The administration of docetaxel (Taxotere)
immediately after conventional chemotherapy with cisplatin (Platinol)/etoposide and radiotherapy results in prolonged survival in
patients with stage IIIB non-small-cell lung cancer, reported researchers from
the Southwest Oncology Group (SWOG) at the Ninth World Conference on Lung
Cancer. Results of the phase II trial showed that 53% of patients remained alive
at 2-year follow-up, which until now, was the highest reported
2-year survival rate for this cohort of patients since a previous SWOG study
reported a 34% survival rate.
"Most patients with locally advanced non-small-cell lung
cancer continue to die of progressive disease despite advances in combined
modality treatment," said David R. Gandara, md, the study’s principal
investigator, professor of medicine and director of clinical trials at the
University of California Medical Center, Davis. "Our data show that the
addition of docetaxel to concurrent chemotherapy and radiation therapy results
in over 50% of patients remaining alive at 2 years of follow-up."
Patient Characteristics and Dosing Schedule
The 83 study participants had newly diagnosed primary
bronchogenic non-small-cell lung cancer and pathologically documented stage
IIIB disease that was too extensive to be surgically cured. Patients ranged from
34 to 80 years old, and their performance status ranged from 0 to 2.
All patients received cisplatin, 50 mg/m2, administered
intravenously on days 1 and 8, and etoposide, 50 mg/m2, administered
intravenously each day for 5 days. The chemotherapy regimen was repeated 4 weeks
later. On the day chemotherapy began, radiotherapy was also initiated, and
continued for 5 days a week for 5 weeks. Docetaxel, 75 to 100 mg/m2, was
administered intravenously starting about 4 weeks after the completion of
chemoradiotherapy, with the treatment repeating every 21 days for three cycles.
The median survival was 26 months, and the 1-year survival rate
was 76%. In the earlier SWOG trial, in which two additional cycles of
cisplatin/etoposide were administered after initial concurrent chemotherapy and
radiotherapy, the median survival was 15 months with a 1-year survival of 58%.
Concurrent chemotherapy with radiotherapy was reasonably well
tolerated. Side effects during consolidation treatment with docetaxel included
neutropenia, and three patients died of pulmonary complications.