Journal of Clinical Oncology, Vol 7, 993-1002, Copyright © 1989 by American Society of Clinical Oncology
A randomized trial of anticoagulation with warfarin and of alternating chemotherapy in extensive small-cell lung cancer by the Cancer and Leukemia Group B
AP Chahinian, KJ Propert, JH Ware, B Zimmer, MC Perry, V Hirsh, A Skarin, S Kopel, JF Holland and RL Comis
Department of Neoplastic Diseases, Mount Sinai School of Medicine, New York.
The Cancer and Leukemia Group B (CALGB) conducted a prospective randomized
trial to evaluate the role of warfarin and alternating chemotherapy in
extensive small-cell lung cancer (SCCL). After stratification for sex and
performance status, patients were randomly assigned to receive chemotherapy
with methotrexate, doxorubicin (Adriamycin; Adria Laboratories, Columbus,
OH), cyclophosphamide, and lomustine (CCNU) (MACC), or MACC plus warfarin
(MACC + W), or mitomycin, etoposide, cisplatin, and hexamethylmelamine
alternating with MACC (MEPH/MACC). Warfarin was given continuously to
maintain a prothrombin time of one and one half to twice the control
values. A total of 328 patients were enrolled, and 294 were evaluable.
There was a statistically significant advantage in objective response rates
(complete [CR] and partial responses [PR], respectively) for MACC + W (17%
and 50%) as compared with MACC alone (8% and 43%) or MEPH/MACC (10% and
38%) (P = .012). Both failure-free survival (P = .054 Wilcoxon test) and
overall survival (P = .098 Wilcoxon test) were higher on MACC + W (median,
6.6 months and 9.3 months, respectively), as compared with MACC (5.0 months
and 7.9 months) and MEPH/MACC (5.0 months and 7.9 months). Toxicity was
comparable among the three arms, except for increased hemorrhagic events on
MACC + W, which were life-threatening in four patients (4%), and lethal in
two others (2%). These data support the role of warfarin in the treatment
of SCCL, but do not establish its mechanism of action. Warfarin deserves
further studies in SCCL, particularly in patients with limited disease.
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ANTICOAGULATION AS A TREATMENT FOR SMALL-CELL LUNG CANCER
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2 - 2.
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