Jones A L, Holborn J, Ashley S, Smith I E
Lung Unit, Royal Marsden Hospital, Sutton, Surrey, UK.
Oncology. 1993 Nov;50 Suppl 2:10-5. doi: 10.1159/000227255.
In an attempt to achieve adequate palliation in patients with small cell lung cancer (SCLC) while keeping toxicity to a minimum, we compared CVM (carboplatin/vinblastine/methotrexate) and standard therapy with ACE (doxorubicin/cyclophosphamide/etoposide). None of the 104 SCLC patients with limited or extensive disease who participated had received previous treatment. After stratification according to disease extent, patients were randomized to receive either CVM or ACE. The maximum number of chemotherapy courses was six. When response rates were compared, ACE was found to be somewhat superior to CVM in terms of objective response [CVM 67%, 95% confidence interval (CI) 54-79%; ACE 88%, 95% CI 80-97%; p = 0.06]; however, a significant difference was evident only among extensive-disease patients. Median response durations (CVM 6 months, 95% CI 5-8; ACE 5 months, 95% CI 3-6) and median survival times (CVM 8 months, 95% CI 7-10; ACE 7 months, 95% CI 4-9) were comparable. CVM met the goal of producing significantly less hematologic toxicity than occurred with ACE. Leukopenia affected 92% of ACE-treated patients and 48% of CVM-treated patients (p = 0.005), and was severe in 80% of the ACE group and 20% of the CVM group. Alopecia occurred much more frequently among those treated with ACE (91 vs. 24%; p < 0.001), as did infection (59 vs. 24%; p < 0.001). The selection of a specific chemotherapy regimen must be individualized. CVM may be appropriate for patients in whom intensive chemotherapy is contraindicated due to performance status, age, concomitant medical disease, or patient refusal.
为了在使小细胞肺癌（SCLC）患者获得充分姑息治疗的同时将毒性降至最低，我们比较了CVM（卡铂/长春碱/甲氨蝶呤）和采用ACE（阿霉素/环磷酰胺/依托泊苷）的标准疗法。参与研究的104例局限期或广泛期SCLC患者均未接受过先前治疗。根据疾病范围分层后，患者被随机分配接受CVM或ACE治疗。化疗疗程最多为6个。比较缓解率时，发现ACE在客观缓解方面略优于CVM[CVM 67%，95%置信区间（CI）54 - 79%；ACE 88%，95%CI 80 - 97%；p = 0.06]；然而，仅在广泛期疾病患者中存在显著差异。中位缓解持续时间（CVM 6个月，95%CI 5 - 8；ACE 5个月，95%CI 3 - 6）和中位生存时间（CVM 8个月，95%CI 7 - 10；ACE 7个月，95%CI 4 - 9）相当。CVM达到了产生比ACE显著更少血液学毒性的目标。白细胞减少影响了92%接受ACE治疗的患者和48%接受CVM治疗的患者（p = 0.005），并且在ACE组的80%患者和CVM组的20%患者中较为严重。脱发在接受ACE治疗的患者中发生频率更高（91%对24%；p < 0.001），感染也是如此（59%对24%；p < 0.001）。具体化疗方案的选择必须个体化。CVM可能适用于因体能状态、年龄、伴发内科疾病或患者拒绝而禁忌强化化疗的患者。
