Forty-four patients with non-
small cell carcinoma of the lung were treated every 3 weeks with
vinblastine (4 mg/m2/day iv X 2) and
cisplatin (20 mg/m2/day iv X 3). Of the 28 patients with metastatic disease, eight (29%; 90% confidence interval of true response, 17%-47%) achieved objective response, for a median duration of 27 weeks. Median survival in this group was 47 and 28 weeks for responders and nonresponders, respectively. Of the 16 patients with advanced regional disease, 11 (69%; 90% confidence interval of true response, 49%-86%) achieved objective response. Thirteen of these patients received consolidation
radiotherapy (4500 cGy/25 fractions/5 weeks), with a boost of 1000 cGy/5 fractions/1 week in those patients who achieved response. In the three patients who did not receive
radiotherapy, two died during the induction phase, one from grade 4
leukopenia and
sepsis and the second from unrelated factors. The third patient had systemic progression of disease during
induction chemotherapy. Six patients experienced overall improvement in their
chemotherapy response from the
radiotherapy. Two patients who did not respond to the
chemotherapy achieved partial response with irradiation. Four patients who had partial response to the
chemotherapy achieved complete response with irradiation, and seven patients had no further change in their degree of response to irradiation. The overall median survival of this group was 81 weeks.
Maintenance chemotherapy was not given. After
radiotherapy, the site of first failure was outside the radiation field in nine of 13 patients (69%). Hematologic toxicity was dose-limiting. Other toxic effects that were not dose-limiting included nephrotoxicity, neurotoxicity, and acute
nausea and
vomiting. In the patients with advanced regional disease, there was no increase in the radiation toxicity attributable to the
chemotherapy. We conclude that: (a) this dose schedule of
vinblastine and
cisplatin has reproducible activity in non-
small cell carcinoma of the lung; (b) the response and median survival of patients with advanced regional disease are superior to those of patients with metastatic disease; and (c) in patients with advanced regional disease, treatment with
chemotherapy followed by
radiotherapy yielded an overall response rate of 81% (90% confidence interval of true response, 60%-93%) and improved survival compared to a similar group of patients studied by others receiving
radiotherapy alone. We recommend further testing of this concept.