Journal of Clinical Oncology, Vol 17, Issue 10
(October), 1999: 3188-3194
© 1999 American Society for Clinical Oncology
Mitomycin, Ifosfamide, and Cisplatin in Unresectable Non–Small-Cell Lung Cancer: Effects on Survival and Quality of Life
M. H. Cullen,
L. J. Billingham,
C. M. Woodroffe,
A. D. Chetiyawardana,
N. H. Gower,
R. Joshi,
D. R. Ferry,
R. M. Rudd,
S. G. Spiro,
J. E. Cook,
C. Trask,
E. Bessell,
C. K. Connolly,
J. Tobias,
R. L. Souhami
From the Queen Elizabeth Centre for the Treatment of Cancer, University Hospital Birmingham, Birmingham; Cancer Research Campaign Institute for Cancer Studies, University of Birmingham, Birmingham; University College Hospitals Trust, London; Royal Hospitals Trust, London; Walsall Manor Hospital Trust, Walsall; Southend Hospital Trust, Southend; Nottingham City Trust, Nottingham; and Darlington Hospital Trust, Darlington, United Kingdom.
Address reprint requests to M.H. Cullen, MD, Queen Elizabeth Centre for the Treatment of Cancer, University Hospital Birmingham, B15 2TH, United Kingdom; email michael.cullen{at}university-b.wmids.nhs.uk
PURPOSE: Chemotherapy for non–small-cell lung cancer (NSCLC) remains controversial. We describe the two largest reported, randomized, parallel trials designed to determine whether the addition of chemotherapy influences duration and quality of life in localized, unresectable (mitomycin, ifosfamide, cisplatin [MIC]1 trial) and extensive (MIC2 trial) disease.
PATIENTS AND METHODS: Ambulatory patients with NSCLC, aged 75 years or younger, with localized disease, were randomized in MIC1 to receive up to four cycles of chemotherapy (CT: mitomycin 6 mg/m2, ifosfamide 3 g/m2, and cisplatin 50 mg/m2) every 21 days, followed by radical radiotherapy (CT + RT) or radiotherapy (RT) alone. Extensive-stage patients were randomized in MIC2 to identical chemotherapy plus palliative care (CT + PC) or palliative care (PC) alone. Short-term change in quality of life (QOL) was assessed in a subgroup of patients. Data from the two trials were combined to allow multivariate and stratified survival analyses.
RESULTS: Seven hundred ninety-seven eligible patients were randomized, 446 in MIC1 and 351 in MIC2. MIC CT improved survival in both trials (significantly in MIC2). The median survival time in MIC1 was 11.7 months (CT + RT) versus 9.7 months (RT alone) (P = .14); whereas in MIC2, median survival time was 6.7 months (CT + PC) compared with 4.8 months (PC alone) (P = .03). QOL, assessed in 134 patients from start of trial to week 6, showed improvement with chemotherapy and deterioration with standard treatment. In the combined analysis of 797 randomized patients, the positive effect of MIC on survival was significant overall (P = .01) and after adjusting for prognostic factors (P = .01).
CONCLUSION: MIC chemotherapy prolongs survival in unresectable NSCLC without compromising QOL.
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