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(NSCLC) were treated with epirubtcin 135-150 me/m* every 3 weeks. There were 6 partial responses. Randomised studies should reveal whether and how incorporation of epirubicin into combination chemo- therapy can enhance outcome in advanced NSCLC.

Recent advances in etoposide therapy for non-small cell lung cancer Bonomi P. Secrion of Medical Oncology, Rush Uniwrsiry Medicaf

Center, 1725 Wesr Harrison. Suife 830, Chicago, IL 60612. Cancer 1991;67:Suppl254-9.

Non-small cell lung cancer (NSCLC) continues to be a major health problem in the US. In l99O, approximately 120,OOO new cases will be diagnosed, and the majority of these patients will have either unre- sectable 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.

Etoposide in the management of non-small cell lung ePncer Ruckdeschel JC. Division of Medical Oncology. Albany Medical Col-

lege, A-167. Albany, NY 12208. Cancer 1991;67:Suppl2SO-3. Etoposide is a phase-specific, schedule-dependent derivative of

podophyllotoxin tha1 appears to act by inhibiting DNA-topoisomerase II. Early ln-eclinical work demimsuated sharp activity in mouse leukemias and possible synergy with cisplatin. As a single agent (either orally or intravenously), it demonstrated limited benefit in non-small cell lung cancer (NSCLC), with response rates around 10% In combination with cisplatin, it has become a mainstay of chemotherapeutic efforts, either as primary therapy or in conjunction with radiation. Response rates in advanced disease average around 30%. climbing IO more than 50% in patients with Stage IIIA or IIIB disease. More recent work suggests that theissueoftheuuesynergyofetoposidewithcisplatininNSCLCneeds reassessment. The relative roles of etoposide and cisplatin in the combination are unclear, as several sludies conflict. Pharmacokinetic data suggest that multiple daily fractions of etoposide are superior to prolonged infusions, warranting several future trials. Thecurrent major role for etoposide plus cisplatin would appear to be in muldmodality

and/or surgery. Several other agents have been studied with etoposide or etoposide plus cisplatin (mitomycin. vindesine, doxorubicin. cyclo- phosphamide,ifosfamide,andcarboplatin). but it isunclearwhetherthe addition of any of them offers any response or survival advantage.

A randomized trial to compare intravenous and oral etoposide in combination with cisphtin for the treatment of small cell lung cancer Johnson DH. Ruckdeschel JC. Keller JH, Lyman GH. Kallas GJ, Macdonald J et al. Division of Medical Oncology, Vanderbilt Univer- siry, NashviNe. TN. Cancer 1991;67:Suppl 245-9.

In a randomized multi-center s1udy. 83 palients wilh small cell lung cancer were randomly assigned to trcalment with cisplatin 100 mg/m’ intravenously (IV) day 1 and etoposide 120 mp/m’ IV days 1.2. and 3 or cisplatin 100 mg/m’IV day 1 and ecoposide 120 mg/m’IV day 1 and 240 me/m’ orally days 2 and 3. Both regimens were repeated every 4 weeks. Prior to randomization, patients were Watified by extent of disease, performance status, and gender. A total of 41 patients were randomly assigned to the parentcral treatment only regimen, and 42 patienls received cisplatin and IV/oral etoposide therapy. Both treat- ment arms were comparable regarding patient characteristics. Limited disease (LD) patients constinued 52% and 49% of tbe patient popula- tion for the oral and IV etoposide regimens, respectively. The overall complete response (CR) and partial response (PR) rate was 50% (95% confidence interval [Cl] 35% to 65%) for the oral etoposlde regimen and 59% (95% CI 44% 10 74%) for the IV etoposide regimen (P = 0.438). For both regimens, 55% of the LD patients achieved either CR or PR. Time to progression and survival were comparable for both treatment arms. Hematologic toxicity was comparable in both treat- mentarms, with 80% of patients experiencing grade 3 or4 neutropenia or thmmbocytopcnia. Moderate to severe anemia and weight loss were more predominant with the IV than with me oral regimen.

Current status of etoposide in tbe management of small cell lung cancer Johnson DH, Hainsworth JD, Hande KR, Greco FA. Division ofhfedl-

ml Oncology, Deparmenr of Medicine, Vanderbilt Universiry. Nash-

ville. TN 37232-5536. Cancer 1991;67:Suppl 2314.

Etoposide is a schedule-dependent drug with excellent activity against small cell lung cancer (SCLC). Single-agent etoposide achieves overall response rates ranging from 15% to 84%. depending on the schedule of drug administration and the characteristics of the tteated population. The mute of etoposide administration (iniravenous versus oral) has little impact on response rate, provided appropriate dose ad- justments are made for oral therapy. In combination with other active agents, etoposide has proven particularly effective in the management of SCLC.Etoposidecan bcsubstituteddordoxorubicinorvincristine in the cyclophosphamide, doxorubicin, and vincristine (CAV) regimen without lossofefficacy.Theetoposideandcisplastin(EP)combination is thought to be synergistic and has proven to be an effective salvage regimen for CAV failures. A regimen that alternates CAV and EP has been found by some investigators to be modestly more effective against SCLC 1han CAV alone; however, EP alone may be as useful as an alternating regimen. Most studies to date have demonstrated that EP induction is at least as cffec1ive as any other standard induction regimen. However, EP has me potential advantage of being more easily integrated with thoracic radiation therapy (RT). This is particularly important in limited-disease patienls: two recent pilot studies employ- ing EP induclion with hyperfractionated thoracic RT yielded 2-year survival rates of greater than 50%. These promising results are being evalualed further in an ongoing Phase III trial in the United States. The available data indicate ma1 etoposide is one of the most active agents against SCLC and therefore should be included as a component of induction therapy in all patients. New schedules of etoposide admini- stration warrant further study.

Cisptatincnrboplatin therapy in extensive non-small celt lung cancer: A cancer and leukemia group B study Kreismao H.GoutsouM, ModeasC,GrazianoSL.CostanzaME.Green MR. Pubnonory Division. Sir Morrimer B. Davis-Jewish General

Hospital, 3755 Cole St Catherine Road, Momreal, Que. H3T IE2. EIU

J Cancer 1990;26:1057-60. The response 10 cisplatin in non-small cell lung cancer (NSCLC) is

limited by the renal and neurological toxicities of this agenl. Car- boplatin hasmodestactivity in NSCLC and when given inconventional doses hasadifferent spectrum of toxicity. Both drugs wereadministered to 76 eligible patients with advanced NSCLC. No patient had be-en previously treated wilh chemotherapy. Cisplatin SO mg/m’ and car- boplatin 350 mg/m* were administered every 28 days until disease progression occurred. There was 1 complete response and the overall response rate among the 68 evaluable for response patients was 13%. Neither histological subtype nor initial performance status was a significant factor influencing response. Median survival was 5.1 months with significant differences based on initial performance status but not on histological subtype. Severe or life-threamning Ieukopenia and thrombocytopenia occurred in 23% and 36% of the 76 patients, respec- tively. There were 2 toxic deaths. 1 each due to infection and haemor- rhage. The efficacy of this combination is not different from that of carboplatin alone, and the combination may be of greater bettent in patients with more responsive tumours ihan NSCLC.

Combination chemotherapy of limited-stage small-cell lung cancer. A controlled trial on 221 patients comparing two alternating regi- mens Osterlind K, Hansen M, Hirsch FR, Dombemowsky P, Sorenson S, Pedersen AG et al. Deparmenf of Oncology, Finsen Ins~irvvlRigshos-

pitalet. DK-2100 Copenhagen. Ann Gncol 1991;2:41-6. The outcome of two differenc alternating regimens of chemotherapy

was investigated in a prospeclive controlled trial in limited-stage small- cell lungcancer(SCLC). Both regimenscomprisedcyclophosphamide, lomustine. vincrisline, mcthotrexatc, doxorubicin and etoposide ad- ministered in different schedules. The investigative regimen (B) in- cluded simultaneous administration of cyclophosphamide + lomustine alternating with cyclophosphamidc + doxorubicin, and with doxorubi-