Chest
Volume 119, Issue 2, February 2001, Pages 340-343
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Clinical Investigations
Lung Cancer
Combination Chemotherapy in Patients With Malignant Pleural Effusions From Non-small Cell Lung Cancer: Cisplatin, Ifosfamide, and Irinotecan With Recombinant Human Granulocyte Colony-Stimulating Factor Support

https://doi.org/10.1378/chest.119.2.340Get rights and content

Objectives

Malignant pleural effusions developfrequently in patients with non-small cell lung cancer (NSCLC), and theprognosis for these patients is very poor. We evaluated the role ofsystemic chemotherapy for patients with malignant pleural effusionsfrom NSCLC.

Methods

We analyzed 34 patients who werefound to have malignant pleural effusions in the course of diagnosis of118 patients enrolled in three consecutive clinical trials on advanced, NSCLC assessing combination chemotherapy of cisplatin, ifosfamide, andirinotecan with recombinant human granulocyte colony-stimulating factorsupport. The objective response in the malignant pleural effusion wasevaluated by CT scans every course with the response criteria of the, Japan Lung Cancer Society.

Results

All patients hadadenocarcinoma. The pleural effusion showed a complete response in 13patients, a partial response in 7 patients, and no response in 14patients. In the assessment of the efficacy of the treatment for themeasurable primary or metastatic lesions, there was a partial responsein 25 patients, no change in 8 patients, and progressive disease in 1patient. The response rate in pleural effusions was 58.8%, and overallresponse in mensurable lesions was 73.5%. The median time to responseand duration of response for pleural effusions were 54 days and 151days, respectively. The median survival time and 1-year survival rateswere 362 days and 48.5%, respectively.

Conclusions

Both the response rate and survival data in this retrospective studysuggest a high degree of activity of this combination chemotherapy inpatients with malignant pleural effusions from, NSCLC.

Section snippets

Materials and Methods

We analyzed 34 patients discovered to have histologically and/orcytologically proven malignant pleural effusion in the course ofdiagnosis of 118 patients entered in three consecutive clinical trialson advanced NSCLC. The protocols of the three trials are describedbelow. The first study, between May 1994 and June 1995, was a phase Istudy to determine the maximum tolerated dose of irinotecan combinedwith a fixed schedule of cisplatin and ifosfamide with rh, G-CSFsupport.4 Cisplatin, 20 mg/m2, and

Results

Patient characteristics are listed in Table 1. There were 18 men and 16 women, with a median age of 57 years (range, 43 to 72 years). All patients had adenocarcinoma. Twenty-two patientshad stage IV disease, and 12 patients had stage IIIB disease. The mostcommon sites for metastasis were the lung (11 patients), brain (7patients), and bone (6 patients). Five patients were asymptomatic atthe time of diagnosis. Fifteen patients presented with chest or backpain, 8 patients with dyspnea, and 6

Discussion

Malignant pleural effusions are a common presentation of NSCLC andcan reduce the quality of life. Most asymptomatic patients developincreasing pleural fluid that eventually evokes symptoms and requirespalliation. Therapeutic thoracentesis can provide temporary relief ofsymptoms but is associated with recurrence in a majority of patientswithin 1 to 3 days.9 The most common therapy for malignantpleural effusions is a chest tube drainage followed by intrapleuralinstillation of a sclerosing agent.

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