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Cancer Chemotherapy Regimen for Non-small Cell Lung Cancer


 VP
_________________________________________________________________
  vinblastine..... 4 mg/sqm IV bolus on days 1 and 2.
  cisplatin....... 20 mg/sqm/day IV on days 1, 2, and 3.
  FREQUENCY....... Repeat cycles every 3 weeks to relapse or to 
                   limiting toxicity.


  reference...
    Blum RH.  Cooper J.  Schmidt AM.  Ashinoff R.  Collins A.  
    Wernz JC.  Speyer JL.  Boyd A.  Muggia FM. Cisplatin and 
    vinblastine chemotherapy for metastatic non-small cell 
    carcinoma followed by irradiation in patients with regional 
    disease. Cancer Treatment Reports.  70(3):333-7, 1986 Mar. 
  abstract...
    Forty-four patients with non-small cell carcinoma of the lung 
    were treated every 3 weeks with vinblastine (4 mg/m2/day iv X 
    2) and cisplatin (20 mg/m2/day iv X 3). Of the 28 patients 
    with metastatic disease, eight (29%; 90% confidence interval 
    of true response, 17%-47%) achieved objective response, for a 
    median duration of 27 weeks. Median survival in this group was 
    47 and 28 weeks for responders and nonresponders, 
    respectively. Of the 16 patients with advanced regional 
    disease, 11 (69%; 90% confidence interval of true response, 
    49%-86%) achieved objective response. Thirteen of these 
    patients received consolidation radiotherapy (4500 cGy/25 
    fractions/5 weeks), with a boost of 1000 cGy/5 fractions/1 
    week in those patients who achieved response. In the three 
    patients who did not receive radiotherapy, two died during the 
    induction phase, one from grade 4 leukopenia and sepsis and 
    the second from unrelated factors. The third patient had 
    systemic progression of disease during induction chemotherapy. 
    Six patients experienced overall improvement in their 
    chemotherapy response from the radiotherapy. Two patients who 
    did not respond to the chemotherapy achieved partial response 
    with irradiation. Four patients who had partial response to 
    the chemotherapy achieved complete response with irradiation, 
    and seven patients had no further change in their degree of 
    response to irradiation. The overall median survival of this 
    group was 81 weeks. Maintenance chemotherapy was not given. 
    After radiotherapy, the site of first failure was outside the 
    radiation field in nine of 13 patients (69%). Hematologic 
    toxicity was dose-limiting. Other toxic effects that were not 
    dose-limiting included nephrotoxicity, neurotoxicity, and 
    acute nausea and vomiting. In the patients with advanced 
    regional disease, there was no increase in the radiation 
    toxicity attributable to the chemotherapy. We conclude that: 
    (a) this dose schedule of vinblastine and cisplatin has 
    reproducible activity in non-small cell carcinoma of the lung; 
    (b) the response and median survival of patients with advanced 
    regional disease are superior to those of patients with 
    metastatic disease; and (c) in patients with advanced regional 
    disease, treatment with chemotherapy followed by radiotherapy 
    yielded an overall response rate of 81% (90% confidence 
    interval of true response, 60%-93%) and improved survival 
    compared to a similar group of patients studied by others 
    receiving radiotherapy alone. We recommend further testing of 
    this concept. 
 

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