Intensive induction chemotherapy of extensive small cell bronchogenic carcinoma in protected environment--prophylactic antibiotic units. A preliminary report.

Abstract

<h2>Abstract</h2> Twenty-two patients with disseminated small cell bronchogenic carcinoma and two patients with limited disease received 3 courses of intensive chemotherapy with ECHO (E = Epipodophyllotoxin VP-16-213, C=Cyclophosphamide, H=Hydroxydaunorubicin, O=Oncovin) in protected environment prophylactic antibiotic (PEPA) units. Maintenance therapy consisted of 3 additional courses of ECHO and 6 of PRIME (PR = Procarbazine, I=Ifosfamide, ME=Methotrexate). All patients received prophylactic brain irradiation. At the time of this evaluation, there were 5 patients who were too early (they had not completed 2 courses of ECHO chemotherapy) and 2 early deaths. All 15 evaluable patients with disseminated disease responded with either complete (53%) or partial (47% ) remission. This included 6 of 6 evaluable patients with signs of superior vena cava compression who achieved complete (5) or partial (1) remissions. Complete remissions were common in patients who had fewer organs involved; 7 of 9 (78%) patients with ≤2 metastatic sites vs. 3 of 8 (38%) patients with ≥3 metastatic sites. With a median followup of 7 months at this writing there have been 3 relapses and 3 deaths (2 early deaths and 1 death secondary to a cerebrovascular accident). There were 1 possible and 1 probable treatment related deaths in 2 nonambulatory patients who died within 1 and 4 weeks from onset of therapy. This approach has resulted in a high complete remission rate in this unfavorable group of patients with small cell bronchogenic carcinoma. Myelosuppression is severe and opportunistic infections are seen more commonly than with lower doses of chemotherapy. The longterm effects of this program are still unknown.