Primary chemotherapy with adriamycin, cisplatin, vincristine and cyclophosphamide in locally advanced thymomas: a single institution experience

From 1990 to 1997, 16 consecutive patients with stage III and IVa invasive thymoma were treated in a single institution with primary chemotherapy cons isting in adriamycin (40 mg m(-2)), cisplatin (50 mg m(-2)) administered in travenously on day 1, vincristine (0.6 mg m(-2)) on day 2 and cyclophospham ide (700 mg m(-2) on day 4 (ADOC). The courses were repeated every 3 weeks. The aim was to evaluate the impact of this cytotoxic regimen with respect to response rate, per cent of patients radically resected, time to progress ion and overall survival. Two complete responses (one clinical and one path ological) and 11 partial responses were observed (overall response rate 81. 2%); two patients had stable disease and one progressed. Toxicity was mild as only two patients developed grade III/IV neutropenia and one patient gra de III nausea/vomiting. Nine patients were radically resected (five out of ten with stage III, and four out of six with stage IVa). Median time to pro gression and overall survival was 33.2 and 47.5 months respectively. Three patients were alive and disease free after more than 5 years. The ADOC sche me is highly active and manageable in the treatment of locally advanced thy moma. As a preoperative approach it should be offered to patients not amena ble to surgery or to those surgically resectable but with a great deal of m orbidity.