Cancer Chemotherapy by Infusion

761 Pages·1987·14.171 MB·English

by  Jacob J. Lokich M.D. (auth.)

Cancer Chemotherapy by Infusion
Cancer Chemotherapy by Infusion
Jacob J. Lokich, M.D.
MTP PRESS LIMITED ....
~
~ a member of the KLUWER ACADEMIC PUBLISHERS GROUP -_ n
.' LANCASTER / BOSTON / THE HAGUE / DORDRECHT
Published in the USA by
Precept Press, Inc.
160 East Illinois Street
Chicago, Illinois 60611
Published in the UK and Europe by
MTP Press Limited
Falcon House
Lancaster, England
British Library Cataloguing in Publication Data
Cancer chemotherapy by infusion.
1. Cancer-Chemotherapy
I. Lokich, Jacob J.
616.99'4061 RC271.C5
ISBN-13: 978-94-010-7932-7 e-ISBN-13: 978-94-009-3193-0
DOl: 10.1007/978-94-009-3193-0
© 1987 by Precept Press, Inc.
All Rights Reserved
Softcover reprint ofthe hardcover 1s t edition 1987
Except for appropriate use in critical reviews or works of scholarship, the
reproduction or use of this work in any form or by any electronic, mechanical or
other means now known or hereafter invented, including photocopying and
recording, and in any information storage and retrieval system is forbidden without
the written permission of the publisher.
Library of Congress Catalog Card Number:
86-62057
International Standard Book Number:
0-931028-68-X
91 90 89 88 87 5 4 3 2 1
For my colleagues and collaborators
on the nursing team
who make medicine possible,
and for my children,
who make my life meaningful
CONTENTS
Preface xix
SECTION I - RATIONALE AND TECHNICAL ASPECTS
1. Introduction to the Concept and Practice of Infusion
Chemotherapy 3
Jacob J. Lokich, M.D.
Categories of Infusion Chemotherapy 5
Rationale for Systemic Infusional Chemotherapy 7
Technologic Impetus to Infusional Chemotherapy 9
Current Clinical Status of Infusional Chemotherapy 10
Summary 11
2. Experimental Rationale for Continuous Infusion
Chemotherapy 12
Mark J. Ratain, M.D., and Nicholas J. Vogelzang, M.D.
Introduction 12
Antimetabolites 14
Plant Alkaloids 19
Alkylating Agents 22
Antineoplastic Antibiotics 25
Miscellaneous Agents 31
Summary 32
3. The Clinical Pharmacology of Infusional Chemotherapy 35
Gregory A. Curt, M.D., and Jerry M. Collins, Ph.D.
Pharmacokinetics of Infusional Therapy 36
Regional Therapy 37
4. Drug Administration Systems for Infusion Chemotherapy 41
Elton M. Tucker, B.S.M.E.
Introduction 41
Patient Worn Extracorporal Systems 43
vii
viii CONTENTS
Implantable Infusion Systems 51
Alarms and Performance Status Information 57
5. Technical Aspects of Vascular Access for Infusional Chemotherapy 59
Albert Bothe, Jr., M.D., and John M. Daly, M.D.
Introduction-Venous Access 59
Arterial Access 68
Summary 73
6. Nursing Management of Infusion Catheters 74
Cheryl L. Moore, R.N.
Hickman Catheters 75
Subclavian Catheters 77
Implantable Venous Access Portals 78
Special Considerations 81
Management of Local Skin Effects 82
Complications Associated with Subclavian Catheters 84
Detection and Management of Infection 85
Hepatic Artery Catheters 91
Implantable Infusion Pump 94
Pump Complications 97
Conclusion 99
7. Pharmaceutical Issues in Infusion Chemotherapy Stability
and Compatibility 100
John A. Benvenuto, Ph.D., Stephen C. Adams, Pharm.D.,
Harish M. Vyas, Ph.D., and Roger W. Anderson, M.S.
Concepts and Definitions 100
Procedures for Study of Stability 102
Short-Term Stability 103
Long-Term Stability 109
Admixtures III
Conclusion 113
SECTION II - CHEMOTHERAPEUTIC AGENTS
8. Antipyrimidines: 5-Fluorouracil and 5-Fluoro-2' -Deoxyuridine 117
Michael J. O'Connell, M.D.
Clinical Trials of Fluorinated Pyrimidines Given by Short- and
Long-Term Intravenous Infusions 118
Studies of Protracted Venous Infusion of the Fluorinated
Pyrimidines 120
Contents ix
9. Mexthotrexate 123
Carmen J. Allegra, M.D., and Gregory A. Curt, M.D.
Introduction 123
Theoretical Considerations 124
Clinical Investigations 126
Summary 129
10. Anthracyclines 130
Sewa S. Legha, M.D., Gabriel N. Hortobagyi, M.D., and
Robert S. Benjamin, M.D.
Introduction 130
General Considerations 131
Methods of Doxorubicin Infusion 132
Therapeutic Implications of Continuous Venous Infusion of
Doxorubicin 137
Anthracycline Analogues 138
11. Cisplatin, Platinum Analogues, and Other Heavy Metal
Complexes 145
Stephen P. Ackland, M.B., B.S., F.R.A.C.P., and
Nicholas J. Vogelzang, M.D.
Cisplatin 145
Intra-Arterial Cisplatin 153
Platinum Analogues 155
Gallium Nitrate (Ga(NOl)l) 157
Spirogermanium 159
12. Cytosine Arabinoside 161
Gregory A. Curt, M.D., Carmen J. Allegra, M.D., and
Bruce D. Cheson, M.D.
Background 161
Clinical Research 162
13. Periwinkle Alkaloids I: Vinblastine and Vindesine 167
Mark J. Ratain, M.D., Nicholas J. Vogelzang, M.D., and
Gerald P. Bodey, M.D.
Background 167
Rationale for Infusion 168
Vinblastine (Phase 1 Trials) 169
Vinblastine (Phase 2 Trials) 171
Vindesine (Phase 1 Trials) 174
Vindesine (Phase 2 Trials) 176
Conclusions 180
X CONTENTS
14. Periwinkle Alkaloids II: Vincristine 181
Don V. Jackson, Jr., M.D.
Clinical Trials 185
Results 191
Discussion 195
15. Bleomycin 200
Robert B. Catalano, Pharm.D., and Robert L. Comis, M.D.
Introduction 200
Mechanism of Action 200
Pharmacology 201
Bleomycin Toxicology 202
Animal Studies 202
Pharmaceutical Data 203
Clinical Trials in Humans 204
Testicular Cancer 204
Head and Neck Cancer 205
Cervical Cancer 205
Lymphomas 206
Other Tumors 207
Discussion 209
16. The Epipodophyllotoxins: VP-16 and VM-26 211
Nancy Phillips, R.Ph., and Robert L. Comis, M.D.
Mechanism of Action 211
Clinical Pharmacology 212
Schedule Dependency 215
Pharmaceutical Data 215
Clinical Trials 215
Discussion 219
17. Alkylating Drugs and Other Agents 221
Jacob J. Lokich, M.D.
Alkylating Agents 222
Antimetabolites 226
Miscellaneous Cytotoxic Agents 227
Summary 230
Contents xi
18. Investigational Agents 231
Merrill J. Egorin, M.D., F.A.C.P.
19. Protracted Infusional Chemotherapy 243
Jacob J. Lokich, M.D.
Preclinical Pharmaceutical Studies 244
Phase 1 Studies 245
Summary of Phase 1 Trials of Protracted Infusion Chemotherapy 254
Phase 2 Studies 256
Phase 3 Trials 261
SECTION III - SYSTEMIC INFUSION BY TUMOR CATEGORY
20. Head and Neck Cancer 265
Efstathios Tapazoglou, M.D., and Muhyi AI-Sarraf, M.D.,
F.R.C.P.(C), F.A.C.P.
Background 265
Rationale of Infusion Chemotherapy 269
Clinical Trials 271
Summary 279
21. Esophageal and Anal Cancer 281
Lawrence Leichman, M.D., Jacob J. Lokich, M.D., and
Cynthia Leichman, M.D.
Preoperative Versus Postoperative Therapeutic Concepts 281
Anal Canal Tumors 282
Squamous Cell Cancer of the Esophagus 285
Present and Future Status of Anal and Esophageal
Cancer Therapy 289
22. Colorectal Cancer 291
Jacob J. Lokich, M.D.
Standard Bolus 5-Fluorouracil 292
5-Fluorouracil and FUDR Continuous Infusion 294
Other Agents 300
Infusional 5-FU Concomitant with Radiation 301
Adjuvant Infusional Chemotherapy 302
Summary 302
xii CONTENTS
23. Gastric, Pancreas, and Biliary Tract Cancer 304
Geoffrey Falkson, M.D., and Baruch Klein, M.D.
Conventional Treatment 304
Chemotherapy by Infusion for Stomach, Pancreas, and Biliary
Tract Carcinoma 310
Intra-Arterial Therapy 312
Discussion 313
24. Breast Cancer 316
Sewa S. Legha, M.D.
Infusion Studies of Doxorubicin 317
Continuous Infusion of Vinca Alkaloids 319
Continuous Venous Infusion Trials with Other Drugs 320
25. Infusion for Hematologic Malignancies 322
Murray M. Bern, M.D.
Vinca Alkaloids 323
Epipodophyllotoxins 324
Antibiotics 325
Alkylating Agents 326
Antimetabolites 327
Metals 329
New Drugs 330
Combination Chemotherapy 332
Conclusions 337
26. Lung Cancer 338
Lucien Israel, Jean-Luc Breau, M.D., and Jean Franrois Morere,
M.D.
Theory and Background 338
Modalities of Administration of DDP-BLM and
Associated Drugs 339
Modalities of Administration of 1 or 2 Complementary Drugs 340
Secondary Therapy Protocols in Relation to Clinical Situations 341
Results 345
Discussion 348
Other Trials of Infusion Chemotherapy 351
Summary 352
27. Testicular Cancer and Other Tumors of the Male Genitourinary
Tract 353
Christopher J. Logothetis, M.D.
Vinblastine and Bleomycin Combination in the Management of
Germ Cell Tumors 353