The subjects were 41 cases with implantable reservoir systems for unresectable hepatic tumors. We evaluated the difference in drug distribution between intra-hepatic arterial continuous infusion and rapid infusion using hepatic perfusion scintigraphy by 99mTc-macroaggregated albumin via reservoirs. The 41 cases were divided into 2 groups (A and B) according to the imaging of the perfusion scintigraphy. There were 17 cases in group A with equal distribution and 24 cases in group B with a different distribution between the continuous infusion and the rapid infusion. The 24 cases in group B were subdivided into groups according to the distribution of 99mTc-MAA in and around liver. In some cases the distribution pattern after rapid infusion improved more than with continuous infusion. These results suggested that the infusion method must be selected for every case.

A multicenter phase I clinical trial of RP 56976 (docetaxel), a new anticancer drug, was performed with single and repeated doses. Based on the results of phase I clinical trials conducted in the United States and Europe, the starting dose was 10 mg/m2. The dose was subsequently increased to 20, 50, 70 and 90 mg/m2. A dose of 60 mg/m2 was additionally tested. Single administrations of the six dose levels were performed in a total of 27 patients via intravenous drip infusion over one hour. Ten of the patients subsequently received repeated doses at three of the dose levels in the same manner. The dose limiting factor (DLF) of docetaxel is leukopenia (especially, neutropenia). Based on the observation of the DLF, the maximum tolerated dose (MTD) was determined to be 70-90 mg/m2. The white blood cell count reached a nadir about 9.5-19.5 days (median) after administration, and took 7-11 days (median) to recover. Other adverse reactions observed were nausea/vomiting anorexia, alopecia, diarrhea, fatigue and fever, which were all acceptable. The results of this trial suggest that a dosage regimen of 60 mg/m2 at 3- to 4 week intervals is appropriate in an early phase II clinical trial.

The antiemetic effect and safety of granisetron injection on nausea and vomiting induced by anticancer drugs were studied in the patients treated with anticancer drugs including 50 mg/m2 or more of cisplatin (CDDP). Granisetron is already on the market, and drip infusion of granisetron at 40 micrograms/kg has been used widely in clinical practice. In this clinical investigation, a simpler administration method of its slow (30 to 60 seconds) intravenous injection at 40 micrograms/kg just before CDDP administration was used. The clinical efficacy, safety and usefulness against nausea and vomiting were investigated in 22 patients, and the study medication was assessed as "remarkably effective" or "effective" in 16 patients (72.7%). Neither adverse experience nor abnormal laboratory test value was reported. In the usefulness rating, the study medication was assessed as "extremely useful" or "useful" in 16 out of 22 patients (72.7%). The above results have shown that the slow intravenous injection of granisetron has an excellent antiemetic effect on nausea and vomiting induced by anticancer drugs including CDDP and a high degree of safety.

To investigate the effects of CPT-11 in combination with other anticancer agents, a human Burkitt's lymphoma cell line, Dauji, was incubated for 3 days in the presence of SN-38 (active substance of CPT-11) and the combined drug and cell growth inhibition was determined by MTT assay. The effects of the drug combinations at ID50 were then analyzed by isobologram (Steel and Peckham). A supra-additive (synergistic) effect was observed for SN-38 in combination with carboplatin, cisplatin, cytosine arabinoside, and mitomycin C. An additive effect was observed for its combination with bleomycin, etoposide, 5-fluorouracil, and mitoxantrone. Additive and sub-additive (antagonistic) effects were observed in combination with doxorubicin. A Sub-additive effect was observed in combination with methotrexate and vincristine.

The in vitro sensitivity testing for four human colorectal cancer cell lines to seven chemotherapeutic drugs including CPT-11, derivative of camptothecin, and its active form SN-38 were determined. MTT assay revealed that SN-38 was the most active for all four cell lines tested and its IC50's were very close to its clinically achievable plasma concentration. Relationship between exposure time and cytocidal effect of SN-38 was also investigated using MTT assay, topoisomerase-I (Topo-I) immunoblot analysis and DNA relaxation-assay, showing that IC50 value, Topo-I protein and Topo-I activity were decreased soon after the administration of SN-38 and reached to the plateau level at 24 hours. We conclude that SN-38 is very potent for colorectal cancer and the optimal schedule of CPT-11 can be the more continuous form of administration capable of as long as 24 hours exposure of its active metabolite, SN-38.

At the Second Tokyo National Hospital, treatment of patients with prostatic cancer was carried out under the same protocol over 12 years. The mean age of the patients was 73.6 years, and 50% of them fell into the Stage D category. As the initial treatment, hormonal therapy consisting primarily of diethylstilbestrol diphosphate (DES-P) was given to 93.8% of the patients, and the effectiveness of the initial treatment was observed in 87.4% of them. The pre-treatment tumor marker value was high in 65.6% of the patients, and reverted to within normal limits after treatment in 51.3% of them. Relapse was observed in 15.0% of the patients. Side effects of hormonal therapy were observed in 20.7% of the patients, and the side effects resulted in death in 1.3% of them. Throughout the duration of the study, 34.4% of the patients resulted in death; 18.8% of these deaths related to cancer and 13.1% of them to other causes. The 5-year survival rate of all patients was 68.1%, and the 10-year survival rate was 52.7%. DES-P which is the primary drug in the protocol employed at our institution was well tolerated in the patients with minimal side effects when given appropriately and was believed to be an extremely effective drug in the treatment of prostatic cancer in Japan.

We performed a randomized clinical trial in granulocytopenic patients with carcinoma or leukemia. Patients with persistent fever for more than 2 days despite antibiotic therapy were randomized to antibiotic plus fluconazole therapy group (FLCZ group) or antibiotic therapy only group (antibiotic group) by the envelope method. It was possible to evaluate clinical efficacies in 62 patients (37 patients in FLCZ group and 25 patients in antibiotics group). In patients whose neutrophil counts were less than 100/microliters on the initial day of therapy, clinical efficacy rates were 72.0% (18/25) in FLCZ group and 57.1% (8/14) in antibiotics group. In patients whose neutrophil counts continued to be less than 100/microliters during therapy, clinical efficacy rates were 64.3% (9/14) and 50.0% (3/6), respectively. Further, in patients whose neutrophil counts continued to be less than 500/microliters during therapy, they were 76.9% (20/26) and 53.3% (8/15), respectively. No severe side effects nor severe case of abnormal change in laboratory test values due to fluconazole were observed in this trial. These data suggest that empiric antifungal therapy with fluconazole is effective for fungal infections in granulocytopenic patients with carcinoma and leukemia.

Diarrhea is one of dose-limiting factors of irinotecan (CPT-11) and its incidence is over 60% in patients receiving this drug. Therefore, it is important to prevent diarrhea for more effective use of CPT-11. We used Hange-shashinto (TJ-14), an ethical Kampo (Chinese herb) Medicine, to prevent diarrhea induced by CPT-11. Twenty-three patients (9 lung cancer, 4 pancreatic cancer, 2 colorectal cancer, 4 malignant lymphoma, and 4 other types of cancer) entered in this study. All patients were treated with CPT-11 in combination with oral TJ-14 (7.5 g t.i.d.) every day starting prior to CPT-11 infusion. The dose of CPT-11 was 60-100 mg/m2/w, 120-150 mg/m2/2 w or 40 mg/m2/d x 3 days/w. Three of 23 patients could not evaluate the efficacy and safety of TJ-14 since they could not take TJ-14 due to its odor and taste. The efficacy and safety of TJ-14 was not evaluated in one patient also since the patient could not continue taking TJ-14 due to vomiting induced by CPT-11. Nine patients showed an excellent response (no diarrhea or only 1 day of ECOG Grade 1 diarrhea). 9 showed a good response (Grade 1 diarrhea that disappears within 3 days) and one did not reveal response. It is suggested that TJ-14 possesses a preventive effect against diarrhea induced by CPT-11.

We measured the concentrations of MCNU and CBDCA in the serum, brain tumor and normal brain tissue. Six patients with malignant glioma were treated with intravenous chemotherapy using 80mg/m2 MCNU and 300mg/m2 CBDCA during surgery. After drug administration, specimens of serum, tumor and normal brain tissue were collected every 30 min and then the drug concentration in each sample was measured. The highest MCNU levels in all samples were obtained immediately after administration which followed by gradual decrease. On the contrary, the mean CBDCA levels in the tumor and normal tissue remained almost at a constant level, although serum CBDCA level declined rapidly as MCNU. As expected, MCNU seemed to have advantages in the treatment of brain tumors as it distributed with higher concentration in the tumor tissue than in the serum and normal brain tissue. On the contrary, CBDCA in the tumor tissue did not exceed the concentration in the serum. Nevertheless, it remained longer in the tumor tissue with a constant level, suggesting that CBDCA can achieve an effective area under the concentration versus time curve (AUC) in the brain tumor tissue to kill tumor cells.

Multiple drug resistance(MDR) is a major clinical obstacle in cancer chemotherapy. Acquirement of MDR phenotype in cancer cells is often associated with enhanced expression of human MDR-1 gene: MDR-1 gene codes membranous P-glycoprotein which catalyses energy-dependent outward transport of anticancer agents. By contrast, MDR cancer cell lines without overexpression of P-glycoprotein are called as atypical MDR (at MDR) cells. The acquirement of at MDR has been shown to be partly associated with altered DNA topoisomerase II. Furthermore, a new ATP binding cassette (ABC) family, MRP gene has just recently shown to involve in acquirement of at-MDR in cancer cell lines, which do not express both altered topoisomerase II and P-glycoprotein.

A novel human CD7-positive leukemia cell line (HSM911) derived from the peripheral blood of a patient with acute myelogenous leukemia (AML) was studied for its cellular and biological characterization. Proliferation assay using a variety of cytokines demonstrated that the HSM911 cells proliferate in response to recombinant granulocyte-macrophage-colony stimulating factor (rGM-CSF), recombinant Interleukin-3 (rIL-3) and recombinant stem cell factor (rSCF), but do not in response to recombinant granulocyte-colony stimulating factor (rG-CSF), natural macrophage-colony stimulating factor (M-CSF), rIL-1, rIL-2, rIL-4, rIL-5, rIL-6 or recombinant erythropoietin (rEpo). Polyclonal anti-GM-CSF antibody and polyclonal anti-IL-3 antibody blocked the proliferation of HSM911 stimulated with rGM-CSF and rIL-3, respectively. HSM911 maintained in the presence of rGM-CSF expressed the CD7, CD13, CD33, CD34, CD41a, HLA-DR, VLA1-VLA5, CD11a, CD54, CD44 and LAM1. These findings suggest that HSM911 might be of multipotent progenitor cell origin. GM-CSF receptors and rIL-3 receptors expressed on this cell line were simultaneously suppressed by rGM-CSF or rIL-3, whereas only IL-3 receptors were down-modulated by rSCF. Treatment with 12-o-tetradecanoyl-phorbol-13-acetate (TPA) induced the differentiation of HSM911 cells into macrophage-like cells but not erythroblasts, megakaryocytes or lymphocytes. Interferon-gamma and transforming growth factor-beta (TGF-beta) suppressed the proliferation of HSM911 cells in a dose dependent manner. HSM911 was relatively resistant against anti-cancer drugs compared with fresh AML cells and other leukemic cell line. HSM911 is a useful tool for analyzing CD7-positive acute myelogenous leukemia.

A nationwide multi-center cooperative phase II clinical study of irinotecan hydrochloride (CPT-11) was conducted to evaluate its efficacy in intractable malignant lymphoma and acute leukemia. In malignant lymphoma, one course of CPT-11 consisted of intravenous drip infusion at a dose of 40 mg/m2 once daily for 3 consecutive days, performed once a week. In acute leukemia, one course of CPT-11 consisted of intravenous drip infusion at a dose of 15 to 20 mg/m2 a day twice daily for 7 consecutive days (1 cycle), performed every 2 to 4 weeks. Among the 79 patients with malignant lymphoma and 50 patients with acute leukemia enrolled in the study, 66 and 41 patients, respectively, completed treatment. These patients had all undergone chemotherapy prior to treatment. Among the malignant lymphomas, the response rate in non-Hodgkin's lymphoma (NHL), including 9 CRs, was 42% (26/62, 95% CI: 30-54%); of these there was a response rate of 39% (5/13), including 1 CR, in adult T-cell leukemia (ATL) as well. In Hodgkin's disease (HD), on the other hand, there were no cases in which efficacy was demonstrated (0/4). The overall response rate in malignant lymphoma was 39% (26/66), and the response rate even among the recurrent intransigent cases was 42% (16/38). The 50% survival time (MST) in the 74 eligible cases of malignant lymphoma was 153 days. In acute leukemia, on the other hand, partial remission was observed in 2 of 17 cases (12%) of acute lymphocytic leukemia (ALL), but no cases of remission were observed in the 24 patients with acute myelogenous leukemia (AML). The overall remission rate in acute leukemia was 5% (2/41, 95% CI: 1-14%). The principal adverse effects were myelosuppression in malignant lymphoma and gastrointestinal symptoms, including diarrhea, nausea/vomiting, anorexia and abdominal pain, in both malignant lymphoma and acute leukemia, and there was little organ damage to the heart, liver or kidney. Myelosuppression and gastrointestinal adverse effects were severe in some of the patients, so caution is required. Based on the above findings, CPT-11 appears to be efficacious in the treatment of non-Hodgkin's lymphoma.

A late phase II study of CPT-11 was conducted to evaluate the antitumor effect and toxicity of CPT-11 in patients with advanced pancreatic cancer as a cooperative study of 19 institutions. From February 1990 to June 1992, 61 patients with advanced pancreatic cancer were enrolled in this study. Fifty-seven patients were evaluable for toxicity and 35 for response. CPT-11 was administered as a 100 mg/m2 weekly intravenous infusion (regimen A) or as a 150 mg/m2 every two weeks (regimen B). The response rate was 11.4% (4/35). The primary tumor showed a 10.3% (3/29) response and the liver metastases showed a 10.5% (2/19) response. The major toxicities were myelosuppression and gastrointestinal symptoms. The incidences (> or = Grade 2) of leukopenia, anemia, anorexia, nausea/vomiting, alopecia and diarrhea were 61.4% (35/57), 56.1% (32/57), 70.2% (40/57), 56.1% (32/57), 40.4% (23/57) and 36.8% (21/57), respectively. The incidence of diarrhea was higher with regimen A than with regimen B, but the antitumor activity was no different between the two regimens. These results suggested that CPT-11 has some antitumor activity against advanced pancreatic cancer.

A multi-institutional collaborative late phase II study of irinotecan hydrochloride (CPT-11) was performed on patients with advanced gastric cancer. CPT-11 was administered as a 100 mg/m2 weekly intravenous infusion or as 150 mg/m2 fortnightly. Of 81 registered patients, 77 cases were eligible and 60 cases were evaluable for response. The overall response rate for evaluable cases was 23.3% (14/60), and the response rate was 16.1% (9/45) for the patients who had received prior chemotherapy. The primary tumor showed a 4.5% response, while metastatic lesions in the lymph-nodes, lungs, and liver showed response rates of 36.4%, 33.3%, and 17.4%, respectively. The major toxicities (> or = Grade 3) were leukopenia (41.2%), anemia (28.9%), diarrhea (22.4%) and anorexia (19.7%). These toxicities were generally reversible. CPT-11 showed activity against advanced gastric cancer, suggesting that further clinical studies of CPT-11 combined with other active chemotherapy agents are warranted.

A late phase II study of CPT-11 for advanced breast cancer was conducted at 27 institutions. Seventy-nine patients were enrolled, 75 were eligible for the study, and 65 were evaluable for efficacy. One complete response and 14 partial responses were obtained, and the response rate was 23%. The response rate of patients with prior endocrine therapy and prior chemotherapy including adriamycin or other anthracycline drugs was 27% (11/41) and 26% (12/46), respectively. The response rate for patients with estrogen receptor-negative tumors and premenopausal patients was 32% (6/19) and 27% (4/15), respectively. Responses were observed not only for soft tissue lesions such as lymph nodes (5/17), but also for distant metastases in the lungs (8/28) and bone (1/18). The major adverse reactions were myelosuppression and gastrointestinal symptoms. The incidence of Grade 2 or higher leukopenia, anemia, nausea/vomiting, anorexia, diarrhea and alopecia was 68%, 31%, 67%, 59%, 37%, and 30%, respectively. These results suggested that CPT-11 was a promising drug for advanced breast cancer.

An early phase II study of MST-16 for breast cancer was conducted with the participation of 9 hospitals. MST-16 was administered at three doses; 1) 1,600 mg/body for 5 consecutive days repeating every 4 weeks, 2) 1,200 mg/body for 10-14 consecutive days every 5 weeks, and 3) 1,200 mg/body daily for at least 4 weeks. A total of 28 patients were entered, and 27 cases were eligible. Twenty-five cases were evaluated for efficacy and 27 cases for safety. One patient achieved complete response, 2 patients attained partial response, and the response rate thus obtained was 12.0%. Major side effects observed were myelosuppression represented by leukopenia (69.2%) followed by gastrointestinal disorders. These symptoms, however, were reversible by the cessation of administration.