local chemotherapy through bronchofiberscope in inoperable non small cell lung cancer growing into...
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Quadruple Alkylating Agent Therapy With ABMR For Advanced Non Small Cell Lung
Cancer (NSCLC). Thatcher, N., Cuthbert, A., Chang, J., Burmester, H., Johnson, R.J., Moussalli, H., Carroll, K.B. Wythenshawe and Christie Hospitals, Manchester, U.K.
Chemotherapy for NSCLC remains unsatig- factory, new approaches are clearly needed.
6 patients with inoperable, locally ad- vanced NSCLC without evidence of brain or abdominal metastases have been entered into the study. There were 3 large cell ana- plastic and 3 squamous cell carcinomas, the patients were aged between 32-44 years. The' study was activated in November 1984. The patients were not considered suitable for radiation therapy because of the advanced nature of the disease and because of their poor performance score (KP20-40).
Immediately after autologous marrow harvest, a 48 hour chemotherapy regimen was commenced. The marrow was reinfused (after storage at 4°C) 56 hours from the start of chemotherapy. Tge treatment consi- sted of ifosfamide 7 g/m with Mesna infu- sed over the first 24 hours wi~h 2 bolus cyclophosphamide doses 1.6 g/m- at + 18 and + 16 hours. At the end of the i~osfa- mide infusion, mitomycin C, 60 mg/m over 24 hours was commenced, with 2 bolus mustine doses 8 mg/m at +32 and +40 hours.
The first patient died at 32 hours, but the other 5 patients have all shown tumor response (2 CR's to date), with sur- prisingly little toxicity. All patients were able to be discharged home 23-27 days after the start of chemotherapy. 2 courses of i.v. antibiotics have been given. The patients performance status has markedly improved in particular in 2 patients opiate analgesia has been dis- continued. The study continues.
Ifosfamide With and Without Mesna in In- operable, Symptomatic Non Small Cell Lung Cancer (NSCLC). Souhami, R.L., Spiro, S.G., Harper, P.G., Tobias, J.S., Geddes, D.M., Quinn, H., Mitchell, D.M. University College Hospital, Gower Street, London, WCIE 6AU, England.
We treated 41 patients with advanced inoperable NSCLC all of whom had evaluable disease, symptoms related to their illness and a performance status (Karnofsky) great- er than ~0%. Patients received ifosfamide 1.5 mg/m i.v. over 30 min on days 1-5 every 21 days. Response was assessed 3 weeks after course 3 and if a partial re- sponse (PR) or better was achieved treat- ment was continued. If response was less than a partial response treatment was stopped. Patients were randomized accord- ing to cell type and received either no MESNA or MESNA 400 g i.v. at the start
of ifosfamide infusion and at 3,6 and 9
hours post. In addition~to assessing the uro-
thelial protection of MESNA, the randomization also assessed any "protective effect" on the tumourcidal properties of ifosfamide. Those not receiving MESNA had a 3L urine output each
treatment day. The patients comprised 15 squamous, 9 ade-
no and 17 large cell tumours. 20 patients re- ceived 2 or less courses - 12 because of dis- ease progression, 2 because of refusal and 6 because of poor tolerance. 5 patients achieved a PR, there were no CRs. Of these 2 were squa- mous, 2 large and i adenocarcinoma; 2 received MESNA. The median duration of response was 6 weeks and all these patients received at least 4 courses of ifosfamide with treatment continu- ing until relapse.
We conclude that ifosfamide has a dis- appointing response rate in patients with ad- vanced NSCLC, and MESNA had no influence on its
Efficiency of Cisplatin and Bleomycin on Brain Metastases of Non Small Cell Lung Cancer. Bonan, G., Bion, C., Caubarrere, I. CMC Foch,
92150 Suresnes, France. The absence of brain penetration of cis-
platin (C) and bleomycin (B) is currently ac- cepted and relies upon pharmacological studies performed on men and animals without brain tumors (J Nucl Med. 13, 191, 1972). These fin- dings led so far to the exclusion of chemotherapy to treat metastatic brain tumgrs. We compared the efficiency of C (i00 mg/m-) and B (25 mg/m 2)
on brain metastases of non small cell carcinomas in ten patients: 5 responders (R) and 5 non responders (NR). In group R after 2 courses of chemotherapy, the marked regression of brain metastases paralleled that of lung tumors, as far as the importance of the regression and the time of its achievement are concerning. In group NR brain lesions were stable or increased
as did the lung tumors. We conclude that:
-C and B cross the blood brain barrier in case of brain tumors (Cancer Res. 42, 2474,
1983). -The evolution of brain metastases
under C and B parallels that of other tumoral localizations.
-Brain metastases do not contra-indi- cate treatment with C and B.
Local Chemotherapy Through Bronchofiberscope in Inoperable Non Small Cell Lung Cancer Growing Into the Endocbronchial Lichen. Cipri, A., De Marinis, F., De ~gelis, G., Mac- cone, C., Alma, M.G., Pallotta, G. Pneumologi- cal Hospital "C. Forlamini" 3rd Div. 00149 Rome, Italy.
Non small cell lung cancer (NSCLC) has a poor response to chemotherapy for reducing the size of the tumor. The A.A. try to improve pul- monary functions and avoid poststhenotic pneu- monia in patient with tumors growing into the
main or lobar bronchi with local injection of