Benefits of polychemotherapy in advanced non-small-cell bronchogenic carcinoma

Abstract

The benefits of polychemotherapy in advanced (Stage III) non‐small‐cell bronchogenic carcinoma remain uncertain. In attempt to answer the important question whether treatment improves well‐being and survival in these patients, we did a prospective, randomized, single‐blind study to compare polychemotherapy to a placebo. Thirty‐nine consecutive patients were enrolled. Twenty received a drug combination consisting of: methotrexate, doxorubicine hydrochloride (Adriamycin), cyclophosphamide, and lomustine (CCNU) (MACC). The other group (19 subjects) received a placebo physically comparable to MACC. The two groups were initially comparable in terms of age, sex, clinical status, and tumor burden. In the treated group, seven patients had a radiologic response (more than 50% reduction in the tumor size), and the tumor stabilized in an additional five subjects. There were no responders in the placebo group. Median survival was 30.5 weeks for the MACC group compared to 8.5 weeks in the placebo group (P < 0.0005, Gehan‐Wilcoxon). We conclude that polychemotherapy (in this case MACC) significantly benefits patients with advanced non‐small‐cell lung cancer.

A randomised trial of cisplatin and vindesine versus supportive care only in advanced non-small cell lung cancer

“…Objective responses were seen in 18% of chemotherapy patients, but there were no significant differences (P = 0.32) in overall survival (median survival, 19.9 weeks chemotherapy vs 14.4 weeks no chemotherapy). The only randomised study, other than that of Rapp et al, to show a survival advantage for chemotherapy over a policy of no chemotherapy is that of Cormier et al (1982). The conclusions of this study are open to discussion since it was very small (only 39 patients) and the no treatment group had a particularly short survival (median 8.5 weeks).…”

“…When this study was instituted only one small randomised study has shown a survival advantage for combination chemotherapy (MACC) over no chemotherapy (Cormier et al, 1982). Because of the need to define clearly the therapeutic potential of platinum based chemotherapy, separate but almost identical randomised trials were begun in Australia and in Southampton, UK.…”

Symptom relief with moderate dose chemotherapy (mitomycin-C, vinblastine and cisplatin) in advanced non-small cell lung cancer

“…An update of an earlier trial (Williams et al, 1988) has shown a trend towards improved survival, and several new trials have shown a small but significant survival benefit for patients receiving chemotherapy compared to control groups receiving symptomatic management alone (Cormier et al, 1982;Rapp et al, 1988). Moreover, there have been reports of chemotherapy leading to significant palliation and improvement in overall quality of life in patients with NSCLC (Cullen et al, 1988;Folman & Rosman, 1988).…”

A pilot study of mitomycin, cisplatin and continuous infusion 5-fluorouracil (MCF) in advanced non-small-cell lung cancer

“…A number of recent trials have shown a survival benefit for combination chemotherapy over best supportive care (Cormier et al, 1982;Rapp et al, 1988;Cartei et al, 1993) and a recent overview analysis confirmed a significant, although modest, survival benefit in favour of chemotherapy (Souquet et al, 1993). No one regimen has been shown to be superior to others in terms of survival in the treatment of advanced NSCLC, although cisplatin-based regimens appear to offer the best response rates (Veronesi et al, 1988;Luedke et al, 1990).…”