Treatment of patients with small‐cell lung cancer at the Memorial Sloan‐Kettering Cancer Center, 1974–1979

Small cell lung cancer (SCLC) has long been recognized as perhaps the most radiosensitive of all carcinomas, but radiotherapy alone is clearly inadequate treatment. The fact that SCLC has a tendency toward early and wide dissemination suggests that chemotherapy might be an important means of tumor control. From July, 1974, to March, 1978, a total of 101 patients were treated at Memorial Sloan‐Kettering Cancer Center on 3 protocols designed for SCLC. The initial regime (COMA) combined vincristine, methotrexate, and high doses of cyclophosphamide. Radiation therapy was employed in most patients with limited disease. Complete response (CR) rate was 17%. BCNU and procarbazine were added to the regimen, and radiation was not part of the primary treatment. Neither the total response rate nor the CR was significantly different from those obtained with the COMA regimen. In the third regimen, DDP and VP‐16 were combined; after 2 such cycles, the patients received CAV for 4 cycles and then were switched back to DDP and VP‐16. Prophylactic cranial irradiation was incorporated into this program. CR rate was 47% and median survival in excess of 18 months. Responses were maximal by the end of the first 6 weeks of treatment. Recent studies include the modifications of abandonment of fixed time intervals for recycling treatment and reintroduction of radiation therapy to the primary complex. Of 43 patients so treated, the CR rate from chemotherapy induction is 62%; after conclusion of radiation, 83% are in CR. However, acute toxicity is significantly greater than that of our previous programs.