COMBINATION CHEMOTHERAPY FOR GENITO-URINARY MALIGNANCIES

Second Report: Analysis of the Clinical Cases

Abstract

In a series of patients with malignant urogenital tumors, systematic aggressive polypharmacy was studied in terms of its effects on the tumor and the host's immunological status. The schedule for drug administration consisted of daily Futraful orally as the basis, and the addition of one drug per day of Oncovin, bleomycin, Endoxan, and Mitomycin C, each of which differs in its side-effects and mechanism of action. Where indicated, radiotherapy was also used, and from the end of 1974, non-specific immunotherapy was instituted on a regular basis.
The tumor types included 8 cases of renal cell carcinoma, 10 of pelvic or ureteric carcinoma, 30 of bladder carcinoma, 2 of prostatic carcinoma, 1 of prostatic rhabdomyosarcoma, and 1 of testicular rhabdomyosarcom a.
The anti-tumor effect was examined in 33 of the total 52 cases, 21 of these being effective, a rate of 63.3% with this schedule of therapy, the effective response rate was high for bladder, pelvic, and ureteric carcinomas, whereas adequate results were not obtained with renal or prostatic carcinomas.
The parameters monitored in these cases as measures of the effectiveness of therapy included erythrocytes sedimentation rates, α₂-globulin levels, PPD reactions, and lymphocytes blastoid transformation (LBT) rates. The LBT rates were measured by the whole blood culture technique reported by Pellegrino et al.
The results indicated a close relationship between the therapeutic effect and the pattern of change in these laboratory results at the time of therapy. There was also a close relationship between the laboratory findings before the commencement of therapy and the prognosis.
Active therapy was instituted from the pre-operative period in cases of advanced bladder carcinoma. In these cases, 5 courses of FOBEM together with OK-432 and ⁶⁰Co 3000rad were given at the same time. A satisfactory anti-tumor effect was obtained. There were, however, some cases of delayed healing of the surgical wound post-operatively. It was considered, therefore, that the pre-operative treatment instituted, to a certain extent, an overdose. On the other hand, a prolonged survival time could be expected following discharge from hospital. Hence, because of the improved prognosis in these urogenital malignancies, planned maintenance therapy aimed at modification of the host's immunologic status was considered necessary over a long period of time.