SAN FRANCISCOA randomized phase III trial of three chemotherapy
regimens in advanced non-small-cell lung cancer (NSCLC) confirmed
platinum-containing combinations as the standard treatment, according to a
presentation at the 37th Annual Meeting of the American Society of Clinical
Oncology (ASCO abstract 1228). The EORTC trial (08975) compared cisplatin
(Platinol) and paclitaxel (Taxol) to gemcitabine (Gemzar) with either
cisplatin or paclitaxel.
Jan P. Van Meerbeeck, MD, of the EORTC-Lung Cancer Group, Brussels, said
that clinical trials have established that combination chemotherapy improves
survival in advanced NSCLC, especially platinum-based therapies.
While paclitaxel/cisplatin is a possible standard combination, other
platinum-based combinations are in use, and attractive non-platinum-based
combinations have been developed. In a recent trial, Dr. Van Meerbeeck noted,
the average response rate for a paclitaxel/gemcitabine combination was 33% with
The multinational EORTC trial was launched to answer which is the better
platinum-based combination and whether cisplatin is really necessary in lung
cancer, Dr. Van Meerbeeck said.
Patients (n = 480) were randomized to 3-week regimens of
paclitaxel/cisplatin (the reference arm), gemcitabine/cisplatin, or
paclitaxel/gemcitabine. In all regimens, paclitaxel was given at 175 mg/m² over 3 hours on day 1; cisplatin at 80
mg/m² on day 1; and gemcitabine at
1,250 mg/m² on days 1 and 8.
Included patients had stage IIIB (malignant pleural effusion and/or
supraclavicular nodes) or IV disease with one or more measurable target
lesions, and performance status 0 to 2. Prior neoadjuvant chemotherapy (more
than than 1 year before enrollment) was allowed.
Among 470 evaluable patients, there was one complete response (in the
gemcitabine/cisplatin arm), and no significant differences between arms for
partial or overall response rates (Table 1).