[Influence of antiplatelet drugs (AD) on the efectiveness of combined therapy of small cell lung cancer. Part II. Influence of treatment on time of remission and patients survival].
In the experimental work evidence has been shown concerning the important relationship that exsists between the neoplastic process and blood coagulation status. In the 1st part of the paper it was shown that antiplatelet drugs (AD) prolonged bleeding and clotting time, increased the threshold ADP and collagen concentration causing platelets aggregation, as well as increased platelet aggregation ratio. The used AD (Defibrotide, Ticlide) resulted in activation of the plasma fibrynollytic system as expressed by the shortenning of ECLT, lowering of fibrinogen level and increasing FDP. The aim of the 2nd part of the paper was to verify the hypothesis that addition of AD blocked platelet aggregation and also destructed the protecting layer of platelets which surround the cancer cells. This may increase the effectiveness of antineoplastic chemotherapy, lengthen remission and life expectancy. The study was performed in 87 male patients aged 35-73 years with unilateral SCLC (histologically verified). Beside the classical chemotherapy: - 2 series in 3 week intervals (VAC scheme according Greco): -Adriamycin (ADR) 40 mg on 1sq.m of body surface; - Vincristin (VCR) 1 mg; on 1sq.m of body surface; -Cyclophosfamid (CTX) 1000 mg. on 1sq.m of body surface; radiation was applied in all patients (40 Gy during 20 days on the tumor and mediastinum). Patients were randomly divided into four groups. Group I, controls (n=22) were treated as above. In the remaining groups--additionally AD were used. Patients from Group II (n=22) received Defibrotide, from Group III (n=22) Ticlide and Group IV (n=21) Aspirin. In the studied groups the percentage of complete and partial remission (CR+PR) was 84% of which 42.5% had complete remission. In each individual group, these percentages differed variously and equaled for CR+PR from 47.6% in Aspirin treated group, to 100% in Defibrotide and Ticlide groups. In a similar fashion, the percentage of CR varied from 9.5% in patients treated with Aspirin to 68% in group of patients treated with Defibrotide. Remission obtained in patients treated with chemotherapy with addition of AD was significantly longer as compared with controls. In the studied controls and patients treated additionally with AD--median remission time equalled 27.5 and 32 weeks. The differences were statistically significant. In each particular group the remission time varied from 8 weeks in controls to 213 weeks in the patients group treated additionally with Defibrotide. The average remission time in each group also varied significantly from 27.5 weeks in group I to 50 weeks in patients treated with Defibrotide. In the studied patients group the medial survival time was on average 50 weeks. This comprised 36.5 weeks within the control group and 53 weeks in the groups treated with addition of AD. Patients treated with chemotherapy combined with AD had 1.5 fold greater probability of survival as compared with controls. The longest survival above 4 years was observed in the group of patients treated with addition with Defibrotide. The performed study in patients with unilateral SCLC treated with cytostatics, irradiation and AD indicate better survival of patients receiving AD. The obtained results confirm the suggestion that improvement of the fate of SCLC patients by utilizing parallel treatment comprising chemio-, radio- and anti- aggregatory therapy is possible.
Ochmański
Władysław
W
Katedra Chorób Wewnetrznych i Gerontologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków.
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D012074:Remission Induction; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy* / Q000401:mortality*; D015996:Survival Rate
D010975:Platelet Aggregation Inhibitors