Intensive induction treatment of small cell bronchogenic carcinoma with cyclophosphamide, methotrexate, and etoposide

Fifty-six patients with histologically confirmed small cell bronchogenic carcinoma were treated with cyclophosphamide, methotrexate, and etoposide. While methotrexate doses were modified for mucositis during the 6-week induction period, none of the drug doses were modified for hematologic toxicity. The overall response rate was 66%, with 16% complete remissions; median survival duration was 28 weeks. In 12 patients, the leukocyte count fell below 1000/mm3, and there were four deaths in febrile, leukopenic patients. Diffuse pulmonary infiltrates were observed in eight patients, and three died from respiratory insufficiency. Lung biopsy in two patients and autopsy in two additional patients showed interstitial changes consistent with drug injury. This regimen produced considerable hematologic and apparent pulmonary toxicity while offering no advantage in response rate or survival duration.