DOSE-EFFECT OF CHEMOTHERAPY IN SMALL CELL LUNG-CARCINOMA

Treatment of patients with small-cell lung cancer (SCLC) remains disap pointing despite high initial complete response rate. The dramatic ini tial chemosensitivity of tumor cells is frustrated by the early emerge nce of chemoresistant clonogenic cells, regardless of front line treat ments. Enhancement of dose-intensity (DI) can be achieved by various s trategies: initial or late intensive chemotherapy with the use of hema tological supports, moderate increase in the initial dose of chemother apy or intensive weekly chemotherapy. Although the dose relationship i s fairly well established regarding the response rate, the effect of D I on survival is not clearly show in the most of the different trials. But the effect of a moderate increase in the initial dose of cisplati num and cyclophosphamide on survival, opens new directions in the ther apeutic strategy of SCLC. The contribution of hematopoietic growth fac tors and reinfusion of hematopoietic progenitors may be of great inter est in the management of this disease.