Vansteenkiste J F, De Leyn P R, Deneffe G J, Lievens Y N, Nackaerts K L, Van Raemdonck D E, van der Schueren E, Lerut T E, Demedts M G
Department of Pulmonology, University Hospital Gasthuisberg, Belgium.
Ann Oncol. 1998 Mar;9(3):261-7. doi: 10.1023/a:1008240127706.
In the pioneer data from the Memorial-Sloan-Kettering group, preoperative mitomycin-C-vindesine-platinum (MVP) induction chemotherapy in N2-NSCLC was accompanied with substantial pulmonary toxicity. In this study, the efficacy and toxicity of three-drug VIP induction chemotherapy, the pathologic response in resection specimens, the early survival and relapse patterns are examined.
Between June 1995 and March 1997, 39 consecutive patients with pathology proven N2-NSCLC were treated with three cycles of VIP induction, followed by definitive locoregional treatment (resection and mediastinal dissection or radical radiotherapy). Several patients had unfavorable prognostic characteristics with respect to clinical and biological findings, tumor location and bulk of disease.
The response rate to chemotherapy was 59% (95% Confidence Interval 34-75). Twenty-three responding patients had radical locoregional treatment: radical radiotherapy in four, resection in 19. Downstaging was present in nine of the 19 resection specimens, with two pathologic complete responses. The median survival time (MST) of all patients is 19 months, with a projected two-year survival of 49%. In patients responsive to chemotherapy who received definitive local treatment, the MST is not yet reached, and the projected two-year survival is 57%. Relapses were mainly distant, with isolated brain relapse as a disturbing finding. The main toxicity's were leukopenia and vomiting, but they were manageable. In contrast with MVP, no severe pulmonary toxicity occurred.
VIP is a suitable induction regimen for N2-NSCLC, demonstrating a good activity and very acceptable toxicity.
在纪念斯隆凯特琳癌症中心的先驱数据中，N2期非小细胞肺癌（NSCLC）患者术前接受丝裂霉素 - 长春地辛 - 铂（MVP）诱导化疗时伴有严重的肺部毒性。在本研究中，对三联药物VIP诱导化疗的疗效和毒性、切除标本中的病理反应、早期生存和复发模式进行了研究。
1995年6月至1997年3月期间，39例经病理证实为N2期NSCLC的连续患者接受了三个周期的VIP诱导治疗，随后进行确定性局部区域治疗（切除及纵隔清扫或根治性放疗）。部分患者在临床和生物学表现、肿瘤位置及疾病范围方面具有不良预后特征。
化疗的缓解率为59%（95%置信区间34 - 75）。23例缓解患者接受了根治性局部区域治疗：4例接受根治性放疗，19例接受手术切除。19例切除标本中有9例实现降期，其中2例病理完全缓解。所有患者的中位生存时间（MST）为19个月，预计两年生存率为49%。接受确定性局部治疗的化疗敏感患者的MST尚未达到，预计两年生存率为57%。复发主要为远处转移，孤立性脑转移是一个令人困扰的发现。主要毒性为白细胞减少和呕吐，但均可控制。与MVP不同，未发生严重肺部毒性。
VIP是N2期NSCLC合适的诱导方案，显示出良好的活性和非常可接受的毒性。
