ASCO--Non-small-cell lung cancer (NSCLC) patients receiving paclitaxel
(Taxol) plus cisplatin (Platinol) had longer survival and achieved
high-er rates of response than patients receiving a current standard
chemotherapy regimen of cisplatin plus etoposide (VePesid) in
a multicenter phase III trial, Phillip Bonomi, MD, reported at
a scientific session of the American Society of Clinical Oncology
(ASCO) annual meeting in Philadelphia.
Average survival times were increased 25% to 30% in patients receiving
pacli-taxel in combination with cisplatin as initial therapy in
the Eastern Cooperative Oncology Group (ECOG) trial, said Dr.
Bonomi, associate professor of oncology, Rush University Medical
ECOG undertook the current study based on previous promising phase
II trial results in which response rates achieved with paclitaxel
hovered at between 21% and 24%, and 1-year survival, at 40%, Dr.
Bonomi said. It was the survival data that caught the eye of the
NSCLC doctors, he said.
"The study enrollment came in like a tidal wave," Dr.
Bonomi noted. "There were 600 patients accrued in 16 months
with about 190 ultimately in each arm." Inclusion criteria
included histologically confirmed stage IIIb-IV NSCLC; no previous
chemotherapy; adequate bone marrow, renal, and hepatic function;
and no brain metastases.
Patients were randomized to one of three arms: a standard chemotherapy
regimen of etoposide and cisplatin; a high 250 mg/m² dose
of paclitaxel with cisplatin plus G-CSF (Neupogen); or a low 135
mg/m² dose of paclitaxel with cisplatin, Dr. Bonomi said.
Primary study endpoints included survival, response to therapy,
Compared with standard chemotherapy, paclitaxel/cisplatin extended
survival by 2 to 3 months, Dr. Bonomi noted. Survival averaged
7.4 months for patients receiving etoposide/cisplatin, 9.6 months
among those receiving low-dose pacli-taxel/cisplatin, and 10.1
months among those receiving high-dose paclitaxel with cisplatin
Response rates for groups receiving paclitaxel were also significantly
better than for those on the standard etoposide/cisplatin regimen,
he said. The response rate for the etoposide/cisplatin arm of
the study was 12% while that for the low-dose paclitaxel/cisplatin
combination was 26%. The high-dose paclitaxel group response rate