Combination Chemotherapy with Adriamycin, Cyclophosphamide, Methotrexate and Vincristine in Lung Cancer Patients with Extensive Disease

Abstract

The combination of adriamycin, cyclophosphamide, methotrexate and vincristine was applied in 38 patients with extensive lung cancer. Sixteen patients had previously undergone radiotherapy, while 22 patients had not been previously treated. The group included 22 squamous cell carcinomas, 12 small-cell carcinomas, 3 adenocarcinomas and 1 large-cell carcinoma. In terms of the performance status, 39% of the patients were in grade 7-5 (Karnofsky scale) and 61% in grade 4-2 group, i.e., the majority of the patients were, chemotherapy-wise, a high risk group. Two complete and 7 partial remissions were achieved, with a response rate of 24%. In terms of histological type, 1 complete and 4 partial remissions were achieved in the 12 treated small-cell carcinoma patients (response rate 42%). In the non-small-cell carcinoma group, the response rate was 17%, but the difference in response was statistically significant only as compared with squamous cell carcinoma (p < 0.05). Previous radiotherapy influenced the results of treatment, but not to an extent which would be statistically significant (p > 0.05). The duration of the remissions was 10 to 18 months in complete responders; the median remission duration was 6.5 months in partial responders and 3 months in stable disease cases. The median survival of responders and non-responders showed a pronounced difference (10.8 months versus 2.2 months). The highest response was obtained in lymph node metastases (44%), the primary tumor (24%), and cutaneous and subcutaneous metastases (20%). Metastases in the liver, lungs and particularly the bones and brain were resistant to therapy. Toxic changes were evident, and therapy had to be discontinued in 5 patients for a longer or shorter time because of myelosuppression. However, no heart failures or drug-related deaths were observed. The study has shown that this combination of cytostatic drugs, even in patients with extensive lung cancer, can be expected to produce a response in about one-fourth of treated patients and an even higher response in small-cell carcinoma and previously non-irradiated cases.