Cisplatin, adriamycin, and etoposide (cav) for remission induction of small-cell bronchogenic carcinoma. Evaluation of efficacy and toxicity and pilot study of a “late intensification” with autologous bone-marrow rescue

Abstract

Chemotherapy with a combination of cisplatin (60 mg/m²), Adriamycin (45 mg/m²), and etoposide (120 mg/m² x 3) (CAV) has been evaluated in 36 patients with small‐cell bronchogenic carcinoma (SCBC) after two full courses. The complete response (CR) rate was 23% in patients with extensive disease and 64% in patients with limited disease; the partial remission (PR) rate was 59% in patients with extensive disease and 22% in those with limited disease after two cycles (six weeks) of therapy. Patients with CR survived significantly longer than patients with PR (P = 0.02). Side effects were acceptable and consisted mostly of nausea, vomiting, alopecia, and myelosuppression. Thirteen patients were included into a “late intensification” program that was performed with increased doses of CAV regimen used for remission induction. This intensification of chemotherapy was carried out in a protective environment and with autologous bone marrow transfusion. In two patients with PR, CR could be obtained after late intensification and in one patient whose disease was progressing, PR has been achieved. However, excessive extramedullary toxicity of the late intensification regimen, consisting of mucositis, suggested that CAV does not appear to be the optimal therapy for further intensification.