Prolonged, alternating chemotherapy for extensive small cell lung cancer

A Southwest Oncology Group study

Robert B Livingston, J. J. Crowley, T. Thompson, S. K. Williamson, F. J. Meyers, T. O'Rourke, J. R. Neefe

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background. Etoposide may be schedule dependent in small cell lung cancer (SCLC), and some data suggest a benefit for increased dose intensity in this disease. This study attempted to optimize dose intensity using an outpatient program that included prolonged, oral etoposide administration. Methods. Cisplatin-etoposide (PE) and cyclophosphamide, doxorubicin, and vincristine (CAV) were alternated at monthly intervals in patients with extensive SCLC. PE was given as cisplatin 50 mg/m2 on days 1 and 8 intravenously (IV) and etoposide 50 mg/m2/day for 14 days by mouth. CAV was administered as cyclophosphamide 60 mg/m2/day for 21 days orally, doxorubicin 20 mg/m2/week for three doses, and vincristine 2 mg IV on day 1 only. At the end of 4 months, responding patients received an additional course of PE alternating with CAV, and whole-brain irradiation (3000 cGy in 15 fractions) was delivered to clinical complete responders (CR). Results. Among 61 eligible patients, 4 achieved CR, and 11 had a partial remission, by strict Southwest Oncology Group criteria. An additional 20 patients demonstrated greater than 50% tumor shrinkage on one disease assessment but did not have confirming measurements at all sites 4 weeks later. The overall response rate was 57%, including the latter group. The toxicity was primarily hematologic, with three treatment-related deaths from neutropenic infection (5%). Grade 4 neutropenia (< 500/μl) occurred in nine patients (15%) and Grade 4 thrombocytopenia (< 25,000/μl), in three (5%). Analysis of the delivered dose intensity (in milligrams per square meter per week) as a function of that which was planned revealed a mean of 93% for all courses. Conclusions. Although substitution of prolonged oral etoposide in PE and oral cyclophosphamide in CAV proved to be feasible, these results suggest no advantage over those from other reported series using these alternating regimens in which the agents are pulsed. Experience with alternating PE-CAV for extensive SCLC is reviewed.

Original languageEnglish (US)
Pages (from-to)3509-3513
Number of pages5
JournalCancer
Volume71
Issue number11
DOIs
StatePublished - 1993
Externally publishedYes

Fingerprint

Small Cell Lung Carcinoma
Cyclophosphamide
Vincristine
Doxorubicin
Etoposide
Drug Therapy
Cisplatin
Neutropenia
Oral Administration
Mouth
Appointments and Schedules
Outpatients
Brain
Infection
Neoplasms

Keywords

  • carcinoma
  • clinical trials
  • combination
  • dose intensity
  • drug therapy
  • lung neoplasms
  • small cell

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Prolonged, alternating chemotherapy for extensive small cell lung cancer : A Southwest Oncology Group study. / Livingston, Robert B; Crowley, J. J.; Thompson, T.; Williamson, S. K.; Meyers, F. J.; O'Rourke, T.; Neefe, J. R.

In: Cancer, Vol. 71, No. 11, 1993, p. 3509-3513.

Research output: Contribution to journalArticle

Livingston, Robert B ; Crowley, J. J. ; Thompson, T. ; Williamson, S. K. ; Meyers, F. J. ; O'Rourke, T. ; Neefe, J. R. / Prolonged, alternating chemotherapy for extensive small cell lung cancer : A Southwest Oncology Group study. In: Cancer. 1993 ; Vol. 71, No. 11. pp. 3509-3513.
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abstract = "Background. Etoposide may be schedule dependent in small cell lung cancer (SCLC), and some data suggest a benefit for increased dose intensity in this disease. This study attempted to optimize dose intensity using an outpatient program that included prolonged, oral etoposide administration. Methods. Cisplatin-etoposide (PE) and cyclophosphamide, doxorubicin, and vincristine (CAV) were alternated at monthly intervals in patients with extensive SCLC. PE was given as cisplatin 50 mg/m2 on days 1 and 8 intravenously (IV) and etoposide 50 mg/m2/day for 14 days by mouth. CAV was administered as cyclophosphamide 60 mg/m2/day for 21 days orally, doxorubicin 20 mg/m2/week for three doses, and vincristine 2 mg IV on day 1 only. At the end of 4 months, responding patients received an additional course of PE alternating with CAV, and whole-brain irradiation (3000 cGy in 15 fractions) was delivered to clinical complete responders (CR). Results. Among 61 eligible patients, 4 achieved CR, and 11 had a partial remission, by strict Southwest Oncology Group criteria. An additional 20 patients demonstrated greater than 50{\%} tumor shrinkage on one disease assessment but did not have confirming measurements at all sites 4 weeks later. The overall response rate was 57{\%}, including the latter group. The toxicity was primarily hematologic, with three treatment-related deaths from neutropenic infection (5{\%}). Grade 4 neutropenia (< 500/μl) occurred in nine patients (15{\%}) and Grade 4 thrombocytopenia (< 25,000/μl), in three (5{\%}). Analysis of the delivered dose intensity (in milligrams per square meter per week) as a function of that which was planned revealed a mean of 93{\%} for all courses. Conclusions. Although substitution of prolonged oral etoposide in PE and oral cyclophosphamide in CAV proved to be feasible, these results suggest no advantage over those from other reported series using these alternating regimens in which the agents are pulsed. Experience with alternating PE-CAV for extensive SCLC is reviewed.",
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T1 - Prolonged, alternating chemotherapy for extensive small cell lung cancer

T2 - A Southwest Oncology Group study

AU - Livingston, Robert B

AU - Crowley, J. J.

AU - Thompson, T.

AU - Williamson, S. K.

AU - Meyers, F. J.

AU - O'Rourke, T.

AU - Neefe, J. R.

PY - 1993

Y1 - 1993

N2 - Background. Etoposide may be schedule dependent in small cell lung cancer (SCLC), and some data suggest a benefit for increased dose intensity in this disease. This study attempted to optimize dose intensity using an outpatient program that included prolonged, oral etoposide administration. Methods. Cisplatin-etoposide (PE) and cyclophosphamide, doxorubicin, and vincristine (CAV) were alternated at monthly intervals in patients with extensive SCLC. PE was given as cisplatin 50 mg/m2 on days 1 and 8 intravenously (IV) and etoposide 50 mg/m2/day for 14 days by mouth. CAV was administered as cyclophosphamide 60 mg/m2/day for 21 days orally, doxorubicin 20 mg/m2/week for three doses, and vincristine 2 mg IV on day 1 only. At the end of 4 months, responding patients received an additional course of PE alternating with CAV, and whole-brain irradiation (3000 cGy in 15 fractions) was delivered to clinical complete responders (CR). Results. Among 61 eligible patients, 4 achieved CR, and 11 had a partial remission, by strict Southwest Oncology Group criteria. An additional 20 patients demonstrated greater than 50% tumor shrinkage on one disease assessment but did not have confirming measurements at all sites 4 weeks later. The overall response rate was 57%, including the latter group. The toxicity was primarily hematologic, with three treatment-related deaths from neutropenic infection (5%). Grade 4 neutropenia (< 500/μl) occurred in nine patients (15%) and Grade 4 thrombocytopenia (< 25,000/μl), in three (5%). Analysis of the delivered dose intensity (in milligrams per square meter per week) as a function of that which was planned revealed a mean of 93% for all courses. Conclusions. Although substitution of prolonged oral etoposide in PE and oral cyclophosphamide in CAV proved to be feasible, these results suggest no advantage over those from other reported series using these alternating regimens in which the agents are pulsed. Experience with alternating PE-CAV for extensive SCLC is reviewed.

AB - Background. Etoposide may be schedule dependent in small cell lung cancer (SCLC), and some data suggest a benefit for increased dose intensity in this disease. This study attempted to optimize dose intensity using an outpatient program that included prolonged, oral etoposide administration. Methods. Cisplatin-etoposide (PE) and cyclophosphamide, doxorubicin, and vincristine (CAV) were alternated at monthly intervals in patients with extensive SCLC. PE was given as cisplatin 50 mg/m2 on days 1 and 8 intravenously (IV) and etoposide 50 mg/m2/day for 14 days by mouth. CAV was administered as cyclophosphamide 60 mg/m2/day for 21 days orally, doxorubicin 20 mg/m2/week for three doses, and vincristine 2 mg IV on day 1 only. At the end of 4 months, responding patients received an additional course of PE alternating with CAV, and whole-brain irradiation (3000 cGy in 15 fractions) was delivered to clinical complete responders (CR). Results. Among 61 eligible patients, 4 achieved CR, and 11 had a partial remission, by strict Southwest Oncology Group criteria. An additional 20 patients demonstrated greater than 50% tumor shrinkage on one disease assessment but did not have confirming measurements at all sites 4 weeks later. The overall response rate was 57%, including the latter group. The toxicity was primarily hematologic, with three treatment-related deaths from neutropenic infection (5%). Grade 4 neutropenia (< 500/μl) occurred in nine patients (15%) and Grade 4 thrombocytopenia (< 25,000/μl), in three (5%). Analysis of the delivered dose intensity (in milligrams per square meter per week) as a function of that which was planned revealed a mean of 93% for all courses. Conclusions. Although substitution of prolonged oral etoposide in PE and oral cyclophosphamide in CAV proved to be feasible, these results suggest no advantage over those from other reported series using these alternating regimens in which the agents are pulsed. Experience with alternating PE-CAV for extensive SCLC is reviewed.

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KW - combination

KW - dose intensity

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KW - lung neoplasms

KW - small cell

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