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tuations in WBC count seen in conventional 3-weekly regimens. In all, one quarter of treatment courses were delayed, most frequently because of leukopenia. Dose reductions were required in 63% of cases. The average delivered dose intensity was calculated and shown to be 73% of projected. Nonhematologic toxicity was mild with nausea and vomiting being the most common. This wegkly schedule of chemotherapy has proved to be active and well tolerated and is currently being compared with conventional 3-weekly chemotherapy in a randomized study.

Dose-intensity metatnalysis of chemotherapy regimens in small- cell carcinoma of the lung K&a RJ, Murray N, Coldman AJ. Division of Medical Oncology. Cancer Control Agency ofBritish Columbia, 600 W 10th Ave. Vancou- ver, EC V524E6. J Clin Oncol1991;9:499-508.

To determine if chemotherapy dose intensity (DI) influences treat- ment outcome, 60 published studies in limited- and extensive-stage small-cell carcinoma of the lung (SCCL) were retrospectively analyzed for relationship between intended DI and response (complete response [CR] or partial response [PR] or median survival (MS). Agents used in the regimens included cyclophosphamide (C), doxorubicin (A), vin- cristine (V), etoposide (E), and cisplatin (P). Relative DI (RDI) of each studyregimenwascalculatedagainstareferenceregimen,andweighted regression analysis was used. Additionally, analysis of individual drug RDI within combinations was performed. For CAV, increasing RDI of the regimen showed no correlation with outcome. For the individual drugs, C RDI correlated positively, while A RDI correlated negatively with attainment of CR in limited disease, but both only after unduly influential observations were eliminated. In extensive-stage disease, A RDI correlated positively with CR +, PR but only in randomized trials, and this correlation lost statistical significance after unduly influential observations were eliminated. For CAE and CAVE, the RDI of the regimens correlated positively with MS in extensive-stage disease as did the C RDI. In limited disease, the C RDI correlated negatively with MS. For EP,nosignificantcorreIations were seen. Weconclude that DI- outcome correlations are not consistent for these chemotherapy regi- mens in SCCL. Me&analysis of retrospective data can generate hy- potheses for testing in prospective clinical trials, but suldy sample and method of analysis can appreciably affect conclusions.

Bolns versus infusion regimens of etoposide and cisplatin in treat- ment of non-small cell lung cancer: A study of the North Central Cancer Treatment Group Goldberg RM, Jett JR, Themeau TM, Johnson PS, Tschetter LK, Krook JE et al. Division of Medical Oncology, Mayo Clinic, Rochesler, MN 55905. J Nat1 Cancer Insl 1990;82:1899-903.

In an effort to test clinically the hypothesis that the duration of cellular exposure 10 etoposide (VP-16) and cisplatin (CDDP) is an important determinant of cytotoxicity, we performed a phase III ran- domized trial comparing an outpatient bolus regimen of combined VP- 16 and CDDP with asequential infusion over 72 hours of these same Iwo drugs. All patients had stage IV non-small cell lung cancer, and survival was the primary end point. Of 113 patients randomly allocated to the study, 108 wereassessable forresponse, survival, and toxicity. A major response was observed in 20 (37%) of 54 patients on the bolus regimen and in 16 (30%) of 54 patients receiving infusion therapy. The median time to progression was 61 and 88 days for bolus and infusion therapy. respectively. The median survival time was I48 and 157 days, respec- tively (F’ = .7l). Study results were not consistent with Ihe possibility that infusion therapy could be associated with a 50% improvement in median survival, ie, from 5 months to 71 months. Toxicity was primarily myelosuppression and was significandy greater with the infusion regi- men. We conclude that infusion therapy as tested in this protocol with VP-16 and CDDP does not offer any advantage in response rate, time Lo disease progression, or survival as compared with bolus therapy. In addition, infusion therapy is associated with a greater degree of neu- lropenia and more treatment-related deaths.

Radiotherapy

Total body irradiation as an alternative to systemic chemotherapy in small-cell anaplastic lung cancer J_hs S, Scott JS, Clark RA. Departmenr ofRadiotherapy and Oncology, Ninewells Ho&al, Dundee. Br J Clin Pratt. 1990;44:571-3.

The effectiveness of total body irradiation (TBI) plus local radiother- apy in the treatment of small cell lung cancer was studied in 13 patients, using4,OOOcGyin 15fractionsoverthree weekstothelocalsiteand 150 cGy in ten fractions over two weeks to the whole body. The mean survival for 12 patients was 31 weeks, with a median survival of 32 weeks. One patient received six courses of combination chemotherapy for recurrent disease four months after TBI without marrow depression and survived 72 weeks, the longest survivor in this series. Brain metastases occurred in only one patient, the most common site of metastases being the liver. All patients tolerated TBI well wilhoul nausea, vomiting or hair loss. When bone marrow suppression occurred it was asymptomatic, requiring no ueatment and resolving within eight weeks.

Other treatment modalities

Endobronchial administration of iodine-131 B72.3 monoclonal antibody in patients with lung cancer Del Vecchio S, Mansi L. Petri110 A, Camera L, Sofia M, Marra A et al. Nuclear Medicine Deparment. Norional Cancer Insritute, II School of Medicine, Via S. Pansini5, Naples. Eur J Nucl Med 1991;18:129-32.

We tested Ihe feasibility of endobronchial administration of radiola- belled monoclonal antibodies (MoAbs) and the biodistribulion of the radiotracer. Ten patients with histological confirmed adenocarcinoma or squamous cell carcinoma were studied. Nine received 470 pCi (103 pg) of Iodine-131-B72.3.a monoclonal antibody reacting against TAG 72 antigen, while one patient received 502 pCi (291 pg) of ‘3’I-4C4, an indifferent antibody used for comparison in a negative control study. The radiolabelled antibody was administered through a flexible fiber- optic bronchoscope and placed on the turnour mass under visual monitoring. Scans with a large field-of-view gamma-camera showed retention of “‘I-B72.3 at the tumour site up to 6-9 days in six of eight patients. No other organs were visualized with the exception of faint activity in the gastrointestinal tract, bladder and thyroid. On the con- trary, the indifferent antibody 13’I-4C4 was not retained at the turnour site6daysafterMoAbadministration.andmoreprominentactivity was found in the gastrointestinal tract. In one patient Ihe study was not technically adequate because of failure of the delivery system. The vascular compartment contained less than 3% of the administered dose. We conclude that endobronchial administration is a feasible technique and allows stable and specific targetting of bronchial turnours. Further- more, the low activity found in the plasma and other organs suggests lhat this approach may be used to deliver therapeutic doses of MoAbs to lung cancers.

Miscellaneous

Intrapleural cisplatin and cytarabine in the management of malig- nant pleural effusions: A Lung Cancer Study Croup trial Rusch VW, Figlin R, Godwin D, Piantadosi S. Memorial Sloan- Kettering Cancer Center. 1275 York Ave, New York, NY 10021. J Clin oncol 1991;9:313-9.

Malignant pleural effusions are a common and significant problem in patients with advanced malignancies. Pleurodesis with tetracycline or other sclerosing agents is the usual treaunent for malignant pleural