Shepherd F A, Evans W K, MacCormick R, Feld R, Yau J C
Department of Medicine, Toronto General Hospital, Canada.
Cancer Treat Rep. 1987 Oct;71(10):941-4.
For two chemotherapy regimens to be truly non-cross-resistant, each should be active as first-line therapy and also as second-line therapy. The effectiveness of both cyclophosphamide, doxorubicin, and vincristine (CAV) and etoposide and cisplatin (VPP) in previously untreated patients with small cell lung cancer has been well-documented. Also, VPP has caused tumor regression in up to 50% of patients when used as second-line therapy after CAV. The effectiveness of CAV after progression or relapse after VPP has not been documented. We identified 29 patients who received CAV after their tumors failed to respond or relapsed after VPP or etoposide and carboplatin (VPC). There were 21 male and eight female patients (median age, 57 years; range, 30-79). Thirteen patients were treated following failure to respond to VPP or VPC and 16 at the time of relapse. Eight patients had limited disease and 21 had extensive disease. Metastatic sites included liver (11 patients), bone (ten), lymph nodes (seven), bone marrow (three), brain (four), and contralateral lung (one). There were three complete responses (durations of 16, 22, and 26 weeks) and five partial responses (duration, 8+ to 36 weeks). Three patients had stable disease and 18 patients had disease progression while receiving treatment. The median survival of the entire group was 15 weeks. Responding patients had a median survival of 34 weeks (range, 8+ to 72+) and stable and nonresponding patients had a survival of only 9 weeks (range, 2-38). A granulocyte count nadir less than 500 X 10(9)/L was seen after 7.9% of evaluable treatment cycles and a platelet count nadir less than 50,000 X 10(9)/L occurred after only 5.3% of cycles. Five patients required transfusion for anemia, and two patients required dose reduction of vincristine for peripheral neuropathy. This study demonstrates that CAV has limited activity following failure to respond to VPP.
要使两种化疗方案真正不存在交叉耐药性，每种方案都应在一线治疗以及二线治疗中发挥作用。环磷酰胺、多柔比星和长春新碱（CAV）以及依托泊苷和顺铂（VPP）在既往未接受治疗的小细胞肺癌患者中的有效性已有充分记录。此外，在CAV治疗后将VPP用作二线治疗时，高达50%的患者出现了肿瘤消退。VPP进展或复发后CAV的有效性尚无记录。我们确定了29例患者，他们在肿瘤对VPP或依托泊苷和卡铂（VPC）无反应或复发后接受了CAV治疗。其中男性21例，女性8例（中位年龄57岁；范围30 - 79岁）。13例患者在对VPP或VPC无反应后接受治疗，16例在复发时接受治疗。8例患者为局限性疾病，21例为广泛性疾病。转移部位包括肝脏（11例患者）、骨骼（10例）、淋巴结（7例）、骨髓（3例）、脑（4例）和对侧肺（1例）。有3例完全缓解（持续时间分别为16周、22周和26周）和5例部分缓解（持续时间为8 +至36周）。3例患者疾病稳定，18例患者在接受治疗时疾病进展。整个组的中位生存期为15周。有反应的患者中位生存期为34周（范围8 +至72 +），疾病稳定和无反应的患者生存期仅为9周（范围2 - 38周）。在7.9%的可评估治疗周期后出现粒细胞计数最低点低于500×10⁹/L，仅在5.3%的周期后出现血小板计数最低点低于50,000×10⁹/L。5例患者因贫血需要输血，2例患者因周围神经病变需要降低长春新碱剂量。本研究表明，在对VPP无反应后，CAV活性有限。
