Induction chemotherapy with MVP (mitomycin-C + vindesine + cisplatin) for stage III (T1-3, N2, M0) unresectable non-small cell lung cancer: the Toronto experience

The 5-year survival rates for patients undergoing a potentially curative surgical resection for pre-operatively identified stage 3A N2 non-small cell lung cancer (NSCLC) vary from 2-13%. In an attempt to improve the curative potential of surgery, 39 patients with mediastinoscopy stage 3A unresectable N2 NSCLC received induction chemotherapy with 2 cycles of mitomycin-C, vindesine and cisplatin (MVP). Responding patients underwent thoracotomy for resection and 2 further courses of MVP. The overall response rate was 64% ( 25 39) with 3 complete and 22 partial responses. 22 patients were resected which included a radical mediastinal node dissection. 18 resections were complete and 4 were incomplete. Pathologically 3 patients (7.7%) had no tumor remaining. There were 2 post-op deaths secondary to a BP fistula. In addition to GI and neurologic side effects, toxicity of chemotherapy included mitomycin pulmonary toxicity in 2 patients and 4 septic deaths. 28 patients have died, 20 with recurrent or progressive disease. Of the 18 patients completely resected, 8 have recurred with a median time to recurrence of 20.6 months. Sites of recurrence include 2 loco-regional, 5 distant (2 in brain) and 1 both. Median survival of the entire 39 patients is 18.6 months with a 3-year survival of 26%. The median survival for those patients completely resected is 29.7 months with a 3-year survival of 40%. These findings suggest that MVP is an effective but toxic chemotherapeutic regimen for limited NSCLC, and although the median survival appears to be prolonged, the role of induction chemotherapy followed by surgery in stage IIIA N2 NSCLC requires a Phase III randomized trial comparing it to other treatment modalities.