapeutic effect against advanced endometrial adenocarcinoma regardless of the tumor distribution. A new treatment program is described. Melphalan, 5-fluorouracil, and medroxyprogesterone acetate achieved 6 of 7 objective responses in patients. This result with combination chemotherapy is substantially better than results with single agents or hormones alone and justifies further evaluation of combinations of cytotoxic chemotherapy as part of the initial treatment of choice for patients with advanced endometrial adenocarcinoma.

Topics: Adenocarcinoma; Aged; Drug Therapy, Combination; Female; Fluorouracil; Humans; Medroxyprogesterone; Melphalan; Middle Aged; Uterine Neoplasms

Steadily progressive improvement in the diagnostic and therapeutic management of malignant trophoblastic disease has occurred over the last few decades. The most important diagnostic aid is the determination of serum HCG by sensitive radioimmunoassay which allows the detection of minute amounts of the hormone and permits discrimination between LH and HCG. Therapeutic advances include the use of combinations of different cytostatic drugs which have increased the cure rate from approximately 50% to a range of 80-95% (1, 2, 3, 4, 5, 6, 7). Malignant trophoblastic disease is rare in the Scandinavian countries which effectively limits opportunities to acquire experience within individual centers. However, a series of 23 cases has been collected at the Karolinska Hospital during the last 10 years. Patients who developed resistance against methotrexate were successfully treated by a combination of an alkylating agent melphalan (Alkeran), actinomycin D and methotrexate. In some cases this modification of a triple-therapy regimen has turned out to be life-saving.

Topics: Adult; Dactinomycin; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Melphalan; Methotrexate; Pregnancy; Trophoblastic Neoplasms; Uterine Neoplasms

Topics: Antibiotics, Antineoplastic; Breast Neoplasms; Cyclophosphamide; Female; Humans; Melphalan; Methotrexate; Ovarian Neoplasms; Pregnancy; Thiotepa; Trophoblastic Neoplasms; Uterine Neoplasms

Description of a case presenting as an inflammatory polyarthritis. A uterine sarcoma was detected one year later and led to the death of the patient. The abnormal protein belonged to the gammal subclass. Biosynthesis experiments, performed on the marrow plasma cells, showed that light chains were not produced and that the molecular weight of the monomeric unit of the serum protein was slightly smaller than that of the protein secreted in vitro, suggesting the occurrence of a secondary and limited extracellular proteolysis.

Topics: Arthritis; Cyclophosphamide; Female; Heavy Chain Disease; Humans; Immunoglobulin A; Immunoglobulin Heavy Chains; Immunoglobulin M; Melphalan; Middle Aged; Molecular Weight; Prednisone; Sarcoma; Uterine Neoplasms

Topics: Adult; Antineoplastic Agents; Choriocarcinoma; Colchicine; Dactinomycin; Daunorubicin; Female; Flavonoids; Humans; Lung Neoplasms; Melphalan; Mercaptopurine; Methotrexate; Middle Aged; Mitomycins; Neoplasm Metastasis; Olivomycins; Pneumonectomy; Pregnancy; Uterine Neoplasms; Vinblastine

Topics: Adolescent; Aged; Bone Neoplasms; Female; Hemangiosarcoma; Hodgkin Disease; Humans; Leukopenia; Lymphoma, Large B-Cell, Diffuse; Male; Melanoma; Melphalan; Neoplasms; Ovarian Neoplasms; Sarcoma, Ewing; Testicular Neoplasms; Thrombocytopenia; Tonsillar Neoplasms; Uterine Neoplasms

Topics: Adenocarcinoma; Antineoplastic Agents; Chlorambucil; Colchicine; Culture Techniques; Cyclophosphamide; Dactinomycin; Female; Floxuridine; Fluorouracil; Hodgkin Disease; Humans; Melphalan; Mercaptopurine; Methotrexate; Nandrolone; Neoplasms; Nitrogen Mustard Compounds; Norethindrone; Prednisolone; Progesterone; Testosterone; Thiotepa; Uterine Neoplasms; Vinblastine

Topics: Antineoplastic Agents; Aziridines; Breast Neoplasms; Cell Nucleus; Coloring Agents; Cyclophosphamide; Female; Hodgkin Disease; Humans; Hyperplasia; Hypertrophy; Mathematics; Melphalan; Ovarian Neoplasms; Pathology; Staining and Labeling; Thiotepa; Triethylenemelamine; Uterine Neoplasms; Vaginal Smears

Topics: Female; Humans; Mechlorethamine; Melphalan; Neoplasms; Nitrogen; Nitrogen Mustard Compounds; Phenylalanine; Uterine Neoplasms