Thatcher N, Honeybourne D, Wagstaff J, Carroll K B, Barber P V, Morrison J B, Crowther D
Br J Dis Chest. 1984 Jan;78(1):89-97.
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.
39例经组织学证实为广泛转移的支气管源性癌患者接受了环磷酰胺和短小棒状杆菌治疗。环磷酰胺的剂量高于常规剂量，因为先前的研究表明增加剂量会有更好的效果。实验研究表明，添加短小棒状杆菌会增强抗肿瘤效果，并可能减少环磷酰胺诱导的粒细胞减少。采用短疗程治疗方案，静脉注射三次环磷酰胺，剂量分别为1.5g/m²、2.5g/m²，然后是3.5g/m²，间隔3周给药。每次环磷酰胺注射后4天，静脉注射2mg/m²的短小棒状杆菌。总体观察到38%的肿瘤缓解率，非小细胞癌患者为18%，小细胞癌患者为65%。39例患者的中位生存期为5个月（范围1 - 16 +个月）。这些结果，特别是非小细胞患者组的结果，与通过更长时间间歇给药的强化联合化疗方案所获得的结果相当。本研究客观评估的一个重要考虑因素是治疗对生活质量和呼吸困难的影响。不仅在有肿瘤缓解的患者中，而且在一部分未达到缓解标准的患者中都注意到了改善。还仔细评估了毒性，尽管环磷酰胺剂量高于常规使用剂量，但未发现过度问题。添加短小棒状杆菌没有任何明显的有益效果。以高于通常剂量但不需要骨髓救援的剂量给予环磷酰胺值得进一步研究。
