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The choice between cisplatin (cis) and carboplatin (carbo) as the platinum analogue to be used in combination chemotherapy regimens continues to be a point of controversy, and a new platinum analog...

The recent introduction of three oral fluoropyrimidine preparations to the antineoplastic armamentarium has been welcomed as a major step forward in providing a patient-convenient delivery system f...

Multifractionated dosing (MFD) schedules for chemotherapy administration such as weekly or twice weekly administration are intended to maximize dose intensity while minimizing toxicity, but the cumulative drug effect may result in neutropenia necessitating interruption of dose fractions and thereby compromising dose intensity. Intermittent granulocyte colony-stimulating factor (G-CSF, Neupogen, Amgen) was administered to patients receiving MFD on three paclitaxel-based chemotherapy regimens. Single-dose G-CSF was administered concomitant with the chemotherapy dose fraction when the white blood count was between 2000 and 3500 cells/microliter. A retrospective analysis of the concomitant administration of single-dose G-CSF with chemotherapy in these trials demonstrated that in most patients, G-CSF administration guided by the level or grade of leukopenia permitted maintenance of the chemotherapy dose intensity and completion of the treatment cycle. The common pattern in a six-dose, twice weekly, multifractionated cycle was for G-CSF to be administered with every other chemotherapy dose beginning with the third, fourth, or fifth dose, but some courses required G-CSF administration with each chemotherapy dose fraction. Guidelines for the concomitant use of G-CSF and paclitaxel-based MFD chemotherapy can be used to maintain chemotherapy dose intensity. A prospective study of guidelines for cytokine usage developed on the basis of this retrospective study will be necessary to determine the optimal cytokine dose and schedule for use simultaneously with chemotherapy.

Bilateral synchronous or metachronous germ cell tumors (GCT) of the testis are recognized in 2-3% of patients. Extragonadal GCT in the mediastinum or the retroperitoneum have been rarely reported in patients with primary GCT of the testes. Two patients were observed with two separate primary GCT; in 1 a retroperitoneal embryonal carcinoma was successfully treated with chemotherapy and surgery and a new primary developed 14 years later in the testicle as a seminoma. A second patient had a primary teratocarcinoma of the testes treated with surgery only; 4 years later he developed a mediastinal endodermal sinus tumor, which was fatal. These cases suggest that not only is the remaining testicle at risk for a second primary GCT, but also that extragonadal sites impose a similar risk and monitoring of patients should consider all potential sites for the development of GCT.

Metastatic breast cancer is thought never to be cured, although anecdotal cases of prolonged survival have been reported. A review of 1581 cases treated with combination chemotherapy at the M.D. Anderson Cancer Center in Houston identified 49 complete responders (3.1%) who remained in complete response (CR) for more than 5 years (1). Another report, from the Eastern Comparative Oncology Group (ECOG), identified 10-year survival in 10% of 147 patients receiving chemotherapy in two trials for metastatic breast cancer (2). In the presence of metastasis, the potential for cure is not a recognized goal or even considered to be a possibility in breast cancer, although isolated instances of long-term survivors with and without disease may contribute to a different definition of cure.

Objective tumor regression in response to therapy invariably results in prolonged patient survival and often improves the quality of remaining life. The author describes criteria for determining, and clinical guidelines for predicting, tumor response. Further, he reviews tactics of cancer chemotherapy with regard to dose-response relationships and kinetics of tumor response.

Continuous delivery of cytotoxic drugs has been shown to yield therapeutic results comparable to bolus-delivery regimens while minimizing toxicity and adverse effects.