Forty‐two patients with recurrent or metastatic squamous cell carcinoma of the head and neck were treated with vinblastine, bleomycin, and cisplatin. All patients had received prior surgery, radiation or chemotherapy and all had measurable disease. Forty‐five percent of the patients responded with a median duration of response of eight months and median survival of nine months. Six patients (14%) were complete responders and had a median duration of response of 12 months and median survival of 24+ months. Thirteen patients (31%) were partial responders and had a median duration of response of seven months and survival of 13 months. Toxicity was mild with nausea and vomiting occurring in all patients after cisplatin. There were two cases of bleomycin‐induced pulmonary fibrosis and two cases of mild renal insufficiency (creatinine clearance level, 45 cc/min). This regimen compares favorably with other published regimens for advanced head and neck cancer.

Thirty-eight patients with nonseminomatous testicular cancer were treated with cis-platinum, bleomycin, and vinblastine in combination without a prolonged maintenance phase. Twenty-Six patients with Stage III disease were treated. Seventy-six percent of those patients treated achieved complete remission. At a median survival time of 30 months, no patient who achieved a complete remission has relapsed. Twelve Stage II patients given adjuvant therapy remain free of disease at a median time of 23 months. Markedly elevated serum lactate dehydrogenase levels and massive disease were common findings in the patients who did not achieve complete remission. One drug death occurred secondary to sepsis. Symptoms of depression and anxiety were significant dose-limiting factors in this group of patients.

A 29‐year‐old male developed myasthenia gravis 29 months after resection of a “benign” mediastinal thymoma. Metastatic thymoma was found in the pleura 45 months after the initial surgical resection. Combination chemotherapy with cyclophosphamide and doxorubicin produced a complete remission of the metastatic thymoma which has continued for 13 months. Concurrently, there has been a marked increase in neuromuscular function.

Forty patients with metastatic colorectal carcinoma who had received no prior chemotherapy were entered onto a trial of methyl-CCNU, 5-fluorouracil, vincristine, and streptozocin (MOF-STREP). Ten of 40 (25%) responded. Two patients (5%) achieved a complete response and eight patients (20%) a partial response. In addition, 10 patients previously treated with chemotherapy received the MOF-STREP regimen; 1 of 10 (10%) responded. The duration of the complete responses were 5 and 16 mo, respectively. The median duration of the partial responses was 4 mo with a range of 1-16 mo. The median survival of the 11 responders was 14 mo. Median survival of the 39 nonresponders was 5 months. Responders lived significantly longer than nonresponders (p = 0.03, log-rank). Toxicity was severe with nausea and vomiting common after streptozocin and myelosuppression requiring dose reductions in 70% of patients. We compare our findings using this regimen to those of two previously reported trials.

We have analyzed a series of 124 young men with Hodgkin's Disease in an attempt to clarify the role of non-invasive tests in the staging evaluation. Data are presented in a way which permits comparison between series and application of the data to decision-making models. Analysis of the data shows our patients to have had primarily limited (stage I and 11) disease. In our hands certain tests were quite accurate in predicting the absence of abdominal disease (lymphangiography, hepatic scintigraphy) as determined by laparotomy, but no study appeared to eliminate the need for laparotomy in this group. EVERAL RECENT REPORTS HAVE EMPHASIZEDS the role of decision analysis in the initial management of patients with Hodgkin's Disease. 16917 This type of approach, while theoretically attractive, suffers because data have not been presented in the medical literature in a way that permits their incorporation into a decision analysis model. There have been, for instance, no studies of the expensive, non-invasive diagnostic tests usually performed on Hodgkin's patients where the data were analyzed by methods usually recommended to evaluate a diagnostic test. Such methods include presentation of the sensitivity and specificity of the test along with the "prior probability" of disease in the population under study. of diagnostic tests, along with data on the population under study are available, then the efficacy of any diagnostic test can be rationally evaluated using standard techniques. Such data also permit more intensive scrutiny of inter-institution variability and facilitate testing of decision-making models.We have evaluated the characteristics of several non-invasive tests in a large, untreated population of patients with Hodgkin's disease. By comparing test results with operative findings we have determined the sensitivity and specificity of these tests vis a' vis abdominal disease as defined by laparotomy. Additionally, our data are based solely on young men. This permits determination of the "prior probability" of abdominal involvement in this group. Data from our series can now be compared with data from different patient populations.We have also examined the other large series in the literature which report data on non-invasive tests in Hodgkin's disease. T o encourage other authors to present data in this form we have determined, when possible, test sensitivities and specificities. We have also presented data on the "predictive accuracy" of the diagnostic tests. The clinically important "predictive accuracy'' can be calculated for any test on any given patient if the sensitivity, specificity, and prior probability are known. These data can now be combined with other clinical parameters and their effect on treatment and survival measured.