MACC chemotherapy for adenocarcinoma and epidermoid carcinoma of the lung: low response rate in a Cooperative Group Study. Eastern Cooperative Oncology Group

Moderate Chemo-Radiotherapy in Non-Small Cell Lung Cancer: Results in 21 Patients with Advanced Disease and Low Performance Status

Twenty-one patients with advanced non-small cell lung cancer and low performance status (Karnofsky: 40–60) were treated with moderate doses of chemo-radiotherapy. Seven patients (33 %) had partial response and a median survival time of 10 months; 5 patients (24 %) had stable disease and a median survival time of 5 months; 9 patients (43 %) had progression of disease and a median survival time of 6 months. Median survival time for the whole group was 7 months. Toxicity related to treatment was minimal and posttreatment performance status was: stable in 10 patients and improved in 5 responsive patients. We conclude that this therapeutic strategy has some efficacy in this category of patients although it failed to show substantial benefit in terms of survival.

Chemotherapy for advanced non-small cell lung cancer

Lung cancer is the most lethal cancer in both men and women. Given that chemotherapy for advanced disease is marginally beneficial and noncurative, its use must be governed judiciously, with each decision being evaluated individually for each patient. Chemotherapy for lung cancer has progressed over the past decade, and with the advent of new agents, its future looks promising.

Recent advances in etoposide therapy for non-small cell lung cancer

Non-small cell lung cancer (NSCLC) continues to be a major health problem in the US. In 1990, approximately 120,000 new cases will be diagnosed, and the majority of these patients will have either unresectable disease or resected disease that has a relatively low chance of being cured. A variety of chemotherapy treatments have been evaluated in patients with advanced NSCLC. The objective of this review is to summarize the results of the chemotherapy trials in Stage III and IV NSCLC patients.

Platinum-based combination chemotherapy in advanced non-small cell lung cancer: a randomized phase II trial of the Cancer and Leukemia Group B

The Cancer and Leukemia Group B (CALGB) utilized a randomized phase II trial design to evaluate two cisplatin-based combinations, cisplatin-cytarabine (ara-C) and cisplatin-vinblastine, in 151 patients with advanced non-small cell lung cancer. Patients entered on study had not received prior chemotherapy. Platinum doses were equivalent in the two treatment programs. The total response rate (complete response, partial response, regression of evaluable disease) for the cisplatin-vinblastine group was 22% (16/73). Failure-free survival at six months for this group was 41%, survival at six months was 63%. The cisplatin-ara-C group had a total response rate of 9% (7/78) with a failure-free survival at six months of 14% and a six-month survival of 47%. Severe or life-threatening toxicity was seen in 73% of cisplatin-vinblastine cases and 59% of cisplatin-ara-C patients. Neither regimen is active enough to warrant designation as "standard therapy" for patients with M1 disease.

Continuation of chemotherapy versus supportive care alone in patients with inoperable non-small cell lung cancer and stable disease after two or three cycles of MACC. Results of a randomized prospective study

Recommendations concerning the continuation of chemotherapy in nonresponding patients with non-small cell lung cancer (NSCLC) and stable disease after the first chemotherapy test are empirical and often conflicting. Between 1984 and 1987, 116 inoperable NSCLC patients were treated with methotrexate, doxorubicin, cyclophosphamide, and lomustine (MACC regimen). After two or three cycles of therapy, 74 patients were judged to have stable disease and assigned at random either to chemotherapy maintenance with the same regimen (38 subjects) or to chemotherapy discontinuation (36 subjects). The two study groups were comparable for all the major prognostic factors. Median time to progression was 26 weeks for the chemotherapy group compared to 24 weeks for the nonchemotherapy group (P = NS). Median survival was prolonged in the treatment arm (47 weeks) compared to nontreatment arm (30 weeks), which was statistically nonsignificant. A patient self-assessment of the quality of life revealed a significantly worse tolerance to therapy and a better physical condition in the chemotherapy group. Objective MACC toxicity was significant with two treatment-related deaths. This study failed to demonstrate sufficient therapeutic benefits to justify the increased cost and toxicity of continuing treatment in nonresponding NSCLC patients.

CAMP chemotherapy for metastatic non-oat cell bronchogenic carcinoma. A 7-year experience (1975-1981) with 160 patients

Between January 1975 and December 1981, 160 patients with metastatic non-oat cell bronchogenic carcinoma (MNOBC) were treated with cyclophosphamide, doxorubicin, methotrexate, and procarbazine (CAMP), or with a CAMP-like regimen. Forty-two (26%) of these patients demonstrated an objective response to the chemotherapy with a median survival of 61 weeks. Thirty-nine (24%) patients had stable disease (SD) with a median survival of 45 weeks. Seventy-nine patients (49.4%) were nonresponders with a median survival of 15 weeks. There was a significant difference in survival times between the responders and the SD patients, and between the responders and SD patients and the nonresponders. Responses were seen in 11% of the patients with squamous cell carcinoma and in 37% of the patients with adenocarcinoma. There was a significant difference in the response and SD categories in favor of adenocarcinoma over squamous cell carcinoma. Once a response was achieved, the median survival of the patients with adenocarcinoma was not significantly longer than that of the patients with squamous cell carcinoma.

New frontiers in the treatment of lung cancer

Surgical resection still is the only significant curative approach in nonsmall cell lung cancer. Recent surgical experience indicates that a modest decrease in the death rate from bronchogenic carcinoma may occur in three general areas: (1) the detection and treatment of radiographically occult squamous cell carcinoma; (2) the combination of adjuvant chemotherapy and surgical excision in selected patients with small cell carcinoma; and (3) surgical resection and postop irradiation of patients with hilar and mediastinal lymph node metastases. At the time of diagnosis, 80 to 85% of the patients present with unresectable lung cancer. These patients may benefit from other modalities of therapy, i.e., radiotherapy, chemotherapy, or immunotherapy. Failures following radiotherapy in unresectable nonsmall cell lung cancer are due to (1) distant metastasis, (2) local region failure, and (3) local and distant failure. To increase the local control, new methods of treatment have been tried, such as hyperfractionation of radiotherapy and the use of 131I antiferritin immunoglobulin. The development of effective systemic chemotherapy is necessary to treat metastatic bronchogenic carcinoma. The response rate to chemotherapeutic agents is substantially lower in nonsmall cell carcinoma than in small cell carcinoma. Investigation is ongoing to assess the effectiveness of new antitumor drugs used alone, in combination with other drugs, or combined with other modalities for the treatment of bronchogenic carcinoma.

Efficacy study of intensive cis-platin therapy in advanced non-small cell bronchogenic carcinoma

Thirty patients with advanced non-small cell bronchogenic carcinoma were treated with cis-platin, 75 mg/M2 weekly for three weeks, then every three weeks. Eighteen were ambulatory, 22 had distant metastases, 14 had prior irradiation, and none had prior chemotherapy. Ten patients (33%) had objective remissions lasting a median of three months. Responders lived a median of five months, compared to three months for nonresponders. Transient mild azotemia was noted in twelve patients. Cis-platin has definite but modest activity in non-small cell bronchogenic carcinoma.

Four-drug combination chemotherapy in advanced lung cancer: methotrexate, doxorubicin, cyclophosphamide and CCNU

One-hundred-twenty patients with advanced lung cancer were treated by the MACC (methotrexate, doxorubicin (Adriamycin), cyclophosphamide and CCNU) regimen. Ninety-eight patients were evaluated. Objective complete response occurred in one case for 27+ months. Partial response was observed in 20 patients lasting for a median of 4.7 months. The overall objective response rate was 21% and the median duration of response was 5.5 months. Stable disease was noted in 44 patients with a median time to progression of 4.7 months from the start of treatment. Tumor progression occurred in 33 cases. There was a significant prolongation of median actuarial survival of responders (11.2 months) vs. stable disease (6.2 months) or vs. non-responders (3.8 months, P less than 0.05). The median actuarial survival for the whole group was 7.3 months. Bone marrow toxicity including thrombocytopenia (less than 100,000 cells/mm3) occurred in 16 patients and leukopenia (less than 3000 cells/mm3) in 24 patients. Forty-seven patients had no hematologic toxicity. Other adverse reactions were nausea and vomiting (50%), stomatitis (16%), alopecia (5%), cardiotoxicity (1%) and fever during leukopenia (1%).