No routine role for vincristine, adriamycin, and cyclophosphamide (VAC) or thoracic radiation therapy in extensive stage small cell lung cancer.

Abstract

A randomized trial of extensive small cell lung cancer (SMCLC) without CNS metastases comparing combination chemotherapy with the three-drug combination of vincristine, doxorubicin, and cyclophosphamide (VAC) versus a program using six drugs and starting with VAC plus Lomustine (CCNU) and etoposide (VAC-LE) was begun. After three cycles, patients without progression of disease were bronchoscoped and then randomized to the original chemotherapy program and prophylactic cranial irradiation (PCI) with or without thoracic radiation therapy (TRT). Patients with CNS metastases at diagnosis were treated with the VAC-LE program. At initial evaluation of 17 patients on VAC, and 18 without CNS metastases, and 10 with CNS metastases on VAC-LE, a statistical superiority for the VAC-LE over VAC was noted. Patients on VAC-LE (in CNS negative patients) had a higher regression rate (89 vs. 82%, 7 CR vs. 0%); a higher negative second bronchoscopy rate (69 vs. 50%); and better median (12.3 vs. 6.8 months), 2-year (14 vs. 0%), and overall survival rates (p = 0.005) than did patients on VAC. Even the VAC-LE, CNS positive patients had higher CR (20 vs. 0%), median (8.6 vs. 6.8 months), and 2-year survival rates (10 vs. 0%) than did VAC patients without CNS metastases.