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and also provided somewhat longer survival. with regard to toxicity, MACC produced a

higher incidence of nausea and vomiting, whereas FAM produced more frequent and se- vere thrombocytopenia. From an overall standpoint, the therapeutic accomplishments of both regimens were disappointing. Out study does, however, provide additional evidence that mitomycin C-containing re- gimens may be selectively effective for squamous-cell carcinoma of the lung.

Combined Polychemotherapy in the Treatment of Primitive Lung Cancer of the "Non-0at Cell" type. Tagle, J.C., Galvez, C.A., Barg, S., Temperley, G.J. Municipal Cancer Hospital, Patricias Argentinas 750, Buenos Aires, Argentina. Drugs Exp. Clin. Res. ii: 141- 147, 1985.

Forty-one patients (30 males, ii females; mean age 49.7 years) with diagnosis of the "non-oat cell" type of lung cancer were studied. All patients were included in a randomized treatment design (regimens A and B) and completed six full cycles of polychemotherapy. Only 28 of the 41 patients proved evaluable. The performance status was 0-2 in 20 subjects (71.4%) and 3-4 in 8 (28.6%). The total number of patients achieving partial and complete responses was 20 (71.4%), of whom 14 (70%) received CDDP and the other 6 DDR. A pro- gression of the disease was seen in 8 patients (28.6%) of whom 5 (62.5%) received DDR and the other 3 (37.5%) CDDP. An in- crease in body weight (3.8 kg) was obser- ved in 15 patients (53.6%). Twenty-four of the 28 patients (85.7%) had subjective feeling of well-being throughout the 6 cycles of chemotherapy. Nausea and vomiting and alopecia were the most frequent side- effects. The most important complications were paralytic ileus in 2 cases and a darkish manifestation in forearm and hand tissue due to vinblastine extravasation in another 2 cases. Haematological toxi- city was found to be acceptable; leuco- penia (< 3.000) in 30 patients (73.2%); and thrombocytopenia (< i00.000) in 12 patients (29.2%), which proved reversible. Some modalities relative to treatment schemes and the incorporation of additional agents are discussed.

Vindesine and High-Dose Cisplatin in the Treatment of Advanced Non-Small-Cell Lung Cancer.

Fuks, J.Z., Patel, H., Van Echo, D.A., et al. Division of Medical Oncology, Albert Einstein College of Medicine, Bronx, New York, NY 10461, U.S.A. Med. Pediatr. Oncol. 13: 73-77, 1985.

Seventeen patients with advanced non- -small-cell lung cancer (NSCLC) were en- tered on a combination chemotherapy proto-

col including vindesine and high-dose cisplatin. All patients had measurable disease and had not previously received chemotherapy. All patients entered were evaluable for toxicity and respon- se. Tumor regression was limited to one comple- te and one partial response (response rate, 11.7%; 95% confidence limits, 0 to 27%). The complete and partial response lasted 260+ and 82 days, respectively. For the 15 nonresponding patients, the median time to disease progressi- on was 76 days. Median survival was 141 days for the whole group. Significant toxic effects were vindesine-related peripheral neuropathy and cisplatin-induced emesis. Myelosuppression was mild and manageable. The response for the vindesine-cisplatin combination observed in our study is inferior to that seen in a previous vindesine-cisplatin trial reported by others. Thus, the true value of this two-drug regimen in the treatment of NSCLC remains to be establ-

ished.

Randomized Trial Comparing Vindesine plus Cis- platin with Vinblastine plus Cisplatin in Patients with Non-Small Cell Lung Cancer, with an Analysis of Methods of Response Assessment. Kris, M.G., Gralla, R.J., Kalman, L.A., et al. Developmental Chemotherapy Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, U.S.A. Cancer Treat. Rep. 69: 387-395,

1985. One hundred eight patients with stage III

non-small cell lung cancer were randomly assig- ned to receive cisplatin (120 mg/msup 2) with either vindesine (3 mg/msup 2) or vinblastine (6 mg/msup 2). None had previously received chemotherapy. An additional goal was to deter- mine if the observation of visible evaluable lesions was as accurate a method of response assessment as the observation of bidimensio- nally measurable lesions in non-small cell lung cancer. When vindesine plus cisplatin was compared to vinblastine plus cisplatin, response rates (33% vs 41%), median response durations (8.6 vs 5.6 months), and median sur- vival times of responding patients (18.4 vs 16.2 months) were similar. Response rates, response durations, and survival times of re- sponding patients determined through the ob- servation of evaluable or measurable indicator lesions did not differ significantly. More patients receiving vinblastine plus cisplatin experienced wbc counts < 2100/mmsup 3 (P = 0.003). The two regimens demonstrated comparab- le response and survival data but clinically significant leukopenia was more common in vin- blastine-treated patients. There was no diffe- rence in response rate obtained through the study of patients with measurable and evaluab- le indicator lesions.

Cyclic Combination Chemotherapy in Advanced Adenocarcinoma of the Lung: Comparison of Two

P~4 Schedules. Lam, W.K., So, S.Y., Ip, M., Yu, D.Y.C. Depart-

ment of Medicine, University of Hong Kong,

80

Queen Mary Hospital, Hong Kong, Hong Kong. Cancer Chemother. Pharmacol. 14: 282-283,

1983. Forty patients with advanced adenocar-

cinema of the lung were treated by two FAM chemotherapy schedules. Group A (20 patients) received Futraful, adriamycin, and mitomy- cin C, and group B (20 patients) received 5-fluorouracil, adriamycin, and mitomycin C. The response/stabilization rate was greater for group B (4 partial responses + 4 cases of stable disease) than for group A (no responders + 5 cases of stable dis- ease), and the median survival was longer for group B (32 weeks) than for group A (22 weeks), although the differences did not reach statistical significance in either case (P > 0.05). Myelotoxicity was mild in both schedules. Further studies of the two FAM schemes at an escalated dose would be worthwhile.

Sequential Methotrexate and 5-Fluorouracil in the Treatment of Non-Small Cell Carci- noma of the Lung. Wood, C.D., Slevin, M.L., Ponder, B.A.J., Wrigley, P.F.M., Department of Medical On- cology, St. Bartholomew's Hospital, London ECIA 7BE, United Kingdom. Eur. J. Cancer Clin. Oncol. 21: 587-589, 1985.

The sequential administration of metho- trexate (MTX) and 5-fluorouracil (5-FU) has been claimed to be synergistic. To investi- gate the potential synergism in non-small cell carcinoma of the lung (NSCCL), 16 pa- tients were treated with a 2-hr infusion of MTX 200 mg/msup 2 followed after 2 hr by 5-FU 1 g/msup 2. All patients had an Eastern Cooperative Oncology Group perfor- mance status of >2 and had received no pre- vious chemotherapy. No responses were seen. This study demonstrates that sequential MTX and 5-FU in this dosage and schedule is ineffective in NSCCL.

Etoposide and Cisplatin Salvage Chemothera- py for Small Cell Lung Cancer. Lopez, J.A., Mann, J., Grapski, R.T., et al. San Antonio Tumor and Blood Clinic, San Antonio, TX 78217, U.S.A. Cancer Treat. Rep. 69: 369-371, 1985.

Thirty patients with previously treated small cell lung cancer received salvage co!u- bination chemotherapy with etoposide and cis-platin. Two complete and six partial responses were observed, for a major response rate of 27%. Responses occurred promptly and sustained palliation was achieved among re- spenders. Myelosuppression was the major dose-limiting toxic effect. A schedule of etoposide (115 mg/msup 2 iv on days 1-3) and cisplatin (25 mg/msup 2 iv on days 1-3 every 28 days) is recommended for further clinical trials.

8, RADIOTHERAPY

Palliative Radiotherapy for Inoperable Carcino- ma of the Lung: Final Report of a RTOG Multi- Institutional Trial. Simpson, J.R., Francis, M.E., Perez-Tamayo, R., et al. Washington University School of Medicine, Division of Radiation Oncology, St. Louis, Me, U.S.A. Int. J. Radiat. Oncol. Biol. Phys. ii: 751-758, 1985.

Between June 1973 and February 1979, 409 pa- tients with inoperable advanced non-oat cell carcinoma of the lung were randomized on RTOG protocol 73-02. Three treatment arms were evalu- ated: 40 Gy split course, 30 Gy continuous cour- se, and 40 Gy continuous course. Patients were also randomized to receive cytoxan or no further therapy following irradiation. Three hundred sixteen patients were evaluable. Palliation of symptoms was achieved in 60% with .25 of the patients becoming symptom-free. Complete regres- sion of local and regional tumor was produced in 15% and partial regression in 26%. There is no significant difference between the treatment arms in these objective response rates. Medican survi- val times were approximately 6 months. No signi- ficant benefit was demonstrated by the adjuvant use of Cytoxan. Although the number of complete responses produced was relatively small, patients achieving a complete response had a significant- ly longer median survival than the remaining pa- tients, i.e., 14.5 months versus 6 months. Sig- nificant toxicity occurred in fewer than 6% of patients. Radiation pneumonitis accounted for the majority of these adverse reactions. Toxici- ty occurred somewhat more often in the group treated with 40 Gy split course therapy. Impli- cations for further studies are discussed.

The Role of R~diation ~lerapy in the l 'ruatment of Small Cell Lung Cancer. Lichter, A.S., Bunn, P.A. Jr., Ihde, D.C., et al. Department of Radiation Therapy, University of Michigan Medical Center, Ann Arbor, MI 48104, U.S.A. Cancer 55 suppl: 2163-2175, 1985.

Patients with small cell lung cancer (SCLC) are candidates for aggressive therapy because of their potential for long-term survival, especial- ly patients with limited-stage disease. Although no treatment protocol can be considered "stan- dard", the best results in limited-stage SCLC ap- pear to be produced by a combination of chemothe- rapy and thoracic irradiation. Ongoing protocols testing the efficacy of thoracic irradiation should be able to settle question of the optimal treatment approach in limited-stage SCLC over the next 1 to 2 years. Careful attention to vo- lume treated and the use of shrinking fields produce the best results with the minimum of toxicity. Treatment of extensive-stage SCLC has not been substantially improved to date with the addition of local systemic irradiation. Prophylactic cranial irradiation reduces the incidence of CNS failure in SCLC and should

be given, at a minimum, to patients