ECOG randomized patients with advanced NSCLC to 1 of 4 new 3 of the 4 regimens used in ECOG docetaxel/cisplatin, paclitaxel/cisplatin. In the ECOG trial, the only direct comparison of similar regimens, response rates and survival times were similar between patients treated with cisplatin. ECOG was chosen as a plenary session presentation because it is an important trial that reflects the state of care in of metastatic NSCLC—the.
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There are several possible reasons for the lower response rates seen in all four arms of this study. Phase III trial of gemcitabine plus cisplatin versus cisplatin alone in patients with locally advanced or metastatic non-small-cell lung cancer. Initially, patients with ECOG PS scores of 0—2 were enrolled, but the protocol was amended after enrollment of 66 patients who had PS scores of 2 to include patients with PS scores of 0 or 1 only. eocg
Lung Cancer Highlights
Nonlinear pharmacokinetics of paclitaxel in mice results from the pharmaceutical vehicle Cremophor EL. Various chemotherapy regimens have been evaluated in an attempt to improve on the outcomes achieved with BSC. First, biological therapies hold the promise of being more selective and less toxic for normal tissues, both in dcog of haematological and non-haematological adverse effects. Cancer Res ; Performance status efog a prognostic factor.
American College of Chest Physicians. Chemotherapeutic management of stage IV non-small cell lung cancer. The deaths were all in patients with squamous cell cancer. Preliminary results in the supportive care setting. Because of its low aqueous solubility, the vehicle for paclitaxel is a purified polyoxyethylated castor oil, which has been implicated in paclitaxel toxicity [ 89 ] and in the nonlinear pharmacokinetics of paclitaxel [ 10 ecot 12 ].
The response rate and 154 did not differ significantly between patients assigned to receive cisplatin and paclitaxel and those assigned to receive any of the three experimental regimens. Each combination, however, is characterized by a unique adverse-event profile, thus allowing for choices of chemotherapy for the individual patient.
These trials are characterised by a remarkable heterogeneity among the drugs and schedules studied. Services E-mail this article to a colleague Alert me when this article is cited Alert me if a correction is posted Alert me when eletters are published Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Download to citation manager.
The study confirmed a substantial incidence of grade 3 and grade 4 toxicities in PS2 patients, although not significantly higher than in patients with better PS. The results of several large phase III studies are reviewed below.
For this latter sub-group, there is no treatment widely accepted as standard and oncologists have to choose among several treatment options for which PS2 patients are potential candidates: Also, with the growing acceptance and momentum favoring treatment of patients with metastatic NSCLC, investigators are placing patients on trial that are more reflective of the general population of lung cancer patients. No significant interaction rcog treatment and PS in terms of overall survival is described, and platinum-free combination chemotherapy could represent a reasonable, less toxic option for PS2 patients.
Grade 3 or 4 neutropenia, anemia, nausea and vomiting, and constipation were more common with VC, while grade 3 or 4 thrombocytopenia was more common with PCb and GC. In this window In a new window.
Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer.
In vitro cross-resistance and collateral sensitivity in seven resistant small-cell lung cancer cell lines: Fear of unacceptable toxicity is one of the major concerns in treatment decisions for PS2 patients and, from this point of view, platinum-free ecoog chemotherapy deserves attention as it is potentially less toxic than platinum-based treatment.
Grade 3 or 4 toxicities were fairly evenly distributed among treatments. These combinations produced higher response rates and longer survival times than the older cisplatin or carboplatin combinations and, thus, have become the standard of palliative care for patients with advanced NSCLC and good performance status [ 1 ecoy, 6 ]. Both taxanes have activity as single agents and in combination in NSCLC and both offer survival and QOL advantages over best supportive care in randomized trials [ 23 ].
None of four chemotherapy regimens offered a significant advantage over the others in the treatment of advanced non-small-cell lung cancer. A Southwest Oncology Group Trial. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Multi-institutional randomized phase II trial of gefitinib for previously treated patients with advanced non-small-cell lung cancer.
Lung Cancer Highlights
Furthermore, the gross categories defined only by PS are inevitably heterogeneous: First, in terms of survival, in the largest prospective phase III study evaluating the efficacy of a taxane-platinum combination in advanced NSCLC, Fossella and scog [ 13 ] reported that DC was modestly superior to VC, with the median survival being about 1 month longer in patients treated with docetaxel.
Like topotecan, irinotecan is a topoisomerase I inhibitor with good activity in patients with lung cancer. A consensus was reached that single-agent chemotherapy with one of the new agents e. Antiemetic prophylaxis was administered to all patients, and patients receiving cisplatin received hydration. Lung Cancer Highlights Thomas J.
Taxane-Platinum Combinations in Advanced Non-Small Cell Lung Cancer: A Review
Throughout the ecgo, lower rates of grade 3 or 4 neutropenia were reported with the PCb combination, most notably demonstrated in the SWOG trial Fig. Median survival was also similar, at 8. The combination of cisplatin and vinorelbine was superior in terms of survival to vindesine—cisplatin and to vinorelbine alone.