ASCOA new study from the Cancer and Leukemia Group B (CALGB 9730) shows
that chemotherapy doublets should be the standard treatment for advanced
non-small-cell lung cancer (NSCLC), Rogerio C. Lilenbaum, MD, reported at the
38th Annual Meeting of the American Society of Clinical Oncology (abstract 2).
"Not only did the results show an increase in response rate but, more
importantly, an increase in survival time in patients who received carboplatin
[Paraplatin] and paclitaxel [Taxol], compared with paclitaxel alone,"
said Dr. Lilenbaum, director of the Thoracic Oncology Program, Mount Sinai
Comprehensive Cancer Center, Miami Beach.
The phase III trial randomized 584 patients (561 evaluable) with stage IIIB/IV NSCLC to receive paclitaxel 225
mg/m² given over 3 hours on day 1 with
or without carboplatin to AUC 6 every 3 weeks for up to six cycles. The
patients had received no prior chemotherapy.
The median patient age was 63.5 years; 155 (27%) were 70 years of age or
older, and 99 (18%) were performance status (PS) 2 on the ECOG scale. Quality
of life was assessed at baseline, 2, 6, 9, and 12 months, using the EORTC
QLQ-C30 and QLQ-LC13 questionnaires.
The objective response rate was 29% in patients on combination therapy vs
17% in those on paclitaxel alone (P < .0001), Dr. Lilenbaum said.
With a median follow-up of 19.7 months, median overall survival was 8.8
months with the combination vs 6.7 months with single-agent therapy, a 24%
relative increase in survival for those receiving carboplatin/paclitaxel.
Failure-free survival was also significantly longer with combination therapy4.6
months vs 2.5 months for single-agent therapy.
One-year survival, at 37% for the combination vs 33% for the single agent,
was not significantly different. This may be due, in part, to a higher use of
second-line therapy in the single-agent arm (39% vs 32%) and of platinum-based
combinations in particular (14% vs 7%), Dr. Lilenbaum said.