Although it is generally accepted that anti-cancer chemotherapy should be administered at the maximum tolerable dose, it is not clearly established that the therapeutic results at dosage levels involving maximum tolerable toxicity are really superior to those with lower, better tolerated doses. 392 patients with advanced primary lung cancer were treated with 5 chemotherapy regimens including cyclophosphamide, methotrexate, vincristine, procarbazine, hydroxyurea, adriamycin and CCNU, in combinations of 3 to 7 agents. Response rates of 50% and over were registered after 8 weeks of treatment. During the same time the intensity of leukopenia, thrombocytopenia, vomiting, other digestive toxicity, neurologic disorders and alopecia was graded according to the worst observation from 0 to 4. The results show that there is no correlation between the grade of toxicity and the rate of response either for the whole group or for subgroups of patients as defined by cell type, degree of dissemination, age, or performance status. They demonstrate that the search for maximum tolerable toxicity is not a sine qua non for the best possible response to chemotherapy in primary lung cancer.

The prognostic value of infectious complications occurring during the induction treatment of acute myelogenous leukaemia is analysed and discussed. Eighty-eight patients were treated with the same chemotherapy. The early major infections (septicemia, pneumonia, ano-rectal abscesses) and on the other hand, the late infections (following the maximum agranulocytosis) are of a bad prognosis. During the second phase of chemotherapy-induced aplasia, the improvement of infection means usually a forthcoming complete remission while its persistence or its aggravation means usually a failure of the chemotherapy. At last, when the complete remission has been achieved, no peculiar feature of the infection is significantly correlated with the survival.

In order to prevent vomiting induced by anti-cancer chemotherapy, the efficiency of domperidone has been compared to metoclopramide in a randomised trial. No difference has been observed between both emetic treatments.

From January 1976 to December 1979, 23 adults with advanced soft tissue sarcomas were treated with palliative chemotherapy associating cyclophosphamide, vincristine, adriamycin and dacarbazine (CYVADIC) according to two different schema administered successively. A higher than 50 per cent rate of tumoral response was observed in 52 per cent of cases with 13 per cent complete remissions. Median survival was 14 months in patients who responded to treatment, and 4 months in non-responders (p less than 0,01). Side effects were severe however, and it was necessary to discontinue treatment in 5 patients, and modify dosage in 9 other patients. The CYVADIC protocol is effective but requires some modifications to improve tolerance.

The interactions between three drugs and X-rays were examined in rat hepatoma cells in vitro. Incubation with Daunomycine or 9-hydroxy ellipticine decreases the survival of both exponential and plateau phase cells, whereas cis-Pt (II) decreases the survival of plateau cells, especially irradiated in anoxia. The decrease in the Do was greater when the cells were incubated with the drugs prior to X-irradiation, and was greater in the case of plateau cells than in the case of exponential cells. The repair of potentially lethal damages was inhibited by these three compounds. However, the repair of sublethal damages was inhibited by cis-Pt II, but was modified neither by Daunomycine nor 9-hydroxy ellipticine.

Systemic chemotherapy and lung irradiation have very similar effects on lung tissue. Several mechanisms are involved, mainly: --cytotoxic effects on lung cells (type II pneumocytes, capillary endothelial cells, and connective tissue); --enhancement of infection; --hypersensitivity and auto-immune phenomena. Acute pneumonitis or chronic lung sclerosis develops which may or may not be compatible with life, depending on the lung volume involved and the clinical course. These effects are dose dependent for radiotherapy, and for most of the chemotherapeutic drugs. In some cases however, the dose-effect relationship is not clear, especially with some drugs such as methotrexate, and sometimes with radiotherapy even when it can be assumed that there is no mistake in dose calculation. It must be stressed that we will lack basic knowledge on the pharmacokinetics and actual concentration of drugs in lung tissue. Additive or supra-additive effects are likely when chemotherapy is combined with lung irradiation, but current relevant data does not allow any firm conclusions to be drawn on the quantitative changes resulting from the association. Prevention of lung complications is however possible if the tolerance doses and the optimal distribution of each agent with time are respected. Combined lung irradiation and bleomycin administration must be avoided.

A man with a carcinoma presented an unusual cytology P. falciparum transfusion malaria. The authors suspect cytotoxic chemotherapy for having induced these cytological changes.

On a two years period, 21 patients with advanced Hodgkin's disease who failed usual therapeutic proceedings were treated by a sequential combination chemotherapy with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD, first described by Bonadonna). Initially 16 patients among 21 had a disseminated disease with stage III B (9 obs.) or IV B (7 obs.). Previously all had been submitted, during a four years mean period, to multiple therapeutic trials always involving MOPP plus lymphoid irradiation and/or other combination chemotherapy. In 19 patients among 21, ABVD was decided because of persistent abdominal lymphoid and/or visceral localizations (liver: 6 obs.; lung: 4 9bs; épidural space: 1 obs.). In 12 patients, abdominal localizations were proved after delayed staging laparotomy. Immediate results with ABVD were: CR: 9 obs. (43%); PR: 5 obs. (24%); failure: 7 obs. (33%). With vinblastine interrupted by intermittent ABVD, 4 CR are persisting with a 8 to 23 months' follow up; among 5 patients who relapsed (3 to 24 months), 4 are still alive. After irradiation of résidual lesions, 4 PR among 5 are persisting with a 6 to 12 months' follow up. For the 21 patients, median survival has not been reached at 30 months.