48

Small Cell Carcinoma of the Lung after

Failure on Combinatin Chemotherapy.

Joss, R.A., Siegenthaler, P., Ludwig, C. et

al. Institut fur Medizinische Onkologie, In-

selspital, Universitat Bern, CH-3010 Bern,

Switzerland. Invest. New Drugs 4: 175-179,

1986.

Thirty-nine previously treated patients

received Nimustine in a phase II trial to

test the therapeutic activity in refractory

small cell lung cancer. Nimustine was given

as a direct i.v. injection of i00 mg/m 2 with

treatments repeated every six weeks. Three

partial remissions of 56, 123 and 355 days

duration were noted among 34 evaluatable

patients. Thrombocytopenia was prominent

with a median platelet nadir of 47,000/~i.

We conclude that Nimustine has minor

antitumor-activity in heavily pretreated

patients with small cell lung cancer. The

definitive value of Nimustine in the treat-

ment of small cell lung cancer, as well as

its superiority over its parent compounds

remains to be established.

High-dose Etoposide with Autologous Bone

Marrow Transplantation as Initial Treatment

of Small Cell Lung Cancer - A Negative

Report.

Littlewood, T.J., Bentley, D.P., Smith, A.P.

Department of Haematology, Llandough Hospi-

tal, Penarth, South Glarmorgan, Wales, U.K.

Eur. J. Respir. Dis. 68: 370-374, 1986.

Seven patients with small cell lung

cancer were treated with high-dose etoposide

(1400-2400 mg/m2), given as a single course

over 3 days, in conjunction with autologous

bone marrow transplantation. Five patients

achieved a partial response and two had no

response. All patients required further

treatment. The lack of any complete

responder or good partial responder dis-

suaded us from entering further patients

into the study, and high-dose, single-agent

etoposide cannot be reco~ended in the ini-

tial treatment of small cell lung cancer.

No Response Improvement after Sequential

Chemotherapy for Small Cell Lung Cancer.

Postmus, P.E., Sleijfer, D.Th., Meinesz,

A.F. et al. State University Hospital,

Department of Pulmonary Diseases, 9713 EZ

Groningen, Netherlands. Eur. d. Respir. Dis.

68: 279-285, 1986.

In a phase II study in patients with

small cell lung cancer (SCLC) the combina-

tion of cyclophosphamide, cisplatin and

etoposide was found to be active, the

response rate was 91% (30% CR, 61% PR) in

the whole group. In 40 limited disease

patients 19 CR (48%) and 20 PR (50%) were

seen, whereas in 30 extensive disease

patients only 2 CR (7%) and 23 PR (77%) were

reached. Adding a second combination of

doxorubicin, vincristine and procarbazine

resulted in response improvement in only two

patients. Median response duration was 41

weeks in CR patients and 30 in PR patients

(p < 0.01). Median survival was 66 in CR and

45 weeks in PR patients (p < 0.002). Perfor-

mance score and disease stage were found to

be good prognostic factors. Four patients

(6%) are disease-free at 2.5 years. The

value of sequential chemotherapy for SCLC is

probably min~l in view of the lack of

response improvement.

Randomized Dose-response Evaluation of

Etoposide in Small Cell Carcinoma of the

Lung: A Southeastern Cancer Study Group

Trial.

Wolff, S.N., Birch, R., Sarma, P., Greco,

F.A. Division of Oncology, Department of

Medicine, Vanderbilt University, Nashville,

TN 37232, U.S.A. Cancer Treat. Rep. 70: 583-

587, 1986.

To evaluate postulated dose-response

relationships of etoposide (VP-16) for

patients with recurrent small cell carcinoma

of the lung, a prospectively randomized

study was undertaken. VP-16 was administered

i.v. at three dose levels: 300, 600, and 900

mg/m 2. Based on historical information, a

20% response rate was anticipated in the

standard-dose level and the study was

designed to be able to detect a response

rate of 40% in either of the high-dose

levels. The planned number of patients

required in each arm was 45, with an alpha-

level of 0.i and a beta-level of 0.2. The

total number of patients actually entered

was less than the planned number due to a

low response rate. Seventy-seven of 79

treated patients were eligible, and 26, 27,

and 26 patients were treated at each dose

level, respectively. Toxicity was

predominantly hematologic, with the higher

dose levels substantially more toxic.

Response to therapy was infrequent, with

only four partial responses achieved and

distributed between all dose levels. In this

study, using previously treated patients,

VP-16 at standard-dose or at moderate-dose

increments had minimal activity.