VI Autologous Bone Marrow Transplantation.pdf - Blog Science ...

TREATMENT OF NONSMALL CELL LUNG CANCER (NSCLC) WITH
AGGRESSIVE COMBINATION CHEMOTHERAPY
KA Dicke, D Hood, V Huff, F Lapetina, MA Scouros.
Houston Cancer Institute, Houston, Texas USA
Estimates for new cases of lung cancer in the Untied States in 1992, suggest
that there will be 157,000 new cases, 102,000 occurring in men and 55,000 in
women. In 1990, lung cancer was the most frequent new cancer in men and
among the most frequent in women. It was also the most frequent cause of cancer
deaths in men (33%) and in women (21%) even more frequent than breast
cancer (18%).1 Of the lung cancers, non-small cell carcinoma is more frequent,
80%, than small cell carcinoma, 20%. Of the NSCLC, squamous cell is regarded
as the most common, followed by adeno carcinoma and large cell
undifferentiated carcinoma.2
The overall cure rate for NSCLC is only 10%. Cures are obtained mainly in
patients with very early disease by surgery. The majority of patients presents
with later stage disease, too extensive for surgical resection and therefore with
bad prognosis. Recent treatment efforts are directed toward increasing surgical
resectability by introducing neoadjuvant chemotherapy and radiotherapy as
well as toward increasing survival of patients with unresectable tumors.
Until recently the role of chemotherapy for NSCLC has been questionable.
Recent studies demonstrate that current chemotherapy regimens can improve
survival in patients with NSCLC. The Canadian multi-center randomized trial
showed a statistically significant advantage with combination chemotherapy for
both response and survival.3
Current evidence suggest that cisplatinum or Platinol is the most effective
single agent. In an effort to obtain greater therapeutic effect, investigations have
focused on dose and schedule of Platinol administration. It appeared that a
pulse dose schedule was more effective than bolus administration 4 and that
higher doses of Platinol were more effective than lower dose \ This letter observation
suggests a dose-response relationship.
Platinol is useful in various combination regimens. Especially in combination
with etoposide or VP-16 higher response rates were obtained than the original
CAMP regimen.6 This is the reason that we have embarked on a VP-16/
Platinol regimen which has been schematically outlined in Table 1. Since dose
relationship may exist, we plan six courses of VP-16/Platinol with a short interval
between each course. In order to achieve this, G-CSF was administered after
each course for 10 days to ameliorate myelosuppression. If the observations of
dose response relationship by Gralla et al are representative for NSCLC, intensification
after VP-16/Platinol with higher dose chemotherapy would be of benefit.
This is the reason why after six courses of VP-16/Platinol two courses of
Cytoxan/Platinol (CP) and one course of cytoxan/VP-16/Platinol (CVP) are administered.
The program has been outlined in Table 2. It can be noted that bone
274 SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION