Evaluation of combined chemotherapy with vinorelbine, ifosfamide and cisplatin in the treatment of metastatic non-small cell bronchial carcinoma

Introduction In France, cancer of the bronchus is responsible for 25,000 deaths per year. Non small cell lung cancer (NSCLC) represents 80% of bronchial carcinoma of which 40-50% are metastatic at the time of diagnosis. At present, although the therapeutic benefits are modest, it is now recognised that combination chemotherapy including platinum salts improves the survival of these patients. Methods We analysed retrospectively a cohort of 57 patients suffering from stage IV NSCLC treated with chemotherapy combining cisplatin (80 mg/m(2) on day 1), vinorelbine (25 mg/m(2) on days 1 and 8) and ifosfamide (3000 mg/m(2) on day 1), (NIP), repeated every 21 days. Results The population studied comprised 6 women and 51 men, of average age 59.8 +/- 9.1 years. A history tobacco use (smokers and ex-smokers) was identified in 93%. The WHO performance index was equal to or greater than 2 in 22.8%. All patients were studied in terms of toxicity and overall survival but only 40 (70%) were able to be evaluated in terms of response to treatment (on account of having received more than three cycles of NIP chemotherapy). For the group considered as a whole, the median survival was 6.7 months with a one year survival of 24.5%. Median survival without progression was 4.4 months. The most frequent toxicities were haematological and digestive. They were most common among patients over the age of 70 but had no effect on median survival. For the 40 patients for whom chemotherapy was evaluable, the objective response rate was 20%. This objective response was the only factor that was significantly correlated with one year survival: 62.5% in responders, 28.1% in non-responders (p < 0.05). Conclusion Treatment of stage IV NSCLC with NIP chemotherapy is effective and improves the survival of these patients independently of other prognostic factors such as age, the presence of cerebral metastases, performance status, histological type, the number of metastatic sites or the serum LDH level.