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Treatment with a combination of adriamycin (ADM) and cis-dichlorodiammineplatinum(II) (DDP) has been evaluated in 24 patients with advanced ovarian cancer. Twenty patients had received prior chemotherapy and/or radiation therapy. Objective remissions were seen in ten patients. The usual toxic manifestations of ADM and DDP were observed. It is concluded that the combination is effective therapy for ovarian cancer. Further investigation of this combination versus single agents is warranted.

The clinical experience at the University of Minnesota Hospitals between 1962 and 1977 was reviewed in the hope of defining the biologic features of testicular cancer, knowledge of which is essential to determine the therapeutic needs of each patient. This collaborative effort between clinicians and statisticians has attempted to define important variables in the assessment of risk factors that determine the choice of treatment for testicular cancer. A preliminary analysis of data on the first 78 patients tabulated was performed to test and plan an approach to the final analysis of a larger group of 282 patients. One prognostic factor, staging, is discussed in detail to illustrate the purpose of this exploratory testing. Retrospective analysis, according to stage, of patients who were referred to this cancer center revealed a poorer prognosis than should be anticipated. In reporting the clinical experience of an individual institution, problems of bias are introduced with respect to the nature of the types of tumors studied.

In 1967 we first started to use daunorubicin and prednisone in the treatment of acute nonlymphocytic leukemia. In this review we describe our results with this regimen in 72 adults who were treated at the University of Minnesota between 1967 and 1977. Fifty-five patients were previously untreated and 17 had received prior cytotoxic chemotherapy. Complete remissions were obtained in 21 (29%) of the 72 patients. The patients achieving complete remission were significantly younger and had lower pretreatment leukocyte and absolute myeloblast counts than the nonresponders. Patients with acute promyelocytic leukemia had a higher response rate (67%) and longer duration of complete remission compared to patients with the morphologic subtypes. Their median duration of complete remission was 29 months compared to 6 months for the other patients. The 21 patients who achieved complete remission survived longer (20 months) than those who failed to enter remission (2 months). Our experience suggests that daunorubicin is an effective drug in the treatment of acute promyelocytic leukemia, but should be combined with additional agents in the treatment of other types of acute nonlymphocytic leukemia.

Forty consecutive patients with small cell bronchogenic carcinoma were treated. The first 18 patients were treated with CCNU and doxorubicin (Adriamycin) (CA). The next 22 patients were treated with CCNU, doxorubicin, procarbazine, and vincristine (CAPO). Patient characteristics were similar. The partial plus complete response rate was 55% (ten of 18 patients) in the CA group compared to 41% (nine of 22 patients) in the CAPO group. The median survival from treatment was 28 weeks in the CA group compared to 33 weeks in the CAPO group. There were no drug-related deaths among the patients receiving CA compared to two definite and three probably drug-related deaths among the patients receiving CAPO. The addition of procarbazine and vincristine to CA for the treatment of small cell bronchogenic carcinoma resulted in increased toxicity and no survival benefit.

A program for treating advanced testicular cancer with vinblastine, bleomycin, and a single dose of cis-dichlorodiammineplatinum(II) was used in an attempt to reduce the toxicity of a 5-day regimen while maintaining a high response rate. In ten previously untreated and six previously treated patients, the complete remission rate was 25%. Toxic reactions were frequent, and there was one drug-related death. This single-dose cis-dichlorodiammineplatinum(II) program is ineffective in the treatment of testicular cancer. Other means for reducing toxicity will have to be considered.

Twelve patients with advanced nodular sclerosis Hodgkin's disease were extensively reassessed following the completion of planned chemotherapy. The evaluation culminated in an exploratory laparotomy. Eight patients with no evidence of abdominal involvement on noninvasive tests also had no Hodgkin's disease found during laparotomy. Four patients had intra-abdominal Hodgkin's disease suspected prior to laparotomy based on the results of the noninvasive procedures. At laparotomy, benign abnormalities were present in three patients; only one had residual Hodgkin's disease. No patient with a negative laparotomy has developed recurrent abdominal Hodgkin's disease, but two patients developed supradiaphragmatic recurrences. The patient with persistent Hodgkin's disease had his treatment regimen successfully altered. These data suggest that patients with negative preoperative findings do not benefit further from a laparotomy. However, in selected patients with suspicious intra-abdominal findings, the results of laparotomy may alter future management.

The three-drug combination of 5-fluorouracil, methyl-CCNU, and daunorubicin was evaluated in 38 patients with unresectable or metastatic carcinoma of the colon. There were five partial responses and one complete response for an overall response rate of 16%. Although toxicity was tolerable, daunorubicin failed to add to the 5-fluorouracil and methyl-CCNU combination.

Renal toxicity and urinary pharmacokinetics following a nonlethal dose (5 mg/kg) of cisplatin were investigated in female F344 (Fischer) rats that were on a standardized light-dark schedule, with water freely available. Circadian timing of drug administration had a major effect on the BUN increase (P less than 0.01), the urine volume increase (P less than 0.025), and the urinary concentration of cisplatin following drug administration (P less than 0.01). Renal toxicity was positively correlated with the peak urinary concentration of cisplatin and with the area under the curve of urinary concentration over the first 20 hours after drug administration (P less than 0.01). Drug administration near the normal circadian maximum of urinary volume prior to treatment resulted in the least renal toxicity, lowest peak, and smallest area of urinary concentration of cisplatin.