DOSE INTENSIFICATION OF CHEMOTHERAPY AND THE ROLE OF GRANULOCYTE-COLONY-STIMULATING FACTOR AND GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR IN SMALL-CELL LUNG-CANCER

The natural history of small cell lung cancer (SCLC) is characterized by early dissemination. Despite the high responsiveness to chemotherap y, the disease remains ultimately fatal in the majority of patients. O ne of the strategies to improve final outcome is the administration of intensified chemotherapy, either by dose escalation or by chemotherap y given at shortened intervals. By now, in only one randomized study, in which cyclophosphamide and cisplatin dosage was escalated by 30% in the first course only, a survival advantage was demonstrated in limit ed disease patients. The different ways of achieving intensification o f chemotherapy are highlighted. The addition of growth factors in curr ent dose-escalated or accelerated schedules seems to result in a relat ive dose intensity of no more than 150% when compared to optimally del ivered conventional regimens. Whether such a moderate degree of dose i ntensification will improve survival rates has to be awaited from phas e III trials.