zinostatin and Anaphylaxis

Though SMANCS-Lipiodol suspension has advantages over tumor regression, its disadvantages should also be considered: (1) Anaphylactic reaction due to its high molecular weight. (2) Since it readily destroys the tissue, a smaller dose and repeated administration are required. (3) Due to its low viscosity, it easily enters the arterioles and causes damage even to the extrahepatic organs. When this drug is infused into the left hepatic artery in subsegmental fashion, it enters the neighboring gastric tissues through the communication of the left hepatic and left gastric arteries, and this ultimately causes intractable gastric ulcers. Considering the above facts, this drug should be used carefully.

Topics: Adult; Aged; Anaphylaxis; Antineoplastic Agents; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Drug Administration Schedule; Female; Hepatic Artery; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Male; Maleic Anhydrides; Middle Aged; Nausea; Polystyrenes; Stomach Ulcer; Vomiting; Zinostatin

A 47-year-old man with hepatocellular carcinoma (HCC) at anterior and medical segment in the liver was treated with hepatic arterial infusion of Zinostatin Stimalamer-lipiodol suspension (SMANCS). After the 2nd infusion of SMANCS, the accumulation of lipiodol in the tumor was not good (Grade II), so additional administration was undertaken at five-weeks intervals. His systolic blood pressure immediately decreased from 120 to 60 mmHg, and he had numbness of hands, shaking chills, sweating, chest pain and numerous urticaria-like red exanthema. In spite of treatment by anti-shock agents such as steroid and catecholamines, these symptoms did not disappear, but antihistaminics greatly improved them without any serious side effects. Because of the remarkable effects of the antihistaminics and possibility of antibody production (IgE) after repeated infusions of high molecular SMANCS, this patient may have suffered anaphylactic shock caused by massive histamine release from mast cells.

Topics: Anaphylaxis; Carcinoma, Hepatocellular; Hepatic Artery; Histamine H1 Antagonists; Humans; Infusions, Intra-Arterial; Iodized Oil; Liver Cirrhosis; Liver Neoplasms; Male; Maleic Anhydrides; Middle Aged; Polystyrenes; Zinostatin

The injection of clinical doses of neocarzinostatin (NCS) in guinea pigs did not result in antibody formation as judged by immunoelectrosyneresis, micro-Ouchterlony agar diffusion, fluorescence polarization, and passive cutaneous anaphylaxis reaction. This confirmed previous work on passive hemagglutination and passive cutaneous anaphylaxis reaction in a heterocytotropic system in guinea pigs. Forty-eight serum samples from 28 patients who were previously treated with NCS alone (8--161 mg) for a period of 8-85 days did not show any sign of antibody formation as revealed by immunoelectrosyneresis, micro-Ouchterlony agar diffusion, and fluorescence polarization techniques. In a homocytotropic system, the passive cutaneous anaphylaxis reaction was carried out with sera of sensitized guinea pigs and test guinea pigs which revealed that no IgE and IgA antibody to NCS was present in the sensitized sera. Those patients with bladder cancer who did not respond to NCS therapy or exhibit any side effects even after 21 mg were found to have proteolytic activity in their sera which degraded NCS very rapidly as revealed by the fluorescence polarization technique.

Topics: Anaphylaxis; Animals; Antibiotics, Antineoplastic; Antibody Formation; Antigens; Guinea Pigs; Humans; Male; Neoplasms; Peptide Hydrolases; Skin Tests; Zinostatin

Neocarzinostain (NCS) was first used by Hiraki and his colleagues for induction chemotherapy in acute leukemia. This new anti-tumor agent is a polypeptide with a high molecular weight of 10,700 daltons. Anti-NCS antibody was produced in rabbits administered NCS intramuscularly with or without adjuvant. The production of anti-NCS antibody in patients treated with NCS was investigated. Forty three leukemia cases of various types were examined totally 65 times. Two mg of NCS for four consecutive days by intravenous drip infusion followed by 7 to 10 days of pause was repeatedly administered. The total amounts ranged 8 to 174 mg and the total periods 4 to 87 days. The methods used to measure the antibody titer are the passive hemagglutination (PHA) test on microplate and the passive cutaneous anaphylaxis (PCA) reaction in guinea pigs. The sera of all patients showed only non-specific agglutination at less than 2(3) dilution by PHA test, and to confirm these results four patient sera were tested by PCA reaction. The production of anti-NCS antibody was not detected in patients by PHA test and PCA reaction. The anaphylactic reaction and other adverse reactions due to anti-NCS adtibody production were not demonstrated in patients. Anti-NCS antibody was not detected by these experiments in the dose schedule administered.

Topics: Anaphylaxis; Animals; Antibiotics, Antineoplastic; Antibodies, Anti-Idiotypic; Antibody Formation; Hemagglutination Inhibition Tests; Hemagglutination Tests; Humans; Leukemia; Rabbits; Zinostatin