Treatment of advanced adenocarcinoma of the lung with ftorafur, doxorubicin, cyclophosphamide, and cisplatin (FACP) and intensive iv hyperalimentation

Sixty-five patients with extensive adenocarcinoma of the lung were treated with ftorafur, doxorubicin, cyclophosphamide, and cisplatin (FACP). Twenty-four received no iv hyperalimentation (IVH) (FACP alone); 19 received simultaneous IVH (S-IVH) beginning on Day 1 and continuing through the first FACP course (median, 25 days), and 22 received prechemotherapy IVH (P-IVH) beginning 10 days prior to FACP and continuing through the first course (median, 35 days). Groups were comparable except for a higher proportion of patients with less pretreatment weight loss in the group that received FACP alone. Of 48 patients with measurable disease, responses ≥ 50% were seen in 15 (4 complete and 11 partial remissions): 7 of 18 patients (39%) who received FACP alone, 2 of 13 (15%) who were given S-IVH, and 6 of 17 (35%) who received P-IVH. Of the 15 responding patients, 93% were fully active and ambulatory (class A), 87% had < 6% pretreatment weight loss, 60% were above the group median for daily nitrogen intake, and 70% were above the group median for daily caloric intake. The 40-week median survival for all patients receiving FACP alone appeared better than the median of 28 weeks for patients receiving P-IVH (P = 0.009) and 21.5 weeks for patients treated with S-IVH (P = 0.09). However, when the data were corrected for imbalances of prognostic factors, there were no differences in survival among the 3 treatment groups. Survival was prolonged in patients with < 6% pretreatment weight loss (P = 0.03), in responding patients (P = 0.01), and in patients with stable disease (P = 0.02). Five of 16 responding patients remained alive for ≥ 18 months. Protection from chemotherapy-induced gastrointestinal and hematologic toxic effects by IVH was minimal. Nutritional parameters have prognostic significance in patients with advanced adenocarcinoma of the lung. The routine use of IVH as an adjunct to chemotherapy in patients with adenocarcinoma of the lung does not appear to be justifiable.