COMBINATION OF CHEMOTHERAPY AND RECOMBINANT ALPHA-INTERFERON IN ADVANCED NONSMALL CELL LUNG-CANCER - MULTICENTRIC RANDOMIZED FONICAP TRIAL REPORT

Background. Preclinical data suggested that alpha-interferon (IFN) may potentiate chemotherapy cytotoxicity. Methods. A prospective multicen tric randomized trial was initiated to assess the clinical benefit of adding recombinant alpha-2-IFN to combination chemotherapy in patients with metastatic non-small cell lung cancer. A total of 182 patients w ere randomized to receive either cisplatin-epidoxorubicin-cyclophospha mide (CEP) combination chemotherapy (cisplatin, 60 mg/m2; epidoxorubic in, 50 mg/m2; and cyclophosphamide, 400 mg/m2 intravenously) alone on day 1 or the same chemotherapy plus recombinant alpha-2-IFN at the dos e of 5 MU intramuscularly from day -2 to +4, then 3 times weekly. Resu lts. The median survival was 6 months in the CEP plus IFN arm versus 5 .5 months in the control arm. The log-rank test showed a marginal stat istically significant difference (P = 0.045) in favor of CEP chemother apy, which disappeared when survival curves were adjusted for prognost ic factors. Progression-free survival was similar in the two treatment arms. Considering all eligible patients, the response rate was 7.6% i n the CEP arm versus 18.9% in the CEP plus IFN arm (P = 0.042). Nearly 40% of the patients receiving IFN had grade 3-4 nadir leukopenia vers us 15% in the control arm (P = 0.01) and 12.5% versus 4.2% had grade 3 -4 thrombocytopenia. Apart from the usual constitutional symptoms, IFN was also responsible for increased emesis and mucositis. Conclusions. This study indicates that the addition of recombinant alpha-IFN to CE P chemotherapy can increase response rate and toxicity to treatment wi thout a positive effect on progression-free survival and survival.