52

tases, female sex, no subcutaneous metas-

tases, non-large-cell histology, 5% prior

weight loss, no symptoms of shoulder or arm

pain, and no liver metastases were predict-

ors of longer survival. Of particular inter-

est was the finding that response duration

was significantly longer (P = .002) for

those patients who experienced a longer time

to best response. In addition, patients who

survived > 1 year experienced greater de-

grees of nonlethal toxicity, in particular,

gastrointestinal and hematologic, than

patients who did not survive 1 year, (P =

.006). A detailed chart review of 32 2-year

survivors and 32 matched controls

demonstrated that maintenance or improvement

of performance status and maintenance of

serum albumin levels at 3 months from the

initiation of treatment were both important

predictors of longer survival.

Etoposide and High-Dose Cisplatin in Good-

Risk Patients with Advanced Squamous Cell

Carcinoma and Adenocarcinoma of the Lung.

Ardizzoni, A., Canobbio, L., Pronzato, P. et

al. Divisione di Oncologia Medica, Istituto

Nazionale per la Ricerca sul Cancro, 1-16132

Genova, Italy. Cancer Treat. Rep. 70: 891-

892, 1986.

Fifty patients with advanced squamous

cell carcinoma and adenocarcinoma of the

lung having good prognostic features

(performance status < or = 2; weight loss <

or = 10%; and age < or = 70 years; absence

of brain metastases; and no prior treatment)

were treated on an outpatient basis with

etoposide (120 mg/m 2 on days i, 3, and 5)

and cisplatin (60 mg/m 2 on days 1 and 2)

every 21-28 days. One complete response and

14 partial responses were observed, with a

median duration of response of 170 days and

an overall median survival of 230 days.

Toxicity was generally mild. Despite the

high-dose cisplatin employed and the choice

of patients with favorable prognostic fac-

tors in this study, results of this therapy

remain disappointing.

Etoposide (VP-16) and Cisplatin in Pre-

viously Treated Small-Cell Lung Cancer;

Clinical Trial and In Vitro Correlates.

Batist, G., Carney, D.N., Cowan, K.H. et al.

NCI-Navy Medical Oncology Branch, Bethesda

Naval Hospital, Bethesda, MD 20814, U.S.A.

J. Clin. Oncol. 4: 982-986, 1986.

Treatment of patients with relapsed

small-cell lung cancer (SCLC) has been

uniformly unsuccessful. Recently, the com-

bination of etoposide (VP-16) and cisplatin

in this setting has been reported to result

in up to 50% response rates. We treated 29

patients with relapsed SCLC with this com-

bination and found only a 12% response rate.

The discrepancy between our results and

those of others is most likely due to dif-

ferences in prior treatment of the patients,

although the effect of dose and schedule

modifications are considered. Our patients

had received a six-drug regimen over a

median of 7 months and had a median drug-

free interval before this treatment of only

three weeks. Evidence is presented that sug-

gests that this aggressive initial therapy

affected both host tolerance to further

treatment and the development of tumor

resistance at the cellular level.

Random Prospective Study of Vindesine Versus

Vindesine Plus High-Dose Cisplatin versus

Vindesine Plus Cisplatin Plus Mitomycin C in

Advanced Non-Small-Ceil Lung Cancer.

Einhorn, L.H., Loehrer, P.J., Williams, S.D.

et al. Department of Medicine, Division of

Hematology-Oncology, Indiana University

School of Medicine, Indianapolis, IN, U.S.A.

J. Clin. Oncol. 4: 1037-1043, 1986.

In this phase III randomized study, 124

evaluatable patients with unresectable non-

small-cell lung cancer (NSCLC) were ran-

domized to vindesine v cisplatin (120 mg/m 2)

plus vindesine v cisplatin (60 mg/m 2) plus

vindesine plus mitomycin C. The objective

response rate for cisplatin and vindesine

was 27% v 20% for cisplatin, vindesine, and

mitomycin C, and 14% for vindesine alone (P

= .25 for cisplatin and vindesine v

vindesine). The percentage of patients

having stable disease (no progression for a

minimum of 3 months) was 20% (cisplatin and

vindesine), 27% (cisplatin, vindesine, and

mitomycin C), and 26% (vindesine alone),

respectively. The median survival time for

vindesine was 18 weeks, compared with 26

weeks for cisplatin and vindesine and 17

weeks for cisplatin, vindesine, and

mitomycin C. Overall survival was not

statistically different for cisplatin plus

vindesine v vindesine (P = .65). There was

no evidence for improved duration of remis-

sion or survival of responders with the

cisplatin (120 mg/m 2) and vindesine arm.

This study failed to demonstrate sufficient

therapeutic benefit for cisplatin and vin-

desine (+ or - mitomycin C) compared with

single-agent vindesine to justify the in-

creased cost and toxicity of these combina-

tion regimens.

Antitumor Effect of Two-Drug Simultaneous or

Sequential Use of Cisplatin, Vindesine or

Etoposide on Hi-nan Pulmonary Adenocarcinoma

Cell Lines in Tumor Clonogenic Assay.

Yung-Chie-Lee, Saijo, N., Sasaki, Y. et al.

Department of Surgery, National Taiwan

University Hospital, Taipei, Taiwan. Jpn. J.

Cancer Res., Gann, 77: 312-318, 1986.

The antitumor effects of two-drug

simultaneous or sequential use of cisplatin,

vindesine or etoposide were examined in

h,m~an pulmonary adenocarcinoma cell lines by

h,-n~n tumor clonogenic assay. Different

tumor cell liens (PC-9, PC-13 and PC-14)

t_hat originated from the same histological

cell type responded quite variably to simul-

taneous and/or sequential therapy. The an-

titumor effects of various sequential com-

binations of cisplatin, vindesine and

etoposide depended strongly on the nature of

the individual tumor cell line tested.

8. RADIOTHERAPY

Changes in Peripheral Lymphocyte Subsets

During Radiotherapy for Lung Cancer

Patients.

Ogawa, Y., Maeda, T., Seguchi, H. et al.

Department of Radiology, Kochi Medical

School, Oko-cho, Nankoku-shi, Kochi 781-51,

Japan. Oncology 43: 154-158, 1986.

In order to better understand the im-

munologic effects of irradiation, blood

levels of lymphocyte subsets were sequen-

tially monitored in 37 patients before and

during irradiation treatment for lung can-

cer. During irradiation, the peripheral

blood levels of each T cell subgroup, OKT3-

reactive (OKT3+), OKT4 +, OKT8 + and OKTII +

lymphocytes showed similar radiosensitivity.

No selective depletion of either OKT4 + or

OKT8 + lymphocytes was seen. The levels of

OKT6 + and OKT9 + lymphocytes were different

depending on the case. AT the end of ir-

radiation, the percent of ly~hocytes bear-

ing the OKTIO antigen increased sig-

nificantly. As to LKMI + and OKIal + lym-

phocytes, the levels were almost consistent

but showed a rather big standard deviation.

Impact of Tumor Control on Survival in Car-

cinoma of the Lung Treated With Irradiation.

Perez, C.A., Bauer, M., Edelstein, S. et al.

53

Division of Radiation Oncology, Mallinckrodt

Institute of Radiology, Washington Univer-

sity School of Medicine, St. Louis, MO,

U.S.A. Int. J. Radiat. Oncol. Biol. Phys.

12: 539-547, 1986.

The long-term results in tumor

response, intrathoracic tumor control and

survival are reported in patients with medi-

cally inoperable or unresectable non-oat

cell and small cell carcinoma of the lung.

In 376 patients with stage TI-3, NO-2 car-

cinoma of the lung tumors, accessioned to a

Radiation Therapy Oncology Group (RTOG) ran-

domized study to evaluate different doses of

irradiation, a higher complete response rate

(24%), intrathoracic tumor control (67%) and

three year survival (15%) was observed with

6000 cGy, compared with lower doses of ir-

radiation (4000 or 5000 cGy). Increased sur-

vival was noted in patients with complete

tumor response. Three year survival in com-

plete responders was 23%, in partial

responders, 10%, and in patients with stable

disease, 5%. Patients treated with 6000 cGy

had an overall intrathoracic failure rate of

33% at 3 years, compared with42% for those

treated with 5000 cGy, 44% for patients

receiving 4000 cGy with split course, and

52% for those treated with 4000 cGy con-

tinuous course (p = 0.02). Patients surviv-

ing 6 or 12 months exhibited a statistically

significant increased survival when the

intrathoracic tumor was controlled. Patients

treated with 5000-6000 cGy, showing tumor

control, had a three year sttrvival of 22%,

versus 10%, if they had intrathoracic

failure (p = 0.05). In patients treated with

4000 cGy (split or continuous), the respec-

tive survival was 20% and 10%, if the

intrathoracic tumor was controlled (p =

0.001). In patients surviving 12 months

after treatment with 5000-6000 cGy, on whom

the intrathoracic tumor was controlled, the

median survival was 23 months, in contrast

to 12 months, if they developed

intrathoracic failure (p "0.05). In patients

treated with 4000 cGy, the median survival

was 17 months with control and 12 months

without control of the intrathoracic tumor.

(p = 0.008). In another RTOG study for

patients with more advanced tumors (T4 or

N3), those with local tumor control at 12

months had a three year survival rate of

25%, compared with 5% for those with

thoracic failures. These differences are

statistically significant (p = 0.006).

Higher doses or irradiation yield a greater