Intensive chemotherapy with autologous bone marrow transplantation for small-cell lung cancer.
Since 1980, 75 patients with small-cell lung cancer (SCLC) have been entered into four consecutive studies of high-dose chemotherapy using autologous bone marrow transplantation (ABMT) to assist haematological recovery. In the first study, 25 patients were treated with cyclophosphamide (160-200 mg/kg) as the sole chemotherapy; in the second (26 patients), the cycle of high-dose cyclophosphamide (with or without 800-1,200 mg/m2 etoposide) was repeated as induction treatment. In the first study, response was high [14 complete responses (CR), 7 partial responses (PR)] but was not increased by repeating the cycle (15 CR, 8 PR), and survival was slightly worse in the second trial. In the third study, 15 patients were treated with doxorubicin, vincristine and etoposide for two cycles and then with 200 mg/kg cyclophosphamide. Although high-dose cyclophosphamide increased the complete response rate, the additional responses were short-lived. In the final study, an attempt was made to increase the initial CR rate by combination chemotherapy using carboplatin (400-600 mg/m2), etoposide (120 mg/m2 x 4) and either high-dose cyclophosphamide (40 mg/kg x 4) or melphalan (140 mg/m2). Although all nine patients responded, none underwent a CR. The long-term survival (up to 7 years) does not appear to be different from that in comparably selected cases treated with conventional chemotherapy.
Souhami
R L
RL
Department of Oncology, University College and Middlesex School of Medicine, London, U.K.
Hajichristou
H T
HT
Miles
D W
DW
Earl
H M
HM
Harper
P G
PG
Ash
C M
CM
Goldstone
A H
AH
Spiro
S G
SG
Geddes
D M
DM
Tobias
J S
JS
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D016190:Carboplatin; D018288:Carcinoma, Small Cell / Q000188:drug therapy* / Q000401:mortality; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008558:Melphalan / Q000008:administration & dosage; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011379:Prognosis; D011879:Radiotherapy Dosage; D012074:Remission Induction; D014750:Vincristine / Q000008:administration & dosage
D009944:Organoplatinum Compounds; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D016190:Carboplatin; D008558:Melphalan