Patients with a broad range of neoplastic diseases will be entered on treatment protocols developed by Cancer and Leukemia Group B (CALGB). These protocols, used under carefully defined conditions, seek to extend our knowledge regarding the best use of established drugs, new chemotherapeutic agents and other treatment modalities in the management of malignant diseases. Individuals from this institution take part in pilot studies, protocol design and group-wide studies in the evaluation of treatment programs. In particular, investigators from Dartmouth have been interested in new approaches to acute myelogenous leukemia, small cell carcinoma of the lung (SCCL) and the use of antithrombotic agents in the treatment of neoplasms. A panel of unique monoclonal antibodies (MoAb) which are cytotoxic to AML cells has been developed at Dartmouth by Dr. Edward Ball for ex vivo treatment of bone marrow from patients with AML in second or third remission prior to autologous bone marrow transplantation (ABMT). On the basis of pilot data from Dartmouth and Scripps (UCSD), two new CALGB protocols will study the use of these antibodies in purging bone marrow prior to ABMT in AML. Dr. William North has continued his studies of neurophysins associated with SCCL. He has developed polyclonal and monoclonal antibodies to these substances and is studying their diagnostic potential. In addition, Dr. Ball has made highly specific MoAb to SCCL. These are presently being used by the Pathology Committee to re-classify this group of diseases, and efforts are underway to utilize these antibodies as therapeutic tools in vivo and ex vivo. Dr. Leo Zacharski has been the PI of two randomized cooperative VA trials studying the efficacy of Warfarin and an antiplatelet agent (RA-233) in the treatment of various tumors. The first trial indicated the Warfarin doubled the median survival in patients with SCCL, and the second trial has shown that RA-233 prolongs survival in patients with non-small cell lung cancer limited to one hemithorox. The beneficial effect of Warfarin has been confirmed in the most recent CALGB protocol (#8084) for extensive SCCL. The present CALGB protocol for limited SCCL (#8433) is testing Warfarin in a controlled trial.
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