Remission induction with daunomycin, vincristine, and prednisone in adult acute lymphocytic leukemia

Prednisone plus vincristine plus daunomycin induced complete remission in nine adults with acute lymphocytic leukemia. The median duration of complete remission will be between 14 and 18 months, with three patients remaining in hematological remission at 10+, 11+, and 18+ months. The median survival will be between 19 and 23 months, with all patients surviving at least one year. This remission induction regimen produced rapid complete remission in adult acute lymphocytic leukemia (ALL) with minimal toxicity, and could be administered predominantly on an outpatient basis.

Improved chemotherapy for small-cell undifferentiated lung cancer

Bleomycin sulfate, doxorubicin hydrochloride, cyclophosphamide, and vincristine sulfate combination chemotherapy was given to 29 patients with small-cell undifferentiated lung cancer. Only four of these patients had limited disease, and in these patients there was 100% complete remission; two of these four patients remain in complete remission at more than 52 and 60 weeks. Of the 25 patients with generalized disease, 18 (72%) had neoplasm regression (greater than 50%), including two with complete remission (8%). The median duration of remission was 25 weeks. The median survival time from diagnosis was 39 weeks and that from initiation of therapy, 35 weeks. The drug regimen was well tolerated, and although substantial leukopenia was produced, there were only three patients in whom granulocytopenic infections developed. There was only one drug-related death.

BACON (bleomycin, adriamycin, CCNU, oncovin and nitrogen mustard) in squamous lung cancer. Experience in fifty patients

Fifty patients with inoperable squamous carcinoma of the lung. 38 with extensive, and 12 with limited disease, were treated with BACON. Tumor regression greater than 50% was observed in 17 patients (45%) with extensive, and four patients (33%) with limited disease. Stabilization of disease for greater than or equal to 8 weeks was seen in four extensive and eight limited patients, and had the same prognostic importance with regard to survival as response: in extensive disease, responding and stable patients had median survival (MST) of 26 weeks from start of therapy, while MST for non-responders was 9 weeks. MST in limited disease (all patients responding or stable) was 32 weeks. Analysis of survival in extensive disease by performance status showed improvement in each category over historical control results for supportive care alone. BACON was better tolerated and probably more effective when CCNU was given every 8 weeks, rather than every 4 weeks.

COMB (cyclophosphamide, oncovin, methyl-CCNU, and bleomycin): a four-drug combination in solid tumors

One hundred eighty-nine patients received a four-drug combination consisting of cyclophosphamide, Oncovin (vincristine), methyl CCNU, and bleomycin (COMB), according to three different drug regimens, performed sequentially. Of the 189, 62 had a partial response (33%) including 11/33 with squamous lung cancer, 11/32 with squamous carcinoma of the head and neck, 13/15 with oat cell carcinoma of the lung, and 7/41 with malignant melanoma. The response rate for patients with squamous lung or head and neck cancer appeared to be higher at weekly bleomycin doses of 30 and 60 mg (15/33 = 45%), compared to a weekly bleomycin dose of 15 mg (7/32 = 25%). A median survival from treatment of 30 weeks was observed in oat cell carcinoma, which represents considerable prolongation over that expected from supportive care alone or single-agent chemotherapy. Toxicity included: 1) myelosuppression, resulting in hospitalization for antibiotics in 20% of patients; 2) probable bleomycin lung damage in 4% of patients; and 3) dose-limiting vincristine neuropathy in 11%. The combination of twice-weekly vincristine and bleomycin for more than 6 weeks produced a disturbing "debilitation syndrome," characterized by weakness, anorexia, weight loss, and apathy. The encouraging response rate suggests a future role for these drugs in combination, especially for vincristine and bleomycin, with other agents showing activity in squamous and oat cell carcinoma. Toxicity precludes recommendation of this combination, in the regimens tested, for broader Phase III studies.

Results of therapy in adult acute lymphocytic leukemia

27 adult patients with acute lymphocytic leukemia have been analyzed. Complete remission was induced in 9 of 113 patients treated with prednisone +6-MP, 4 of 6 patients treated with prednisone + vincristine, and the one patient treated with a combination of prednisone, vincristine, 6-MP, and methotrexate. The median survival for these 20 patients was 11 months and the median duration of complete remission was 71/2 months. Two of these patients remain in complete remission at 8+ years. Our most recent regimen for remission induction, prednisone + vincristine + daunomycin, has produced complete remission in 7 of 7 patients, with a median duration of complete remission of 15 months. Three patients remain in their original complete remission from 16+ to 24+ months, and 5 of these 7 patients remain alive from 16+ to 24+ months.