Nochmalige Anfrage an Prof. Wust

[Bert]

Lieber Prof. Wust,

leider habe ich keine Anwort auf meine Frage bekommen.
Bei meinem Vater ist im Februar ein "Dring. V.a. Alveolarcarcinom mit disseminiertem Wachstum bds" festgestellt worden. Er bzw. sein Internist hat jetzt die Klinikergebnisse bekommen und die Aussage ist, dieser Tumor ist sehr selten und es gibt kein Medikament dagegen. Ich kann das gar nicht glauben, kann man diesen Tumor mit nichts stoppen??
Bringt eine Thymus- oder Enzymtherapie etwas?

Vielen Dank für Ihre Antwort

[Prof. Wust]

RE: Nochmalige Anfrage an Prof. Wust


Wie Sie sehen (s.u.), wird die Lungentransplantation sogar erwogen – demzufolge sind die therapeutischen Möglichkeiten begrenzt. Bitte erwarten Sie nicht, dass eine solche Transplantation durchgeführt wird (die Ergebnisse sind auch nicht so gut). Der dritte Beitrag weist auf eine Chemotherapie hin (Xeloda und Taxol), die bei solchen resistenten Tumoren mit einigem Erfolg eingesetzt wird.

Pulmonary transplantation for advanced bronchioloalveolar carcinoma.
AU: Zorn,-G-L Jr; McGiffin,-D-C; Young,-K-R Jr; Alexander,-C-B; Weill,-D; Kirklin,-J-K
AD: Departments of Surgery, The University of Alabama at Birmingham, Birmingham, Ala. 35294-0016, USA. [email protected]
SO: J-Thorac-Cardiovasc-Surg. 2003 Jan; 125(1): 45-8
AB: BACKGROUND: No effective therapy is currently available for the diffuse stage of bronchioloalveolar carcinoma. OBJECTIVE: We tested the hypothesis that total lung replacement with standard lung transplantation techniques would provide curative therapy. METHODS: Nine patients aged 31 to 58 years with bronchioloalveolar carcinoma were entered in the study. Five patients initially had bilateral diffuse tumor. Four patients had recurrence in the contralateral lung after pulmonary resection. RESULTS: Between 1993 and 1998, all 9 patients underwent transplantation (2 single-lung and 7 bilateral transplants, 1 reoperative single-lung transplant, and 1 reoperative bilateral transplant). Two patients had mediastinal node metastasis (level 7) at the time of transplantation, and 1 of these had a frankly invasive adenocarcinoma. Of the 8 patients with pure bronchioloalveolar carcinoma, 6 had recurrent pulmonary tumor after transplantation. In 2 of these patients the tumor was localized and could be resected with left lower lobectomy in one case and left pneumonectomy in the other. One is alive 89 months after transplantation; the other died 82 months after transplantation. Four other patients had a diffuse pattern of pulmonary recurrence. Two died of progressive pulmonary failure; 1 of these had retransplantation with recurrence. A third patient died of cerebral edema shortly after bilateral retransplantation. The other patient is alive with recurrence 39 months after transplantation and has bronchiolitis obliterans. Two patients without recurrence are well with unrestricted performance levels 87 and 76 months after transplantation. CONCLUSIONS: Transplantation produces a powerful palliative outcome in patients with advanced bronchioloalveolar carcinoma, but the recurrence rate is high. Transplantation for this indication remains controversial.

Clinical pattern and pathologic stage but not histologic features predict outcome for bronchioloalveolar carcinoma.
AU: Ebright,-M-I; Zakowski,-M-F; Martin,-J; Venkatraman,-E-S; Miller,-V-A; Bains,-M-S; Downey,-R-J; Korst,-R-J; Kris,-M-G; Rusch,-V-W
AD: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
SO: Ann-Thorac-Surg. 2002 Nov; 74(5): 1640-6; discussion 1646-7
AB: BACKGROUND: The histologic criteria defining bronchioloalveolar carcinoma (BAC) were recently revised, but it is unclear whether these criteria predict clinical behavior. This study determined the outcome of resected BAC in relationship to clinical and radiologic disease pattern, and pathologic features. METHODS: Between 1989 and 2000, 100 consecutive surgically treated patients with adenocarcinomas exhibiting various degrees of BAC features were retrospectively studied. Histology was reviewed; tumors were classified as pure BAC, BAC with focal invasion, and adenocarcinoma with BAC features. Clinical and radiologic pattern were classified as unifocal, multifocal, or pneumonic. Demographic data, tumor stage, and outcome were recorded. Survival was analyzed by the Kaplan-Meier method, and prognostic factors were determined by the log-rank test. RESULTS: Patient median age was 65, and 74% of the patients were female. Pure BAC, BAC with focal invasion, and adenocarcinoma with BAC features occurred in 47, 21, and 32 patients, respectively. Unifocal disease occurred in 64 patients, multifocal in 29, and pneumonic in 7. Seventy-one patients had stage I/II tumors, 22 had stage III/IV, and 7 patients had Stage X tumors. Overall 5-year survival was 74%. There was no significant difference in survival among the three histologic subtypes. The pneumonic pattern had significantly worse survival compared with unifocal and multifocal patterns. Pathologic stage predicted survival, with 5-year survivals for I/II and III/IV of 83.7% and 59.6%, respectively. CONCLUSIONS: Clinical pattern and pathologic stage, but not the degree of invasion on histologic examination predict survival. Multifocal disease is associated with excellent long-term survival after resection. The favorable survival of stage III/IV BAC indicates that the current staging system does not fully describe this disease in patients undergoing resection because of its distinct tumor behavior.

Pharmacobiologically based scheduling of capecitabine and docetaxel results in antitumor activity in resistant human malignancies.
AU: Nadella,-P; Shapiro,-C; Otterson,-G-A; Hauger,-M; Erdal,-S; Kraut,-E; Clinton,-S; Shah,-M; Stanek,-M; Monk,-P; Villalona-Calero,-M-A
AD: Department of Medicine, Ohio State University College of Medicine and Public Health, Columbus, OH 43210-1240, USA.
SO: J-Clin-Oncol. 2002 Jun 1; 20(11): 2616-23
AB: PURPOSE: Capecitabine and docetaxel have demonstrated preclinical antitumor synergy. This synergy is thought to occur from docetaxel-mediated upregulation of thymidine phosphorylase (dThdPase), an enzyme responsible for the relative tumor selectivity of capecitabine. On the basis of the time-dependency and transiency for this upregulation, we performed a phase I study of capecitabine in combination with weekly docetaxel. We hypothesized that weekly docetaxel would result in sustained dThdPase expression and that capecitabine administration at times of maximum dThdPase upregulation would increase the therapeutic index for this combination. PATIENTS AND METHODS: Patients with advanced solid malignancies received docetaxel on days 1, 8, and 15, and capecitabine bid on days 5 to 18, every 4 weeks. Docetaxel was fixed at 36 mg/m(2)/wk, whereas capecitabine was escalated in successive patients cohorts. RESULTS: Sixteen patients received 77 courses at capecitabine doses from 950 to 1,500 mg/m(2)/d. The most common toxicities were hand-foot syndrome, diarrhea, nausea/vomiting, and asthenia. Grades 3 to 4 hematologic toxicities were infrequent and no treatment-related hospitalizations occurred. Three of three patients treated at 1,500/36 mg/m(2) capecitabine/docetaxel developed grade 3 hand-foot syndrome or diarrhea during either their first or second course, whereas only two of 13 patients at 1,250/36 mg/m(2) doses developed significant toxicity. Antitumor responses (n = 7) occurred in patients with hepatocellular, non-small-cell lung, and chemotherapy-refractory breast, bladder, and colorectal carcinomas. Prolonged stabilizations occurred in patients with metastatic mesothelioma (n = 2), chemorefractory non-small-cell lung carcinoma, and bronchioloalveolar carcinoma. CONCLUSION: Capecitabine in combination with weekly docetaxel is well tolerated. Recommended doses are capecitabine 1,250 mg/m(2)/d (625 mg/m(2) bid) with docetaxel 36 mg/m(2)/wk. The acceptable toxicity profile in this dose schedule, and the antitumor activity observed, warrant further evaluation of this regimen.