[Experiences with VP-16 in combination with cyclophosphamide or adriamycin in the anaplastic, predominantly small...

VP 16-213, the new semisynthetic epipodophyllotoxin, was tested for activity and toxicity in two small pilot series of 24 mainly untreated patients with anaplastic, predominantly small-cell lung cancer. It was given in combination with cyclophosphamide or adriamycin. Among 10 evaluable patients receiving VP-16 + cyclophosphamide (5 orally, 5 intravenously) only 1 good partial remission and 4 partial remissions (less than 50%) were achieved. Toxicity was minimal. In 14 patients on VP-16 and adriamycin, remission was complete in 2, good partial in 5 and lesser partial in 2. The hematological toxicity of the second combination was marked. Severe granulocytopenia required reverse isolation of most patients for periods of up to 2 weeks. The response rate for VP-16 + adriamycin was better than for VP-16 + cyclophosphamide, but lower than expected. Possible explanations are given.