VP-16 alone and in combination with cisplatin in previously treated patients with small cell lung cancer

Fifty-four patients with small cell cancer of the lung (SCCL) who failed to respond to induction chemotherapy or relapsed within 3 months of its completion were treated either with VP-16 alone or VP-16 and cisplatin. Fifty-two patients were initially treated with cyclophosphamide, doxorubicin (Adriamycin) and vincristine (CAV), and two were treated with cyclophosphamide, methotrexate, and vincristine. Nine patients also received other drug combinations either as maintenance therapy or as treatment for relapse. Fourteen of 18 patients treated with VP-16 alone were evaluable for response, and there was only one partial remission. On the other hand, 15 of the 34 evaluable patients (44%) treated with VP-16 and cisplatin had a partial response, and an additional 11 patients (32%) showed substantial tumor regression and were classified as improved. Two patients had stable disease, and six (18%) progressed. Five of the nine (55.6%) limited-disease patients achieved a partial response compared with 10 of 25 (40%) with extensive disease. The median survival time from the date of first treatment with the combination was 17 weeks (29 weeks for patients achieving a partial response; 19 weeks for those showing improvement; 11 weeks for those with stable disease; and 13 weeks for patients with disease progression). Gastrointestinal toxicity was mild relative to that of CAV-induction therapy but myelosuppression, particularly thrombocytopenia, was common. Mild nephrotoxicity occurred in four patients, but no other important toxicities were identified.