CHEMOTHERAPEUTIC TREATMENT IN UNRESECTABLE NONSMALL CELL LUNG-CANCER (NSCLC) - A FURTHER ATTEMPT TO MODULATE CISPLATIN, VINBLASTINE AND MITOMYCIN-C (PVM) SCHEDULE

Abstract

Searching for a more appropriate PVM (cisplatin, vinblastine and mitomycin-C) schedule against NSCLC, we treated 62 patients with unresectable NSCLC (49 males and 13 females), with the following regimen: high-dose cisplatin, 120 mg/m(2) i.v., day 1; common-dose vinblastine, 6 mg/m(2) i.v., day 1, and low-dose-mitomycin-C, 6 mg/m(2) i.v., day 1, repeated every 3 weeks, until progression or tolerance. Following a minimum of 2 courses, responses, by extent of disease, were as follows: in 16 patients with stage IIIB: 2 CR, 5 PR (total response rate, 44%), 8 SD and 1 PD; in 42 patients with stage IV: no CR, 15 PR (total response rate, 33%), 18 SD and 13 PD. Overall response rate was 35% with (95%) confidence limit range 23%-47%. In all the series, median duration of response was 17 weeks (range, 4-98 wks) and median time to progression 26 weeks (range, 7-111 wks). Drug related toxicity was WHO grade III and IV, leucopenia: in 30% and 11% of patients, thrombocytopenia in 27% and 10% of patients, respectively. Twelve patients (19%) developed severe anemia requiring transfusions. Three out of 5 patients dismissed treatment due to irreversible nephrotoxicity. No pulmonary toxic effect was recorded and no drug related death occurred. Fifty out of 62 patients (81%) received full doses as scheduled and 12 (19%) required cisplatin-dose reduction alone from 30% to 50%. Median duration of survival, in overall patients, was 27 weeks (range, 2-144 wks). Our results were in line with those of literature; this schedule with low-dose mitomycin-C and a single-dose vinblastine per course, seemed well feasible and safe. However, we recommend a cisplatin dose reduction to 80-90 mg/m(2) to optimise this schedule.