Multimodality treatment of non‐small cell lung cancer: Response to cisplatin, VP‐16, and 5‐FU chemotherapy and to surgery and radiation therapy

Abstract

Twenty-one patients with unresectable non-small cell lung cancer (NSCLC), 11 with stage III M0, five with malignant pleural effusion, and five with a single resectable metastasis were treated with multimodality therapy. All received two to three cycles of preoperative chemotherapy with a new sequential combination of cisplatin (50 mg/m2 IV X 1) followed by 5-FU infusion (40 mg/m2/hr X 72) and etoposide (80 mg/m2/day X 3). Thirteen of 21 (62%) had a partial response, and three (14%) had a minor response to chemotherapy. Of the 19 who underwent surgical exploration, 17 were confirmed to have NSCLC. Ten patients with NSCLC and one with choriocarcinoma were rendered disease free by resection of the primary tumor and lymph nodes. Six received intra- and/or perioperative interstitial therapy with 125I and/or 192Ir. Another patient was treated with 32P. Postoperative external radiotherapy was administered in 15 patients, and adjuvant chemotherapy was administered in ten. This multimodality therapy was well tolerated, safe, and highly effective, resulting in excellent palliation even in patients with pleural effusion and metastasis. The most promising results were in unresectable stage III M0 with a partial response rate of 82% following neoadjuvant chemotherapy and a complete response rate of 73% after surgery. In this group, median survival has not yet been reached and will exceed 12 months.

Induction chemotherapy with a new regimen alternating cisplatin, fluorouracil with mitomycin, hydroxyurea and bleomycin in carcinomas of nasopharynx or other sites of the head and neck region

“…34 In an attempt to increase the response rate and minimize the hospitalization and toxicities of cisplatin, we designed the new induction chemotherapy regimen 9% and 23% of patients refused to be treated with the 4th and 5th cycles (adjuvant chemotherapy), respectively.…”

“…We previously reported'' a 17% CR rate in patients with recurrent/metastatic disease using a modification of the Wayne State regimen4 We chose a 24-hour interval between cisplatin and FU to permit adequate hydration and correction of electrolyte disturbances and also because our in vitro data suggested additive effects with this time sequence. 34 In an attempt to increase the response rate and minimize the hospitalization and toxicities of cisplatin, we designed the new induction chemotherapy regimen 9% and 23% of patients refused to be treated with the 4th and 5th cycles (adjuvant chemotherapy), respectively. consisting of cisplatin plus Fu alternating with three cycles of bleomycin, mitomycin, and hydroxyurea.…”

Review: Perioperative therapy for locoregional nonsmall-cell lung cancer

“…In the following decade, numerous Phase I1 clinical trials of preoperative chemotherapy andor chemo-radiotherapy for patients with locally advanced (mostly Stage IIIA) NSCLC were reported (Table I) (21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The rationale of the preoperative chemotherapy in these trials was to improve the postoperative survival by downstaging the lesion by preoperative chemotherapy.…”

Neoadjuvant chemotherapy in stage IIIa non-small cell lung cancer.

“…[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Overall, significant responses were seen in more than 50% of patients and a response usually indicated an improved chance of successful resection. Resection rates ranged from 0% to 88%, with an overall resection rate of more than 50%.…”