Evans W K, Feld R, Murray N, Pater J, Shelley W, Willan A, Osoba D, Levitt M, Coy P, Hodson I
Semin Oncol. 1986 Sep;13(3 Suppl 3):10-6.
In an attempt to circumvent innate or acquired tumor-cell resistance to chemotherapy, patients with small-cell lung cancer (SCLC) were treated with induction therapy that incorporated two active and potentially non-cross-resistant chemotherapy regimens on two National Cancer Institute of Canada (NCI-C) trials. Patients with limited disease (LD) SCLC were treated with cyclophosphamide, doxorubicin (Adriamycin [Adria Laboratories, Columbus, Ohio]) and vincristine (CAV) and VP-16 plus cisplatin in two different sequences. One arm was randomized to receive CAV alternating with VP-16 plus cisplatin for a total of six treatment cycles, and the other arm received three courses of CAV followed by three courses of VP-16 plus cisplatin. Both treatment strategies produced similar response rates and survival curves, and each treatment group has a projected 2-year survival of 20%. Patients with extensive disease (ED) were treated with either six cycles of CAV (standard regimen) or CAV alternating with VP-16 plus cisplatin for a total of six treatment cycles. In this study, the alternating regimen produced a higher complete response (CR) rate (40% v 27%) and overall response rate (61% v 39%; P less than .01). The progression-free survival was also superior for the alternating arm (P = .001), as was overall survival (P less than .05). The frequency of thrombocytopenia and severe gastrointestinal toxicity was slightly greater in the alternating arm, but the frequency of neutropenia and infection was less. The alternation of CAV and VP-16 plus cisplatin during induction therapy is an effective treatment strategy in the management of SCLC and superior to CAV alone in extensive SCLC.
为了克服肿瘤细胞对化疗的先天性或获得性耐药，在加拿大国立癌症研究所（NCI-C）的两项试验中，对小细胞肺癌（SCLC）患者采用了诱导治疗，该治疗纳入了两种有效的且可能无交叉耐药性的化疗方案。局限性疾病（LD）SCLC患者接受了环磷酰胺、阿霉素（阿霉素[阿德里亚实验室，俄亥俄州哥伦布市]）和长春新碱（CAV）以及VP-16加顺铂的两种不同顺序的治疗。一组随机接受CAV与VP-16加顺铂交替治疗，共六个治疗周期，另一组接受三个疗程的CAV，随后是三个疗程的VP-16加顺铂。两种治疗策略产生了相似的缓解率和生存曲线，每个治疗组预计2年生存率为20%。广泛性疾病（ED）患者接受六个周期的CAV（标准方案）或CAV与VP-16加顺铂交替治疗，共六个治疗周期。在本研究中，交替方案产生了更高的完全缓解（CR）率（40%对27%）和总缓解率（61%对39%；P<0.01）。交替治疗组的无进展生存期也更优（P = 0.001），总生存期也是如此（P<0.05）。交替治疗组血小板减少和严重胃肠道毒性的发生率略高，但中性粒细胞减少和感染的发生率较低。诱导治疗期间CAV与VP-16加顺铂交替是SCLC治疗中的一种有效治疗策略，在广泛性SCLC中优于单独使用CAV。
