A landmark research trial by the University of Wisconsin Comprehensive
Cancer Center showed that chemotherapy offers survival benefits for
advanced, nonsmall-cell lung cancer patients. The study,
presented at the 36th annual meeting of the American Society of
Clinical Oncology (ASCO), was designed to compare three
platinum-based chemotherapy regimens with a control arm of cisplatin
(Platinol) and paclitaxel (Taxol). The regimens were gemcitabine
(Gemzar) plus cisplatin, docetaxel (Taxotere) plus cisplatin, and
paclitaxel plus carboplatin (Paraplatin).
The studys primary objective was to determine which of
four different types of chemotherapy treatment is best for patients
with advanced lung cancer, said Joan Schiller, MD, professor,
University of WisconsinMadison Medical School, and lead
investigator of the study. While all of the chemotherapy
regimens used today are effective in the treatment of lung cancer,
only the paclitaxel-plus-carboplatin regimen has shown to have
statistically fewer life-threatening side effects.
Largest US Trial of Its Kind
The trial, conducted by the Eastern Cooperative Oncology Group, was
the largest randomized trial of advanced lung cancer patients in the
United States. More than 1,200 patients with previously untreated
stage IIIB or stage IV nonsmall-cell lung cancer participated.
Results of the study showed no significant difference in survival
among the three arms when compared to paclitaxel with cisplatin (the
control arm). The median time of survival for all arms was 8 months;
1-year survival was 33.5% and 2-year survival was 12%. Median time to
progression was 3.6 months for all arms.
The percentage of grade 4/5 toxicities experienced with each regimen
were 68%/4% with paclitaxel plus cisplatin; 69%/4% with gemcitabine
plus cisplatin; 61%/6% with docetaxel plus cisplatin; and 53%/3% with
paclitaxel plus carboplatin. These toxicities included absolute
neutrophil count, vomiting, and neuropathy.
Both the paclitaxel-plus-carboplatin combination and the
docetaxel-plus-cisplatin combination are administered on day 1, every
3 weeks. Gemcitabine plus cisplatin is administered on days 1, 8, and
15 every 4 weeks. The paclitaxel-plus-cisplatin regimen includes
paclitaxel administered on day 1 every 3 weeks with cisplatin
administered on day 2. For cancer patients who have to go to the
hospital or outpatient facility for treatment, this can represent a
considerable difference in the convenience of drug administration.
More Treatment Options
Currently, only 25% of all lung cancer patients undergo chemotherapy
as treatment for their disease. However, these newer chemotherapy
regimens are helping to achieve 1-year survival rates of 35% to 40%,
compared to 20% to 25% 5 years ago. Based on these data, it is
expected that more lung cancer patients will be offered chemotherapy
Lung cancer is a major disease with traditionally bad
outcomes because there have not been many proven treatment
regimens, said Dr. Schiller. Our study shows that there
is new hope for the treatment of advanced lung cancer patients that
can help extend their survival with a better quality of life.