A phase II study of weekly alternating chemotherapy in extensive-stage small cell lung cancer

Despite the recent development of new chemotherapeutic agents with activity in small cell lung cancer (SCLC), the long-term prognosis of patients with extensive-stage disease remains poor and has not improved in the past 20 y ears. The present study was designed to evaluate the activity and toxicity of weekly. alternating-regimen chemotherapy in patients with extensive-stag e SCLC. Patients with previously untreated extensive-stage SCLC and perform ance status 0-2 were treated with cyclophosphamide 250 mg/m(2), etoposide 1 00 mg/m(2), and cisplatin 50 mg/m(2) on day I; vincristine I mg/m2 on day 8 ; and ifosfamide 1.2 gm/m(2) on days 8 and 9 with the entire treatment repe ated every 14 days. Eighteen patients received chemotherapy for a median of 14 weeks (range, 1-35 weeks). Seventeen patients (94%) required dose delay s and 16 patients (89%) required at least one dose reduction due to toxicit y. Twelve patients (67%) exhibited cm objective response (I complete re spo nse, I I partial response) with a median duration of response of 18 weeks ( range, 8-32 weeks). Median survival was 33 weeks (range, 1-57 weeks) with a I-year survival rate of 22%. Toxicity was primarily hematologic, including grade 3-4 leukopenia (82% of patients) and anemia (53% of patients). Only 2 patients developed grade 3 peripheral neuropathy and none exhibited grade 3-4 renal insufficiency. This regimen of weekly alternating combination ch emotherapy resulted in tolerable toxicity as well as response and survival rates comparable to those achieved with standard chemotherapy in patients w ith extensive-stage SCLC. However, weekly chemotherapy regimens for the tre atment of SCLC remain investigational.