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Randomized phase II study of cyclophosphamide, doxorubicin, and vincristine compared with single‐agent carboplatin in patients with poor prognosis small cell lung carcinoma
Author(s) -
White Shane C.,
Lorigan Paul,
Middleton Mark R.,
Anderson Heather,
Valle Juan,
Summers Yvonne,
Burt Paul A.,
Arance Ana,
Stout Ron,
Thatcher Nick
Publication year - 2001
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20010801)92:3<601::aid-cncr1360>3.0.co;2-k
Subject(s) - carboplatin , medicine , vincristine , chemotherapy , regimen , gastroenterology , cyclophosphamide , doxorubicin , neutropenia , surgery , oncology , cisplatin
BACKGROUND Information on the effect of chemotherapy in a group of patients with poor prognosis, poor performance status small cell lung carcinoma (SCLC) is scarce. A randomized study comparing single‐agent carboplatin with combination chemotherapy in this largely unreported population of SCLC patients was undertaken. METHODS One hundred nineteen patients were allocated to four cycles of either cyclophosphamide, doxorubicin, and vincristine (CAV) or single‐agent carboplatin. Patients had either a Karnofsky performance score ≤ 50 and/or a prognostic score indicative of a 1‐year survival rate ≤ 15%. RESULTS Grade 3–4 neutropenia and intravenous antibiotic use were significantly more common with the CAV regimen ( P < 0.005). Conversely, Grade 3–4 thrombocytopenia was more common ( P < 0.0009) and platelet transfusion was more frequent ( P < 0.05) with carboplatin therapy. Nonhematologic toxicity was similar in both treatment arms, except for alopecia with CAV therapy ( P < 0.0007). Symptom relief occurred in 48% and 41% of patients in the CAV and carboplatin treatment arms, respectively. Dyspnea was improved in 66% and 41% of patients and cough was improved in 21% and 7% of patients in the CAV and carboplatin treatment arms, respectively. CAV therapy produced a higher response rate than carboplatin (38% vs. 25%), but this was not statistically significant ( P = 0.15). The median overall survival for patients in the CAV and carboplatin treatment arms was 17 weeks and 15.9 weeks, respectively, with 1‐year survival rates of 12% and 6%. CONCLUSIONS Single‐agent carboplatin is a feasible treatment in patients with poor prognosis SCLC and produces response rates, relief of tumor‐related symptoms, and survival similar to what is seen in patients who receive CAV chemotherapy. The lower risk of life‐threatening sepsis and less need for hospitalization or intravenous antibiotic courses is advantageous in this susceptible patient population. Cancer 2001;92:601–8. © 2001 American Cancer Society.