Moderate to high dose cyclophosphamide and intercalated Corynebacterium parvum in patients with metastatic lung cancer.

Thirty-nine patients with histologically proven widely metastatic bronchogenic carcinoma were treated with cyclophosphamide and Corynebacterium parvum. The dosage of cyclophosphamide was higher than conventional as previous work had indicated better results with increased dosage. Experimental work had suggested that the addition of Corynebacterium parvum would increase the antitumour effect and possibly reduce the cyclophosphamide induced granulocytopenia. A short treatment programme using three i.v. injections of cyclophosphamide, 1.5 g/m2, 2.5 g/m2 then 3.5 g/m2, at 3 week intervals were given. Four days after each cyclophosphamide injection, C. parvum 2 mg/m2 i.v. was administered. An overall 38% tumour response rate was observed, 18% for patients with non-small-cell carcinoma and 65% for small-cell carcinoma patients. The median survival for the 39 patients was 5 months (range 1-16+ months). These results, particularly for the non-small-cell patient group are comparable to those obtained with intensive combination chemotherapy regimens administered intermittently over much longer periods. An important consideration, objectively assessed in the present study, was the effect of treatment on quality of life and breathlessness. Improvement was noted not only in those patients with tumour response but also in a proportion of those who did not fulfil the criteria of response. Toxicity was also carefully assessed and, although the cyclophosphamide dosages were higher than conventionally used, no undue problems were noted. The addition of C. parvum did not have any noticeable beneficial effect. Cyclophosphamide given at dosages higher than is usual but which do not require bone marrow rescue is worthy of further study.