The waning war on cancer.

In the Medical Research Council's lVth trial in Myelomatosis the possible benefit of adding vincristine to first line treatment with intermittent melphalan and prednisone has been assessed. This was analysed in 530 patients who were randomly allocated to receive vincristine or not. Survival was not improved by the addition of vincristine. A total of 268 patients reached plateau phase on first line therapy. Of these 226 patients were rerandomised either to continue receiving first line therapy for a further year or to cease therapy. At the present time there is a slight but not significant survival advantage in the group which received no further treatment on reaching plateau. Several multiple-drug chemotherapy regimens for the treatment of myelomatosis have incorporated vincristine (Lee et al. The value of this drug in multiple-drug combinations has in general been assessed by comparison with melphalan and prednisone or with other combination regimens not containing vincristine. On this basis the addition of vincristine has been judged to be helpful. However, no report has appeared in which vincristine has been added to first line therapy as a single randomised variable. The Cancer and Leukaemia Group B carried out a randomised controlled trial of the use of vincristine and prednisone after the first 22 weeks of induction therapy in myelomatosis (Cornwell et al., 1982). Initial treatment comprised either melphalan, BCNU or CCNU. In this study, the late introduction of prednisone and vincristine failed to increase response rates or to prolong survival. The IVth MRC Myelomatosis Trial was designed to assess the value of vincristine in first line treatment of myelomatosis. It admitted 530 previously untreated patients who were randomised to receive either: courses of melphalan and prednisone alone or courses of the same drugs plus vincristine. Patients reaching plateau phase were randomised either to stop first line treatment or to continue this for a further year.