[Cyclic alternating combination chemotherapy of small cell carcinoma of the lung]

Twenty-six consecutive previously untreated patients with small cell carcinoma of the lung were treated with cyclic alternating combination chemotherapy. COAM consists of cyclophosphamide 140 mg/m2 i.v. day 1 through 5, vincristine 1.3 mg/m2 i.v. day 1 and 15, ACNU 50 mg/m2 i.v. day 1, methotrexate 7 mg/m2 i.v. day 1 through 5 repeated at 4 week intervals. VAP consists of VP-16 100 mg/m2 p.o. day 1 through 5, adriamycin 30 mg/m2 i.v. day 1, procarbazine 100 mg/m2 p.o. day 1 through 14 repeated at 4 week intervals. The order of alternating course was determined by the time of entry into the study. There were 12 complete and partial responses (86%) among 14 patients treated with COAM-VAP including 6 complete responses (43%), whereas there were 12 responses (100%) including 4 complete responses (33%) among 12 patients treated with VAP-COAM. There was no significant difference between patients receiving COAM-VAP and VAP-COAM with respect to response, duration of response, and survival. Overall median survival was 9.8 months. There was no significant difference between patients with and without distant metastasis with respect to response, duration of response and survival. Two patients were alive at 24 months. The addition of second combination chemotherapy did not increase the response rate. Most patients had mild or moderate leukopenia. Four patients developed interstitial pneumonia.