TREATMENT OF PATIENTS WITH SMALL CELL LUNG CANCER

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A. A protocol combining twice a day radiotherapy plus VP 16 and cisplatin for limited stage small cell lung cancer continues. Forty-four patients have been entered onto study and 29 of 41 (71%) patients who have completed therapy have achieved a complete remission. The projected median survival is 24 months with a median potential follow-up more than 3 years. Seventeen patients have undergone biopsy for attempts at in vitro drug sensitivity testing. Seven of the 17 (42%) have been treated with an in vitro determined combination and those patients have survived for a median 39 months. B. The study of dose intensity using cisplatin and etoposide in patients with extensive stage studies continues. Eighty-three patients have been randomized to receive either VP-16 80 mg/m2 on days 1-3 days with cisplatin 80 mg/m2 administered on day 1 (43) or etoposide 80 mg/m2 and cisplatin 27 mg/m2 on days 1-5 (40) every 3 weeks for the first 2 cycles and receive standard chemotherapy after the first 6 weeks. Although there is increased hematologic toxicity in patients treated with higher dose etoposide cisplatin, there is not difference in complete response rate, overall response rate, or survival between the high and low dose arm. The trial has completed accrual. This prospective study of dose rate intensity of etoposide cisplatin in small cell lung cancer does not show any survival advantage to administering 67% more chemotherapy in the first six weeks of treatment. C. A monoclonal antibody (2A11) directed against gastrin releasing peptide (bombesin) which functions as an autocrine growth factor in small cell lung cancer has been used to treat patients with small cell lung cancer. Twelve patients have been treated with the phase II dose of 25mgm/m2. One of the ten patients (10%) who completed therapy has responded with a clinical complete response. The plans are to continue to trial.