To examine whether weight loss at presentation influences outcome in patients who received chemotherapy for lung cancer or mesothelioma. Multivariate analysis of prospectively collected data 1994 -2001. Data were available for age, gender, performance status, histology, stage, response, toxicity, progression-free and overall survival. The outcomes of patients with or without weight loss treated with chemotherapy for small cell lung cancer (SCLC; n ¼ 290), stages III and IV non-small-cell lung cancer (NSCLC; n ¼ 418), or mesothelioma (n ¼ 72) were compared. Weight loss was reported by 59, 58 and 76% of patients with SCLC, NSCLC and mesothelioma, respectively. Patients with weight loss and NSCLC (P ¼ 0.003) or mesothelioma (P ¼ 0.05) more frequently failed to complete at least three cycles of chemotherapy. Anaemia as a toxicity occurred significantly more frequently in NSCLC patients with weight loss (P ¼ 0.0003). The incidence of other toxicities was not significantly affected by weight loss. NSCLC patients with weight loss had fewer symptomatic responses (P ¼ 0.001). Mesothelioma patients with weight loss had fewer symptomatic (P ¼ 0.03) and objective responses (P ¼ 0.05). Weight loss was an independent predictor of shorter overall survival for patients with SCLC (P ¼ 0.003, relative risk (RR) ¼ 1.5), NSCLC (P ¼ 0.009, RR ¼ 1.33) and mesothelioma (P ¼ 0.03, RR ¼ 1.92) and an independent predictor of progression-free survival in patients with SCLC (P ¼ 0.01, RR ¼ 1.43). In conclusion, weight loss as a symptom of lung cancer predicts for toxicity from treatment and shorter survival.

Sinry The role of chemotherapy m the palliation of patients with advanced st (IIB and non-small-cel (Souquet et al., 1993), and chemotherapy remains very much a palliative approach.No single chemotherapy regimen has been shown superior to others in the treatment of NSCLC, but best response rates have consistently been achieved with cisplatin-based regimens (Veronesi et al., 1988;Luedke et al., 1990). The combination of isplatin with mitomycin C and vinblasti has been shown in randomised trials to be one of the most effective regimens (Ruckdeschel et al., 1986), and this has the advantage over most other combinations of very rarely causing signiicant alopecia (an important consideration for palliative treatment). There is a tendency to use cisplatin in high dosage (100-120mgm-) in many of these regimens, but this is associated with significnt toxicity, including emesis, peripheral neuropathy, nephrotoxicity and high-frequency hearing loss. These problems disappear or are at least very markedly reduced with moderate-dose cisplatin (50mgm-2) and probably without significant reduction in efficacy (Hardy et al., 1989).We have therefore developed a moderate-dose cisplatin (P) regimen in combination with mitomycin C (M) and vinblastine (V) (MVP) which is well tolerated with few side-effects (Hardy et al., 1989

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In this patient group, presenting with stable symptoms after control of pleural effusion, the early use of chemotherapy provided an extended period of symptom control, and in this small trial a trend to survival advantage.

SummaryMycobacterial preparations have been used with limited success against cancer apart from superficial bladder cancer. Recently, a therapeutic vaccine derived from Mycobacterium vaccae has been given to patients with prostate cancer and melanoma indicating a possible beneficial effect on disease activity in such patients. We have recently initiated a series of randomized studies to test the feasibility and toxicity of combining a preparation of heat-killed Mycobacterium vaccae (designated SRL172) with a multidrug chemotherapy regimen to treat patients with inoperable non-small cell lung cancer (NSCLC) and mesothelioma. 28 evaluable patients with previously untreated symptomatic NSCLC and mesothelioma were randomized to receive either 3 weekly intravenous combination chemotherapy alone, or chemotherapy given with monthly intra-dermal injections of SRL172. Safety and tolerability were scored by common toxicity criteria and efficacy was evaluated by survival of patients and by tumour response assessed by CT scanning. The toxicity of chemotherapy was similar in the two groups. SRL172 caused mild inflammation at the injection site. In the group of patients randomized to receive chemotherapy combined with SRL172, there was a trend towards improved response rate (54% vs. 33%) with more patients in the combined arm receiving radical surgery and radiotherapy, improved median survival (9.7 months vs. 7.5 months) and improved 1 year survival (42% vs. 18%). SRL172 appeared to improve sleep (P = 0.08) and improved appetite (P = 0.01). There was no detectable change in serum cytokine levels for gamma-interferon and TNF-α before and after treatment. In patients with NSCLC and mesothelioma, there may be a beneficial interaction when chemotherapy is administered in combination with SRL172. Confirmation of this effect and further investigation is underway in a randomized phase III trial and in laboratory models.