pirarubicin and Peritoneal-Neoplasms

Nineteen patients diagnosed with peritoneal carcinomatosis were treated by in-home chemotherapy over a period of four years from August, 1990 to July, 1994. Primary diagnoses of the four male and 15 female patients included 12 cases gastric cancer (four males, eight females), five cases of ovarian cancer, one case (female) of appendicular cancer, and one case (female) of breast cancer. In addition to oral administration of UFT-E and 5'-DFUR, chemotherapy included weekly intravenous injection of a massive dose of 5-FU (1,000 mg/m2), subselective intraaortic infusion and intraperitoneal infusion using a reservoir. These methods were used individually and in combination. The drugs used included 5-FU, CBDCA, CPA, THP, and EPIR. Subselective intraaortic infusion was performed by low dose continuous infusion using the Baxter infusor multiday type. Six gastric cancer patients lived normally for over one year, while four died in less than a year. All ovarian and appendicular cancer patients were CR, the breast cancer patient was PR. Ten patients continued working at their jobs while receiving at home chemotherapy treatments. Diuretics were used to alleviats ascites. Although there were no side effects on digestive organs, 5-FU and CBDCA were mixed with 100 mg hydrocortisone in the infusor to improve cachexia, and promote appetite and activity. Bone marrow suppression was very slight at these dosages, and weekly checkups were adequate. The at-home rate (number of days at home/entire period since onset) of all patients was 78%.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carboplatin; Cyclophosphamide; Doxorubicin; Drug Administration Schedule; Epirubicin; Female; Fluorouracil; Home Care Services, Hospital-Based; Home Infusion Therapy; Humans; Infusion Pumps, Implantable; Infusions, Parenteral; Male; Middle Aged; Ovarian Neoplasms; Peritoneal Neoplasms; Stomach Neoplasms

Free malignant cells, which are frequently detected in the washing liquid from the peritoneal cavity before and after resection of human colorectal cancer, are suspected to cause recurrent peritoneal cancer. We carried out an experimental study to compare the prophylactic efficacy of washing the peritoneum with several anticancer drugs and the antiseptic povidone-iodine against the development of peritoneal carcinomatosis from colonic origin in rats and nude mice. The in vitro anticancer activity of a short, 15-minute exposure of pirarubicin, doxorubicin, 5-fluorouracil, cisplatin, mitomycin C, and 1% povidone-iodine was first evaluated by an MTT assay on DHD/K12/PROb rat and LS174T human colon cancer cells. For the in vivo experiments, BDIX rats were inoculated intraperitoneally (i.p.) with 1 x 10(6) DHD/K12/PROb cells followed by peritoneal scarring and a colocolic anastomosis. A 15-minute peritoneal washing with the anticancer drugs or povidone-iodine was then performed. Nude mice were i.p.-inoculated with 1 x 10(7) LS174T human cells and treated 2 hours later with i.p. pirarubicin. Only pirarubicin, mitomycin C, and povidone-iodine were fully cytotoxic in vitro against DHD/K12/PROb rat colon cancer cells. In contrast to pirarubicin and povidone-iodine, mitomycin C was not completely active against LS174Tcells. In vivo, pirarubicin cured DHD/K12/PROb-inoculated rats, even at the site of the peritoneal scarring and intestinal anastomosis. i.p. pirarubicin prevented the development of peritoneal carcinomatosis and liver metastasis in LS174T-inoculated mice. i.p. washing with pirarubicin cured 2-day-old, but not 7-day-old, peritoneal carcinomatosis in rats. Short exposure to i.p. pirarubicin is nontoxic and more active than povidone-iodine and other anticancer drugs in preventing the development of peritoneal carcinomatosis from colonic origin in rats and mice. The prophylactic effect of preoperative peritoneal washing with pirarubicin on the development of recurrent peritoneal cancer should be evaluated in a randomized clinical trial.

Topics: Animals; Anti-Infective Agents, Local; Antineoplastic Agents; Carcinoma; Cell Line, Tumor; Colonic Neoplasms; Doxorubicin; Immunosuppressive Agents; Injections, Intraperitoneal; Male; Mice; Mice, Nude; Neoplasm Seeding; Peritoneal Lavage; Peritoneal Neoplasms; Pharmaceutical Solutions; Povidone-Iodine; Rats

A 53-year-old female with peritoneal metastasis of breast cancer was treated with hyperthermia with chemotherapy. One course consisted of THP 60 mg and FT 400 mg/iv (day 1), CPM 100 mg and MPA 800 mg/daily/po) with RF heating of hyperthermia monthly. After completion of 10 courses of this regimen, ascites completely disappeared and peritoneal metastases were not found observed in any peritoneal cavity with abdominal CT and ultrasound. Peritoneal metastasis of breast cancer was one of the worst reactions with any therapy. The patient has been living for about four years without any signs of recurrence, with the tumor markers within the normal range after surgery. Thermochemotherapy seems a very promising treatment modality for peritoneal metastasis of breast cancer.

Topics: Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Combined Modality Therapy; Cyclophosphamide; Doxorubicin; Female; Humans; Hyperthermia, Induced; Lymphatic Metastasis; Middle Aged; Penicillin V; Peritoneal Neoplasms; Tegafur

A 33-year-old house wife with malignant lymphoma in the lesser omentum was treated with a combination of surgery and VEP-THP chemotherapy (consisting of pirarubicin, cyclophosphamide, fildesin and predonine). Complete remission has been observed by reduction surgery and subsequent chemotherapy of VEP-THP. Although mild bone marrow suppression was seen during the chemotherapy, gastrointestinal toxicity and alopecia were minimal, which led to 10 complete courses of VEP-THP regimen. The patient has been in good health 5 years after the operation with no sign of recurrence. This case indicates that even advanced malignant lymphoma may be successfully treated with a combination of surgery and proper chemotherapy.

Topics: Adult; Antibiotics, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Doxorubicin; Female; Humans; Lymphoma, Large B-Cell, Diffuse; Omentum; Peritoneal Neoplasms; Remission Induction; Vindesine

We report a case of left renal cell carcinoma extending into vena cava with malignant peritoneal mesothelioma. A 41-year-old man presented to our outpatient clinic with macroscopic hematuria. Upon laparotomy, numerous white nodules were identified on diaphragm and serosa of liver, stomach, small intestine and mesentery. Biopsied specimen showed malignant mesothelioma of peritoneum and renal cell carcinoma of left kidney. He was treated with intraperitoneal cisplatinum and intravenous pirarubicin for mesothelioma, and chemoembolization for renal tumor. After two courses of therapy, he suffered from disseminated intravascular coagulation and died of subarachnoid hemorrhage. Autopsy revealed that intraperitoneal nodules were markedly decreased in number and renal tumor had changed into hemorrhagic necrosis, but tumor thrombus in vena cava had little necrotic change.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Renal Cell; Cisplatin; Doxorubicin; Embolization, Therapeutic; Humans; Kidney Neoplasms; Male; Mesothelioma; Neoplasms, Multiple Primary; Peritoneal Neoplasms

Fifteen patients with peritoneal metastasis of gastric cancer were treated with mainly ip-ETP (Etoposide: i.p., THP-ADM: i.v. and CDDP: i.p.) or other drugs by the use of a totally implantable peritoneal access system. In principle, intraperitoneal drug delivery was carried out every two weeks. CDDP was administered into the intraperitoneal cavity with intravenous sodium thiosulfate delivered simultaneously to protect against cisplatin-induced nephrotoxicity. RI-scintigram showed that the intraperitoneal catheter was fully useful even six months after the operation. As a result, performance status has been improved in 12 out of 15 cases, and ascites disappeared in 3 out of 6 cases with same. Ten cases have been alive for more than 6 months after operation. There have been no severe complications (e.g., nephrotoxicity or myelosuppression) even in the cases treated at frequent intervals for more than 8 months. The findings in this study indicated that ip-ETP using totally implantable peritoneal access system is beneficial for advanced gastric cancer with peritoneal metastasis.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Doxorubicin; Drug Evaluation; Etoposide; Female; Humans; Infusion Pumps; Infusions, Parenteral; Male; Middle Aged; Peritoneal Cavity; Peritoneal Neoplasms; Stomach Neoplasms

Eight patients with diffuse malignant mesothelioma of the pleura or peritoneum, previously untreated with chemotherapy, were treated with a new anthracycline 4'-0-tetrahydropyranyladriamycin (pirarubicin). Pirarubicin was given intravenously at the rate of 5 mg per minute, at doses ranging from 35 to 70 mg/m2 once every 21 days. On clinical evaluation, one patient had complete response lasting 4 months. On second-look laparotomy residual tumor was found and she was labelled a partial responder and changed to alternate chemotherapy. Another patient had a partial response of recurrent chest wall tumors lasting 11 months. A third patient had a partial response lasting 4+ months of a pleural-based tumor and resolution of pleural effusion. After the fifth course of chemotherapy, he developed severe granulocytopenia, pseudomonas sepsis, shock, and renal failure. Despite recovery of blood counts to normal within 3 days, renal failure proved fatal. Autopsy revealed only fibrosis and no gross or microscopic evidence of malignant mesothelioma. A fourth patient had improvement in evaluable disease lasting about 4 months; and the remaining four had stable disease for at least 2 months each. The authors conclude that, whenever feasible, noninvasive clinical assessment of tumor response should be supplemented by surgical-pathologic evaluation. Pirarubicin is active in malignant mesothelioma. This is the first report documenting complete tumor eradication after chemotherapy in an adult with malignant mesothelioma.

Topics: Aged; Biomarkers, Tumor; Doxorubicin; Female; Humans; Leukocyte Count; Male; Mesothelioma; Middle Aged; Neoplasm Recurrence, Local; Peritoneal Neoplasms; Pleural Neoplasms; Remission Induction; Stroke Volume