Etoposide compared with the combination of vincristine, doxorubicin, and cyclophosphamide in the treatment of small cell lung cancer.

One hundred and three patients with small cell lung carcinoma were stratified according to stage of disease (47 limited disease, 56 extensive disease) and then randomised to receive etoposide 300 mg/m2 alone for two days or a combination (VAC) of vincristine 1 mg/m2, doxorubicin (Adriamycin) 50 mg/m2, and cyclophosphamide 1000 mg/m2. The drugs were given at three week intervals. Patients were assessed after three cycles of treatment and continued with the same regimen if in complete remission and with the alternative regimen if in partial remission; they were withdrawn if the disease had progressed. Twenty four patients (23%) achieved complete remission and this occurred more often when patients were receiving VAC (19 of 82) than etoposide (5 of 75). There was no difference, however, in overall survival between those initially treated with etoposide and those having combination chemotherapy, whether for limited disease (both 8 months) or extensive disease (7 and 5.5 months). Toxicity was less with etoposide. Survival was disappointing, especially with limited disease, even in patients who showed a complete response to treatment.

Intravenous infusion of a dextrin, Caloreen, in human subjects: metabolic studies.

1. Caloreen, a glucose-polymer dextrin infused into human volunteers, although producing a clear increase in total plasma carbohydrate did not produce a satisfactory increase in plasma glucose levels or serum insulin levels. 2. Urinary losses were high and although small fragments of the dextrin (suggesting metabolic breakdown of the dextrin) were demonstrated in the urine, no suppression of plasma free fatty acid, glucagon or immediate increase in the respiratory quotient were noted, suggesting that the metabolism is too slow to make it useful for parenteral nutrition in its present form. 3. A dextrin with fewer branch-links might be more suitable.