Co-trimoxazole prophylaxis during high-dose chemotherapy of small-cell lung cancer.

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Abstract
In 103 patients with small-cell lung cancer, 4 courses of standard doses of Adriamycin (A), vincristine (V), and cyclophosphamide (C) were compared with a regimen of increased doses of cyclophosphamide and to a lesser extent, Adriamycin. No significant difference in rate (22% vs. 21%) or median duration (7 vs. 9 mo.) of complete remission was found. Patients not in complete remission after the 4 cycles of AVC received 2 courses of VP-16 (etoposide) and cisplatin: the complete remission rate increased to 49% and 48%, respectively. Patients on the high-dose arm received co-trimoxazole prophylaxis; those on the standard arm did not. Patients on the high-dose arm had a higher incidence of neutropenia (nadir < 500 cells/.mu.l) but a lower incidence of infection for similar degrees of neutropenia. They also suffered more severe side effects of a different kind. Cotrimoxazole thus allowed for the administration of higer doses of chemotherapy to outpatients by protecting them from infection. The higher dose of cyclophosphamide and Adriamcyin, did not improve treatment results, produced more severe side effects, and is not recommended.