MACC (methotrexate, adriamycin, cyclophosphamide and CCNU) in advanced lung cancer

Eighty‐three patients (53 men, 30 women) with advanced lung cancer were treated with a four‐drug combination (MACC) consisting of methotrexate, adriamycin, cyclophosphamide and CCNU given once every 3 weeks. The overall objective response rate (complete response and partial response >50%) was 52% with a median duration of therapy of 29 weeks. Response rate was highest for small cell carcinoma (87%) followed by adenocarcinoma (58%) and squamous cell carcinoma (36%). There was a significant prolongation of median survival for responders vs. nonresponders: 48 weeks vs. 17 weeks for the whole group (p < 0.005), 48 weeks vs. 19 weeks for small cell carcinoma, 48 weeks vs. 15 weeks for adenocarcinoma, 40 weeks vs. 20 weeks for squamous cell carcinoma, and 56 weeks vs. 17 weeks for large cell carcinoma. Prolongation of survival was also apparent when analyzed by extent of the disease (limited vs. extensive) and by performance status. Major toxic effects included bone marrow depression (leukopenia in 36 and thrombocytopenia in 12 patients), mucositis (13 patients), fever and/or sepsis (11 patients), renal toxicity (4 patients) and skin rash (4 patients), There was only one case of cardiotoxicity, and one treatment‐related death from septic shock during leukopenia. This regimen has shown activity in all cell types of lung cancer and is easy to administer on an out‐patient basis.