VIENNA--Although the majority of patients with advanced non-small-cell
lung cancer (NSCLC) are too ill to tolerate platinum therapy, the more
benign safety profile of gemcitabine (Gemzar) is opening up the possibility
of palliative chemotherapy for a wider group of NSCLC patients.
"Gemcitabine is at least as effective as and much less toxic than
the standard two-drug combination chemotherapy of cisplatin [Platinol]
and etoposide," said Dr. Christian Manegold in his report of the results
of a European multicenter trial at the 21st Congress of the European Society
for Medical Oncology (ESMO).
This phase II study randomized patients with stage III or IV NSCLC to
receive either gemcita-bine (1,000 mg/m2 as a 30-minute IV infusion
on days 1, 8, and 15 of a 28-day cycle) or cisplatin (100 mg/m2 on
day 1) plus etoposide (100 mg/m2 on days 1, 2, and 3 of a 28-day
cycle). None of the 150 participants had undergone prior chemotherapy or
previous irradiation of the measured lesion, and none had CNS metastases.
The two regimens yielded entirely comparable response rates (18% with
gemcitabine and 15% with cisplatin-etoposide), times to progression (4.2
months and 4.9 months, respectively), and median survival durations (6.6
months and 7.6 months, respectively).
No Serious Hematologic Toxicity
Neither chemotherapy regimen was seriously compromised by hematologic
toxicity, with roughly three quarters of patients in both arms maintaining
normal neutrophil counts.
Nausea and vomiting were common in the cisplatin-etoposide group, reaching
severe proportions in more than a quarter of patients. Nearly half of the
gemcitabine-treated patients were free of nausea and vomiting.
An especially striking contrast, Dr. Manegold emphasized, was in the
incidence of alopecia, which afflicted more than 80% of patients in the
combination arm but only 3% of gemcitabine-treated patients.