title: A phase IIb trial assessing the addition of disulfiram to chemotherapy for the treatment of metastatic non-small cell lung cancer.
abstract: BACKGROUND
  Disulfiram, an alcohol aversion agent, has been in use for >50 years. Numerous authors have reported an anticancer effect of this drug in vitro and in mouse models. More recently, several reports have claimed that disulfiram also possesses anti-stem cell activity. We set out to obtain initial data regarding the safety of combining this drug with chemotherapy and the possible effectiveness of disulfiram in a combination regimen in non-small cell lung cancer (NSCLC).
  
  
  METHODS
  This phase II, multicenter, randomized, double-blinded study assessed the safety and efficacy of adding of disulfiram to cisplatin and vinorelbine for six cycles. Newly diagnosed NSCLC patients were recruited. Patients with either stage IV or what was considered at the time "wet IIIb" (since 2009, these patients have been considered stage IV) were recruited. The patients were treated with only chemotherapy, and none were treated with either surgery or chemoradiation. Disulfiram was administered at a dose of 40 mg three times daily.
  
  
  RESULTS
  Forty patients were treated for more than two cycles, half with and half without disulfiram, which was well tolerated. An increase in survival was noted for the experimental group (10 vs. 7.1 months). Interestingly, there were only two long-term survivors, both in the disulfiram group.
  
  
  CONCLUSIONS
  The addition of disulfiram to a combination regimen of cisplatin and vinorelbine was well tolerated and appeared to prolong survival in patients with newly diagnosed non-small cell lung cancer. The results from this small study seem encouraging enough for assessment in larger trials. Disulfiram is an inexpensive and safe drug; if its addition to chemotherapy could be shown to prolong survival, an effective regimen could be established and used widely, even in resource-poor countries.
authors.affiliation: Hadassah Hebrew University Medical Center, Jerusalem, Israel; hovavnech@hadassah.org.il.
authors.forename: Hovav
authors.initials: H
authors.lastname: Nechushtan
authors.affiliation: Augusta Victoria Cancer Center, Jerusalem, Israel;
authors.forename: Yousef
authors.initials: Y
authors.lastname: Hamamreh
authors.affiliation: Augusta Victoria Cancer Center, Jerusalem, Israel;
authors.forename: Salim
authors.initials: S
authors.lastname: Nidal
authors.affiliation: Meir Medical Center, Kfar Saba, Israel;
authors.forename: Maya
authors.initials: M
authors.lastname: Gotfried
authors.affiliation: Ora Bio Ltd., Nazareth, Israel.
authors.forename: Amichai
authors.initials: A
authors.lastname: Baron
authors.affiliation: Ora Bio Ltd., Nazareth, Israel.
authors.forename: Yossi Israeli
authors.initials: YI
authors.lastname: Shalev
authors.affiliation: Hadassah Hebrew University Medical Center, Jerusalem, Israel;
authors.forename: Benjjamin
authors.initials: B
authors.lastname: Nisman
authors.affiliation: Hadassah Hebrew University Medical Center, Jerusalem, Israel;
authors.forename: Tamar
authors.initials: T
authors.lastname: Peretz
authors.affiliation: Hadassah Hebrew University Medical Center, Jerusalem, Israel;
authors.forename: Nili
authors.initials: N
authors.lastname: Peylan-Ramu
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D004221:Disulfiram / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D017741:Survivors; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine
chemical_list: D014747:Vinblastine; D002945:Cisplatin; D000077235:Vinorelbine; D004221:Disulfiram