SC                                                  carcinoid(38)
 _________________________________________________________________
  streptozotocin.. 500 mg/sqm/day IV day 1 to day 5 inclusive.
  cytoxan......... 1,000 mg/sqm IV day 1 and day 21.
  FREQUENCY....... Repeat cycle every 42 days (6 weeks).


  reference...
    Moertel CG.  Hanley JA. Combination chemotherapy trials in 
    metastatic carcinoid tumor and the malignant carcinoid 
    syndrome. Cancer Clinical Trials.  2(4):327-34, 1979 Winter. 
  abstract...
    One hundred eighteen patients with metastatic carcinoid tumor 
    were randomized to treatment with streptozotocin combined with 
    cyclophosphamide or with 5-fluorouracil (5-FU). Commonly 
    experienced side effects were nausea, vomiting, leukopenia, 
    thrombocytopenia, and nephrotoxicity. Objective response rates 
    among eligible and evaluable patients treated with the 5-FU 
    combination was 14 of 42 (33%) and with the cyclophosphamide 
    combination, 12 of 47 (26%). Among those patients with 
    carcinoids primary to the small bowel the respective response 
    rates were 44% and 37%. The overall response rates for 
    patients with carcinoids of pulmonary or unknown origin were 
    only 12% and 17%. There was no significant difference in 
    patient survival between the two treatment arms. Among 11 
    patients who received crossover therapy with 5-FU alone there 
    were two responders. There were no responders among eight 
    patients treated with cyclophosphamide alone. Urinary 5HIAA 
    excretion proved to be a useful biologic marker in these 
    patients that correlated well with the observed measurements 
    of tumor bulk. Median survival times from the diagnosis of 
    unresectable malignant disease related to sites of origin of 
    carcinoid tumor were the following: small bowel, 28.4 months; 
    pancreas, 24.0 months; lung, 15.1 months; and unknown origin, 
    9.0 months. Metastatic carcinoid tumor is a malignant disease 
    susceptible to chemotherapeutic approaches and continued 
    investigation of the therapy of these neoplasms should be 
    strongly encouraged.