Nitrosourea combinations in lung cancer

BCNU, CCNU, and methyl CCNU have undergone extensive trial in multiple drug combinations for bronchogenic carcinoma. The addition of a nitrosourea appears to be an improvement over cyclophosphamide used alone in oat cell carcinoma and over the two drug combination of cyclophosphamide and methotrexate in both adenocarcinoma of the lung and oat cell disease. Encouraging response rates have been seen in squamous lung cancer with multiple drug combinations of a nitrosourea, an alkylating agent, vincristine, and bleomycin with or without adriamycin. The nitrosoureas have been easily incorporated, at reduced doses, into multiple drug regimens with cumulative myelosuppression seen only when the interval between nitrosourea doses is < 6 weeks. Conclusions about the ultimate role of these compounds in lung cancer treatment must await comparative trials of combinations with and without a nitrosourea, and further exploration of new approaches to increase their therapeutic index.