Is the MVP regimen less active than previously described? Results of a phase II study in advanced non-small cell lung cancer

Combination chemotherapy with anti-proliferative agents is often used in patients with advanced non-small cell lung cancer (NSCLC) in good performance status. The mitomycin C, vinblastine and cisplatin (MVP) regimen has been the Eastern Cooperative Oncology Group (ECOG) standard for several years because of high response rates in spite of significant toxicity. In a phase II study, we observed 55 consecutive patients treated with MVP chemotherapy using the same dosage, schedule, and precautions as used by the ECOG group. The dose intensity reached for each drug was 85% of the projected dose. Fifty-one patients were assessable for response and toxicity, while all subjects were evaluable for survival. There was no complete remissions, 8 partial (15%), 34 stable (66%) and 9 progressive (17%) in patients. The median survival rate was 34 weeks (95% confidence interval 28-37 weeks). There were no treatment-related deaths and no grade 4 toxicity. Alopecia and emesis were the most significant adverse effects. Haematological toxicity was minimal. Other side-effects, such as neuropathy and nephrotoxicity, were also rare. Hence, response rates and toxic complications were lower than previously reported. We conclude that the MVP regimen has to be re-evaluated.