CHEMOTHERAPY FOR INOPERABLE, NON-SMALL CELL BRONCHOGENIC-CARCINOMA - EST 2575, GENERATION-II

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  • 1 January 1981
    • journal article
    • research article
    • Vol. 65  (11-1) , 965-972
Abstract
Between 1976-1978 the Eastern Cooperative Oncology Group [USA] tested 10 regimens in 415 patients with histologically documented, inoperable non-small cell bronchogenic carcinoma. Most patients were ambulatory (69%) and had extensive disease (69%). Patients were stratified by the following cell types: squamous cell carcinoma (SQ), large cell anaplastic carcinoma (LC), or adenocarcinoma (AD). Ineffective single agents (including cell types tested and percent complete and partial responses) were dactinomycin (SQ, 6%), dianhydrogalactitol (SQ, O), ftorafur (AD and LC, 3%) and piperazinedione (AD and LC, 7%). Ineffective combination regimes included the contemporary standard regimen cyclophosphamide (CYT) plus CCNU [1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea] (SQ, AD and LC, 9%), methotrexate plus doxorubicin (ADR) plus CYT plus CCNU (MACC) (SQ and AD, 12%), and mitolactol plus ADR (AD and LC, 8%). When compared to CYT plus CCNU the following regimens demonstrated significant activity: CYT plus bleomycin plus cisplatin (SQ, 23%; P = 0.02) and ADR plus 5-FU [5-fluorouracil] plus cisplatin (AD and LC, 24%; P = 0.006). Mitomycin demonstrated marginal activity in squamous cell cancer (19%, P = 0.06). Neither active regimen improved survival although responders to any regimen had a significant prolongation of median survival (31.6 vs. 15.7 wk, P = 0.002). The MACC regimen, piperazinedione and mitomycin were substantially more toxic than the 2 effective regimens, which were adequately tolerated. Ambulatory performance status, limited disease and prior surgery were significant positive prognostic variables; prior radiation and pretreatment weight loss adversely affected response or survival.