VP
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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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