Journal of Clinical Oncology, Vol 5, 1874-1879, Copyright © 1987 by American Society of Clinical Oncology
A phase II trial of cyclophosphamide, etoposide, and cisplatin with combined chest and brain radiotherapy in limited small-cell lung cancer: a Cancer and Leukemia Group B Study
DJ Kwiatkowski, KJ Propert, RW Carey, N Choi and M Green
Department of Medicine, Harvard Medical School, Boston, MA.
Limited-extent small-cell lung carcinoma (SCLC) remains a therapeutic
problem with little improvement in complete response (CR) rates and
long-term survival in the past 5 years. From June 1984 through January
1985, 56 patients with limited-extent SCLC were enrolled in a Cancer and
Leukemia Group B (CALGB) phase II study using five cycles of
cyclophosphamide (500 mg/m2 intravenously [IV] day 1), etoposide (80 mg/m2
IV days 1 to 3), and cisplatin (33 mg/m2 IV days 1 to 3) administered at
3-week intervals (CEP), with radiation therapy (50 Gy to chest and 30 Gy to
brain) administered concomitant with cycles 4 and 5, followed by three
cycles of cyclophosphamide (500 mg/m2 IV day 1), etoposide (80 mg/m2 IV
days 1 to 3), and doxorubicin (50 mg/m2 IV day 1). Of 49 patients evaluable
for response, the overall response rate was 88%, with 57% CRs. The median
overall survival was 14 months; the median duration of CR was 10 months,
and nine CRs remain disease free at a median follow-up of 23 months.
Toxicity was significant: 56% patients experienced WBC less than 1,000
microL, 32% platelets less than 25,000 microL and 10% hemoglobin less than
7 g/dL. There was one treatment-related septic death. These results are as
good as the best previous CALGB study of SCLC, despite a reduction in
duration of treatment from 18 to 5 months. We are currently using a variant
of this multimodality treatment approach as our standard management for
patients with limited-extent SCLC.
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