A RANDOMIZED TRIAL OF 3 OR 6 COURSES OF ETOPOSIDE CYCLOPHOSPHAMIDE METHOTREXATE AND VINCRISTINE OR 6 COURSES OF ETOPOSIDE AND IFOSFAMIDE INSMALL-CELL LUNG-CANCER (SCLC) .1. SURVIVAL AND PROGNOSTIC FACTORS

A total of 458 eligible patients, from 21 centres, with histologically or cytologically confirmed SCLC were allocated at random to three che motherapy regimens, each given at 3-week intervals. In two regimens, e toposide, cyclophosphamide, methotrexate and vincristine were given fo r a total of either three courses (ECMV3) or six courses (ECMV6). In t he third regimen, etoposide and ifosfamide were given for six courses (EI6). Patients with limited disease (56% of the total) also received radiotherapy to the primary site after the third course of chemotherap y in all three groups. A partial response occurred in 45% of 144 ECMV3 patients, 48% of 141 ECMV6, and 53% of 141 E16 patients assessed, and a complete response in a further 15%, 9%, and 13% respectively, givin g total response rates of 60%, 57%, and 67%, respectively. There was n o overall survival advantage to any of the three regimens. At 1 year, 24%, 29%, and 30% of patients were alive, and at 2 years 7%, 8%, and 9 %, respectively. The median survival time was 7.4 months in the ECMV3 group, 8.6 months in the ECMV6 group and 8.8 months in the E16 group. The individual factors: poor performance status, extensive disease, th e presence of dysphagia and a raised white blood cell count on admissi on adversely affected prognosis. The results do not exclude the possib ility of a minor survival advantage with the two 6-course regimens. Th e findings on quality of life are presented in the companion paper (MR C Lung Cancer Working Party, 1993b).