INTENSIVE CHEMOTHERAPY OF SMALL CELL BRONCHOGENIC CARCINOMA

Abstract

Patients (32) (27, extensive disease; 5, regional disease) with histologically documented small cell carcinoma entered a randomized study to determine the efficacy of intensive induction chemotherapy. The necessity of a protected environment (laminar air flow room) during this treatment was also evaluated. Patients received high dose or standard dose cyclophosphamide, methotrexate and CCNU [1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea] (CMC) during the first 6 wk of treatment. Subsequent maintenance therapy consisted of standard dose CMC until disease progression. In 23 patients treated with high dose chemotherapy there were responses in 96% (30% complete). Standard dose chemotherapy gave responses in 45%, none of which were complete. Median survival correlated with completeness of response and was 16+ mo. for the 7 complete responders. Patients receiving high dose CMC spent an average of 10 days with neutrophil counts < 1000/mg3. There was only 1 documented, non fatal infection. High dose chemotherapy gives better responses and longer survival than previously utilized standard doses of the same drugs. Patients could safely be treated in the hospital ward.