Clinical trials of cyclophosphamide, etoposide, and vincristine in the treatment of small-cell lung cancer.

Etoposide is one of the most active drugs used in the treatment of small-cell lung cancer (SCLC). Recently, studies were completed that evaluated the substitution of etoposide for doxorubicin (Adriamycin) used in combination with cyclophosphamide and vincristine. This study has shown that equivalent antitumor activity, as measured by objective response, can be obtained with the combination of cyclophosphamide, etoposide, and vincristine (CEV) as compared with the CAV combination. A longer response duration and median survival are seen in extensive-disease patients treated with the CEV combination. As expected, no cardiotoxicity is associated with CEV therapy, and interestingly, there is no potentiating neurotoxicity with CEV. A study recently completed has shown that CEV can be effectively combined with intensive radiation therapy to the chest administered simultaneously. CEV appears to be an effective alternative to CAV, and it can be readily combined with aggressive radiation therapy.