Studies on chemotherapy for advanced lung cancer Part 1. An alternating non-cross-resistant combination chemothepay (COMP-VAN) for extensive small cell lung cancer

Fifty-two patients with extensive small lung cancer entered a study of cyclic alternating combination chemotherapy between February 1981 and December 1984. The chemotherapy consisted of a four-drug combination of cyclophosphamide (CPA), vincristine (VCR), methotrexate (MTX) and procarbazine (PCZ), and a three-drug combination of etoposide (VP-16), adriamycin (ADM) and nimustine hydrochloride (ACNU). The doses and schedule were as follows: CPA, 270mg/㎡, i.v., day 1-5; VCR, 1.4mg/㎡, i.v., day 1; MTX, 6.5mg/㎡, i.m., day 1-5; PCZ, 65mg/㎡, p.o., day 1-5; VP-16, 140mg/㎡, p.o., day 29-32; ADM, 40mg/㎡, i.v., day 29; ACNU, 40mg/㎡, i.v., day 29. Cycles were repeated every 8 weeks. Of 52 patients, 45 were fully evaluated for tumor response and toxicity. The overall response rate was 89%, and the complete response rate was 33%. The median survival time of all the patients who could be evaluated was 11.0 months: 16.5 months for complete responders, 10.0 months for partial responders, and 6.5 months for non-responders. Responders lived significantly longer than non-responders. The major toxicity was myelosuppression. However, patients tolerated the chemotherapy well, and no patients encountered life-threatening complications. The cyclic alternating chemotherapy appears beneficial compared to the four-drug combination of CPA, VCR, MTX and PCZ.