Ambulatory combination chemotherapy with oral etoposide and cisplatin for advanced non small cell lung carcinoma patients. A phase II study.

Thirty nine male patients with locally advanced and/or extensive non small cell lung cancer (NSCLC) were treated with oral etoposide (240 mg/m2 days 1 to 3) and cisplatin (100 mg/m2 day 4) according to a fully ambulatory schedule. Eight out of 33 (24%) evaluable patients achieved a partial response (PR) and 6 a minor response (MR). Stable disease (SD) was observed in 7 (25%) and progressive disease (P.D.) in 12 (26%). Median survival time (MST) of all patients was 8 months. No difference in MST was observed between limited (LD) and extensive disease (ED) patients. Only overall responding patients (PR + MR + SD) in the E.D. subgroup lived significantly longer than PD patients. Patients with LD did not obtain a significant survival benefit whether or not a response was achieved. The overall toxic cost of the regimen was low and patient tolerance remarkably good. This combination chemotherapy can safely be recommended for ambulatory use and does not seem to compromise heavily the patients' quality of life.

Randomised trial comparing sequential methotrexate (or 5-FU), vinblastine and ifosfamide to vincristine, adriamycin and ifosfamide in advanced lung cancer.

A randomised trial has compared the sequential administration of ifosfamide (with its urinary antidote mesna) combined with methotrexate (or 5-FU in adenocarcinomas) and vinblastine (protocol I) or combined with adriamycin and vincristine (protocol II) in advanced lung cancer. In 29 evaluable cases the results were not influenced by the protocol nor by the histology of the tumors (oat cell v non-oat cell) or the clinical stage (limited v extensive). An overall response rate of 58.6% was obtained (100% in the oat cell and anaplastic carcinomas, 44% in adenocarcinomas, 50% in squamous cell carcinomas) with a clear prolongation of survival in responding groups, whatever the clinical stage.

Neurological toxicity of vindesine used in combination chemotherapy of 51 human solid tumors.

The authors treated 51 patients with solid tumours with vindesine 4 mg/m2, generally every third week, in combination chemotherapy protocols scheduled according to diurnal variability of kinetics. No dose-related sensory disorders were observed: On the contrary, motor toxicity appeared cumulative: 1) Early depression of osteotendinous reflexes from the first course onward, with progressive deterioration. No more normal reflexes could be evoked after 55 mg; 2) Early appearance of neurogenic pattern in the electromyograph after 5-10 mg. Progressive alteration with no normal detection recordings after 45 mg; 3) Late slowing down of conduction speeds (normal in 50% of cases up to 55-60 mg). Improvement or even complete recovery of neuropathy was documented following reduction of the unit dose, increased time interval between doses, or discontinuation of the treatment. The drug had to be withheld in only three patients: in two cases a low dosage related to individual sensitivity was being used.