VP-16-213 in combination chemotherapy with chest irradiation for small-cell lung cancer: a randomized trial of the Piedmont Oncology Association.

Abstract

The role of etoposide epipodophyllotoxin (VP-16-213) in a combined modality treatment program incorporating local chest irradiation and combination chemotherapy with cyclophosphamide, Adriamycin (Adria Laboratories, Columbus, Ohio), and vincristine has been evaluated in a randomized trial of 165 patients with small-cell lung cancer. The overall response rate (complete response [CR] plus partial response [PR]) was significantly greater in the VP-16-213 arm (85% v 64%, P = .005) primarily as a consequence of improved response in patients with extensive disease (85% v 38%, P = .002 and 30% v 8% for CR only, P = .045). No differences in the response rates were observed in limited disease. The duration of response (months) was greater in the VP-16-213 arm (8.6 v 7.0 overall and 14.4 v 11.5 for CR) but not significantly so. Median survival times (months) were consistently greater in the group receiving VP-16-213 when analyzed according to extent of disease and response (10.6 v 9.5 overall; 15.0 v 13.6 for limited disease; 9.0 v 6.7 for extensive disease; 18.5 v 16.2 for CR overall; and 18.6 v 16.1 for CR in limited disease); the results were not statistically significant. The median survival of extensive disease patients attaining a CR was 15.3 months (range 3.2 to 34.3 + months) in the VP-16-213 arm and 7.4+ and 8.1+ months for the two patients with CR in the other group. Anemia and leukopenia occurred to a greater degree in the four-drug regimen, but no unusual or significant compounding toxicity (ie, neurotoxicity) was observed otherwise. Further investigation of this agent in combination chemotherapy programs for small-cell lung cancer appears to be warranted.

Pharmacokinetic Study of High Dose Etoposide Infusion in Patients with Small Cell Lung Cancer

“…The drug is usually employed in combination, and in previously untreated patients the results of phase I1 studies compare favourably in response rate and survival with regimens that do not contain etoposide (7, 15,16). A number of high dose regimens have now been studied, but no clear picture has emerged of a prolongation in survival, although consistently high responses are obtained (9, 10).…”

Interobserver-Agreement zwischen Pneumologen und dem Zytopathologen, die identische TBNA-Ausstriche bewertet haben

“…Wirksamkeitsverstärkung (Jett et al 1990;Jackson, D V Jr et al 1984). Auf Anthrazykline wird eher verzichtet werden, da diese Schemata bei simultaner Radiatio mit einer signifikant höheren Toxizität belastet sind (Gregor et al 1997;Perry et al 1987).…”