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Intensive induction chemotherapy in 54 patients with small cell carcinoma of the lung.

Fifty-four patients with localized and extensive small cell carcinoma of the lung and no prior therapy were treated with intensive induction chemotherapy. The induction regimen consisted of two courses of high-dose cyclophosphamide, doxorubicin, and VP-16-213. The objective response rate was 78% (42 responses among 54 patients), with 14 complete (26%) and 28 partial (52%) responses. The median survival time for the entire group of patients is 378 days, with a projected 2-year survival rate of 22%. The most significant determinant of survival was the attainment of a complete response. Tumor progression in most relapsing patients occurred at the sites of initial involvement. Toxicity was significant, as expected, but treatment-related mortality did not exceed that of less intense regimens. Despite the use of such intensive induction regimens, the major challenge in the therapy for small cell carcinoma remains the achievement of more durable complete remissions.