Effect of Soviet bleomycin-bleomycetin on the body of animals in multiple parenteral administration]

Toxicity of bleomycetin was studied on 3 animal species (rats, rabbits and dogs). The antibiotic was administered intramuscularly and intravenously in various doses for a prolonged period of time. The death of the rats, rabbits and dogs treated with repeated lethal doses of bleomycetin was due to its toxic effect on the kidneys and probably lungs. The level of urea in the blood of the animals before death increased up to 300--400 mg %. Histological examination of the kidneys revealed the picture of glomerulonephritis. The lungs were highly plethoric and showed areas of alveolar collapse and consolidation consisting mainly of the collapsed alveolar epithelium. The liver was not affected by bleomycetin according to both the results of some functional tests and histological examination. tthe blood sugar level after bleomycetin administration was not altered significantly. The changes in the peripheral blood were not pronounced. An increased P wave, decreased R wave and deep S wave were seen on the ECG. Such deviitions may be due not only to the changes in the myocardium but also to the lung affection. When bleomycetiin was used repeatedly in nonlethal doses (1 mg/kg for rats, 1--2 mg/kg for rabbits and 0.25--0.5 mg/kg for dogs), the above changes were less pronounced or not manifested at all. No inhibitory effect on hemopoiesis is an important positive characteristics of bleomycetin, so that it compares very favourably with most other antitumor drugs.     

Toxicity, pharmacokinetics and pharmacodynamics of the Soviet bleomycin, bleomycetin, in a single administration to laboratory animals]

Toxicity of bleomycetin (bleomycin A2) administered intravenously, intraperitoneally, subcutaneously or intramusculary in a single dose to animals was almost identical. On its oral administration bleomycetin was 10--14 times less toxic than on its parenteral use. Rats were somewhat less sensitive to bleomycetin than mice. Bleomycetin had no significant effect on the level of the arterial pressure, respiration, ECG characteristics and elements of the vegetative nervous system in narcotized cats. After a single intravenous or subcutaneous administration to rabbits bleomycetin was detectable in the blood for 4--5 hours. The highest bleomycetin levels were registered in the skin, kidneys and lungs. Bleomycetin was mainly excreted with the urine.     

Obtaining a productive strain of Streptoverticillium griseocarneum var. bleomycini that yields the new antineoplastic antibiotic, bleomycetin

Selection of the organism producing bleomycin, a multicomponent antitumor antibiotic, was performed. The aim was the selection of a more active strain with preferable synthesis of component A5 (bleomycetin) of the bleomycin complex. Optimal variants of the conditions for mutagensis with UV light and gamma-rays in step-wise selection of the active strain were determined and a possibility of selecting analog-resistant mutants with the use of structural analogs of the metabolites participating in synthesis of the bleomycin molecule was studied. A mutant analog-resistant strain capable of supersynthesis of bleomycin A5 (bleomycetin) was selected, the biosynthetic capacity of Streptoverticillum griseocarneum var. bleomycini being increased at least 19 times.     

Results of the clinical study of the antineoplastic antibiotic bleomycetin

Bleomycetin was applied to the treatment of 68 patients with common forms of malignant tumors. The objective therapeutic effect was observed in 21 patients (31 per cent). The frequency of the favourable therapeutic effects was the most significant in the group of patients with generalized forms of lymphogranulomatosis: objective remissions for 1 to 4 months and stabilization of the tumor process were attained in 12 (41 per cent) and 8 out of 29 patients, respectively, in 9 patients (31 per cent) treated with bleomycetin progression of the underlying disease was recorded. A less pronounced therapeutic effect (33 per cent of the remissions) was recorded in the patients with nonlymphogranulomatous lymphomas. The use of bleomycetin in 48 out of 68 patients was complicated by certain adverse reactions. Intravenous infusions of bleomycetin in a dose of 10-15 mg twice a week (the total dose up to 125 mg) may be recommended as the initial therapeutic regimen in the oncological practice. The trials have showed that bleomycetin made in the USSR has a sufficiently pronounced activity against lymphogranulomatosis and nonlymphogranulomatous lymphomas. In this respect it is not inferior to the bleomycin analog made in Japan.     

Elaboration of the combination of antitumor preparations bleomycetin + 5-fluorouracil + cisplatin

Clinical trials on efficacy and toxicity of combined use of bleomycetin, 5-fluorouracil and cisplatin in patients with disseminated tumor processes were conducted. Two regimens were applied. Regimen I included intravenous administration of cisplatin in a dose of 100-150 mg/m2 on day 1, intramuscular administration of bleomycetin in a dose of 10 mg on days 2-4 and intravenous jet injection of 5-fluorouracil in a dose of 400 mg/m2 on days 2-4. Regimen II consisted of intramuscular administration of bleomycetin in a dose of 10 mg on days 1-3, intravenous jet injection of 5-fluorouracil in a dose of 400 mg/m2 on the same days and intravenous administration of cisplatin in a dose of 100-150 mg/m2 on day 4. The intervals between the courses amounted to 4 weeks. Complete regression of cervical carcinoma relapsing was observed in 1 patient. In 5 patients i.e. 1 with small-cell lung cancer, 3 with squamous cell lung cancer and 1 with metastases of low-differentiated cancer from an undetected focus to supraclavicular lymph nodes the effect was partial. Long-term stabilization of the disease at the background of the treatment for 6-7 months was stated in 3 patients. On the whole the objective response was in 6 out of 22 patients or in 27 per cent. 7 of them were treated with cisplatin in a dose of 150 mg/m2. The regimens of the combined use of 5-fluorouracil, bleomycetin and cisplatin were low toxic. The therapeutic effect showed that the combination was of practical value.     

Clinical evaluation of a bleomycin-group antitumor antibiotic bleomycetin

The efficacy of bleomycetin or bleomycin A5 was studied in 128 patients with different malignant neoplasms. The antibiotic was used as a systemic or intracavitary chemotherapeutic agent. Bleomycetin was effective in 75-80, 81.8, 58.3, 70 and 50 per cent of the cases with disseminated derminogenic tumor of the testicle, squamous cell carcinoma of the head and neck, cancer of the penis, carcinoma of the skin and lymphogranulomatosis, respectively. When used intracavitarily the drug was effective in 41.2 per cent of the patients with cancer of the ovaries and lungs, teratoblastoma of the ovaries, cancer of the mammary gland and sarcoma of the soft tissues. Hyperthermia and focal hyperkeratosis as the adverse reactions were observed in 40.6 and 5.4 per cent of the patients, respectively. No toxicity with respect to the lungs was registered.     

Chemical modification of an antineoplastic antibiotic bleomycetin by the C-end fragment]

Bleomycetin, an antitumor antibiotic, was subjected to chemical modification by the C-end fragment i.e. the residue of 3-[(4-aminobutyl)amino]propylamine (spermidine++) with acylation, carbamoylation and reducing alkylation, which yielded its new semisynthetic derivatives. The use of physicochemical methods showed that the chemical modification involved the primary and secondary amino groups++ of spermidine++ and gave rise to N,N'-diacyl, N,N'-dicarbamoyl and N,N'-dialkyl bleomycetins. The biological properties of the derivatives, i.e. their cytotoxic activity, acute and pulmonary toxicities were studied. The transformation of bleomycetin by the C-end fragment lowered the antibiotic toxicity and was believed to be a promising approach to modifying its molecule.     

Belomycetin in the combined chemotherapy of testicular tumors

The results of the treatment of 21 patients with testicle tumors of various histological structure, stages III and IV, are presented. The combination of bleomycetin (bleomycin A5), an antitumor antibiotic made in the USSR, with vinblastine and platinum derivatives was used. The antitumor effect was observed in 63 per cent of patients, including 21 per cent of patients with complete regression of tumors. The periods of complete and partial remission were 3--13 and 1--9 months, respectively. The combination is sufficiently effective and may be recommended for the treatment of patients with disseminated malignant tumors of the testicle.     

Use of 5-fluorouracil, bleomycetin and platidiam in combined treatment of localized cancer of the larynx]

Preliminary results of chemoradiotherapy in 30 patients with the larynx cancer T3T4N0M0 are presented. Two treatment schemes were applied. According to scheme I, the treatment was started with chemotherapy with 5-fluorouracil in doses of 1000 mg on days 1, 2 and 3, bleomycetin in doses of 15 mg on days 1, 2 and 3 and platidiam in doses of 120 mg/m2 on day 4 followed by radiotherapy to the total dose of 66 to 70 Gy. Scheme II included two analogous courses of the chemotherapy, one prior to the radiotherapy and the other after irradiation in a dose of 38 to 40 Gy, after a two-week interval the radiotherapy was continued to doses of 66 to 70 Gy. 15 patients were treated in accordance with each scheme. Complete resorption of the tumor was observed in 66.6 and 83.3 per cent of the patients treated according to schemes I and II, respectively. The results showed that the use of 5-fluorouracil, bleomycetin and platidiam in combination with radiotherapy was promising in treatment of patients with local cancer of the larynx.     

Use of bleomycetin in malignant testicular tumors and the problem of studying bleomycin analogs

The efficacy of the chemotherapy of 16 patients with metastases of malignant tumors of the testicle was studied. The chemotherapy included vinblastine, platidiam and bleomycetin. The latter was used in a dose of 10 mg daily intramuscularly or as long-term intravenous infusions. As a result of the treatment complete and partial regression of the tumors was observed in 5 (31 per cent) and 4 (25 per cent) patients, respectively. Leukopenia was the main side effect. By present the total doses of bleomycetin had amounted to 250 mg for 4 patients and to 300-350 mg for 7 patients. No signs of pulmonary toxicity were observed with the use of these doses. The problem of clinical studies of bleomycin analogs is discussed.     

Antineoplastic antibiotics in the combined chemotherapy of squamous cell carcinoma

Sixty five patients with squamous cell carcinoma of various localization at stages III-IV or with severe relapses were subjected to chemotherapy according to 3 schemes: AMB (adriamycin + methotrexate + bleomycin or bleomycetin), 34 patients; AMBP (adriamycin + methotrexate + bleomycetin + platidiam), 17 patients and AMFP (adriamycin + methotrexate + fluorofur + platidiam), 14 patients. The efficacy of the schemes was 35, 17.7 and 43 per cent respectively. The AMB scheme in treatment of the patients with maxillofacial carcinoma resulted in remission in 8 out of 20 cases (40 per cent). Analysis of the adverse reactions to the chemotherapy showed that all the three schemes were relatively low toxic. The AMB and AMFP schemes may be recommended for treatment of patients with disseminated or inoperable forms of epidermoid tumors in oncological departments.     

The results of the use of bleomycin and its analogs in the VAB-6 protocol in treating testicular tumors

Efficacy and toxicity of VAB-6 combinations with bleomycin, bleomycetin or peplomycin were studied in treatment of 77 patients with metastases of germ-cell tumors: testicle tumors in 71 patients and extragonadal tumors in 6 patients. After the chemotherapy complete regression was observed in 37 patients (48.7 per cent). In 44 patients (57.1 per cent) residual metastases after the chemotherapy were resected. The frequency of complete regression after using the VAB-6 combinations with bleomycin, bleomycetin and peplomycin amounted to 58.8, 61.5 and 47.1 per cent respectively. The treatment results depended on the disease extent. When the disease extent was minimal complete regression was observed in 87.5 per cent of the patients. The respective figures for the disease moderate and significant extents were 66.7 and 37.8 per cent. During the average observation period of 22.1 months (7-40 months) 39 patients survived and had no signs of the disease. The combinations markedly differed in their toxicity.     

Pharmacokinetics of C14-olivomycin in the body of mice with lymphosarcoma (L10-1 strain)]

The pharmacokinetics of C14-olivomycin after its single intravenous administration to mice with lymphosarcome (LIO-I) was studied. It was shown that according to the specific radioactivity the organs may be placed in the following order: I hour after the antibiotic administration-the blood, liver, spleen, thymus, tumor, muscle; 3 hour after the administration-the liver, spleen, thymus, blood, tumor, muscle. Accumulation of olivomycin in the mouse organs was mainly in direct dependence on the dose of the antibiotic administered. Chromatography of the substances extraceted with ethylacetate from the urine collected at various periods after C14-olivomycin administration showed the presence of a new radioactive product (Rf 0.35-0.37) in addition to the unchanged antibiotic (Rf 0.53). Bioautographic analysis of the chromatograms showed that the product of C14-olivomycin conversion preserved its biological activity. The analysis of the substances extracted with ethylacetate from the liver, spleen and tumors 3 hours after the antibiotic administration reveiled (except of the liver) the presence of a spot with Rf corresponding to that of the initial drug.     

Blood coagulation system in oncological patients treated with rubomycin, adriamycin and carminomycin]

Systems of blood coagulation in patients treated with antibiotics of the anthracycline group were studied. Rubomycin was used in the treatment of patients with acute leukemia Adriamycin and carminomycin were used in the treatment of patients with solid tumors. The antibiotics affected the process of blood coagulation mainly through their cytostatic effect on thrombocytopoesis. Thrombocytopenia induced deficit of thrombocytal factors participating in the process of blood coagulation which resulted in hypocoagulation and hemorrhagic complications. The plasmic factors did not significantly change during the antibiotic therapy. A tendency to decrease in the levels of prothrombine, fibrinase and fibrinogen was noted which was possible due to an inhibitory effect of the antibiotics on the function of the reticuloendothelial tissue cells or indirectly to suppression of the tumor process. More pronounced changes in the system of blood coagulation of patients treated with rubomycin were probably associated with inferiority of the thrombocytal apparatus of the patients with acute leukemia treated with the antibiotic.     

Hypotension caused by intravenous infusion of rifampicin and its relation to the administration schedule

It was shown in studies on animals that bolus administration of rifampicin induced hypotension whose severity depended on the rate of the antibiotic administration. When the antibiotic was administered in the 5-, 10- or 15-minute regimen in a dose of 10 mg/kg the maximum decrease in blood pressure was 44, 34 or 21% of the initial level and the maximum antibiotic concentration attained in the blood was 34.4, 27.2 or 22.6 micrograms/ml, respectively. With the infusion for 30 minutes, the maximum antibiotic concentration in the blood was 17.6 micrograms/ml and the blood pressure did not undergo any significant changes. When the rate of the antibiotic infusion was high there was pharmacokinetic heterogeneity of the blood serum and biophase which could lead to unpredictable results. After repeated administrations of rifampicin to the same animals pronounced tachyphylaxis to the antibiotic was noted, which manifested itself in decreasing of hypotension, though the serum antibiotic level was 1.5 to 2 times higher that the initial one. It was concluded that administration of rifampicin in the therapeutic dose equal to 10 mg/kg for 30 minutes was the most sparing regimen for the antibiotic bolus intravenous infusion. Gradual increase in the antibiotic dose and administration rate in patients is possible under careful control of blood pressure and pharmacokinetic studies.     

57Co-bleomycetin pharmacokinetics in the body of mice with LIO-1 lymphosarcoma

Pharmacokinetics of 57Co-bleomycetin was studied on mice with lymphosarcoma LIO-1. It was found that at early periods of intravenous administration of the labeled antibiotic, i.e. within the period from 5 minutes to 1 hour its higher levels are detected in the liver, kidneys, blood serum, lungs, intestine and tumor. At later periods the drug levels in the organs and tissues gradually decrease and by the 72nd hour the concentration of 57Co-bleomycetin in the blood serum appears to be 30 times lower as that after 5 minutes. In the muscles and tumor its concentrations by that period are 15 and 2 times lower respectively. Radiometry of the animals showed that within the first 24 hours more than 85 per cent of 57Co-bleomycetin was excreted from the mice.     

Clinical and laboratory comparisons of tetracycline penetration through the blood-cerebrospinal fluid barrier in central nervous system diseases]

The data on tetracycline penetration from the blood into the serebrospinal fluid of patients with different diseases of the central nervous system are presented. Clinico-laboratory comparisons showed that the antibiotic penetration did not depend on the character and severity of the main disease of the brain (tumor, trauma, abscess). No dependence on the surgical intervention was either found. The index of tetracycline penetration from the blood into the liquor did not depend on the drug administration route, i.e. intramuscularly or orally. The presence of the post-operative meningitis increased permeability of the brain membranes for tetracycline.     

C14-variamycin content in normal and tumorous brain tissues of white rats]

Penetration of variamycin, a new antitumor antibiotic into the normal and tumor tissues of the brain of rats with multiform glioblastoma was investigated. The content of the C14-labeled antibiotic was determined radiometrically. The radioactive label penetrated into the normal and tumor tissues of the brain during the first hours after the drug administration. The level of the radioactivity in the tumor tissue was higher than that in the normal brain tissue during the whole period of the study. The greatest deviation in the contents of the radioactive label in the tumor and normal tissues was observed 2 and 3 hours after administration of the labeled antibiotic, i. e. 4.3 and 3.6 times respectively.     

不同预防性抗生素用于肿瘤患者围手术期的成本-效果分析

目的:探究不同抗生素用于肿瘤患者围手术期的成本-效果。方法:选择于我院接受手术治疗的93例肺癌患者,所有患者按照随机数字表法均分为三组,每组31例,三组患者实施不同的抗生素预防方案,对比三组患者的一般手术情况(手术时间、术中出血量、术后7 d最高体温、术后住院时间)、抗生素应用效果(术后呼吸道感染率、术后7 d平均体温、术后7 d平均白细胞计数)以及不同抗生素预防方案成本-效果。结果:(1)三组患者手术时间、术中出血量、术后7 d最高体温、住院时间对比差异均无统计学意义(P0.05);(2)三组患者术后呼吸道感染率、术后7 d平均体温、术后7 d平均白细胞计数对比差异均无统计学意义(P0.05);(3)A组患者具有最高的成本-效果比值,单位效果所花费的成本显著低于B、C两组(P0.05)。结论:术前预防及术后短疗程应用头孢唑林钠能够显著降低肺癌患者术后感染率,减少抗生素用量及花费,提高患者围手术期成本-效果。     

Characteristics of 57Co-bleomycetin accumulation in the primary tumor and in its metastases to the lungs in mice with Lewis carcinoma

Distribution of 57Co-bleomycin was studied in mice with Lewis carcinoma implanted into different parts of the body. It was found that organ distribution of the labeled antibiotic did not depend on the tumor localization. The accumulation level of 57Co-bleomycin in Lewis carcinoma implanted subcutaneously into the pad foot was 3 times higher than that in the healthy pad. Resection of the primary tumor stimulated metastasis to the lungs resulting in relatively selective accumulation of the antibiotic in the lungs. The levels of 57Co-bleomycin in the lungs the main part of which was affected with metastases were 3--7 times higher than the respective control values.