Intensive induction therapy for small cell carcinoma of the lung
Abeloff, M.D.; Ettinger, D.S.; Khouri, N.F.; Lenhard, R.E.
Cancer Treatment Reports 63(4): 519-524
1979
ISSN/ISBN: 0361-5960 PMID: 221117 Document Number: 144402
Patients (15) with extensive small cell carcinoma of the lung and no prior therapy were treated with a chemotherapeutic regimen similar to in intensity to the approach used in acute myelocytic leukemia. The patients received intensive induction therapy with cyclophosphamide, adriamycin and VP-16 -213 [4'-dimethylepipodophyllotoxin-.beta.-D-ethylidene] [CAV] followed by treatment with a combination of BCNU [1,3-bis(2-chloroethyl) -l-nitrosourea], vincristine, methotrexate and procarbazine. The objective response rate was 87% (13 of 15 patients) with 3 complete responses and 10 partial responses. With the exception of 1 patient the maximal response to therapy was achieved during therapy with the intensive CAV regimen. The 3 complete responders remain in remission for 159, 351 and 285 days but 7 of the 10 partial responders have relapses and 5 of these have died. There was no unexpected morbidity associated with the intensive chemotherapy despite marked bone marrow suppression. Very intensive combination chemotherapy can be safely used to achieve a high objective response rate in patients with extensive small cell carcinoma, but the complete response rate is low. An analysis of treatment failures and future directions is presented.