Intensive chemotherapy of small cell bronchogenic carcinoma

Thirty two patients (27, extensive disease; 5, regional disease) with histologically documented small cell carcinoma entered a randomized study to determine the efficacy of intensive induction chemotherapy. The necessity of a protected environment (laminar air flow room) during this treatment was also evaluated. Patients received high dose or standard dose cyclophosphamide, methotrexate, and CCNU (CMC) during the first 6 wk of treatment. Subsequent maintenance therapy consisted of standard dose CMC until disease progression. In 23 patients treated with high dose chemotherapy there were responses in 96% (30% complete). Standard dose chemotherapy gave responses in 45%, none of which were complete. Median survival correlated with completeness of response and was 16+ months for the 7 complete responders. Patients receiving high dose CMC spent an average of 10 days with neutrophil counts <1000/mm ³. There was only one documented, non fatal infection. High dose chemotherapy gives better responses and longer survival than previously utilized standard doses of the same drugs. Patients could safely be treated in the hospital ward.