mesna and Mediastinal-Neoplasms

Between 1985 and 1989, 36 consecutive male patients with advanced germ-cell tumors, who had failed to be cured with either the cisplatin, vinblastine, bleomycin (PVB) or the cisplatin, etoposide, bleomycin (PEB) combinations, entered either of two modified salvage therapy regimens consisting of cisplatin, etoposide, and ifosfamide (PEI) or cisplatin, vinblastine and ifosfamide (PVI). All patients had evidence of active disease. Ifosfamide was given at the dosage of 2.5 gr/m2 (with mesna protection) on days 1 and 2; etoposide and cisplatin were given at the dosage of 100 mg/m2 and 40 mg/m2, respectively, on days 3 to 5. In the PVI schedule, vinblastine 6 mg/m2 was given on day 3. Overall, 20 (56%, C.I. 39 to 72) patients entered complete response (CR) or achieved disease-free status (NED) with post-chemotherapy surgery. After a follow-up of 2 to 7 years, 15 patients (42%, C.I. 24 to 58) remain alive and free of disease. None of the 9 patients unresponsive to the first-line therapy and/or with extragonadal primaries entered CR or achieved the NED status, versus 20 (74%, C.I. 58 to 91) of the 27 patients with primary testicular tumors who were responsive to the first-line therapy (p less than 0.001). PEI was used in 20 of these 27 patients, with excellent results (90% CR and 70% continuously NED) independently of primary therapy, PVB or PEB. By contrast, only 2 of the 7 patients treated with PVI following PEB entered CR. Toxicity was not life-threatening. Nine (25%) patients suffered granulocytopenic fever and 3 (8%) required platelet transfusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Dose-Response Relationship, Drug; Drug Administration Schedule; Etoposide; Follow-Up Studies; Humans; Ifosfamide; Male; Mediastinal Neoplasms; Mesna; Middle Aged; Neoplasms, Germ Cell and Embryonal; Retroperitoneal Neoplasms; Testicular Neoplasms; Vinblastine

Mediastinal angiosarcoma is a rare intrathoracic tumour and the therapeutic approach remains poorly codified.. We report the case of a 65-year-old female patient presenting with chest pain. Further exploration revealed an anterior mediastinal mass with pericardial invasion. Transthoracic biopsy gave the diagnosis of angiosarcoma. Multimodal treatment with neoadjuvant chemotherapy (doxorubicin 20 mg/m(2), Ifosfamide 2500 mg/m(2), Uromitexan® 2500 mg/m(2)) and surgery followed by adjuvant radiotherapy has led to remission of the tumour that has persisted for 12 months.. Systematic recording of such conditions in dedicated registries could contribute to enhance the description of the clinical and pathological characteristics, thus helping define the principles of specific management.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Chest Pain; Doxorubicin; Dyspnea; Female; Hemangiosarcoma; Humans; Ifosfamide; Magnetic Resonance Imaging; Mediastinal Neoplasms; Mesna; Neoadjuvant Therapy; Neoplasm Invasiveness; Positron-Emission Tomography; Radiotherapy, Adjuvant; Remission Induction; Tachycardia, Sinus; Tomography, X-Ray Computed; Weight Loss

Topics: Antibiotics, Antineoplastic; Antineoplastic Agents, Alkylating; Doxorubicin; Female; Humans; Ifosfamide; Immunohistochemistry; Mediastinal Neoplasms; Mesna; Middle Aged; Protective Agents; Radiography, Thoracic; Sarcoma; Tomography, X-Ray Computed; Trachea; Vimentin

Primary mediastinal nonseminomatous germ cell tumors (NSGCT) have a worse prognosis than gonadal germ cell tumors (GCTs). Malignant transformation of teratomatous components of GCT to a somatic malignancy is rare. We present a case of primary mediastinal NSGCT with malignant transformation of a teratoma in an active duty airman who presented with a 12-cm anterior mediastinal mass and vertebral body lesion. Pathology confirmed NSGCT with yolk sac and teratomatous components. Chemotherapy for GCT normalized serum tumor markers with little effect on the mediastinal mass. Incomplete resection of the residual tumor revealed high-grade mixed sarcoma. Serum tumor markers rose 3 months following resection with metastatic disease to bone and liver. Chemotherapy targeting sarcoma induced a partial response, but the patient developed acute myeloid leukemia refractory to chemotherapy. We discuss our approach to management of this complicated patient.

Topics: Adult; Dacarbazine; Doxorubicin; Fatal Outcome; Humans; Ifosfamide; Leukemia, Myeloid, Acute; Male; Mediastinal Neoplasms; Mesna; Neoplasms, Germ Cell and Embryonal; Teratoma

To evaluate the activity of two cycles of high-dose ifosfamide, carboplatin, and etoposide (ICE) with autologous hematopoietic progenitor cell support (aHPCS) in patients with poor-prognosis, chemotherapeutically sensitive germ cell cancer.. Twenty patients with germ cell tumor who had persistent disease or relapse from standard-risk or high-risk presentation were entered on this pilot study. The entry criteria included relapsed gonadal and extragonadal germ cell cancer unlikely to be cured by standard salvage therapy but without proven refractoriness to chemotherapy. Treatment consisted of two cycles of ICE chemotherapy with mesna uroprotection and aHPCS. On the first cycle, ifosfamide (IFX), 2 gm/m2; carboplatin, 400 mg/m2; and etoposide, 20 mg/kg, were administered on days -6, -5, and -4. On the second cycle, the doses and schedule of carboplatin and etoposide were identical, and patients with normal renal function received additional IFX, 2 g/m2 on day -3 and 1 g/ m2 on day -2. Mesna, 600 mg/m2 every 6 hours, was given until 24 hours following the final dose of IFX on each cycle, and autologous bone marrow and/or peripheral stem-cells were infused on day 0.. All twenty patients are assessable for toxicity and current disease status. Two patients received only one cycle of therapy, one because of the development of active hepatitis C following cycle 1, and one because of renal insufficiency. No patient died as a result of protocol therapy, and no patient developed debilitating peripheral neuropathy, symptomatic hearing loss, or severe renal insufficiency requiring dialysis. The median time to recovery of > or = 500 neutrophils/microL and platelets > or = 50,000/microL was day +11 and day +15, respectively. The median maximum creatinine was 1.6 mg/dL on each treatment cycle, and there was no other significant organ toxicity. With a median follow-up of 45 months, nine patients are alive and disease-free following protocol chemotherapy. One patient with embryonal cancer developed progressive pulmonary metastases 3 months after completing high-dose therapy, underwent complete resection of lung metastases, and remains disease-free at 63+ months. Eight patients are continuously disease free at 23+ to 70+ months after protocol therapy. Eleven patients died of progressive disease between 4 and 23 months following completion of treatment.. These results compare favorably to other studies in similarly selected patients undergoing salvage therapy with one or two cycles of chemotherapy containing high-dose carboplatin and etoposide with or without cyclophosphamide (CTX) or IFX. The excellent safety and tolerability profile of this regimen and its encouraging activity in poor-prognosis patients make it worthy of further study as part of initial therapy in randomized protocols for high-risk disease and early in the treatment of relapsed germ cell cancer.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Carboplatin; Combined Modality Therapy; Etoposide; Female; Follow-Up Studies; Germinoma; Hematopoietic Stem Cell Transplantation; Humans; Ifosfamide; Male; Mediastinal Neoplasms; Mesna; Middle Aged; Ovarian Neoplasms; Pilot Projects; Retroperitoneal Neoplasms; Testicular Neoplasms