Pilot study of teniposide in combination chemotherapy for small cell lung cancer

Teniposide is one of the most active agents in small cell lung cancer (SCLC). Because of the experimental evidence of synergistic activity between teniposide and methotrexate and between vincristine and methotrexate, 34 SCLC patients were treated with a combination of teniposide, vincristine, methotrexate and cyclophosphamide. Chest radiotherapy was given to responding patients with limited disease and prophylactic cranial irradiation was given to complete responders only. Most patients had extensive disease and good performance status. The main side-effects were myelosuppression, mucositis and peripheral neuropathy, which were all common and often severe. A response rate of 78% with 22% complete responses was obtained in 32 evaluable patients. Median durations of responses and survival were 252 and 311 days, respectively. Patients with limited disease had a median survival of 556 days while extensive disease patients had a median survival of 240 days. 2 patients with limited disease have been in continuous complete remission for more than 2 years from start of treatment.