ASCO LOS ANGELES--Five studies presented at the American Society
of Clinical Oncology (ASCO) meeting raise questions as to whether
platinum/taxane combinations are better in non-small-cell lung
cancer (NSCLC) than standard platinum/etoposide (VePesid) regimens,
and if so, which platinum and which taxane used in combination
are best with respect to efficacy, toxicity, and cost?
"In the 1990s and for ever more, no discussion of clinical
trials results can be considered adequate without addressing cost,
including consumption of supportive care medical resources,"
Ron Natale, MD, of the University of Southern California Norris
Cancer Center, said in his discussion of the five trials.
The studies all involved use of a platinum--either cisplatin (Platinol)
or carboplatin (Paraplatin)--combined with 96-hour, 24-hour, or
3-hour infusions of paclitaxel (Taxol), or with docetaxel (Taxotere).
He noted that supportive care measures seemed to be profoundly
different with different taxane regimens.
Three-Hour Paclitaxel Favored?
"There appears to be a difference in the rate of severe granulocytopenia
and febrile neutropenia favoring the 3-hour Taxol regimens,"
Dr. Natale said. Growth factor support is not required with 3-hour
paclitaxel infusion, he added. Furthermore, serotonin antagonists
for nausea and vomiting, which are almost always required with
cisplatin plus docetaxel or 24-hour paclitaxel, are rarely required
with carboplatin plus 3-hour paclitaxel.
All of the platinum/taxane regimens require steroid support, "but
steroids are cheap; hospitalization is not," Dr. Natale said.
In his own study of carboplatin plus 3-hour paclitaxel, there
were only four hospitalizations for management of chemotherapy-related
toxicity out of 206 courses of outpatient therapy.
Dr. Natale noted that "no firm conclusions can be drawn from
this type of comparison" and looked to three comparative
trials to help resolve the issues.