Phosphorus is a major component of proteins, phospholipids, and nucleotides. The increased uptake of phosphorus by cells during erythropoiesis can result in severe hypophosphatemia. A case of severe hypophosphatemia due to accelerated erythropoiesis in response to Cefotetan-induced hemolytic anemia is described. The hypophosphatemia seen during hemolysis may be the result, rather than the cause, of the hemolysis.

Summary:The purpose of this study was to develop a regimen of docetaxel, cyclophosphamide (CY) and filgrastim for mobilization of peripheral blood stem cells (PBSC) in patients with metastatic breast cancer (n = 66). A phase I trial of CY 2, 3 or 4 g/m 2 with docetaxel 100 mg/m 2 , in consecutive cohorts of four patients each, did not reveal any dose-limiting toxicities and subsequent patients were randomized to receive 3 or 4 g/m 2 of CY. The median yield of CD34 ؉ cells from all patients was 11.06 ؋ 10 6 /kg (range, 0.03-84.77) from a median of two aphereses (range, 1-7); 6.52 ؋ 10 6 CD34 ؉ cells/kg/apheresis (range, 0.01-52.07). Target CD34 ؉ cell doses у у у2.5 and у у у5.0 ؋ 10 6 /kg were achieved in 89% and 79%, respectively. There were no statistically significant differences in CD34 ؉ cell yields or target CD34 ؉ cell doses achieved following 3 or 4 g/m 2 of CY. Patients with only one prior chemotherapy regimen yielded a median of 12.82 ؋ 10 6 CD34 ؉ cells/kg/ apheresis compared to 5.85 for those receiving у у у2 regimens (P = 0.03). It was concluded that the combination of docetaxel, 100 mg/m 2 , CY 3 g/m 2 without mesna could be administered with acceptable toxicity with collection of adequate quantities of PBSC from the majority of patients. Keywords: mobilization; docetaxel; cyclophosphamideThe role of HDC with PBSC support for the treatment of patients with breast cancer is controversial 1 despite the fact that numerous phase 2 studies 2-5 and one prospective randomized trial 6 have demonstrated superiority compared to conventional-dose therapies. Patients in complete remission (CR) appear to benefit more from HDC than patients not in CR. 4 Thus, one approach to improving outcomes for patients with metastatic breast cancer is to improve the CR rate prior to HDC with PBSC support.Theoretically, chemotherapy administered for mobilization of PBSC can be integrated into the treatment plan of patients scheduled to receive HDC. Previous studies in patients with metastatic breast cancer have evaluated induction followed by drug combinations including: cyclophosphamide (CY), etoposide, 7 CY, etoposide and cisplatin 5 and CY and paclitaxel for mobilization of PBSC. 8 The taxanes, paclitaxel and docetaxel, are active in the treatment of patients who have failed doxorubicin-based regimens and are increasingly being evaluated in initial treatment regimens. 9-17 The administration of paclitaxel or docetaxel prior to HDC with PBSC support is also being evaluated in patients with breast cancer. 18,19 In order to incorporate new chemotherapeutic agents into a treatment strategy of induction, mobilization of PBSC and HDC with PBSC support it is important to determine the efficacy of such agents for the mobilization of PBSC. The combination of paclitaxel 200 mg/m 2 , CY 3 g/m 2 and filgrastim can be administered with acceptable toxicity allowing collection of adequate quantities of PBSC from the majority of patients with breast cancer. 8,[20][21][22] The purpose of the current study was to determine if regimens of do...

Thirty-two evaluable patients with metastatic carcinoma of the breast received chemotherapy consisting of BCNU plus cyclophosphamide followed in 18 hours by Adriamycin. Treatments were repeated every 4 weeks. Complete or partial responses were observed in 14 patients (43.7%) and in 12 of 27 drug-resistant patients (44.4%). An additional 26% of patients had objective improvement, for an overall objective response rate of 70.4% in drug-resistant patients. Skin, lymph node, and soft tissue metastases more frequently responded to therapy, while hepatic, peritoneal, and osseous metastases responded with an intermediate frequency. Pulmonary, pleural, and central nervous system metastases did not respond to therapy. The median duration of complete and partial responses was 6.8 months, and the median survival of these patients was 9.6 months. Overall, the median survival of all patients in this study was 6.5 months. The dose-limiting toxicity was myelosuppression, particularly granulocytopenia. Congestive heart failure and stomatitis were rare. This combination of drugs is a reasonably well-tolerated regimen for treating advanced breast carcinoma in an ambulatory setting, and produces a high rate of objective antitumor response of moderate duration.

A phase II trial of Adriamycin, BCNU, and cyclophosphamide was performed in 29 patients with advanced prostatic carcinoma (Southeastern Cancer Study Group protocol SEG 76 PR 0102P). Therapy consisted of BCNU 100 mg/m2, plus cyclophosphamide, 300 mg/m2 i.v., on day 1, followed by Adriamycin, 30 mg/m2 i.v., on day 2. Therapy was repeated every four weeks. In 27 evaluable patients refractory to prior estrogen therapy, one patient had a complete response, six patients had partial responses, and two patients had objective improvement (complete plus partial response rate 26%, and overall response rate 33%). Responders had a median time to progression of disease of 5.5 months, compared with a median time to progression of 4.0 months for those patients with stable disease. The median survival of responders was 9.3 months, compared with 6.7 months for stable disease and 3.9 months for patients with progression. Patients with higher pretreatment performance status did not have higher response rates. No life-threatening toxicity was observed. Only five patients had nadir platelet counts below 50,000/mm3, and only six patients had nadir granulocyte counts below 750/mm3. This regimen palliates the effects of hormone-resistant metastatic prostatic carcinoma.