Neoadjuvant mitomycin C, cisplatin, and infusion vinblastine in locally and regionally advanced non-small cell lung cancer: problems and progress from the perspective of long-term follow-up.
Thirty-one patients with inoperable, locally and regionally advanced non-small cell lung cancer (NSCLC) were treated with mitomycin C, cisplatin, and continuous-infusion vinblastine (M-PV) in combination with thoracic irradiation (26 patients) or attempted surgical resection following M-PV (five patients). The total response rate to primary M-PV was 73%, and four of five patients undergoing thoracotomy following M-PV were completely resected. With a median follow-up in excess of 4 years, the median survival with neoadjuvant M-PV is 19 months, and the 4 and 6 year actuarial survivals are 31% and 26%, respectively. In contrast, in 42 individuals with equivalent prognostic factors concurrently treated with irradiation alone, the median survival is 8 months, the 4 and 6 year survivals are 6% and 3%, respectively. Although lung injury was the major toxicity encountered with neoadjuvant therapy, the incidence and severity of that complication could be significantly reduced with administration of dexamethasone, 10 to 12 mg IV X 1, before each dose of mitomycin C; a maximum of three courses of primary M-PV before consolidation with radiation therapy (RT) or surgery; and serial diffusion capacity (DLCO) measurement as a potential gauge of impending toxicity with further therapy.
Spain
R C
RC
Penrose Cancer Hospital, Colorado Springs.
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001853:Bone Marrow / Q000187:drug effects; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000187:drug effects; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D016685:Mitomycin; D008937:Mitomycins / Q000008:administration & dosage; D014747:Vinblastine / Q000008:administration & dosage
D008937:Mitomycins; D016685:Mitomycin; D014747:Vinblastine; D002945:Cisplatin