Dose intensification of chemotherapy and the role of granulocyte colony stimulating factor and granulocyte macrophage colony stimulating factor in small cell lung cancer.
The natural history of small cell lung cancer (SCLC) is characterized by early dissemination. Despite the high responsiveness to chemotherapy, the disease remains ultimately fatal in the majority of patients. One of the strategies to improve final outcome is the administration of intensified chemotherapy, either by dose escalation or by chemotherapy given at shortened intervals. By now, in only one randomized study, in which cyclophosphamide and cisplatin dosage was escalated by 30% in the first course only, a survival advantage was demonstrated in limited disease patients. The different ways of achieving intensification of chemotherapy are highlighted. The addition of growth factors in current dose-escalated or accelerated schedules seems to result in a relative dose intensity of no more than 150% when compared to optimally delivered conventional regimens. Whether such a moderate degree of dose intensification will improve survival rates has to be awaited from phase III trials.
Tjan-Heijnen
V C
VC
Department of Medical Oncology, University Hospital Nijmegen, The Netherlands.
Postmus
P E
PE
Wagener
D J
DJ
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology / Q000627:therapeutic use; D018288:Carcinoma, Small Cell / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D004358:Drug Therapy / Q000379:methods*; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology* / Q000627:therapeutic use; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy; D013234:Stem Cells / Q000187:drug effects / Q000378:metabolism
D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor