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53 patients with advanced and measurable cancerr were treated with vindesine in doses of 3 mg/m2 (pretreated) and 4 mg/m2 (non pretreated) i.v. once weekly. 48 patients are evaluable for response: of 14 patients with squamous cell carcinoma of the lung, 1 partial remission (PR), 1 minor response (MR) and 1 no change (NC) were observed. In 5 patients with large cell carcinoma of the lung: 1 NC. In 3 with adenocarcinoma of the lung: 1 MR. One patient with nasopharyngeal carcinoma had progressive disease. Stable disease was observed in a patient with carcinoma of the tongue and in a patient with adenocarcinoma of the esophagus. Four patients with colorectal carcinoma had progressive disease. One MR was observed in a patient with breast cancer, while all of the other 3 patients had progressive disease. One carcinoma of the penis was stable. One MR was observed in a patient with Hodgkin's disease. One PR was observed in a case with no-Hodgkin's lymphoma. A patient with acute leukemia had progressive disease. Among 9 patients with malignant melanoma, 3 had an MR and 1 patient had stable disease. A patient with fibrosarcoma had progressive disease. Observed toxicity included leukopenia, thrombocytopenia, anemia, paresthesias, constipation, jaw pain, nausea, stomatitis, alopecia, loss of taste, pruritus and skin rash, weakness and fatigue.

Cis-diamminedichloroplatinum(II) (DDP) represents a new class of platinum compounds with cytostatic activity. Although the exact mechanism of action remains unknown, it is the most widely studied of these agents to date. The toxicology, metabolism, mode of application and clinical experience with this drug are presented and discussed. The value of DDP as monotherapy as well as in combination with other cytostatic agents, especially in the treatment of testicular cancer, as well as the possibilities of controlling its nephrotoxic effects are presented in greater detail.

Adriamycin (doxorubicin, Adriblastin) and cis-diammine-dichloro-platinum (II) (DDP, NSC 119 875) were used in the treatment of 18 patients with ovarian carcinoma, usually after intensive pre-treatment, both in a dosage of 50 mg/m2 once every 4 weeks. Forced diuresis was initiated at the same time. On average three such treatments were given. Six patients showed partial remission defined as decrease of tumour mass by more than 50% or as almost complete disappearance of ascites during more than two months without concomitant diuretic treatment. The remission time was 2+, 3, 3+, 3.5, 7+, and 9+ months. In all patients severe gastrointestinal toxicity occurred, however the myelosuppressive action was only moderate. Nephrotoxicity was negligible. Combined chemotherapy with Adriblastin and DDP thus seems effective even in intensively pretreated patients with ovarian carcinoma.

The carcinomas of the male genitourinary tract--prostate, testicle, bladder, kidney and penis--are discussed with regard to incidence, prognosis and therapeutic possibilities. The results of drug treatment, especially for prostatic and non-seminoma testicular cancers, are presented in detail.

As the observation times of current studies using adjuvant chemotherapy in the treatment of operable stage II breast cancer lengthen, the probability of significantly reducing the high risk of developing metastases associated with this stage of the disease is also increasing and should be reflected in improved cure rates. The theoretical basis, prerequisites and presently available results for adjuvant chemotherapy of breast cancer are discussed. Adjuvant combination chemotherapy provides better results than monochemotherapy with Alkeran. While earlier results suggested that adjuvant chemotherapy is especially effective in premenopausal women, newer studies and analyses indicate that appropriate dosage and consistent administration of chemotherapy are of decisive importance. Exact determination and documentation of the tumor stage, and especially the regional lymph node status, is the most important factor in determining the indication for adjuvant chemotherapy. Adjuvant chemotherapy is still best with many unsolved problems. These include the duration, necessary intensity based upon risk factors, and short- and long-term side effects.

Criteria for the diagnosis of multiple myeloma and differential diagnostic considerations are presented. The indications for treatment are discussed. Combination of melphalan or cyclophosphamide with prednisone may be considered standard therapy today. This produces objective tumor regression in 50-70% of patients. The parameters for determining remission and their significance with regard to survival and tumor cell mass are discussed. The importance of supportive measures is stressed. Persistent problems and potential for improving present therapy are discussed.

Ten patients with metastatic testicular or ovarian carcinoma were treated with cis-platinum II diaminedichloride. All had received prior chemotherapy with other agents. A therapeutic effect was seen in 7 cases, though it was of short duration in all instances. The drug proved to be very nephrotoxic and caused marked bone marrow depression. The future of this highly effective cytostatic agent, either with different dosage schedules or in combination with other drugs, is discussed. The possibility of new platinum derivatives with a better therapeutic index is also mentioned.

29 patients with advanced malignant lymphoma were included in a phase-II trial conducted by Cancer and Acute Leukemia Group B. The patients received cis-diamminedichloroplatinum (DDP) in a dose of 70 mg/m2 every three weeks. In this still ongoing study, 23 patients are already evaluable. Out of 23 cases partial remission was observed in 6. The main toxicity was profuse vomiting. Myelosuppression and nephrotoxicity were both manageable. Based on these preliminary data, the incorporation of DDP in combination chemotherapy for malignant lymphoma appears to be warranted.

Acute myeloid leukaemia occurred in six patients who had been treated for Hodgkin's disease for a number of years. Usually the leukaemia diagnosis was preceded by a striking pancytopenic phase, bone-marrow aspiration being more useful diagnostically than biopsy. Five of these six patients have come under observation in the last eighteen months. This extraordinary frequency of secondary acute myeloid leukaemia once again raises the question of the leukaemogenic effect of intensive radiotherapy and chemotherapy, and also new aspects in the therapeutic management of Hodgkin's disease, especially combined radiotherapy and chemotherapy, as well as long-term maintenance chemotherapy.

Thirty patients with bronchogenic carcinoma underwent an 8 week course of induction therapy consisting of cyclophosphamide, methotrexate, vincristine, and VP 16-213 (NSC 141 540). Those who achieved objective remission or tumor stabilization were then placed on an intermittent treatment schedule with the same drugs. Of the 30 patients, 17 had an objective response, 5 were unchanged and 8 progressed. Responses were more frequent in anaplastic carcinoma (13/19) than epidermoid or adenocarcinoma (4/11). The toxicity mainly consisted of leukopenia, thrombopenia, alopecia, nausea and vomiting. The implications of these findings in the planning of further chemotherapeutic programs are discussed.

The podophyllotoxin derivative VP 16-213 was used as monotherapy in 6 patients and combined with 5-fluorouracil in another 6. Of the 12 patients treated, 11 had measurable tumor criteria and 5 of these responded to treatment. These responses were attributed mainly to the effects of VP 16-213. Patients responding to chemotherapy lived significantly longer than non-responders. Each case of objective tumor response was accompanied by subjective improvement. In view of these results, a more active approach to the treatment of hepatocellular carcinoma would seem to be justified.

82 patients treated with adriamycin alone or in combination with other cytostatic agents underwent scalp hypothermia by application of a gel cap. The cap ws applied 10 minutes before the injection of the drugs and maintained until 30 minutes after the administration of the chemotherapy. Prevention of hair loss was achieved in 47 patients (57%). The prophylaxis was successful in 16 out of 21 males (76%) compared with 31 out of 61 female patients (p less than 0.05). No statistically significant difference was found between patients receiving higher or lower doses of adriamycin or between patients wtih or without liver dysfunction. The tolerance of the gel cap was excellent; only one patient did not tolerate the cap because of anxiety during application.

Ten acute leukemia patients were treated with the new cytostatic agent VP 16-213. Almost all these patients had received previous therapy. One complete and two partial remissions were achieved, while one patient showed brief clinical improvement. VP 16-213 appears to be effective not only in acute monocytic leukemia, as therapeutic effects could also be observed in other forms of acute leukemia. VP 16-213 should further be tested in therapy of refractory acute leukemia patients as a drug of second choice. The relatively mild toxic effect of this substance and its special mode of action would appear to make it highly suitable for incorporation into combination chemotherapy regimes and further clinical trials.