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Treatment of Relapsed ro Refractory Acute leukemia with High / Intermediate - dose Cytarabine and Idarubicin
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Seong Chul Kim, Yoo Hong Min, Hyun Jin Noh, Seung Tae Lee, Bo Yong Chung, Jee Sook Hahn, Yun Woong Ko
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J Korean Cancer Assoc. 1996;28(2):301-308.
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 Abstract
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- Background
The therapeutic outcome for relapsed or refractory adults with acute leukemia is so poor, and it is difficult to expect the long-term disease-free survival in these patients. We evaluated the therapeutic outcome of a salvage chemotherapy consisting of high- or intermediate-dose(HD or ID) cytarabine and a new daunorubicin analogue, idarubicin. Material and method: Twenty one patients with refractory or relapsed acute lymphocytic leukemia(ALL) and 13 patients with acute myeloid leukemia(AML) were treated with a regimen that included idarubicin 12 mg/§³ intravenously daily for 3 days plus HD cytara- bine(3,000 mg/§³ by infusion over 2 hours daily for 3 days) or ID cytarabine(1,000 mg/§³ every 12 hours for six doses). Results: 1) Complete remission(CR) was achieved in thirteen of 34 patients (38%; 10 of relapsed and 3 of refractory): 16 patients(47%) did not respond to the treatment and 5 patients(15%) died during chemotherapy. 2) The median days to the neutrophils over 500/ul was 23 from the initiation of chemotherapy (range 12-39). The significant non-hematologic taxicities were not observed. 3) Two of 13 patients who achieved CR relapsed within 2 months, four relapsed 2 months after CR. Remaining seven patients have been in continuous CR(CCR). 4) For all complete responders, the median CR duration was 6 months, and the projected actuarial disease-free survival rate was 32% at 9 months. For the all patients, the projected overall survival was 15% at 18 months. Conclusion: We found that HD or ID cytarabine and idarubicin can be one of the effective salvage regimens for patients with relapsed acute leukemia. To improve remission rate of refractory cases, the modification of administration and combination therapy with other non-cross resistant drug will be designed.
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A Retrospective Comparison of Infusional 5-Fluorouracil , Doxorubicin , Mitomycin - C ( Modified FAM ) Combination Chemotherapy Versus Palliative Therapy in
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Joon Oh Park, Jae Kyung Roh, Hyun Cheol Chung, Hyun Jin Noh, Jae Yong Cho, Sun Young Rha, Chong In Lee, Cheol Woo Kim, Joo Hang Kim, Choong Bai Kim, Sung Hoon Noh, Kyong Sik Lee, Jin Sik Min, Byung S
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J Korean Cancer Assoc. 1995;27(2):165-175.
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Abstract
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- In Korea, gastric cancer is the most common cancer and the leading cause of cancer death. About one-third of the patients with gastric cancer is unresectable at the time of diagnosis. Their median survival is less than 6 months with very poor prognosis. Accordingly, various regimens of chemotherapy have been proposed as intensive treatment for unresectable patients. After MacDonald et aL reported 42% response rate and 9 months response duration using combination of 5-Fluorouracil, Doxorubicin and Mitomycin-CFAM), it became the most widely used regimen in the treatment of advanced gastric cancer. However, despite of high initial response rate, there was no survival benefit in randomised comparative trials. To increase the drug effect, we modified the standard FAM regimen by continuously infusing the 5- Fluorouracil instead of bolus injection(modified FAM). We retrospectively reviewed the clinical recoreds of 409 patients with histologically proven advanced gastric cancer in Yonsei University Medical Center and Yonsei Cencer Center between Jan. 1, 1991 and Dec. 31, 1993. The purpose of this study is to assess the efficacy of infusional FAM combination chemotherapy compared with other palliative therapy in advanced gastric cancer. Among 409 patients, 266 were male and 143 were female with a median age of 57-year(range: 15~75). There were 202 patients in mFAM-treated group and 207 patients in control group. In mFAM-treated group, 140 patients had no surgery, 30 patients underwent a palliative bypass and 32 patients underwent a palliative resection. In control group, 151 patients had no surgery, 33 patients underwent a palliative bypass and 23 patients underwent a palliative resection. In preoperative staging, 257 patients had locally advanced disease, 48 had carcinomatosis and 104 had distant metastasis. There was no difference of distribution in age, sex, perfomance status, preoperative stege and treatment modalities between mFAM-treated and control group. 1) Among 154 of evaluable patients, no CRs were observed. PR were seen in 17.5% of patients in mFAM-treated group. The median response duration was 30 weeks and progression free survival was 23 weeks. 2) Higher 1-year survival rate was demonstrated in mFAM-treated group comparing to control group(34.1% vs 22.5)(p=0.0135). 3) Median survival was longer in mFAM-treated group than that of control group(40 week vs 28 week). 4) The toxicities were relatively tolerable and reversible. This results proposed that the infusional FAM combination chemotherapy showed a probalbility of survival pralongation, especially combined with palliative surgery in advanced gastric cancer. Further prospective randomized study will be warranted.
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KCA
