Concomitant brain radiotherapy and vinorelbine-ifosfamide-cisplatin chemotherapy in brain metastases of non-small cell lung cancer

Aim: To determine whether or not brain radiotherapy and concomitant three-d rug chemotherapy is feasible and yields anti-tumour activity in patients wi th non-small cell lung cancer and brain metastases at time of presentation. Patients and methods: Twenty-three previously untreated patients suffering from non-small cell lung cancer and brain metastasis were prospectively in cluded in this feasibility study. Most of the patients had neurological sym ptoms and an Eastern Collaborative Oncology Group (ECOG) performance index over 2. Treatment consisted of three courses of whole brain radiotherapy (1 8 Gy in 10 fractions) and vinorelbine, 30 mg/m(2) on days 1 and 8, ifosfami de, 1.5 g/m(2) daily from day 1 through day 3 with uromitexan uroprotection , and cisplatin, 100 mg/m(2) on day 2. A cycle restarted every 28 days. Res ults: Eighteen patients completed the three-cycle programme. All patients w ere affected by a grade 4 neutropenia and 14 of them experienced a febrile episode. Other toxicities were mild to moderate and manageable. Received-do se intensities of vinorelbine, ifosfamide and cisplatin were 80, 90 and 90% , respectively. Overall response rate was 30%. Specific evaluation of brain response demonstrated complete response for seven patients, and partial re sponse in six (objective brain response rate, 56%). All responders benefite d by a remission of symptoms and improvement of performance index. Median s urvival from start of protocol was 7.6 months. Conclusion: Although the hig h rate of toxicity requiring re-admission, concomitant brain radiotherapy p lus vinorelbine, ifosfamide and cisplatin chemotherapy is feasible in patie nts suffering from brain metastasis, and demonstrates an anti-tumour activi ty for this particular subset of stage IV non-small cell lung cancer. The d evelopment of such an aggressive approach needs further comparative evaluat ion. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.