Chemotherapy for advanced adenocarcinoma of the lung: the Copenhagen study and review of the literature.

The Copenhagen Lung Cancer Study Group conducted a prospective randomized trial comparing three chemotherapy regimens: (A) vindesine (VDS) 4 mg/m2 IV weekly X 8, then every second week; (B) lomustine (CCNU) 70 mg/m2 orally, cyclophosphamide (CTX) 1000 mg/m2 IV every 4 weeks, methotrexate (MTX) 20 mg/m2 orally days 15 and 18 of each course; and (C) CCNU + CTX + MTX + VDS in the same schedule as above, but with lower doses of CCNU (50 mg/m2), CTX (750 mg/m2), and VDS (2 mg/m2). Two hundred fifty-nine patients were accrued with unresectable adenocarcinoma-type non-small cell lung cancer (NSCLC); 218 were evaluable for response. Overall response rates on the chemotherapy arms were: (A) 22%, (B) 23%, and (C) 27%. Median survival rates were: 29 weeks, (B) 29 weeks, and (C) 34 weeks. Peripheral neuropathy was the major toxicity in arm A, and myelosuppression in arms B and C. The independent influence of 27 pretreatment variables were analyzed by the Cox multivariate regression model, which revealed that six have prognostic impact: performance status, nonradical resection, liver metastases, serum LDH (lactate dehydrogenase), WBC (white blood count), and serum AST (aspartate aminotransferase). The data clearly demonstrate prognostic variables in this disease and emphasize the need for better chemotherapy.