CIS-DICHLORODIAMMINEPLATINUM(II) ALONE FOLLOWED BY ADRIAMYCIN PLUS CYCLOPHOSPHAMIDE AT PROGRESSION VERSUS CIS-DICHLORODIAMMINEPLATINUM(II), ADRIAMYCIN, AND CYCLOPHOSPHAMIDE IN COMBINATION FOR ADENOCARCINOMA OF LUNG

Abstract

Patients [41] with proven metastatic adenocarcinoma of the lung were randomized into 2 comparable groups after stratification for performance status and presence of measurable or evaluable disease. Treatment 1 consisted of cis-dichlorodiammineplatinum(II) (P) at a dose of 15 mg/m2 per day by i.v. push on days 1-5 every 4 wk. On progression or the onset of renal toxic effects, patients were crossed over to cyclophosphamide (C) at a dose of 400 mg/m2, and adriamycin (A) at a dose of 40 mg/m2, both given by i.v. push on day 1 every 4 wk. Treatment 2 consisted of C-A in the same doses as above plus concurrent P [CAP-I], 40 mg/m2 by i.v. push on day 1 every 4 wk. Eight patients receiving P developed serum creatinine values .gtoreq. 1.5mg/100ml vs. 1 patient receiving CAP-I (P = 0.05). Objective regressions occurred in 2 of 22 patients with P, 5 of 17 with C-A, and 8 of 19 with CAP-I (P = 0.025; CAP-I vs. P). There was a significant increase in the median duration of regression in patients responding to C-A following P (267 days) vs. patients responding to CAP-I (95 days). The improved rate of response with CAP-I and the prolonged duration of response with C-A following P suggest a potentiating effect between P and C-A whether given simultaneously or sequentially.