SYMPTOMATIC, STAGE-IV, NON-SMALL-CELL LUNG-CANCER (NSCLC) - RESPONSE,TOXICITY, PERFORMANCE STATUS CHANGE AND SYMPTOM RELIEF IN PATIENTS TREATED WITH CISPLATIN, VINBLASTINE AND MITOMYCIN-C

In a series of 46 symptomatic patients with metastatic, stage IV, non- small-cell lung cancer (NSCLC), we used a three-drug combination with cisplatin (120 mg/m2), vinblastine (6 mg/m(2)) and mitomycin-C (6 mg/m (2)) (PVM), repeated every 3 weeks. After two courses, we observed tha t none of the patients had achieved a complete response; 33% (15/46) h ad partial response (95% confidence limits: 19.2-46.8); 39% (18/46), s table disease and 28% (13/46), progressive disease. Median response du ration was 14.0 weeks (range, 4-36.7), median time to progression 22.4 weeks (range, 7-44.4), and median survival time 26.4 weeks (range, 1- 103). WHO grade III-IV myelotoxicity occurred in 15.2% of the courses administered, affecting 39.5% of patients, and severe nephrotoxicity w as observed in 9.3% of patients. No toxic death occurred. The post-tre atment KPS score increased in 7 patients with partial response (47%), 4 with stable disease (22%) and 1 with progressive disease (8%), while it decreased in 3 patients with partial response (20%), 3 with stable disease (17%) and 10 with progressive disease (77%). In all, KPS incr eased in 12/46 cases (26%). However, no statistically significant diff erence was observed when the KPS score before and after treatment was compared in the total group of patients or when it was compared in res ponders and in non-responders. After chemotherapy, there was complete disappearance of at least one symptom in 27.1% of cases and improvemen t in 27.1%. Overall, major symptom control occurred in 54.3% of cases, with a median palliation time lasting 10 weeks (range, 4-32). Patient s with partial remission and stable disease achieved symptomatic palli ation in 90% and 55.5% of cases, respectively. When we compared the pa lliation rate between responders and non-responders, a significant dif ference was noted (Chi-square test: P < 0.05). Although our schedule d id not produce a higher objective response rate and the KPS score was not significantly improved, the symptom palliation appeared worthwhile considering the highly unfavourable prognosis of the patients investi gated.