Vindesine, cisplatin, and bleomycin combination chemotherapy in non-small cell lung cancer: survival and quality of life.
Although combination chemotherapy is applied on a large scale in advanced non-small cell lung cancer (NSCLC), we still lack evidence indicating in which subsets of patients survival or quality of life might be improved. We studied these issues among a sample of 28 NSCLC patients with a high performance status, who received a tri-weekly vindesine, cisplatin, and bleomycin combination. Treatment was extended for an additional two courses only if a response was observed after the initial three courses. An overall response rate of 13/27 evaluable patients (48%) was found (complete response 1/27 and partial response 12/27) with a median response duration of 24 weeks. Median survival was 33 weeks (47 for responders and 26 for non-responders). Toxicity was primarily related to cisplatin, including severe nausea and vomiting and nephrotoxicity in 68% and 21% of the patients, respectively. Performance status and body weight dropped significantly during chemotherapy both among responders and non-responders. Performance status after discontinuation of chemotherapy approached pre-treatment scores in responders only. While the antitumor effect of this drug combination was confirmed, we conclude that treatment-associated toxicity and deterioration of the patients' well-being offset any potential survival advantage for the majority of patients.