Cisplatin small-cell lung carcinoma

Levitan N, Dowlati A, Shina D, et al. Multi-institutional phase ITU trial of paclitaxel, cisplatin, and etoposide with concurrent radiation for limited-stage small-cell lung carcinoma. J Clin Oncol 2000 18(5) 1102-1109. 

Small cell lung carcinoma Multiple combinations that include cyclophosphamide, cisplatin, doxorubicin, etoposide, and vincristine... 

Despite its lower chemical reactivity, carboplatin has antitumor activity that is similar to that of cisplatin against ovarian carcinomas, small cell lung cancers, and germ cell cancers of the testis. Most tumors that are resistant to cisplatin are cross-resistant to carboplatin. 

A semisynthetic podophyllotoxin derivative, VP 16213 (etoposide), has been approved in the United States as a chemotherapeutic agent (often in combination regimes with cisplatin, bleomycin, and others) for the treatment of refractory testicular tumors and for the treatment of small cell lung cancer. VM26 (teniposide) is being investigated for the treatment of acute lymphoblastic leukemia, various lymphomas, and other carcinomas. Semisynthetic derivatives are being used in Europe for the treatment of psoriasis and rheumatoid arthritis. 

Ratain MJ, Kaminer LS, Bitran JD, Larson RA, Le Beau MM, Skosey C, Purl S, Hoffman PC, Wade J, Vardiman JW, et al. Acute nonlymphocytic leukemia following etoposide and cisplatin combination chemotherapy for advanced non-small-cell carcinoma of the lung. Blood 1987 70(5) 1412-17. 

Etoposide is used primarily for treatment of testicular tumors, in combination with bleomycin and cisplatin, and in combination with cisplatin and ifosfamide for small cell carcinoma of the lung. It also is active against non-Hodgkin s lymphomas, acute nonlymphocytic leukemia, and Kaposi s sarcoma associated with AIDS. Etoposide has a favorable toxicity profile for dose escalation in that its primary acute toxicity is myelosuppression. In combination with ifosfamide and carboplatin, it is frequently used for high-dose chemotherapy in total doses of 1500-2000 mg/nf. 

Cisplatin is used for the treatment of ovarian and cervical carcinomas small cell and non-small cell bronchial and lung carcinomas testicular, endometrial, bladder, and prostate carcinomas tumors of the head and throat as well as sarcomas and melanomas. The treatment with cisplatin is complicated by the presence of considerable side effects, whereby the high nephrotoxicity is an especially dosage-limiting factor. Other side effects include hair loss, a reduction of leukocytes and thrombocytes (anemia), an impairment of the taste and hearing senses, as well as nausea and vomiting. 

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