A pilot study of MVP (mitomycin-C, vinblastine and cisplatin) chemotherapy in small-cell lung cancer

Abstract

Summary MVP chemotherapy (mitomycin C 8 mgm-2, courses 1,2,4 and 6, vinblastine 6 mgm-2, cisplatin 50 mgm-2) is an active low-toxicity regimen in non-small-cell lung cancer (NSCLC). Based on the single-agent activity of these agents in SCLC, we have conducted a phase 11 trial of MVP in SCLC. Fifty chemo-naive patients with SCLC were entered in this trial. There were 33 men and 17 women with median age 66 years (range 46-83 years); 18 patients had limited disease (LD) and 32 extensive disease (ED). WHO performance status (PS) was: three patients PS 0, 33 patients PS 1, ten patients PS 2, four patients PS 3. A maximum of six cycles was given in responding patients. On completion of chemotherapy, patients with LD obtaining complete response (CR)/good partial response (PR) received thoracic irradiation and those obtaining CR were offered entry into the ongoing MRC Prophylactic Cranial Irradiation Trial. The overall response was 79% with 17% CR and 62% PR. For LD patients, 38% obtained CR but for ED only one patient achieved CR. Median response duration for LD patients was 8 months and for ED patients 5 months. Median survival was 10 months for LD patients and 6 months for ED patients. There was complete resolution of symptoms in 24%, partial improvement in 68%, no change in 2% and progressive symptoms in 6%. As regards toxicity, 24% developed WHO grade 3/4 neutropenia, 16% grade 3/4 thrombocytopenia and 6% significant hair loss. Two patients died during the first week of treatment with neutropenic infection. Quality of life using the EORTC questionnaire (QLC-C30) with lung cancer module demonstrated significant improvements from baseline levels in emotional and cognitive functioning, global QOL, of pain, dyspnoea and cough. MVP, an effective palliative regimen for NSCLC, is also active against SCLC with low toxicity and merits comparison with more toxic conventional schedules.

Use of the lung cancer–specific Quality of Life Questionnaire EORTC QLQ‐LC13 in clinical trials: A systematic review of the literature 20 years after its development

“…The remaining 314 records dealt with the LC13; however, of these, 74 records were excluded because they did not present original data obtained by means of the module. Consequently, n = 240 articles were considered clinical studies according to our definition and were included in further analyses …”

Lung volume reduction surgery for severe emphysema increases exercise capacity but not does not affect mortality

“…123 Other studies which have included patients with a median age of >65 years have shown a favourable response and survival data together with the suggestion of improved symptom control, less hospitalisation, and reduced risks of life threatening sepsis. [124][125][126][127] Most recently, the cisplatin-irinotecan combination has been shown to be more efficacious in extensive stage disease than cisplatinetoposide, and this effect persisted despite adjustment for age (up to 70 years) and performance status. 128 Early reports of newer combinations are also emerging with encouraging response rates in phase II studies.…”

Aggressive management leads to improved survival in patients with small cell lung carcinoma

“…Our present survival figures (1993-1998 group) reflect our day-to-day practice, yet compare favourably with those reported in the current medical literature, both with conventional and novel therapies (Table 3). [7][8][9][10] In patients with SCLC, median survival continues to improve but improvement in longterm survival remains an elusive goal. More intensive chemotherapy regimes have shown improved survival, but are limited by excessive toxicity.…”