title: O-MAX chemotherapy: high activity in metastatic esophagogastric adenocarcinoma and possible relation to subclinical hemolysis.
abstract: OBJECTIVE
  Our objectives were to confirm the activity of O-MAX chemotherapy in adenocarcinoma of the stomach and esophagus, particularly the high rate of complete remission (CR) and the relation of subclinical hemolysis to CR.
  
  
  METHODS
  Twenty-five patients with metastatic esophagogastric adenocarcinoma were treated with O-MAX. Two developed cancer-related hemolytic-uremic syndrome (C-HUS); both achieved CR. Subsequent patients were monitored for serum haptoglobin for subclinical hemolysis.
  
  
  RESULTS
  Median survival was 16.5 months. The objective response rate was 90%, with 38% CR. Three patients achieving CR relapsed in the central nervous system and died (2 without systemic disease). Four patients have remained alive, off therapy, the longest for 20 years. Two patients developed clinical C-HUS and 5 of 8 monitored patients developed subclinical hemolysis based on abnormal serum haptoglobin. Four of the patients with subclinical hemolysis achieved CR. Of the 7 patients developing clinical C-HUS or subclinical hemolysis, 6 (86%) achieved CR.
  
  
  CONCLUSIONS
  O-MAX appears highly active in esophagogastric adenocarcinoma. A few long-term survivors of metastatic disease are being seen. CR and long-term survival appear to correlate with the development of hemolysis. Although highly promising, these results should be considered only as hypothesis-generating and require confirmation in a prospective trial.
authors.affiliation: Division of Hematology and Oncology, The George Washington University Medical Center, Washington, D.C., USA.
authors.forename: James
authors.initials: J
authors.lastname: Ahlgren
authors.forename: Nihar
authors.initials: N
authors.lastname: Patel
authors.forename: Samuel
authors.initials: S
authors.lastname: Simmens
authors.forename: Esma
authors.initials: E
authors.lastname: Akin
authors.forename: Catherine
authors.initials: C
authors.lastname: Bishop
authors.forename: Dean
authors.initials: D
authors.lastname: Kirkel
authors.forename: Paula
authors.initials: P
authors.lastname: Siegel
authors.forename: Suzanne
authors.initials: S
authors.lastname: Schuck
authors.forename: Hiwot
authors.initials: H
authors.lastname: Guebre-Xabiher
authors.forename: Robert
authors.initials: R
authors.lastname: Siegel
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D000069287:Capecitabine; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004938:Esophageal Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006242:Haptoglobins / Q000378:metabolism; D006402:Hematologic Diseases / Q000139:chemically induced; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced / Q000209:etiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D012074:Remission Induction; D013274:Stomach Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D006242:Haptoglobins; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D016685:Mitomycin; D000069287:Capecitabine; D004317:Doxorubicin; D005472:Fluorouracil