By F. M. Muggia, J. Henney, V. DeVita Jr. (auth.), Professor Georges Mathé, Professor Franco M. Muggia (eds.)
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Extra info for Cancer Chemo- and Immunopharmacology: 1. Chemopharmacology
The consequence of this kind of treatment is a selective antitumor effect. To avoid cytotoxic side effects, this therapeutic regimen must be monitored carefully. The decrease of the ratio of 3H-deoxyuridine (dUR)J3H-thymidine (dTR) incorporation into the DNA of the cells is a good biochemical parameter for estimating the MTX effect on rapidly proliferating cell systems. Using this indicator, it was shown that the usually administered dose of Leucovorin is not sufficient for an effective rescue of the bone marrow cells as long as the MTX serum concentration is equal or higher than 1O-6M.
A controlled study of chemo- and immunotherapy. Proc Am Soc Clin Oncol 20: 423 34 Salmon SE, Jones SE (eds) (1980) Adjuvant therapy of cancer II. Grune and Stratton, New York, pp 1-663 35 Maurer HM (1978) Intergroup Rhabdomyosarcoma Study (IRS): Current status. Proc Xth Meet Int Soc Pediatr Oncol, Bruxelles, p 23 36 Maurer HM, Moon T, Donaldson M, Fernandez C, Gehan EA, Hammond D, Hays DM, Lawrence W Jr, Newton W, Ragab A, Raney B, Soule EH, SutowWW, Tefft M (1977) The Intergroup Rhabdomyosarcoma Study.
This needs to be confirmed in phase III studies. One approach could be to treat larger numbers of patients with this regimen in an uncontrolled fashion. If the response rate stays in excess of 70%, relate it to the S. K. Carter 34 historical data base and decide the combination is superior. If the response rate should fall to 50% -60%, this would pose a problem since that would not be significantly higher than the 50% response rate that has been reported with methotrexate alone. An idealized, prospectively randomized, controlled trial would be as follows: ,-----DDP + bleomycin--P Methotrexate R I----DDP Randomize-----i 1 - - - - Bleomycin o G Methotrexate R E Methotrexate S '------Methotrexate S DDP I V E DISEASE + bleomycin As yet, neither of these types of trials have been undertaken and the true role of DDP in head and neck cancer still remains to be elucidated.