mercaptopurine and Head-and-Neck-Neoplasms

This review highlights the most important recent advances in the chemotherapeutic management of patients with squamous cell carcinoma of the head and neck. Previous chemotherapy trials must be interpreted with caution in the absence of information concerning important prognostic variables, such as prior treatment, nutritional and performance status, and the heterogeneity of primary sites. In patients who have recurrent or metastatic disease, methotrexate, platinum, and bleomycin are three active drugs when used as single agents. There is no evidence that high dose methotrexate therapy is superior to more conventional weekly intravenous administration of methotrexate in the treatment of recurrent disease. Platinum is a new agent that has demonstrated activity against hematogenous as well as regional disease. In the absence of evidence of a dose-response curve for platinum, the lower dosage schedules that can be used with acceptable toxicity on an outpatient basis should be selected. Combination chemotherapy has resulted in a high proportion of objective responders and approximately 20 per cent complete remissions with any of several platinum containing regimens. However, the median duration of response remains short, and none of the combination drug programs has as yet been established to be superior to single agent chemotherapy in a randomized trial. Both single agent and combination chemotherapy programs have been used prior to initial surgery or radiation in patients with advanced inoperable but nonmetastatic disease. Despite dramatically higher response rates over those obtained with the same drugs used in recurrent disease, there is as yet no evidence that chemotherapy given in this manner has resulted in improved disease free or overall survival compared with local treatment alone. Similarly, the use of adjuvant chemotherapy following tumor clearance to eradicate potential micrometastatic disease is currently under investigation and cannot be recommended in the absence of a controlled trial. This article reviews the clinical trials currently in progress both for patients with recurrent squamous cell carcinoma of the head and neck and those with advanced local or regional disease.

Topics: Antineoplastic Agents; Bleomycin; Carcinoma, Squamous Cell; Chlorambucil; Clinical Trials as Topic; Cyclophosphamide; Drug Administration Schedule; Fluorouracil; Head and Neck Neoplasms; Humans; Hydroxyurea; Mechlorethamine; Mercaptopurine; Methotrexate; Procarbazine; Vinblastine

This review highlights the most important recent advances in the chemotherapeutic management of patients with squamous cell carcinoma of the head and neck. Previous chemotherapy trials must be interpreted with caution in the absence of information concerning important prognostic variables, such as prior treatment, nutritional and performance status, and the heterogeneity of primary sites. In patients who have recurrent or metastatic disease, methotrexate, platinum, and bleomycin are three active drugs when used as single agents. There is no evidence that high dose methotrexate therapy is superior to more conventional weekly intravenous administration of methotrexate in the treatment of recurrent disease. Platinum is a new agent that has demonstrated activity against hematogenous as well as regional disease. In the absence of evidence of a dose-response curve for platinum, the lower dosage schedules that can be used with acceptable toxicity on an outpatient basis should be selected. Combination chemotherapy has resulted in a high proportion of objective responders and approximately 20 per cent complete remissions with any of several platinum containing regimens. However, the median duration of response remains short, and none of the combination drug programs has as yet been established to be superior to single agent chemotherapy in a randomized trial. Both single agent and combination chemotherapy programs have been used prior to initial surgery or radiation in patients with advanced inoperable but nonmetastatic disease. Despite dramatically higher response rates over those obtained with the same drugs used in recurrent disease, there is as yet no evidence that chemotherapy given in this manner has resulted in improved disease free or overall survival compared with local treatment alone. Similarly, the use of adjuvant chemotherapy following tumor clearance to eradicate potential micrometastatic disease is currently under investigation and cannot be recommended in the absence of a controlled trial. This article reviews the clinical trials currently in progress both for patients with recurrent squamous cell carcinoma of the head and neck and those with advanced local or regional disease.

Topics: Antineoplastic Agents; Bleomycin; Carcinoma, Squamous Cell; Chlorambucil; Clinical Trials as Topic; Cyclophosphamide; Drug Administration Schedule; Fluorouracil; Head and Neck Neoplasms; Humans; Hydroxyurea; Mechlorethamine; Mercaptopurine; Methotrexate; Procarbazine; Vinblastine

Of those patients with localized (CS I-II) non-Hodgkin's lymphoma of Waldeyer's ring who were treated with radiotherapy or radiotherapy plus chemotherapy and who suffered relapses at the National Cancer Center Hospital over the past 22 years, 24 cases were analyzed on the basis of their response rate and duration of remission with reinduction chemotherapy, and survival time after recurrence. The group [ADM (+)], treated with regimens including adriamycin, was compared with the group [ADM (-)] treated with regimens excluding adriamycin. Complete response was seen in 9 out of 11 cases (81.8%) and in 8 out of 13 cases (61.5%) for the ADM (+) group and the ADM (-) group, respectively (p greater than 0.1). The period of complete response of the ADM (+) and ADM (-) groups was compared using the logrank method. The prognosis of the former was significantly (p less than 0.01) better than that of the latter and the median duration of remission was 30 months and 7 months, respectively. When the survival after recurrence of the ADM (+) and ADM (-) groups was compared, the median survival time was 38 months for the ADM (+) group and 12 months for the ADM (-) group, but no significant difference was observed between the two groups (0.05 less than p less than 0.1).

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Doxorubicin; Female; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Lymphoma; Male; Mercaptopurine; Methotrexate; Middle Aged; Prednisone; Retrospective Studies; Vincristine

Twenty-seven evaluable patients with advanced head and neck squamous carcinoma were treated with a polychemotherapeutic regimen described in 1975 by Price et al. Chemotherapy consisted of vincristine, adriamycin, bleomycin, methotrexate, 5-fluorouracil, hydroxyurea, 6-mercaptopurine and citrovorum factor administered sequentially. One complete remission, 4 partial remissions, 7 minor responses were obtained for a total of 12/77 (44%) objective responses. Toxicity was acceptable. The results obtained were not better than those observed with less complicated regimens administrable on an outpatient basis.

Topics: Adult; Aged; Bleomycin; Carcinoma, Squamous Cell; Doxorubicin; Female; Fluorouracil; Head and Neck Neoplasms; Humans; Hydroxyurea; Leucovorin; Male; Mercaptopurine; Methotrexate; Middle Aged; Vincristine

A multiple drug regimen was given to 36 patients with advanced carcinomas of the head and neck. In 19 of the 24 patients who were assessable the tumour regressed more than 50%; in one it regressed by 25%; and in four it did not respond at all. Multiple drug chemotherapy should be given much earlier in the course of these cancers, preferably as an adjuvant to surgery or radiotherapy.

Topics: Antineoplastic Agents; Bleomycin; Doxorubicin; Drug Synergism; Drug Therapy, Combination; Ear Neoplasms; Fluorouracil; Head; Head and Neck Neoplasms; Humans; Hydroxyurea; Laryngeal Neoplasms; Maxillary Neoplasms; Mercaptopurine; Methotrexate; Mouth Neoplasms; Nasopharyngeal Neoplasms; Neoplasms; Tongue Neoplasms; Tonsillar Neoplasms; Vincristine

Drug screening trials and general treatment of solid tumours in advanced cancer patients have been concerned only with the site of primary origin, regardless of where metastases might have seeded. Since the environment for tumour growth can differ appreciably at various anatomical sites, an investigation was undertaken to determine the effect of metastatic site on response to chemotherapy. Data from 1961 to 1965 of the screening trials of the Eastern Clinical Drug Evaluation Program were utilized. Response and location data extensive enough for analysis represented 6 sites of primary origin and 6 metastatic site groups, totalling 1687 lesions. Analysis of percentage reduction in tumour size after chemotherapy regimens of up to 60 days revealed a significant amount of variation associated with metastatic sites and a non-significant amount associated with sites of primary origin. Advanced primary tumours showed marked variation in responsiveness and some showed a difference in response to different drug groups. Generally, metastases responded better than the advanced primaries from which they were derived, except for those from breast tumours.

Topics: Antineoplastic Agents; Breast Neoplasms; Chlorambucil; Female; Fluorouracil; Genital Neoplasms, Female; Head and Neck Neoplasms; Humans; Lung Neoplasms; Melanoma; Mercaptopurine; Mitomycins; Neoplasm Metastasis; Neoplasms

Topics: Adolescent; Adult; Antineoplastic Agents; Choriocarcinoma; Cyclophosphamide; Dactinomycin; Female; Follow-Up Studies; Head and Neck Neoplasms; Hemangiosarcoma; Humans; Infant; Lung Neoplasms; Male; Mechlorethamine; Mercaptopurine; Methotrexate; Middle Aged; Neoplasm Metastasis; Pregnancy; Prostatic Neoplasms; Sarcoma; Teratoma; Testicular Neoplasms; Thoracic Neoplasms; Thyroid Neoplasms; Triaziquone; Uterine Neoplasms; Vinblastine

Topics: Adolescent; Child; Child, Preschool; Cobalt Isotopes; Cyclophosphamide; Head and Neck Neoplasms; Humans; Leukemia; Lymphoma, Non-Hodgkin; Mediastinal Neoplasms; Mercaptopurine; Methotrexate; Peritoneal Neoplasms; Prednisone; Radioisotope Teletherapy; Remission, Spontaneous; Time Factors; Vincristine