Skip to main content
NCBI home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1993 Dec;68(6):1157–1166. doi: 10.1038/bjc.1993.497

A randomised trial of three or six courses of etoposide cyclophosphamide methotrexate and vincristine or six courses of etoposide and ifosfamide in small cell lung cancer (SCLC). II: Quality of life. Medical Research Council Lung Cancer Working Party.

N M Bleehen, D J Girling, D Machin, R J Stephens
PMCID: PMC1968653  PMID: 7505104

Abstract

A total of 458 eligible patients, from 21 centres, with microscopically confirmed SCLC were allocated at random to three chemotherapy regimens, each given at 3-week intervals. In two regimens, etoposide, cyclophosphamide, methotrexate and vincristine were given for a total of either three courses (ECMV3) or six courses (ECMV6). In the third regimen, etoposide and ifosfamide were given for six courses (E16). Patients with limited disease also received radiotherapy to the primary site after the third course of chemotherapy in all three groups. As reported by clinicians, 59% of the ECMV3, 67% of the ECMV6 and 63% of the EI6 patients experienced moderate or severe adverse reactions to their chemotherapy. The major symptoms of disease, cough, haemoptysis, chest pain, anorexia, and dysphagia, were palliated in 63% or more of patients and the median duration of palliation was 63% or more of survival, the results being similar in the three groups. Among patients with poor overall condition, physical activity and breathlessness on admission, the proportions who improved were higher in the EI6 group but the differences were small. In all three groups, levels of anxiety fell substantially during treatment. Levels of depression were lower and showed little change. As assessed by patients using a daily diary card, the patterns of nausea, vomiting, activity and mood, associated with courses of chemotherapy were very similar in the three groups. In the EI6 group there was less dysphagia and better overall condition between courses, but these advantages need to be weighed against the inconvenience of the 24-h infusions required, compared with the 30-min infusions of the other two regimens. As reported in the companion paper (MRC Lung Cancer Working Party, 1993a) there was no statistically significant survival advantage to any of the three regimens, although the results do not exclude the possibility of a minor survival advantage with the two six-course regimens. In conclusion, there was no major clinical gain from continuing chemotherapy beyond three courses or from using the ifosfamide regimen.

Full text

PDF
1157

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brock N., Pohl J. The development of mesna for regional detoxification. Cancer Treat Rev. 1983 Sep;10 (Suppl A):33–43. doi: 10.1016/s0305-7372(83)80005-x. [DOI] [PubMed] [Google Scholar]
  2. Cullen M., Morgan D., Gregory W., Robinson M., Cox D., McGivern D., Ward M., Richards M., Stableforth D., Macfarlane A. Maintenance chemotherapy for anaplastic small cell carcinoma of the bronchus: a randomised, controlled trial. Cancer Chemother Pharmacol. 1986;17(2):157–160. doi: 10.1007/BF00306746. [DOI] [PubMed] [Google Scholar]
  3. Earl H. M., Rudd R. M., Spiro S. G., Ash C. M., James L. E., Law C. S., Tobias J. S., Harper P. G., Geddes D. M., Eraut D. A randomised trial of planned versus as required chemotherapy in small cell lung cancer: a Cancer Research Campaign trial. Br J Cancer. 1991 Sep;64(3):566–572. doi: 10.1038/bjc.1991.351. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fayers P. M., Bleehen N. M., Girling D. J., Stephens R. J. Assessment of quality of life in small-cell lung cancer using a Daily Diary Card developed by the Medical Research Council Lung Cancer Working Party. Br J Cancer. 1991 Aug;64(2):299–306. doi: 10.1038/bjc.1991.296. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Fayers P. Quality-of-life assessment in small cell lung cancer. Pharmacoeconomics. 1992 Sep;2(3):181–188. doi: 10.2165/00019053-199202030-00001. [DOI] [PubMed] [Google Scholar]
  6. Ganz P. A., Figlin R. A., Haskell C. M., La Soto N., Siau J. Supportive care versus supportive care and combination chemotherapy in metastatic non-small cell lung cancer. Does chemotherapy make a difference? Cancer. 1989 Apr 1;63(7):1271–1278. doi: 10.1002/1097-0142(19890401)63:7<1271::aid-cncr2820630707>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  7. Geddes D. M., Dones L., Hill E., Law K., Harper P. G., Spiro S. G., Tobias J. S., Souhami R. L. Quality of life during chemotherapy for small cell lung cancer: assessment and use of a daily diary card in a randomized trial. Eur J Cancer. 1990 Apr;26(4):484–492. doi: 10.1016/0277-5379(90)90022-l. [DOI] [PubMed] [Google Scholar]
  8. Giaccone G., Dalesio O., McVie G. J., Kirkpatrick A., Postmus P. E., Burghouts J. T., Bakker W., Koolen M. G., Vendrik C. P., Roozendaal K. J. Maintenance chemotherapy in small-cell lung cancer: long-term results of a randomized trial. European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group. J Clin Oncol. 1993 Jul;11(7):1230–1240. doi: 10.1200/JCO.1993.11.7.1230. [DOI] [PubMed] [Google Scholar]
  9. Miles D. W., Earl H. M., Souhami R. L., Harper P. G., Rudd R., Ash C. M., James L., Trask C. W., Tobias J. S., Spiro S. G. Intensive weekly chemotherapy for good-prognosis patients with small-cell lung cancer. J Clin Oncol. 1991 Feb;9(2):280–285. doi: 10.1200/JCO.1991.9.2.280. [DOI] [PubMed] [Google Scholar]
  10. Slevin M. L., Plant H., Lynch D., Drinkwater J., Gregory W. M. Who should measure quality of life, the doctor or the patient? Br J Cancer. 1988 Jan;57(1):109–112. doi: 10.1038/bjc.1988.20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Slevin M. L. Quality of life: philosophical question or clinical reality? BMJ. 1992 Aug 22;305(6851):466–469. doi: 10.1136/bmj.305.6851.466. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Spiro S. G., Souhami R. L., Geddes D. M., Ash C. M., Quinn H., Harper P. G., Tobias J. S., Partridge M., Eraut D. Duration of chemotherapy in small cell lung cancer: a Cancer Research Campaign trial. Br J Cancer. 1989 Apr;59(4):578–583. doi: 10.1038/bjc.1989.117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x. [DOI] [PubMed] [Google Scholar]
  14. de Haes J. C., van Knippenberg F. C., Neijt J. P. Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist. Br J Cancer. 1990 Dec;62(6):1034–1038. doi: 10.1038/bjc.1990.434. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES