Standard combination versus alternating chemotherapy in small cell lung cancer - A randomised clinical trial including 394 patients

Purpose: to compare standard and alternating administration of chemotherapy combinations in small cell lung cancer (SCLC) patients. Material and metho ds: in a multicenter clinical trial, 394 previously untreated SCLC patients were randomised to receive, every 4 weeks, eight courses of either a stand ard regimen with CCNU, cyclophosphamide, adriamycin (CCA) and VP16 or an al ternating regimen (CCA regimen alternating with cisplatin-vindesine-VP16). Results: overall response rate was higher in the standard group (78%) than in the alternating group (64%) (P = 0.0001). Complete response rate was als o higher in the standard group (32%) than in the alternating group (18%) (P = 0.004). The median survival in the overall SCLC population was 306 days in the standard group and 272 days in the alternating group (P = 0.08). In limited SCLC patients, median survival was higher in the standard group (42 1 days) than in the alternating group (328 days) (P = 0.01). Grade III/IV h aematological toxicity was lower in patients in the alternating group (25 v ersus 47%) (P < 0.001). Conclusion: the standard regimen was better than th e alternating regimen for patients with limited forms of SCLC. The alternat ing regimen, associated with better haematological safety and ensuring a fa irly similar survival, may be considered in patients with extensive SCLC. P leiomorphic resistance mechanisms to chemotherapy make iii difficult to def ine a non-cross-resistant chemotherapy regimen. (C) 1999 Elsevier Science I reland Ltd. All rights reserved.