COMP-VAN Alternating Chemotherapy in Patients with Small Cell Lung Cancer 1 A Long-term Follow-up

We evaluated the long-term outcome of 112 patients with small cell lung cancer (SCLC) treated with COMP-VAN alternating chemotherapy between 1981 and 1986. The chemotherapy consisted of a combination of cyclophosphamide, vincristine, methotrexate, and procarbazine (COMP), alternating every four weeks with a combination of etoposide, adriamycin, and nimustine (VAN). Randomized trials of chest irradiation (chest RT) of 40 Gy for patients with limited disease (LD) and prophylactic cranial irradiation (PCI) of 40 Gy for complete responders were conducted simultaneously. Fifty-four patients with LD and 56 with extensive disease (ED) were fully evaluated. Two patients who developed fatal radiation-induced pneumonitis were excluded from the evaluation of tumor response and relapse site. The overall response rate was 89% for both LD and ED patients, with a CR rate of 56% for LD and 32% for ED patients. The median survival time was 14.5 months for LD patients and 11.1 months for ED patients, and the 3-year, 5-year and 10-year survival rates were 17.9%, 14.3%, 9.4% for LD patients and 3.6%, 0%, 0% for ED patients, respectively. Cumulative actuarial relapse rate in the chest or brain was significantly less frequent in the chest RT group and PCI group than the respective control groups, however, no meaningful survival benefit was obtained by chest RT and/or PCI. The dose-limiting toxicity for chemotherapy was leukopenia, and 70% of patients encountered grade 3 or 4 leukopenia. With chest RT, esophageal irritation occurred in 46% of patients irradiated, but it was well tolerated. Radiation pneumonitis occurred in 29% of those irradiated, including 2 fatal episodes. Although a substantial proportion of patients achieved a, long-term survival by the alternating chemotherapy, further investigation is required to achieve better outcome in the treatment of SCLC.