Ronald G. Vincent

The changing histopathology of lung cancer: a review of 1682 cases.

We have reviewed the histopathology of lung cancer patients seen over the past 13 years at RPMI. Assessment of this data indicates that adenocarcinoma is becoming progressively more prevalent as related to the other forms of lung cancer. Factors which in part may account for this increased prevalence are: 1) changes in criteria for reading histopathology of lung cancer, particularly since 1967; 2) the increased incidence of lung cancer among the female population who have a propensity for adenocarcinoma; and 3) occupational and environmental factors. In 1974 adenocarcinoma for the first time became the most prevalent type of lung cancer at RPMI. Whatever the reason, if our data are truly representative of a national trend, adenocarcinoma will soon become the most prevalent type of lung cancer in the United States. This fact may result in an increasing death rate since the present 18‐month survival rate for adenocarcinoma is substantially less than for squamous cell carcinoma, which has in the past been the prevalent form of the disease. As the smoking habits of women more closely approximate those of men, we expect that the incidence and mortality of lung cancer will prove to be quite similar in both sexes.

Phase II study—intra-arterial bcnu therapy for metastatic brain tumors

Thirty‐one patients with metastatic brain tumors (MBT) from lung cancer and ten patients with MBT from melanoma received BCNU, 100 mg/m2, every four weeks by intracarotid and/or vertebral artery infusion into each involved site. Twenty‐five patients with lung cancer and all melanoma patients are currently evaluable. Twelve patients with lung cancer had complete and partial responses lasting from 1 to 14 months. Four of them with the histologic diagnosis of small cell carcinoma, one with large cell carcinoma and one with squamous cell carcinoma showed complete responses. None of the patients with melanoma MBT experienced any response. All of the patients had periorbital erythralgia and/or occipital pain during the infusion. Four patients manifested mild focal seizures during the infusion or 6 to 24 hours after the treatment. Transient confusion with disorientation was observed in two patients 4 and 24 hours, respectively, after a BCNU infusion. Two patients developed reversible thrombocytopenia after the fifth course of the IA chemotherapy. Median survival of patients with MBT from lung carcinoma was 4 months, with two of them still alive at 10 and 14 months, respectively. Only one patient of the 25 with lung carcinoma died from MBT. Failure to control the primary disease resulted in the deaths of a vast majority of the patients.

Evaluation of methotrexate in the treatment of bronchogenic carcinoma

One hundred ninety‐five patients with disseminated bronchogenic carcinoma were treated with 10 different dosage schedules of methotrexate. Patient response to methotrexate therapy varied with the type of treatment, but overall, 18% of the patients treated responded to a measurable degree. Survival was not increased in any of the treatment categories when compared to a placebo group; however, the survival of patients that responded to therapy was greater than the survival of patients that did not respond to therapy. Methotrexate will find its greatest potential use in combination with other drugs proven to be effective in treating bronchogenic carcinoma.

Weight loss and Cachexia in lung cancer

Abstract Incidence, timing and severity of weight loss were studied in 479 patients with lung cancer. A phase of early weight loss, associated with a ∼ 50% reduction in survival, was identified. Food consumption was studied in normal individuals and in patients with and without weight loss. In these patients, anorexia failed to account for the weight loss. We discuss the possibility that weight loss results from interference by cancer with the metabolism of the host.

Progress in the chemotherapy of small cell carcinoma of the lung

A comparison was made between six different approaches to the chemotherapy of small cell carcinoma of the lung. The value of single‐agent chemotherapy was compared to combination chemotherapy and radiation therapy, and with cyclic alternating combination chemotherapy in 161 patients. Cyclic alternating chemotherapy with modest radiation therapy to the primary site provided significant advantages over single‐agent or combination chemotherapy. A combination of VP‐16 + Adriamycin + vincristine seemed particularly effective in inducing an initial objective tumor response rate of 83%, with a projected median survival of 13.2 months. Of patients treated with cyclic alternating therapy, 51% were alive at one year. It thus appears that where complete response is achieved, prolonged disease‐free survival can be expected.

Chemotherapy of extensive large cell and adenocarcinoma of the lung. A randomized trial in 210 patients

Two hundred ten patients with advanced adenocarcinoma of the lung were entered into a two‐arm randomized trail. Cytoxan + CCNU + methotrexate was compared to Adriamycin and procarbazine. The tumor response to CCM was significantly higher than the tumor response to Adriamycin and procarbazine. No significant difference existed between the two treatments with respect to survival. Initial performance status, weight loss prior to therapy, and response to therapy were all found to be significant prognostic factors. Median survival time relative to responders in both treatment groups was 31.7 weeks and 15.8 weeks for non‐responders.

Hematoporphyrin derivative in the diagnosis and treatment of lung cancer.

Since 1978 we have studied the properties of hematopor-phyrin derivative (HPD) and have sought means to improve the drug as well as the instrumentation used in both diagnostic and therapeutic clinical procedures (1–3).

Cyclic alternating combination chemotherapy for small cell lung cancer.

SummarySixty-two patients with small cell carcinoma of lung received cyclic alternating non-cross-resistant combination chemotherapy. Radiation to the chest was given to all the patients. Patients were given a course of VP16, adriamycin and vicristine (VAV) followed by radiation (3,000 rads) to the chest and then a second course of VAV. Three weeks later, a course of cytoxan, CCNU, and methotrexate (CCM) was given (6 weeks). Subsequently, the treatment was cycled between two courses of VAV (6 weeks) and one course of CCM (6 weeks). Overall objective response rate of 73%, with 45% complete response, was noted. Overall median survival was 50 weeks, with 83 weeks for complete responders. Median survival for patients with regional disease was 58 weeks compared to 40 weeks for extensive disease. All the patients headed for complete response did so prior to receiving CCM. These results were not superior to conventional combination chemotherapy regimens.