TESTING THE POSSIBLE NONCROSS RESISTANCE OF 2 EQUIPOTENT COMBINATION CHEMOTHERAPY REGIMENS AGAINST SMALL-CELL LUNG-CANCER - A PHASE-II STUDY OF THE EORTC-LUNG-CANCER-COOPERATIVE-GROUP

The Goldie-Coldman hypothesis of alternating non-cross resistant combination chemotherapy regimens for small-cell lung cancer has never been adequately evaluated. In previously reported studies non-cross resistance and/or equipotency of the combinations used had not been tested before the phase III study was started. We describe two combination chemotherapy regimens with comparable efficacy against small-cell lung cancer and present a phase II test of their possible non-cross resistance. Patients clinically resistant to cyclophosphamide, doxorubicin and etoposide (CDE), were treated with the second-line regimen consisting of vincristine, ifosfamide, mesna and carboplatin (VIMP) (n = 25). This resulted in 1 complete and 14 partial responses, response rate 60% [95% confidence interval (CI): 38.7-78.9%]. Patients clinically resistant to vincristine, carboplatin (n = 22) or ifosfamide, mesna, carboplatin (n = 21) were treated with CDE, resulting in 6 complete responses and 16 partial responses, response rate 51% (95% CI: 35.5-66.7%). The clinical value of such a degree of non-cross resistance has to be evaluated in a phase III study

LONG-TERM SURVIVAL OF SMALL-CELL LUNG-CANCER PATIENTS AFTER CHEMOTHERAPY

Eighty-one patients with small cell lung cancer (SCLC) with a survival Of more than 2 years start of chemotherapy were studied. Twenty-six of the 28 patients who died of relapsed SCLC had in relapsed before two years and of the 55 who had not then only two (4%) relapsed subsequently. It is stressed that with such observations treatment related factors should be taken in account. Second tumours were observed in ten patients, nine proven malignant. Of the eight patients with non-small cell lung cancer three had residual disease after initial chemotherapy. In our patient group after a 2 year disease-free interval the risk of developing non-small cell lung cancer seems higher than a subsequent relapse of SCLC