Comb (cyclophosphamide, oncovin, methyl ccnu, and bleomycin): a four drug combination in solid tumors

R. B. Livingston, Lawrence Einhorn, G. P. Bodey, M. A. Burgess, E. J. Freireich, J. A. Gottlieb

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

One hundred eighty nine patients received a four drug combination consisting of cyclophosphamide, Oncovin (vincristine), methyl CCNU, and bleomycin (COMB), according to three different drug regimens, performed sequentially. Of the 189, 62 had a partial response (33%) including 11/33 with squamous lung cancer, 11/32 with squamous carcinoma of the head and neck, 13/15 with oat cell carcinoma of the lung, and 7/41 with malignant melanoma. The response rate for patients with squamous lung or head and neck cancer appeared to be higher at weekly bleomycin doses of 30 and 60 mg (15/33 = 45%), compared to a weekly bleomycin dose of 15 mg (7/32 = 25%). A median survival from treatment of 30 weeks was observed in oat cell carcinoma, which represents considerable prolongation over that expected from supportive care alone or single agent chemotherapy. Toxicity included: 1) myelosuppression, resulting in hospitalization for antibiotics in 20% of patients; 2) probable bleomycin lung damage in 4% of patients; and 3) dose limiting vincristine neuropathy in 11%. The combination of twice weekly vincristine and bleomycin for more than 6 weeks produced a disturbing 'debilitation syndrome', characterized by weakness, anorexia, weight loss, and apathy. The encouraging response rate suggests a future role for these drugs in combination, especially for vincristine and bleomycin, with other agents showing activity in squamous and oat cell carcinoma. Toxicity precludes recommendation of this combination, in the regimens tested, for broader Phase III studies.

Original languageEnglish (US)
Pages (from-to)327-332
Number of pages6
JournalCancer
Volume36
Issue number2
DOIs
StatePublished - 1975
Externally publishedYes

Fingerprint

Bleomycin
Vincristine
Drug Combinations
Cyclophosphamide
Neoplasms
Small Cell Carcinoma
Squamous Cell Carcinoma
Semustine
Apathy
Lung
Small Cell Lung Carcinoma
Anorexia
Head and Neck Neoplasms
Weight Loss
Melanoma
Lung Neoplasms
Hospitalization
Neck
Head
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Comb (cyclophosphamide, oncovin, methyl ccnu, and bleomycin) : a four drug combination in solid tumors. / Livingston, R. B.; Einhorn, Lawrence; Bodey, G. P.; Burgess, M. A.; Freireich, E. J.; Gottlieb, J. A.

In: Cancer, Vol. 36, No. 2, 1975, p. 327-332.

Research output: Contribution to journalArticle

Livingston, R. B. ; Einhorn, Lawrence ; Bodey, G. P. ; Burgess, M. A. ; Freireich, E. J. ; Gottlieb, J. A. / Comb (cyclophosphamide, oncovin, methyl ccnu, and bleomycin) : a four drug combination in solid tumors. In: Cancer. 1975 ; Vol. 36, No. 2. pp. 327-332.
@article{16d74da367bb406ab594d6678d1d4315,
title = "Comb (cyclophosphamide, oncovin, methyl ccnu, and bleomycin): a four drug combination in solid tumors",
abstract = "One hundred eighty nine patients received a four drug combination consisting of cyclophosphamide, Oncovin (vincristine), methyl CCNU, and bleomycin (COMB), according to three different drug regimens, performed sequentially. Of the 189, 62 had a partial response (33{\%}) including 11/33 with squamous lung cancer, 11/32 with squamous carcinoma of the head and neck, 13/15 with oat cell carcinoma of the lung, and 7/41 with malignant melanoma. The response rate for patients with squamous lung or head and neck cancer appeared to be higher at weekly bleomycin doses of 30 and 60 mg (15/33 = 45{\%}), compared to a weekly bleomycin dose of 15 mg (7/32 = 25{\%}). A median survival from treatment of 30 weeks was observed in oat cell carcinoma, which represents considerable prolongation over that expected from supportive care alone or single agent chemotherapy. Toxicity included: 1) myelosuppression, resulting in hospitalization for antibiotics in 20{\%} of patients; 2) probable bleomycin lung damage in 4{\%} of patients; and 3) dose limiting vincristine neuropathy in 11{\%}. The combination of twice weekly vincristine and bleomycin for more than 6 weeks produced a disturbing 'debilitation syndrome', characterized by weakness, anorexia, weight loss, and apathy. The encouraging response rate suggests a future role for these drugs in combination, especially for vincristine and bleomycin, with other agents showing activity in squamous and oat cell carcinoma. Toxicity precludes recommendation of this combination, in the regimens tested, for broader Phase III studies.",
author = "Livingston, {R. B.} and Lawrence Einhorn and Bodey, {G. P.} and Burgess, {M. A.} and Freireich, {E. J.} and Gottlieb, {J. A.}",
year = "1975",
doi = "10.1002/1097-0142(197508)36:2<327::AID-CNCR2820360206>3.0.CO;2-U",
language = "English (US)",
volume = "36",
pages = "327--332",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "2",

}

TY - JOUR

T1 - Comb (cyclophosphamide, oncovin, methyl ccnu, and bleomycin)

T2 - a four drug combination in solid tumors

AU - Livingston, R. B.

AU - Einhorn, Lawrence

AU - Bodey, G. P.

AU - Burgess, M. A.

AU - Freireich, E. J.

AU - Gottlieb, J. A.

PY - 1975

Y1 - 1975

N2 - One hundred eighty nine patients received a four drug combination consisting of cyclophosphamide, Oncovin (vincristine), methyl CCNU, and bleomycin (COMB), according to three different drug regimens, performed sequentially. Of the 189, 62 had a partial response (33%) including 11/33 with squamous lung cancer, 11/32 with squamous carcinoma of the head and neck, 13/15 with oat cell carcinoma of the lung, and 7/41 with malignant melanoma. The response rate for patients with squamous lung or head and neck cancer appeared to be higher at weekly bleomycin doses of 30 and 60 mg (15/33 = 45%), compared to a weekly bleomycin dose of 15 mg (7/32 = 25%). A median survival from treatment of 30 weeks was observed in oat cell carcinoma, which represents considerable prolongation over that expected from supportive care alone or single agent chemotherapy. Toxicity included: 1) myelosuppression, resulting in hospitalization for antibiotics in 20% of patients; 2) probable bleomycin lung damage in 4% of patients; and 3) dose limiting vincristine neuropathy in 11%. The combination of twice weekly vincristine and bleomycin for more than 6 weeks produced a disturbing 'debilitation syndrome', characterized by weakness, anorexia, weight loss, and apathy. The encouraging response rate suggests a future role for these drugs in combination, especially for vincristine and bleomycin, with other agents showing activity in squamous and oat cell carcinoma. Toxicity precludes recommendation of this combination, in the regimens tested, for broader Phase III studies.

AB - One hundred eighty nine patients received a four drug combination consisting of cyclophosphamide, Oncovin (vincristine), methyl CCNU, and bleomycin (COMB), according to three different drug regimens, performed sequentially. Of the 189, 62 had a partial response (33%) including 11/33 with squamous lung cancer, 11/32 with squamous carcinoma of the head and neck, 13/15 with oat cell carcinoma of the lung, and 7/41 with malignant melanoma. The response rate for patients with squamous lung or head and neck cancer appeared to be higher at weekly bleomycin doses of 30 and 60 mg (15/33 = 45%), compared to a weekly bleomycin dose of 15 mg (7/32 = 25%). A median survival from treatment of 30 weeks was observed in oat cell carcinoma, which represents considerable prolongation over that expected from supportive care alone or single agent chemotherapy. Toxicity included: 1) myelosuppression, resulting in hospitalization for antibiotics in 20% of patients; 2) probable bleomycin lung damage in 4% of patients; and 3) dose limiting vincristine neuropathy in 11%. The combination of twice weekly vincristine and bleomycin for more than 6 weeks produced a disturbing 'debilitation syndrome', characterized by weakness, anorexia, weight loss, and apathy. The encouraging response rate suggests a future role for these drugs in combination, especially for vincristine and bleomycin, with other agents showing activity in squamous and oat cell carcinoma. Toxicity precludes recommendation of this combination, in the regimens tested, for broader Phase III studies.

UR - http://www.scopus.com/inward/record.url?scp=0016786968&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0016786968&partnerID=8YFLogxK

U2 - 10.1002/1097-0142(197508)36:2<327::AID-CNCR2820360206>3.0.CO;2-U

DO - 10.1002/1097-0142(197508)36:2<327::AID-CNCR2820360206>3.0.CO;2-U

M3 - Article

C2 - 50870

AN - SCOPUS:0016786968

VL - 36

SP - 327

EP - 332

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 2

ER -