Epoetin alpha prevents anaemia and reduces transfusion requirements in patients undergoing primarily platinum-based chemotherapy for small cell lung cancer.

Anaemia commonly occurs in cancer patients receiving chemotherapy, often necessitating blood transfusion. This multicentre study was designed to evaluate the efficacy and safety of epoetin alpha in preventing the decline in haemoglobin (Hb) level, and to determine whether the transfusion requirement could be reduced, in patients receiving 4-6 cycles of primarily platinum-based combination cyclic chemotherapy for small cell lung cancer (SCLC). A total of 130 non-anaemic SCLC patients were randomized to receive no additional treatment (n = 44), epoetin alpha 150 IU kg(-1) subcutaneously (s.c.) three times a week (n = 42) or 300 IU kg(-1) s.c. three times a week (n = 44). Reductions in epoetin alpha dosage were made during the study if Hb level increased to >15 g dl(-1). The mean weekly dosage was 335 and 612 IU kg(-1), respectively, in the two active treatment groups. Significantly fewer (P < 0.05) epoetin alpha-treated patients experienced anaemia (Hb < 10 g dl(-1)) during the course of chemotherapy (300 IU kg(-1), 39%; 150 IU kg(-1), 48%; untreated, 66%). This was reflected in the significantly lower number of treated patients transfused [300 IU kg(-1), 20% (P< 0.001); 150 IU kg(-1), 45% (P< 0.05); untreated, 59%]. Epoetin alpha was well-tolerated, and there was no evidence of sustained, clinically significant, hypertension. In summary, epoetin alpha is effective and well-tolerated in maintaining Hb level and reducing transfusion requirement in patients undergoing cyclic chemotherapy for SCLC.

Metastatic carcinoma of uncertain primary site: a retrospective review of 57 patients treated with vincristine, doxorubicin, cyclophosphamide (VAC) or VAC alternating with cisplatin and etoposide (VAC/PE).

BACKGROUND: Metastatic carcinoma of uncertain primary site (CUPS) is a common problem and has a poor prognosis. The intention of this study was to determine whether the addition of cisplatin and etoposide (PE) to vincristine, doxorubicin and cyclophosphamide (VAC) chemotherapy improves outcome. METHODS: Fifty-seven consecutive patients with an initial diagnosis of CUPS were studied. The first 40 patients had received six or 10 cycles of VAC and 17 patients VAC alternating with PE for six cycles. Review of histology using immunohistochemical techniques where appropriate was performed in all cases. RESULTS: Histologic review resulted in six tumors reclassified as non-Hodgkin's lymphoma (NHL), one as hepatocarcinoma, and one as adenocarcinoma. Six of the 11 responses occurred in patients with a review diagnosis of NHL. If the six cases of NHL and the case of hepatocarcinoma were excluded, there was no difference in survival between VAC and VAC/PE treated patients. Five patients with true CUPS who responded to VAC or VAC/PE had poorly differentiated histology, and this group (n = 24) also had a significantly longer survival. CONCLUSIONS: Some patients thought to have CUPS actually have NHL, and it is this group which responds well to chemotherapy. True CUPS patients respond to chemotherapy only if the tumor is poorly differentiated; survival is significantly longer for this group of patients. An advantage for VAC/PE over VAC chemotherapy was not identified.

Ifosfamide and mitomycin in combination for the treatment of patients with progressive advanced non-small cell lung cancer.

42 patients with progressive and advanced non-small cell lung cancer received chemotherapy comprising ifosfamide 1.5 g/m2, mesna 1.5 g/m2 and mitomycin 1.2 mg/m2 daily for 5 days. Only those patients with symptoms and progressive disease were selected for treatment. Partial response was achieved in 10/42 patients (23.8%) and stable disease in 25/42 (59.5%). The Karnofsky performance status (KP) improved in 10/42 patients (23.8%) and a subjective respiratory symptom score improved in 12 patients (28.6%). In addition 27 patients (64.3%) had stabilisation of both the KP and respiratory score following chemotherapy. These results indicate that the ifosfamide and mitomycin combination is active in non-small cell lung cancer in this selected group of patients with antitumour and symptom control activity.