Abstract
Mitomycin, ifosfamide and cis-platin are three of the most active single agents in the chemotherapy of non-small cell lung cancer. We have combined them for a phase 2 study in patients with inoperable non-small cell lung cancer. The regimen ('MIC') comprised: mitomycin 6 mg m-2, ifosfamide 3 g m-2 and cis-platin 50 mg m-2, with routine use of lorazepam, dexamethasone and high dose metoclopramide for anti-emesis. Seventy-four ambulatory patients with untreated, limited (LD) or extensive (ED) disease have entered this study, and 66 are evaluable for response. Thirty patients (45%) have achieved partial remission and 7 (11%) complete remission, as assessed radiologically. The overall response rate is thus 56% (95% confidence interval 44%-68%). There have been 29/43 responses in LD (67%, 95% CI 53%-81%) and 8/23 in ED (35%, 95% CI 15%-55%). The median response duration, measured from the start of treatment is 8.75 months. The median survival for the whole group is 9.2 months. The principal toxicity was nausea and vomiting which was severe or prolonged (greater than 48 h) for one or more courses, in 9% of patients. Performance status (PS) and weight were assessed before, and 3 weeks after the last course of chemotherapy. Fifteen (of 31 evaluable) responders improved their PS and only 1 responder deteriorated. Twenty-one of the 28 evaluable non-responders had no change in PS. The difference in PS change between responders and non-responders is highly significant (P = 0.002). Thirty evaluable responders experienced a mean increase in weight of 2.9% with treatment, whereas 24 evaluable non-responders had a mean weight loss of 3.8%. This change is also highly significant (P = 0.0013). MIC is clearly a well tolerated regime and among the most active combinations in non-small cell lung cancer. It will now be tested in a randomized trial against no chemotherapy.
Highlights
Thirty patients were assessable for response to chemotherapy - 8 achieving partial remission (PR) and 5 complete remission (CR)
There have been 29/43 responses in limited disease (67%, 95% CI 53-81%) and 8/23 in extensive disease (35%, 95% CI 15-55%)
Thirty evaluable responders experienced a mean increase in weight of 2.9% with treatment (Figure 5), whereas 24 evaluable non-responders had a mean weight loss of 3.8%
Summary
There are only 5 drugs (ifosfamide, mitomycin, cis-platin, vinblastine and vindesine) which, when tested as single agents in large numbers, produce major responses in 15% or more of cases (Kris et al, 1985). Ifosfamide and cis-platin have been associated with response rates of 20%, 26% and 20% respectively and are the 3 most active agents (Bakowski et al, 1983). We have combined ifosfamide with mitomycin in a recent phase 2 study in NSCLC (Chetiyawardana et al, 1985).
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