Originally published as JCO Early Release 10.1200/JCO.2002.12.111 on October 21 2002

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Cisplatin and Etoposide Regimen Is Superior to Cyclophosphamide, Epirubicin, and Vincristine Regimen in Small-Cell Lung Cancer: Results From a Randomized Phase III Trial With 5 Years’ Follow-Up

From the Departments of Oncology and Pulmonology, University Hospital of Trondheim, Trondheim; Departments of Oncology and Pulmonology, University Hospital of Tromsø, Tromsø; Departments of Oncology and Pulmonology, Ullevål Hospital, and Department of Oncology, Norwegian Radium Hospital, Oslo; Department of Pulmonology, Haukeland Hospital, Bergen; and Department of Internal Medicine, Østfold Sentralsykehus, Fredrikstad, Norway.

This article was published ahead of print at www.jco.org.Address reprint requests to Roy M. Bremnes, MD, Department of Oncology, University Hospital of Tromsø, N-9038 Tromsø, Norway; email: roy.bremnes{at}unn.no

PURPOSE: To investigate whether chemotherapy with etoposide and cisplatin (EP) is superior to cyclophosphamide, epirubicin, and vincristine (CEV) in small-cell lung cancer (SCLC).

PATIENTS AND METHODS: A total of 436 eligible patients were randomized to chemotherapy with EP (n = 218) or CEV (n = 218). Patients were stratified according to extent of disease (limited disease [LD], n = 214; extensive disease [ED], n = 222). The EP group received five courses of etoposide 100 mg/m² intravenously (IV) and cisplatin 75 mg/m² IV on day 1, followed by oral etoposide 200 mg/m² daily on days 2 to 4. The CEV group received five courses of epirubicin 50 mg/m², cyclophosphamide 1,000 mg/m², and vincristine 2 mg, all IV on day 1. In addition, LD patients received thoracic radiotherapy concurrent with chemotherapy cycle 3, and those achieving complete remission during the treatment period received prophylactic cranial irradiation.

RESULTS: The treatment groups were well balanced with regard to age, sex, and prognostic factors such as weight loss, and performance status. The 2- and 5-year survival rates in the EP arm (14% and 5%, P = .0004) were significantly higher compared with those in the CEV arm (6% and 2%). Among LD patients, median survival time was 14.5 months versus 9.7 months in the EP and CEV arms, respectively (P = .001). The 2- and 5-year survival rates of 25% and 10% in the EP arm compared with 8% and 3% in the CEV arm (P = .0001). For ED patients, there was no significant survival difference between the treatment arms. Quality-of-life assessments revealed no major differences between the randomized groups.

CONCLUSION: EP is superior to CEV in LD-SCLC patients. In ED-SCLC patients, the benefits of EP and CEV chemotherapy seem equivalent, with similar survival time and quality of life.

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