Streptozocin–Doxorubicin, Streptozocin–Fluorouracil, or Chlorozotocin in the Treatment of Advanced Islet-Cell Carcinoma
| Autor: | Myrto Lefkopoulo, David Klaassen, Richard G. Hahn, Charles G. Moertel, Stuart R. Lipsitz |
|---|---|
| Rok vydání: | 1992 |
| Předmět: |
Adult
Male endocrine system medicine.medical_specialty endocrine system diseases medicine.medical_treatment Antineoplastic Agents Pharmacology Streptozocin Random Allocation chemistry.chemical_compound Internal medicine Multicenter trial Antineoplastic Combined Chemotherapy Protocols Chlorozotocin medicine Carcinoma Humans Doxorubicin Aged Aged 80 and over Chemotherapy business.industry General Medicine Middle Aged Adenoma Islet Cell Streptozotocin medicine.disease Pancreatic Neoplasms Survival Rate Endocrinology chemistry Fluorouracil Female business medicine.drug |
| Zdroj: | New England Journal of Medicine. 326:519-523 |
| ISSN: | 1533-4406 0028-4793 |
| DOI: | 10.1056/nejm199202203260804 |
| Popis: | The combination of streptozocin and fluorouracil has become the standard therapy for advanced islet-cell carcinoma. However, doxorubicin has also been shown to be active against this type of tumor, as has chlorozotocin, a drug that is structurally similar to streptozocin but less frequently causes vomiting.In this multicenter trial, we randomly assigned 105 patients with advanced islet-cell carcinoma to receive one of three treatment regimens: streptozocin plus fluorouracil, streptozocin plus doxorubicin, or chlorozotocin alone. The 31 patients in whom the disease did not respond to treatment were crossed over to chlorozotocin alone or to one of the combination regimens.Streptozocin plus doxorubicin was superior to streptozocin plus fluorouracil in terms of the rate of tumor regression, measured objectively (69 percent vs. 45 percent, P = 0.05), and the length of time to tumor progression (median, 20 vs. 6.9 months; P = 0.001). Streptozocin plus doxorubicin also had a significant advantage in terms of survival (median, 2.2 vs. 1.4 years; P = 0.004) that was accentuated when we considered long-term survival (greater than 2 years). Chlorozotocin alone produced a 30 percent regression rate, with the length of time to tumor progression and the survival time equivalent to those observed with streptozocin plus fluorouracil. Crossover therapy after the failure of either chlorozotocin alone or one of the combination regimens produced an overall response rate of only 17 percent, and the responses were transient. Toxic reactions to all regimens included vomiting, which was least severe with chlorozotocin; hematologic depression; and, with long-term therapy, renal insufficiency.The combination of streptozocin and doxorubicin is superior to the current standard regimen of streptozocin plus fluorouracil in the treatment of advanced islet-cell carcinoma. Chlorozotocin alone is similar in efficacy to streptozocin plus fluorouracil, but it produces fewer gastrointestinal side effects than the regimens containing streptozocin. It therefore merits study as a constituent of combination drug regimens. |
| Databáze: | OpenAIRE |
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