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Cisplatin-vinorelbine combination chemotherapy in locally advanced non-small cell lung cancer
(19%) topenia patients similar vanced
and four (9%) patients respectively, but only grade 2 thrombocywas observed. Phlebitis at the infusion sire was observed in 24 (53%). This treatment programme achieved a response rate to other active combination regimens for the treatment of adNSCLC, and was less toxic.
A phase II study of mitomycin C, vindesine and cisplatin combined with alpha interferon in advanced non-small cell lung cancer Silva RR, Bascioni R, Rossini S. Servizio di Oncologia Medica, Ospedale ‘Profili’, 60044 Fabriano. Tumori 1996;82:68-71. Aims and background MVP chemotherapy (mitomycin C, vi&sine or vinblastine, cisplatin) is one of the most commonly used regimens for advanced non-small cell lung cancer (NSCLC). Experimental data suggest a synergistic cytotoxic activity of alpha-interferon (a-IFN) when combined with cisplatin, mitomycin C, and vinca alkaloids. In an effort to improve MVP chemotherapy activity, we have combined this regimen with a-IFN. Patients and methods: Thirty-five patients with advanced NSCLC (19 stage IV) were treated with the MVP regimen (mitomycin C, 8 mg/m*; vindesine, 3 mg/m*; cisplatin, 75 mg/m*, all on day 1) plus a-Za-IFN, 3 x lo6 U im from day 1 to 7. The cycles were repeated every 28 days, Results. There were no complete responses and 18 partial responses, for an overall response rate of 51%. Median time to treatment failure was 6 months (range, l-18). and median survival was 9.5 months (range, l-32). WHO grade 3 toxicity was recorded in up to 8% of patients, flu-like syndrome was a common complaint; one toxic death occurred. Conclusions: The combination yielded a level of response comparable to that of other cisplatin-based regimens. Larger randomized trials are needed to assess the role of a-JFN combined with chemotherapy in advanced NSCLC.
Cisplatin-vinorelbine combination chemotherapy in locally advanced non-smaIl cell lung cancer Frontitti L, Candid0 P, Cattaneo M et al. Ospedale Luigi Sacco. I/fa G.B. Grassi 74, 0157Milan. Tumori 1996;82:57-60. Aim: The North Milan Group presents the results of a phase11 study on a cisplatin-vinorelbine combination schedule inthe treatment of locally advanced non-small cell lung concerto evaluate its activity and tolerability, MethodsSeventy-six consecutive patients entered the study, Patients’ characteristics were the following: males/females 69/7; median age, 61.4 years (range, 40-73); ECOG performance status, O-l; 17 stage IIIa and 59 stage IIIb.There were 49 sqtamous cell carcinomas, 20 adenocarcinomas,and 7 large cell carcinomas. All patients had not beenpreviously treated and showed measurable disease. Treatment consisted of vinorelbine, 25 mg/m’ on days 1 and 8, phrscisplatin, 80 mg/ m’ on day 1, administered intravenously every 2 1 days for three standard courses. Results: Seventy-four patients were evaluable for response. Objective responses were documented in 42/74 patients with an overall response rate (CP + PR) of 56.7%;18/74 patients (24.3%) showed stable disease and the remaining 14/74 (18.9%) went into progression. Twelve patients (16.2%) were suitable for a subsequent surgery. The median duration of response was 13.3 months. Survival time ranged from 4 to 36 months: it was 14.6 months for PR patients, 8.6 months for NC and 5 months for PD. Mean survival time is presently 12.85 months (SE, 1.2 months). Toxicity evahrated on 222 cycles administered was acceptable, and it was necessary to use G-CSF or delay the treatment because of severe leukopenia in only a few cases. Conclusions: The regimen is active and safe: the slight survival increase is likely due to the small amenability to surgery achieved (16.2%). However, our results am fully comparable to others c&ained with vlnorelbine in two/three drug combination chemotherapy regimens.
Radiation treatment of superior sulcus lung carcinoma MlRar J, Ball D, Worotniuk V, Smith J, Crennan E, Bishop M. Wfiam Buckland Radiotherapy Centre. A&d Hospital. Commercial Road. Prahran. l&.3181. Australas Radio1 1996;40:55-60. The survival of patients with superior sulcus lung carcinoma and the effect; of treatment were reviewed. From a prospective database of 4123 consecutive new patients with lung carcinoma, 131 (3.2%) cases of superior sulcus lung carcinoma were identified. Seventy-four patients were planned to receive radiation with paltiative intent, 53 radical radiotherapy and one was observed only. The remaining three patients, with small-cell carcinoma, were treated with chemotherapy with or without radiotherapy. Of the 53 radically treated patients, nine were treated with pm-operative radiation prior to intended radical resection, Analysis was carried out on the effect on survival of performance status, nodal involvement, weight loss, vertebral body or rib involvement, treatment intent and radical combined modality treatment compared with radical radiation alone. The estimated median survival for the whole group was 7.6 months; for those treated radically it was 18.3 months, while for the palliatively treated patients it was 3.7 months. Radically treated patients with no initial nodal involvement had an estimated median survival of 22 months, while radically treated patients with nodal involvement had an estimated median survival of 8.4 months (P = 0.003). There were no statistically significant differences in survival between radically treated patients grouped according to initial weight loss, performance status, or vertebral body and rib involvement. Patients treated with pre-operative radiation did not survive significantly longer than patients treated with radiation alone, although the numbers are small.
High dose rate brachytherapy for the local control of endobronchial cnrcinomo following external irradiation Hernandez P, Gursahaney A, Roman T et al. Division o/Respiratory Medicine, Royal Mctoria Hospital, McGill University. Montreal, Que. H3A IAI. Thorax 19%;51:354-8. Background -External irradiation is an established palliative treatment for patients with inoperable lung cancer. However, persistent or recurrent symptoms due to local disease are common following external irradiation. The impact of high dose rare (HDR) brachytlterapy in the palliative management of patients with local sequelae of residual or recurrent endobronchial lung carcinoma following external irradiation was investigated. Methods - A prospective cohort of 29 patients (19 men, mean age 65 years) underwent HDR brachytherapy for inoperable lung cancer. All patients had completed external irradiation at least one month before entry into the study (mean (SD) dose 4400 (1481) cGy, completed 12.9 (21.3) months previously). Patients underwent outpatient bronchoscopic placement of l-3 HDR brachytherapy catheters for delivery of 750-1000 cGy of intraluminal irradiation every two weeks on 1-3 occasions. Prospective evaluation before and four weeks after completion of HDR brachytherapy included assessment of indices of level of function, symptoms, extent of atelectasis (chest radiogra,phy), and bronchoscopic determination of degree of endobronchial obstruction. Results - One hundred and eighteen catheters were placed in 8 1 treatments. Eleven of the 26 patients who underwent repeat bronchoscopy showed a reduction in the degree of endobronchial obstruction; five of 18 patients bad radiographic improvement in the extent of atelectasis. Positive reqxmse rates tanged from 25% for signs and symptoms related to pneumonitis to 69% for haemoptysis. Performance status improved in 24% of patients. ‘Bvo patients died before completion of the study pmtocol. Short term complications included one episode of non-fatal, massive baemoptysis, five of minor haemoptysis. and one pneumothorax. Conclusions - HDR brachytherapy may improve the
and four (9%) patients respectively, but only grade 2 thrombocywas observed. Phlebitis at the infusion sire was observed in 24 (53%). This treatment programme achieved a response rate to other active combination regimens for the treatment of adNSCLC, and was less toxic.
A phase II study of mitomycin C, vindesine and cisplatin combined with alpha interferon in advanced non-small cell lung cancer Silva RR, Bascioni R, Rossini S. Servizio di Oncologia Medica, Ospedale ‘Profili’, 60044 Fabriano. Tumori 1996;82:68-71. Aims and background MVP chemotherapy (mitomycin C, vi&sine or vinblastine, cisplatin) is one of the most commonly used regimens for advanced non-small cell lung cancer (NSCLC). Experimental data suggest a synergistic cytotoxic activity of alpha-interferon (a-IFN) when combined with cisplatin, mitomycin C, and vinca alkaloids. In an effort to improve MVP chemotherapy activity, we have combined this regimen with a-IFN. Patients and methods: Thirty-five patients with advanced NSCLC (19 stage IV) were treated with the MVP regimen (mitomycin C, 8 mg/m*; vindesine, 3 mg/m*; cisplatin, 75 mg/m*, all on day 1) plus a-Za-IFN, 3 x lo6 U im from day 1 to 7. The cycles were repeated every 28 days, Results. There were no complete responses and 18 partial responses, for an overall response rate of 51%. Median time to treatment failure was 6 months (range, l-18). and median survival was 9.5 months (range, l-32). WHO grade 3 toxicity was recorded in up to 8% of patients, flu-like syndrome was a common complaint; one toxic death occurred. Conclusions: The combination yielded a level of response comparable to that of other cisplatin-based regimens. Larger randomized trials are needed to assess the role of a-JFN combined with chemotherapy in advanced NSCLC.
Cisplatin-vinorelbine combination chemotherapy in locally advanced non-smaIl cell lung cancer Frontitti L, Candid0 P, Cattaneo M et al. Ospedale Luigi Sacco. I/fa G.B. Grassi 74, 0157Milan. Tumori 1996;82:57-60. Aim: The North Milan Group presents the results of a phase11 study on a cisplatin-vinorelbine combination schedule inthe treatment of locally advanced non-small cell lung concerto evaluate its activity and tolerability, MethodsSeventy-six consecutive patients entered the study, Patients’ characteristics were the following: males/females 69/7; median age, 61.4 years (range, 40-73); ECOG performance status, O-l; 17 stage IIIa and 59 stage IIIb.There were 49 sqtamous cell carcinomas, 20 adenocarcinomas,and 7 large cell carcinomas. All patients had not beenpreviously treated and showed measurable disease. Treatment consisted of vinorelbine, 25 mg/m’ on days 1 and 8, phrscisplatin, 80 mg/ m’ on day 1, administered intravenously every 2 1 days for three standard courses. Results: Seventy-four patients were evaluable for response. Objective responses were documented in 42/74 patients with an overall response rate (CP + PR) of 56.7%;18/74 patients (24.3%) showed stable disease and the remaining 14/74 (18.9%) went into progression. Twelve patients (16.2%) were suitable for a subsequent surgery. The median duration of response was 13.3 months. Survival time ranged from 4 to 36 months: it was 14.6 months for PR patients, 8.6 months for NC and 5 months for PD. Mean survival time is presently 12.85 months (SE, 1.2 months). Toxicity evahrated on 222 cycles administered was acceptable, and it was necessary to use G-CSF or delay the treatment because of severe leukopenia in only a few cases. Conclusions: The regimen is active and safe: the slight survival increase is likely due to the small amenability to surgery achieved (16.2%). However, our results am fully comparable to others c&ained with vlnorelbine in two/three drug combination chemotherapy regimens.
Radiation treatment of superior sulcus lung carcinoma MlRar J, Ball D, Worotniuk V, Smith J, Crennan E, Bishop M. Wfiam Buckland Radiotherapy Centre. A&d Hospital. Commercial Road. Prahran. l&.3181. Australas Radio1 1996;40:55-60. The survival of patients with superior sulcus lung carcinoma and the effect; of treatment were reviewed. From a prospective database of 4123 consecutive new patients with lung carcinoma, 131 (3.2%) cases of superior sulcus lung carcinoma were identified. Seventy-four patients were planned to receive radiation with paltiative intent, 53 radical radiotherapy and one was observed only. The remaining three patients, with small-cell carcinoma, were treated with chemotherapy with or without radiotherapy. Of the 53 radically treated patients, nine were treated with pm-operative radiation prior to intended radical resection, Analysis was carried out on the effect on survival of performance status, nodal involvement, weight loss, vertebral body or rib involvement, treatment intent and radical combined modality treatment compared with radical radiation alone. The estimated median survival for the whole group was 7.6 months; for those treated radically it was 18.3 months, while for the palliatively treated patients it was 3.7 months. Radically treated patients with no initial nodal involvement had an estimated median survival of 22 months, while radically treated patients with nodal involvement had an estimated median survival of 8.4 months (P = 0.003). There were no statistically significant differences in survival between radically treated patients grouped according to initial weight loss, performance status, or vertebral body and rib involvement. Patients treated with pre-operative radiation did not survive significantly longer than patients treated with radiation alone, although the numbers are small.
High dose rate brachytherapy for the local control of endobronchial cnrcinomo following external irradiation Hernandez P, Gursahaney A, Roman T et al. Division o/Respiratory Medicine, Royal Mctoria Hospital, McGill University. Montreal, Que. H3A IAI. Thorax 19%;51:354-8. Background -External irradiation is an established palliative treatment for patients with inoperable lung cancer. However, persistent or recurrent symptoms due to local disease are common following external irradiation. The impact of high dose rare (HDR) brachytlterapy in the palliative management of patients with local sequelae of residual or recurrent endobronchial lung carcinoma following external irradiation was investigated. Methods - A prospective cohort of 29 patients (19 men, mean age 65 years) underwent HDR brachytherapy for inoperable lung cancer. All patients had completed external irradiation at least one month before entry into the study (mean (SD) dose 4400 (1481) cGy, completed 12.9 (21.3) months previously). Patients underwent outpatient bronchoscopic placement of l-3 HDR brachytherapy catheters for delivery of 750-1000 cGy of intraluminal irradiation every two weeks on 1-3 occasions. Prospective evaluation before and four weeks after completion of HDR brachytherapy included assessment of indices of level of function, symptoms, extent of atelectasis (chest radiogra,phy), and bronchoscopic determination of degree of endobronchial obstruction. Results - One hundred and eighteen catheters were placed in 8 1 treatments. Eleven of the 26 patients who underwent repeat bronchoscopy showed a reduction in the degree of endobronchial obstruction; five of 18 patients bad radiographic improvement in the extent of atelectasis. Positive reqxmse rates tanged from 25% for signs and symptoms related to pneumonitis to 69% for haemoptysis. Performance status improved in 24% of patients. ‘Bvo patients died before completion of the study pmtocol. Short term complications included one episode of non-fatal, massive baemoptysis, five of minor haemoptysis. and one pneumothorax. Conclusions - HDR brachytherapy may improve the