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Background: Paclitaxel has been found to be efficacious in the treatment of breast carcinoma either when administered alone or in combination with other anticancer agents. Synergistic interaction between paclitaxel and cisplatin has been demonstrated in vitro., Methods: Thirty-two patients with breast carcinoma that was resistant to anthracyclines and to several other antineoplastic agents were selected to receive 80 mg/m(2) of paclitaxel on Day 1 and 80 mg/m(2) of cisplatin on Day 2 with a 3-week interval between the courses., Results: High response rates were observed, with 3 complete responses (9.4%) and 13 partial responses (40.6%) reported. Furthermore, the disease remained stable in 7 patients (21.9%) and progressed in only 9 patients (28.1%)., Conclusions: The results show that high response rates can be achieved with the combination of paclitaxel and cisplatin, even in heavily pretreated breast carcinoma patients. The combination of paclitaxel plus cisplatin was found to be highly efficacious and well tolerated., (Copyright 2000 American Cancer Society.)

Peritoneal effusion is a common complication in disseminated cancer. Intracavitary instillation of various agents has achieved control rates of 30-60% with no rational preference for one agent or another. However, serious side effects have also been observed and deaths due, for instance, to bleomycin have been reported. Mitoxantrone has recently been tested to treat effusions, and preliminary results suggest the high efficacy of this drug in the treatment of peritoneal, pericardial and pleural effusions. Nevertheless, some results have been conflicting. In the present study, 41 patients with peritoneal effusions were treated with intracavitary bleomycin or intracavitary mitoxantrone. The median duration of control of effusion was 5 months (range 1 week to 14 months) with mitoxantrone and 4 months (range 1 week to 12 months) with bleomycin. We conclude that, taking into account their limitations, both agents can be used successfully in the treatment of peritoneal effusions.

Spontaneous regression of advanced breast cancer is a rare phenomenon. Efforts have been made in order to explain it by means of immunological mechanisms. Corticosteroids have demonstrated important efficacy in the treatment of breast cancer. We present a patient with stage IV breast cancer in whom large tumour masses dramatically regressed during treatment with dexamethasone alone. In this patient, histological and hormonal findings, with results of analyses on surface and intracellular blood cells markers demonstrated significant redistribution of lymphocytes and accumulation of natural killer cells in tumour masses. It seems that dexamethasone has acted through the hypophyse against cancer.

Effusions are common in advanced cancer. Intracavitary instillation of various agents such as bleomycin has achieved control rates varying between 20% and 60%. However, serious side effects have also been observed, and cases of death due, for instance, to bleomycin have been reported. Mitoxantrone has been tested recently in the treatment of effusions, and preliminary results suggest high efficacy of this drug in the treatment of peritoneal, pericardial, and pleural effusions. Nevertheless, certain results have been conflicting. In the present study, 29 patients with pleural effusions were treated either with intracavitary bleomycin or intracavitary mitoxantrone. Effusions were controlled almost equally by both agents; 67% with mitoxantrone and 64% with bleomycin. We conclude that both agents can be used successfully in the treatment of pleural effusions.

Cases of 109 patients with metastases from cancer of unknown primary (CUP) were retrospectively analyzed. The highest survival rates were observed in patients with high performance status and metastases limited to the cervical lymph nodes. With other metastatic presentations, the survival was generally very short. Tumor markers did not demonstrate diagnostic value. The primary tumor was revealed by autopsy in 43 of 64 cases. Lungs were the most common primary site, followed by the gastrointestinal tract. Extensive clinical investigations during the initial diagnostic period were, as a rule, fruitless. Patients with CUP require efficacious treatment, but need to be investigated with adequate measures.

Between February 1985 and October 1989, 26 patients previously treated for metastatic breast cancer received oral tegafur, at a median daily dose of 1200 mg. Of these, 21 were evaluable for response. The overall response rate was 29%; six (two in lungs, two in skin and two in lymph nodes) of 44 evaluable lesions (14%) responded to therapy. Haematological toxicity was mild, and no other dose-limiting toxicity was seen. The data indicate some activity in heavily pretreated metastatic breast cancer even after previous 5-FU therapy.

59 patients who had earlier developed an infection following antineoplastic chemotherapy were randomised to receive either granulocyte colony-stimulating factor (G-CSF) alone or G-CSF+quinolone as prophylaxis during subsequent identical chemotherapy courses. 30 patients received 48 courses of G+CSF, while 29 patients received 44 courses of G-CSF+ofloxacin or ciprofloxacin. The overall infection rate was 23%. Patients with WHO grade IV leukopenia at the onset of prophylactic treatment developed infection in 61% of cases when on G-CSF, but only in 22% when on G-CSF+quinolone (P = 0.002). Patients with initial leukopenia of grade WHO III-I had only a 11% infection rate showing no significant difference between the treatment groups. The median duration of leukopenia < 1 x 10(9)/l was 4 days for patients receiving G-CSF alone and 3.5 days for those receiving additional quinolone. Patients developing infection had grade IV leukopenia for a median of 5 days. Both prophylactic treatments were well tolerated. We conclude that when prophylactic G-CSF is initiated at WHO grade IV leukopenia, addition of an oral quinolone reduces the risk of infection.

The purpose of this study was to characterize the epidemiological features of cancer of the penis in Finland. After histological re-examination and exclusions, the final series comprised 269 patients with cancer of the penis diagnosed and reported to the Finnish Cancer Registry between 1955 and 1977. The age-adjusted incidence rate of cancer of the penis decreased slightly from the 1960s onwards and was on the order of 0.5 per 100,000 person-years in the 1970s. Cancer of the penis was a disease of elderly males, which showed no systematic geographical variation in Finland in terms of risk. The most frequent predisposing factors were phimosis, in 44% of the cases, and condylomatous lesions, in 20% of the cases. The general survival (all patients, all stages) was favourable; the 5-, 10-, and 20-year relative survival rates were 71, 69 and 78%, respectively.

The suppression of potentially pathogenic microorganisms using prophylactic antibacterial treatment could eventually protect the patient from infection. Oral absorbable and non-absorbable antibacterial agents have been used with variable results. In the present study, 47 patients with cancer and neutropenia received oral ofloxacin 200 mg twice daily prophylactically. All patients were previously treated with antineoplastic chemotherapy. Septicemia developed in ten patients (21%). The number of infections was higher in patients with a level of granulocytopenia under 0.5 x 10(9)/1. Infection was caused in almost all patients by gram-positive organisms. Prophylaxis with ofloxacin provided efficacious protection against gram-negative bacteria and was well tolerated.

A system of histological grading based on retrospective analysis of 239 patients with squamous cell carcinoma of the penis is presented. A new scoring system with 4 histological grades was used. The results of this study confirm previous reports that penile cancer is usually a highly (50%) or moderately (29%) differentiated squamous cell carcinoma. Poorly differentiated carcinomas and cancers of other types are very rare. The new grading system was found to be practical and a correlation between histological grade, clinical findings and prognosis was established. Patients with grade 1 tumours had an exceptionally favourable prognosis, with more than 80% being long-term survivors; for these patients, treatment with delayed side effects should be avoided and new forms of treatment should be explored.

Immune deficiency generally leads to infections. Cancer chemotherapy, medical interventions and various investigational procedures are important factors in the development of infection. In recent decades, there has been a major change in most cancer centers in the etiology of bacterial infections occurring in the immunocompromised host, most infections now being caused by gram-positive organisms. This might be partly due to prophylactic use of agents effective against gram-negative bacteria. The quinolones are now widely used in the treatment of serious infections of the immunocompromised patient. Prophylaxis with quinolones is also practised in cancer centers.

Infection is the immediate cause of death in many patients with cancer. Traditionally, combinations of modern beta-lactam antibiotics and aminoglycosides are empirically used in the treatment of patients with neutropenia and presumed infection. However, the new quinolones appear to have become potent combination partners for beta-lactams. Eighty-seven patients with presumed serious infection were blindly randomised to receive either 2 g cefotaxime i.v. plus 200 mg ofloxacin twice daily (group 1) or 2 g cefotaxime i.v. twice daily plus tobramycin i.v. three times daily with dosage adjustment according to renal function and body weight (group 2). The response rate was significantly higher in group 1 (71%) compared to group 2 (47%). The cefotaxime/ofloxacin combination proved to be safe and represented a considerable reduction of workload on the nursing staff.

Two hundred and thirty-nine patients with squamous cell carcinoma of the penis were grouped into the existing different clinical classifications and staging systems, i.e. the UICC-TNM (1978 and 1987), Jackson's and that used in Heidelberg. Because of shortcomings observed in the previous systems, a new classification and staging system was developed. The present authors' classification and staging system were found applicable and all patients except 2 with unknown tumor size were classifiable. The distribution into different stages was more even in the proposed staging system than in the previous ones. A good correlation and a gradient for survival rate according to stages were also obtained. We propose that the systems presented should be examined and applied prospectively for clinical classification and staging of carcinoma of the penis.

The relationship between carcinomas of the penis and cervix uteri was analyzed in married couples. The final series comprised 239 patients with squamous cell carcinoma of the penis and their 224 wives. Two wives were found to have squamous cell carcinoma of the cervix uteri. The expected number of cervical cancers within the group of wives was 1.88, the relative risk thus being 1.05 (95% confidence interval 0.13-3.8). The incidence of condylomas has increased during the recent decades, while that of carcinomas of the penis and uterine cervix has decreased. The results of this study did not support the hypothesis that wives of men with penile cancer incur an increased risk of carcinoma of the cervix uteri. Although there is much evidence from a large number of studies that human papilloma virus (HPV) has a role in the aetiology of cervical cancer, our study suggests that HPV associated with genital malignancies has a low infectivity or that these cancers have multifactorial aetiology.

Nineteen patients with squamous cell carcinoma of the penis had surgical treatment or a combination of surgery and radiation. They also had chemotherapy using bleomycin as a single agent or in combination with vincristine and methotrexate. The total doses of bleomycin varied between 89 mg/m2 and 212 mg/m2. The best results were obtained in well differentiated carcinomas.