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Journal of Clinical Oncology, Vol 19, Issue 5 (March), 2001: 1336-1343
© 2001 American Society for Clinical Oncology

Duration of Chemotherapy in Advanced Non–Small-Cell Lung Cancer: A Randomized Trial of Three Versus Six Courses of Mitomycin, Vinblastine, and Cisplatin

By Ian E. Smith, Mary E.R. O’Brien, Denis C. Talbot, Marianne C. Nicolson, Janine L. Mansi, Tamas F. Hickish, Alison Norton, Susan Ashley

From the Royal Marsden National Health Service Trust, London and Surrey; Kent Cancer Centre, Maidstone; Imperial Cancer Research Fund Medical Oncology Unit, Churchill Hospital, Oxford; Aberdeen Royal Infirmary, Aberdeen; St George’s Hospital, London; and Royal Bournemouth Hospital, Bournemouth, United Kingdom.

Address reprint requests to Ian Smith, MD, Royal Marsden National Health Service Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom; email: ian.smith{at}rmh.nthames.nhs.uk

PURPOSE: So far there are no published data on optimal duration of chemotherapy for advanced non–small-cell lung cancer (NSCLC); six or more courses are usually recommended. We have carried out a multicenter randomized trial comparing three versus six courses of chemotherapy.

PATIENTS AND METHODS: Patients with stage IIIb or IV NSCLC were randomized at start of treatment to receive either three or six courses of mitomycin 8 mg/m2 (courses 1, 2, 4, and 6), vinblastine 6 mg/m2, and cisplatin 50 mg/m2 (MVP) every 21 days. Treatment was stopped early in both arms for progressive disease or unacceptable toxicity. Key end points were overall survival, duration of symptom relief, and quality-of-life assessment using the European Organization for Research and Treatment of Cancer (EORTC) core questionnaire QLQ-C30 with lung cancer–specific module QLQ-LC13.

RESULTS: Three hundred eight patients were randomized. Seventy-two percent of the 155 patients randomized to three courses completed treatment. In the 153 patients randomized to six courses, 73% completed three courses and 31% six courses. Median survival was 6 versus 7 months, respectively, and 1-year survival 22% versus 25% (P = .2). Median duration of symptom relief was 4.5 months (both arms), and 8% versus 18% had continuing symptom relief (P = .4). Quality-of-life parameters were the same or improved for patients randomized to only three courses, including significantly decreased fatigue (P = .03) and a trend toward decreased nausea and vomiting (P = .06).

CONCLUSION: Our findings show no evidence for additional clinical benefit by continuing MVP chemotherapy beyond three courses. This challenges current orthodoxy of six courses or more. Further trials addressing duration of chemotherapy are now warranted, particularly with newer chemotherapy schedules.




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