Etoposide/vincristine-based chemotherapy with or without carboplatin in extensive-stage small cell lung cancer: a prospective randomized phase III trial.

In the treatment of small cell lung cancer, carboplatin/etoposide/vincristine (CEV) is one of the most active regimens. In contrast, the etoposide/vincristine (EV) combination also has produced acceptable results in patients with extensive disease. To evaluate the efficacy and survival of patients treated with EV in comparison to those treated with more intensive CEV chemotherapy, a prospective, randomized, phase III trial was performed. The protocol for the treatment groups was as follows: treatment A (156 patients): carboplatin 300 mg/m2 day I, etoposide 140 mg/m2 days 1 through 3, and vincristine 1.4 mg/m2 days 1, 8, and 15; and treatment B (161 patients): etoposide 200 mg/m2 days 1 through 3 and vincristine 1.4 mg/m2 days 1 and 8. Chemotherapy cycles in each treatment arm were repeated every 4 weeks. Doses were reduced by 20% when hematologic or nonhematologic toxicity (grade 4) occurred. In all, 317 evaluable patients were treated. The overall response rate for patients treated with CEV was 79.8% compared with 59.8% for those treated with EV (P < .001). The median length of survival was 10 months for CEV-treated patients compared with 9 months for EV-treated patients (P = .19). Based on long-term survival rates, there was an advantage for the CEV-treated patients if they had good performance status, were younger than 60 years, had no distant metastases, and achieved a complete response to first-line therapy. We conclude that patients with poor prognostic factors (ie, poor performance status, multiple distant metastases, and less than partial response to the first cycle of chemotherapy) should appropriately be treated with the less aggressive two-drug combination chemotherapy. On the other hand, patients with good prognostic factors should be treated as aggressively as possible, and they will benefit from the more aggressive induction chemotherapy.

Carboplatin/etoposide/vincristine therapy in small cell lung cancer.

Carboplatin is one of the most active agents in untreated small cell lung cancer (SCLC; 14% complete response, CR; and 61% CR + partial response, PR). The combination carboplatin/etoposide/vincristine (CEV) (phase II trial) led to an overall remission rate of 84% in patients with limited disease, with 52% CR. The median survival time with this combination was 13 months in patients with limited disease and 9.5 months in those with extensive disease. The 4-year survival rates are 26% in limited disease and 8% in extensive disease, with a plateau of the survival curve. This regimen is highly effective and exhibits low toxicity in SCLC. To evaluate the role of carboplatin in combination chemotherapy in patients with extensive SCLC, a phase III trial was performed. In this ongoing trial comparing CEV and etoposide/vincristine in SCLC patients with extensive disease, CR and overall response rates are higher in the CEV arm (CR 32 vs. 17%, CR + PR 80 vs. 60%), with statistically significant difference. In summary, chemotherapy regimens containing platinum compounds are among the most active in the treatment of SCLC. The use of the new compound carboplatin instead of cisplatin has led to similar or increased remission rates and is preferable because it has fewer side effects. Preliminary results from this ongoing, prospective, randomized phase III trial will be presented.

[Tuberculous encephalitis--a complication of lung tuberculosis]. / Enzephalitis tuberculosa--eine Komplikation bei Lungentuberkulose.

On the basis of a number of cases, the symptomatology and the diagnostic work-up of encephalitis tuberculosa are presented. All the patients had neurological findings, which in some cases were masked. Although computed tomography of the head and CSF examination provide sensitive, but nonspecific findings, the diagnosis would not have been established without a detailed knowledge of the clinical picture. A greater incidence of complications than has previously been assumed, is postulated.

[Churg-Strauss syndrome]. / Churg-Strauss-Syndrom.

The Churg-Strauss syndrome, or allergic angiitis and granulomatosis of the lungs, is one of the systemic vasculitides with predominantly involvement and an unclear genesis. The clinical picture is characterized by a combination of intrinsic bronchial asthma, eosinophila with elevated IgE, and systemic vasculitis of the small blood vessels. Apart from the lungs, other organ systems may also be involved. We report, here, on a case, observed for a period of eight months, that showed complete remission under treatment with corticosteroids.

[Polychemotherapy of non-small cell bronchial cancer with mitomycin C, ifosfamide and vindesine]. / Polychemotherapie beim nicht kleinzelligen Bronchialkarzinom mit Mitomycin C, Ifosfamid und Vindesine.

The results of antineoplastic polychemotherapy in non-small-cell carcinomas of the lungs revealed on overall remission rate of 42.1%, with a distribution from limited to extensive disease of approximately 32% to 58%. Severe undesired side effects of the treatment were not observed, the duration of remission was, on average, 78 days, and the survival period 101 days.

[Determination of tumor markers NSE and CEA in patients with various lung diseases, especially carcinomas]. / Die Bestimmung der Tumormarker NSE und CEA bei Patienten mit verschiedenen Lungenerkrankungen, insbesondere Karzinomen.

Serum neuron-specific enolase (NSE) and carcinoembryonic antigen (CEA) are two very good tumor markers for diagnosis and for monitoring response to therapy in patients with lung carcinoma. Especially, NSE has a high sensitivity and specificity for early detection of small-cell lung cancer and for management of these patients.