A RANDOMIZED STUDY OF BOLUS VS CONTINUOUS PUMP INFUSION OF IFOSFAMIDEAND DOXORUBICIN WITH ORAL ETOPOSIDE FOR SMALL-CELL LUNG-CANCER

One hundred and fifty-nine previously untreated patients with small ce ll lung cancer (SCLC), who were not eligible for intensive chemotherap y, were entered into a randomised study of intravenous (IV) doxorubici n and ifosfamide (with mesna) and oral etoposide. The IV drugs were gi ven either by bolus therapy or by a continuous infusion (CI) pump over 7 days via a central venous line. Therapy was given for 6 weeks only. On weeks 1, 3 and 5 IV doxorubicin 35 mg m-2 was given with 5 days of oral etoposide 100 mg m-2 daily. On weeks 2, 4 and 6 IV ifosfamide 5 g M-2 was given with equidose mesna. The overall median survival was 2 5 weeks for patients in the bolus arm and 30 weeks for the CI therapy (P = 0.45). The overall response rate was 64% (18% complete response - CR) and 69% (30% CR) respectively (P = 0.13). The median WHO score fo r haematological toxicity was 4 for bolus therapy and 3 for CI therapy (P = 0.0007). Despite a trend for less supportive care for patients o n CI therapy there were no significant differences in the use of IV an tibodies and blood or platelet transfusions. There were fewer treatmen t delays due to myelotoxicity in the CI arm (P = 0.04). The median WHO score for non-haematological toxicity was 2 in both treatment groups. There was significantly less nausea (P = 0.037) but more mucositis (P = 0.01) in the CI arm. Weekly chemotherapy using CI treatment was as effective as bolus therapy. It was well accepted by patients. The asse ssment of quality of life in a subgroup of patients showed a statistic ally significant reduction in anxiety and depression for both groups o f patients during therapy.