Methyl CCNU and adriamycin for patients with metastatic sarcomas: a Southwest Oncology Group study

This protocol study (SWOG-7431) combining adriamycin and methyl CCNU (MAD) for metastatic sarcomas was initially used on patients who were refractory to cytoxan, vincristine, and/or actinomycin-D. After the initial good results, the study was expanded to include any untreated patients with metastatic sarcoma. The initial starting dose of adriamycin was 60 mg/M2 on day 1 and 45 mg/M2 on day 22. Methyl CCNU was given once every six weeks at an initial dose of 150 mg/M2 orally. Fifty-five patients received therapy and 53 were evaluable for response. The complete remission rate was 9.4%. The partial remission rate was 35.9%, with a total complete and partial remission rate of 45.3%. The median survival time was ten months. When the combination of cytoxan, DIC, vincristine and adriamycin was used, the response rate was similar and the median survival time in eligible patients was 10 months. The methyl CCNU and adriamycin combination is more convenient for the patient because it necessitates fewer clinic visits and significantly fewer injections than other combinations. These data suggest that treatment with methyl CCNU, when combined with adriamycin, increases the response rate and survival time over adriamycin alone, but that the response is similar to that seen with the combination of cytoxan, DIC, vincristine, and adriamycin.