Chemotherapy of non-small cell lung cancer: Clinical trials at the Memorial Sloan-Kettering Cancer Center

Bronchogenic carcinoma is one of the most difficult and pressing problems in cancer therapy. Overall survival of 799 primary cases at Memorial Sloan-Kettering Cancer Center was 7.8%, reflecting the advanced nature of most lung cancer at the time of presentation and the inadequacy of current local therapies as potential cures. The need for effective systemic therapy having acceptable toxicity is obvious. From 1972 to 1975, four combination drug regimens were tested at the Center: MAV, MFC, CAMF, and VAB. Despite the lack of significant responses, the median survival was 2.5 to 6 months. A subsequent study of the effect of high doses of cyclophosphamide, followed by high doses of methotrexate with leukovorin rescue, produced significant toxicity; partial responses were seen in 5/20 patients. Other agents tested have included pyrazofurin, vindesine, chlorozotocin, PCNU, PALA, m-AMSA, and interferon. Only vindesine has shown promise. Recent trials of cisplatin (DDP) in combination with vindesine have been encouraging. Eighty-one patients with measurable inoperable non-small cell lung cancer have been treated with this combination. Toxicity has been easily managed. Complete or partial responses have been demonstrated in 43 percent of 35 patients. Duration of response has been significantly greater for patients receiving high-dose DDP as compared to low-dose DDP. Addition of cyclophosphamide to the regimen appeared to offer no obvious advantages. Future studies include a clinical trial of the DDP-vindesine combination in the adjuvant setting.