ASCO--Cycling docetaxel (Taxo-tere) treatments with cisplatin
(Platinol) and vinorelbine (Navelbine) achieves better response
rates in non-small-cell lung cancer (NSCLC) patients than can
be expected from any of the components used alone or in traditional
combination, according to the multicenter pilot study presented
by Jean Viallet, MD, at a pos-ter session of the American Society
of Clinical Oncology (ASCO) meeting in Philadelphia.
The goal of the alternating drug regimen in the phase II trial
was to capitalize on the efficacy of each of the agents while
avoiding any cumulative toxicity. "These three agents are
arguably the three most active individual agents in the treatment
of NSCLC," said Dr. Viallet, director of the Oncology Center
at the Hospital Notre-Dame, Montreal.
Unfortunately, prior attempts at devising regimens pairing the
agents have not been well tolerated.
Effects of Same Day Dosing
"When you try to give docetaxel with cisplatin or docetaxel
with vinorelbine on the same day, the impact on the white blood
cell count is such that a substantial fraction of patients are
exposed to the risk of febrile neutropenia and infectious complications,"
Dr. Viallet told Oncology News International in an interview.
Traditionally, clinicians have reduced doses in an effort to compensate
for this effect--with the result that efficacy is lost, Dr. Viallet
noted. As an alternative strategy, Dr. Viallet and his colleagues
cycled the treatments, giving docetaxel first and then, 3 weeks
later, administering the cisplatin with vinorelbine.
Unlike the earlier strategy, which provided small, suboptimal
doses to reduce the chance of cumulative side effects, here each
patient received a full dose of each drug. "This way we would
avoid the potential cumulative toxicity, while hopefully obtaining
efficacious and perhaps even additive activity," Dr. Viallet