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therapy of which 20 are alive and free of

disease at least one year post-operatively. Of the remaining 37, there was one post- operative death, one lost to follow up and four dead of unrelated causes. Twenty five died of their disease within one year and six are alive with recurrence. Twenty nine patients underwent their last resection more than 3 years ago of which ten are ali- ve and free of disease (34.5%). In nine of these latter patients both tumours were squamous cell whereas fourteen of the nineteen deceased patients succumbed to adenocarcinoma.

Four patients required post-operative ventilation (74 ~ Complications included the following: pneumonia (5), arrhythmias (9), post-operative hemorrhage (I) , major atelectasis (2) and myocardial infarction (2). Karnofsky exercise tolerance could be determined in forty-three of the operative patients as follows: Level i-7, level 2- 27, level 3-5, level 4-3, and level 5-1. Our data suggests that second primary dis- ease may be handled successfully with surgery, albeit with a slightly increased morbidity. Survival would appear improved when both tumours are of the squamous cell type.

Long Term Results of Surgical Treatment in Bronchial Carcinoma (BC). Hasse, J. Division of Cardiac & Thoracic Surgery, Department of Surgery, University of Basel, Switzerland.

Although surgery commonly is regarded the treatment of choice in non small cell BC if ever feasible, reported survival rates not only are often disappointingly low but may also differ considerably from one series to another.

Beginning in 1972, during a 7 years period 206 surgically treated consecutive patients were included in the study. All underwent a standardized diagnostic pro- cedure for evaluation of their disease stage (UICC) and their functional condi- tion. Resection was technically possible in 188 patients; 6 of them had a 2nd resec- tion at a later time for new or recurrent BC. The operative mortality was 7% for pneumonectomies, 2.5% for lobectomies in- cluding sleeve procedures, it was less than 1% for stage I and II disease.

In the long term follow up only one patient was lost. Follow up intervals were 3 to 6 months for 5 years and 12 months thereafter. 46 patients are still alive. Since the most recent biostatistical calcu- lation of the cumulative survival (Operative mortality included) took place on Jan. 21, 1985, the follow up periods are ranging from 6.3 to 13 years.

Survival 3 5 i0 years Stage

I 60.0% 51.6% 28.8% II 41.9% 34.9% 24.2% III 26.4% 18.9% 4.7%

The stage of the disease in this series is by far the most predominant determinant of survival as compared to the histological type (except small cell BC) and extent of the re- section, i.e. pneumonectomy or lobectomy.

7, CHEMOTHERAPY

Activity of Auranofin Against Small Cell Lung Cancer (SCCL) Cell Lines in Vitro. Roed, H., Brenner, N., Vindel@v, L.L., Spang- Thomsen, M., Skovsgaard, T., Christensen, I.J. The Finsen Institute and University Institute of Pathological Anatomy, Copenhagen, Denmark.

Auranofin (2,3,4,6-tetra-0-acetyl-l-thio- [~-0-glucophyranosato-5-triethylphospine gold (i)) is a gold complex active in the treatment of rheumatoid arthritis. Recently, there have been a number of reports on the cytotoxic ef- fects of Auranofin on a variety of tumor cell lines in vitro and on the antineoplastic effect on mouse leukemia P388 in vivo. (Cancer Res 45: 32-39, 1985).

To elucidate whether Auranofin has any activity against SCCL the drug was tested on 5 cell lines established from patients with SCCL. The cell lines were exposed to the drug for one hour, washed twice and plated in soft agar. The colonies were counted after 3 weeks and the surviving fractions calculated. Expo- nential surviving courves were produced. 90% cell kill was achieved between i,i ug/ml - 4,2 ug/ml depending on cell line and culture conditions. These concentrations should be obtainable in humans since 6 mg/day will pro- vide a serum concentration of 1,75 ug/ml (Cancer 44: 1965, 1975).

Our results indicate than Auranofin is cytotoxic against SCCL in vitro and justifies additonal in vivo experiments.

The Value of A Prognostic Index Following Diag- nosis of Small Cell Lung Cancer (SCLC). Sagman, U., DeBoer, G., Feld, R., Evans, W.K., Shepherd, F.A., Ciampi, A., Sculler, J.P., Haddad, R., Ginsberg, R. University of Toronto, Canada.

Derivation of a prognostic index based on a retrospective analysis of 28 pretreatment at- tributes in 480 patients with small cell lung cancer is described. The statistical methodo- logy developed to formulate the index is based on elaboration of recursive partition (sequen- tial assortment of a population into progres- sively smaller classes characterized by group- ings of variables), and amalgamation algorithms (reconstruction of subpopulations defined by distinct attributes into classes of homogenous outcome distributions).

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7 pretreatment attributes (performance

status, extent, mediastinal disease, CEA and LDH levels, liver and brain involve- ment) were identified as the most signifi- cant in the formation of the index.

Index scores were found to be predictive of response rates and survival intervals in the analysis of the 480 patient sample.

The validity of the prognostic index was tested on a subsequent cohort of 180 pa- tients with SCLC. Index scores correlated predictively with outcome.

The index developed herewith provides a consistent integrated approach to prognostic stratification. A universal applicability is proposed as an essential component in the design of clinical trials, the notion of individual risk scores, and in the further elucidation of the interactions between prognostic factors and therapeutic objec- tives. Refinement of statistical methodolo- gy and further validity analysis utilizing larger cohorts in both prospective and retrospective fashion is necessary prior to general usage.

CisplatinAnd Etoposide Followed by Adria- mycin and Cytoxan for Treatment of SCLC Limited Disease. Salvati, F., Mugnaini, L., Cruciani, A.R., Portalone, L., Nunziati, F., Antilli, A., Mecarocci, D., Signora, M. 8th Department of Pneumology "Forlanini" Hospital, 00149 Rome, Italy.

To evaluate the effectiveness on SCLC of induction combined chemotherapy with cisplatin and VP-16 followed by treatment with adriamycin and cyclophosphamide, 22 pts with limited disease were treated initially with cispl~tin 60 mg/m i.v. day 1 and VP-16 120 mg/m i.v. day 2, 3, 4 every 28 days for 3 courses. After 4 weeks the pts were submitted to combined chemo- therapy with adriamycin 59 mg/m i.v. plus cyclophosphamide 600 mg/m- i.v. day 1 eve- ry 28 days until progression. Eighteen of 22 entered pts resulted evaluable and the limited stage of their disease was previ- ously determined after careful staging (clinical evaluation, chest tomography, brain CT, abdomen CT, bone scanning, etc.). The median age of treated evaluable pts was 62 years (range 48.72). At present, the results of this trial are the follo- wing: Complete response was obtained in 7 pts (CR=38,9%), partial response was ob- tained in 9 pts (PR=50%) and stable dis- ease in 2 pts (SD=II,I%). In no pt is still appeared progression of disease. The median duration of response resulted in 18 weeks (range 8+ - 38+) and the MST is presently 13 months (range 7-26+). The tolerance was acceptable, particularly renal and G.I. ones. The results so far observed seem to be encouraging (CR+PR rate = 88,9%),

taking into account the low dose of cisplatin

and considering that in 3/18 pts the survival exceeds 18 months.

Cisplatin and Vinblastine: A Salvage Chemo- therapy (CT) Regimen in Small Cell Lung Cancer (SCLC). Pallotta, G., De Marinis, F., Maccone, C. Pneumological Institute, "C. Forlanini", 3rd Division , 00149 Rome, Italy.

Between August 81 and March 83, fifteen pa- tients (pts) with SCLC, resistant to initial CT or relapsed after initial response, were treatedAwith a CT regimen with vinblastine

2 z (8 mg/m i.v.d, i) and cisplatin (i00 mg/m i.v.d. 2) every 21 days until progression. All pts initially were treated with at least 3 cycles of co~ination CT with cyclophospha- m~de (i000 mg/m i.v.d, i), a~riamycin (50 mg/ m- i.v.d, i), VP-16 (i00 mg/m- i.v.d. 1,2,3) every 21 days. The pts limited in CR, follow- ed by RT to the primary and a prophylactic brain irradiation, after which CT was given monthly until progression or at maximum for one year of therapy. The median age of pts was 58, the median PS was 70, 8 pts were LD and 7 ED, the response to initial CT was 5 CR, 1 PR, 9 NR. The median duration of initial re- sponse was 9 months(mo) : five pts had progres- sion in metastatic sites (liver, two pts, bone two pts, brain two pts, adrenal glands one pt).

None pts resistant to initial CT and four pts relapsed, had objective response to this salvage regimen. Toxicity was moderate. The median survival from the progression was 5 mo (i-i0+), for the entire group from the initial treatment was 9 mo (3-22+). Further studies are needed for a valuation final.

Cisplatin, Adriamycin, Etoposide (PAE) vs Cytoxan, Adriamycin, Etoposide (CAE) in The Chemotherapy (CT) of Small Cell Lung Cancer (SCLC). Pallotta, G., De Marinis, F., Maccone, C. Pneumological Institute "Forlanini", 3rd Di- vision, 00149 Rome, Italy.

A total of 49 patients (pts) with untreat 5 ed SCLC were given either cisplating(60 mg/m- i.v.d, i), adriamycin (A).(40 mg/m- i.v.d. i), etoposide (E) 580 mg/m z i.v.d. 1,2,3)2or cytoxan (i000 mg/m- i.~. d. i), A (50 mg/m i.v.d, i), E (80 mg/m- i.v.d. 1,2,3), for 6 cycles repeated every 3 weeks. In the PAE group, pts achieving a response received a maintenance non cross resistant CT alternating regimen with CTX, MTC, ADM, VCR, VP-16. In the CAE group, pts in CR received a chest RT and a PCI. There were 23 pts evaluable in PAE group (2 non toxic deaths) and 21 pts in CAE group (3 too early to evaluate). No signifi- cant differences were between the groups with respect to prognostic factors. Overall after induction, in limited disease, PAE group gave a 30% of CR and a 80% of CR+PR, a median du-