ASCOTreatment with chemotherapy extends the lives of patients
with advanced lung cancer and should become a standard treatment
option offered to these patients, according to two papers presented
at the 36th Annual Meeting of the American Society of
Clinical Oncology (New Orleans).
At the plenary session, Joan H. Schiller, MD, University of Wisconsin
Medical School, reported results of a randomized phase III trial
examining the relative benefits of four platinum-based chemotherapy
All offered similar survival benefits: Median survival for all arms
was 8 months, 1-year survival 33.5%, and 2-year survival 12%. These
results are superior to those achieved with drugs offered just 5
years ago. Patients now have a 35% to 40% chance of 1-year
survival, up from 20% to 25% with the older regimens, Dr.
The study, conducted by the Eastern Cooperative Oncology Group,
compared three platinum-based regimens containing third-generation
drugs to a control regimen of cisplatin (Platinol) and paclitaxel
(Taxol) in 1,207 patients with stage IIIB or IV, previously untreated
non-small-cell lung cancer (NSCLC).
The experimental regimens were paclitaxel plus carboplatin
(Paraplatin), gemcitabine (Gemzar) plus cisplatin, and docetaxel
(Taxotere) plus cisplatin.
While all of the regimens used today are effective, only the
paclitaxel plus carboplatin arm was shown to have statistically fewer
life-threatening side effects, Dr. Schiller said. Other
important toxicities such as nausea and vomiting were also reduced in
the paclitaxel/carboplatin arm. Gemcitabine/cisplatin had the longest
time to recurrence (4.5 months vs 3.5 months for the other treatments).
Dr. Schiller concluded that the decision to use one regimen over
another should be based on weighing different parameters, such as
side effects, cost, dosing schedules, and response rate.
In a poster session, David R. Gandara, MD, professor of medicine,
University of California, Davis, presented phase II results showing
improved survival with consolidation docetaxel.
Dr. Gandara and investigators from the Southwest Oncology Group added
docetaxel to traditional chemotherapy with cisplatin/etoposide given
concurrently with radiation therapy in 83 patients with stage IIIb
Median survival with the addition of docetaxel was 22 months, and
2-year survival is 50%. This is substantially better than results
reported in an earlier study using concurrent cisplatin/etoposide and
radiation therapy followed by two more courses of
cisplatin/etoposide. That trial achieved a median survival of 15
months and 2-year survival of 34%.
We cant say that results from this latest trial are
definitive because its a phase II study, and the only trial we
can compare it to is our own, Dr. Gandara told ONI. But
the results were markedly superior with docetaxel, and I believe this
regimen can be considered an acceptable alternative therapy for these
patients. Further study is warranted, he added.