Initial therapy with cisplatin plus VP-16 in small-cell lung cancer

Cisplatin plus VP-16 has become a widely used salvage regimen for CAV (cyclophosphamide, doxorubicin [Adriamycin], and vincristine) failures. However, the major value of this two-drug combination will probably be as an integral part of the initial therapeutic strategy. Cisplatin plus VP-16 has been used as induction therapy in four separate published studies involving 238 patients. The response rates ranged from 71% to 94% and complete remission (CR) rates varied from 30% to 53%. Cisplatin plus VP-16 has also been alternated with CAV in several phase II studies with encouraging results. A Southeastern Cancer Study Group (SECSG) protocol in extensive disease is currently testing this hypothesis in a random prospective study. A recently completed SECSG protocol in limited small-cell lung cancer tested the concept of late intensification with two courses of cisplatin plus VP-16 following six courses of CAV, v six courses of CAV alone. Presently, there is a statistically significant survival advantage for cisplatin plus VP-16.