The Case for Mitomycin in Non-Small Cell Lung Cancer

The activity of mitomycin in non-small cell lung cancer (NSCLC) has been well documented in both single-institution pilot and multi-institution randomized trials. Despite the inclusion of patients ineligible for current trials of newer single agents due to poor performance status, prior irradiation to indicator lesions, or prior chemotherapy, mitomycin emerges from such prior studies as the most consistently active single agent currently available for NSCLC. While randomized trials in stage IV disease demonstrate an improved response rate with mitomycin and cisplatin in comparison with cisplatin alone (p = 0.03), and with mitomycin, vindesine, and cisplatin in comparison with vindesine and cisplatin alone (p = 0.003), the potential with mitomycin is most apparent with weekly bolus or infused vindesine/vinblastine, and higher-dose cisplatin (MVP) in neoadjuvant approaches to stage III disease. Indeed, four trials of neoadjuvant MVP in predominantly stage IIIA (bulky N2) disease produced a consistent 19-month median and 26–33% 3-year survival, which is to be compared with 8 months and 6%, respectively, with traditional thoracic irradiation alone. Nonetheless, prior use of mitomycin w