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17. Now I Look Away.

Author

Osteen, Robert T.

Abstract

The poem "'Now I Look Away" by Robert T.Osteen is presented. First Line: His eyes, Last Line: And look down.

Published
2023
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20. Adjuvant High-Dose Interferon Alfa-2b in Patients with High-Risk Melanoma.

Author

Jonasch, Eric, Kumar, Uday N., Linette, Gerald P., Hodi, F. Stephen, Soiffer, Robert J., Ryan, Bonita F., Sober, Arthur J., Mihm, Martin C., Tsao, Hensin, Langley, Richard G., Cosimi, Benedict A., Gadd, Michele A., Tanabe, Kenneth K., Souba, Wiley, Haynes, Harley A., Barnhill, Raymond, Osteen, Robert, and Haluska, Frank G.

Subjects
ADJUVANT treatment of cancer, MELANOMA, INTERFERONS, ANTINEOPLASTIC agents, HEPATOTOXICOLOGY
Abstract

We performed an analysis of toxicity and survival in stage III melanoma patients receiving adjuvant interferon alfa-2b (IFN). This was a retrospective single-arm analysis of 40 patients with stage III melanoma who received (IFN) administered at maximum tolerated doses of 20 mU/m²/day intravenously (IV) for 1 month and 10 mU/m² three times per week subcutaneously (SC) for 48 weeks. Toxicity in our series is comparable to that experienced in the Eastern Cooperative Oncology Group (ECOG) 1684 trial, except for higher rates of dose-limiting myelosuppression and hepatotoxicity. All 40 patients experienced constitutional symptoms, but only 14/40 (35%) experienced grade 3 to 4 symptoms. Of the 40 patients, 36 (90%) experienced neurologic symptoms, but only seven (17.5%) experienced grade 3 to 4 neurotoxicity. Two patients stopped treatment because of severe psychiatric symptoms; one patient attempted suicide, and a psychosis developed in another. Thirty-nine (97.5%) patients experienced myelosuppression; 31 (77.5%) developing grade 3 to 4 myelosuppression. Hepatotoxicity was evident in 39 (97.5%) patients, and 26 (65%) experienced grade 3 to 4 hepatotoxicity. Three patients (7.5%) experienced mild renal toxicity. At a median follow-up of 27 months from initiation of therapy, there have been 19 relapses (47.5% disease-free survival [DFS]) and 10 deaths (75% OS) resulting from progression of disease. The DFS compares with the treatment arm in ECOG 1684 at 27 months, but overall survival is higher in our series of patients at the same time point. In a single program setting, IFN can be administered with similar side effects and outcome profiles seen in multi-institutional studies. Modifications in the induction regimen resulted in notably higher hematologic and hepatic toxicities but did not preclude administering further therapy and did not result in increased attrition rate among patients: only nine patients (22.5%) had their treatment stopped as a result of IFN-related toxicity. In comparison, 26% of patients had to have their treatment discontinued because of toxicity in ECOG 1684. [ABSTRACT FROM AUTHOR]

Published
2000

26. Comparison of adjuvant chemotherapy with methotrexate and fluorouracil with and without cyclophosphamide in breast cancer patients with one to three positive axillary lymph nodes.

Author

Shapiro, Charles L., Gelman, Rebecca S., Hayes, Daniel F., Osteen, Robert, Obando, Antonio, Canellos, George P., Frei, Emil, Henderson, I. Craig, Shapiro, C L, Gelman, R S, Hayes, D F, Osteen, R, Obando, A, Canellos, G P, Frei, E 3rd, and Henderson, I C

Subjects
ANTINEOPLASTIC agents, AXILLA, BREAST tumors, COMBINED modality therapy, COMPARATIVE studies, FLUOROURACIL, RESEARCH methodology, MEDICAL cooperation, METASTASIS, METHOTREXATE, RESEARCH, STATISTICAL sampling, EVALUATION research, RANDOMIZED controlled trials, PROPORTIONAL hazards models, CYCLOPHOSPHAMIDE
Abstract

Background: Alkylating agents administered as single agents or in combination with antimetabolites or anthracyclines delay the appearance of metastases and prolong the survival of breast cancer patients after surgery.Purpose: This phase III clinical trial was designed to evaluate the therapeutic efficacy and toxicity of the alkylating agent cyclophosphamide in combination with the antimetabolites methotrexate and fluorouracil adjuvant to breast cancer surgery.Methods: This study consisted of 255 breast cancer patients (a) with one to three histologically positive axillary lymph nodes and either no detectable primary tumor or operable primary tumors 5 cm or less (T0-T2) (95% of the patients) or (b) with tumors larger than 5 cm (T3) and with negative axillary nodes. Patients were randomly allocated to receive either methotrexate (60 mg/m2) and fluorouracil (600 mg/m2) (MF) intravenously on days 1 and 8 every 28 days for eight cycles or cyclophosphamide (100 mg/m2) orally on days 1-14 plus MF (CMF) every 28 days for the same duration. Median follow-up was 7.8 years, and maximum follow-up was 13 years.Results: There were no statistically significant differences in time to treatment failure or overall survival for patients treated with MF or CMF. At 8 years after completion of treatment, time to treatment failure was 55% (95% confidence interval [CI] = 50%-60%) and 59% (95% CI = 54%-64%) and overall survival was 69% (95% CI = 65%-73%) and 67% (95% CI = 62%-72%) for MF- and CMF-treated patients, respectively. The hazard ratios (MF to CMF) for time to treatment failure and for survival, estimated with a proportional hazards model, were 1.02 (95% CI = 0.69-1.50) and 0.87 (95% CI = 0.56-1.34), respectively. Myelosuppression was significantly greater (P < .0001) in CMF-treated patients during cycles 1-6. Median white blood cell count nadirs were between 4.4 x 10(3)/microL and 3.5 x 10(3)/microL in patients receiving MF and between 3.0 x 10(3)/microL and 2.4 x 10(3)/microL in those receiving CMF. Dose reductions were more frequent in CMF-treated patients, which led to statistically significant differences (P < .0001) in amounts of methotrexate and fluorouracil administered. Primary cancers at other sites occurred in 14 patients (5.5%)--six treated with MF and eight treated with CMF.Conclusions: Our findings suggest that the addition of cyclophosphamide to adjuvant chemotherapy with MF offers no therapeutic advantage but results in increased myelosuppression.Implications: Future trials will define the possible advantages of antimetabolites in adjuvant therapy. Further information will also become available when results of the ongoing National Surgical Adjuvant Breast and Bowel Project trial comparing adjuvant MF to CMF in node-negative breast cancer patients are presented. [ABSTRACT FROM AUTHOR]

Published
1993

36. Primary radiation therapy for locally advanced breast cancer.

Author

Sheldon, Thomas, Hayes, Daniel F., Cady, Blake, Parker, Leroy, Osteen, Robert, Silver, Barbara, Recht, Abram, Come, Steven, Henderson, I. Craig, Harris, Jay R., Sheldon, T, Hayes, D F, Cady, B, Parker, L, Osteen, R, Silver, B, Recht, A, Come, S, Henderson, I C, and Harris, J R

Published
1987
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