The changing presentation of lung adenocarcinoma.

etoposide combination chemotherapy for locally advanced or metastatic thymoma: a phase II study of the European The experience of Drs. Musi, Di Vito, and Rosti with salvage chemotherapy for recurrent thymoma using a platinum-based regimen reiterates the observations we reported previously1 and raises new issues on the choice of therapy for recurrences after a second remission. A prolonged disease-free interval, usually greater than 12 months, has been shown to be a predictor of response to salvage chemotherapy in breast, lung, and ovarian cancers, as well as in Hodgkin's lymphomas.1 Our report sup¬ ported these observations. However, the reported case of Musi et al seems to suggest that shorter disease-free intervals do not preclude response. We are ambivalent about deleting doxorubicin from the regi¬ men. In a recent trial by Loehrer and others,2 30 patients treated with doxorubicin in combination with cisplatin and cyclophosph¬ amide yielded three complete and 12 partial responders, for an overall response rate of 50%. Fornasiero et al3 reported an overall response rate of 91% in 32 patients treated with doxorubicin, cisplatin, vincristine, and cyclophosphamide. Etoposide, in com¬ bination with cisplatin, is emerging as an alternative regimen for unresectable thymomas. High-dose chemotherapy with stem cell support is a novel treatment option for recurrent disease, but currently is not recommended due to the paucity of evidence that it improves clinical outcome. invasive thymoma with platinum, doxorubicin, and cyclophos¬ phamide.