Combination chemotherapy should be the standard treatment for patients with advanced non-small-cell lung cancer, according to a study presented at the 38th annual meeting of the American Society of Clinical Oncology (ASCO). The phase III, randomized study compared the combination of carboplatin(Drug information on carboplatin) (Paraplatin) and paclitaxel(Drug information on paclitaxel) with paclitaxel alone and showed that patients in the combination arm achieved a statistically significant better response (29%) than patients in the paclitaxel alone arm (17%).
Survival Duration Increased
"Not only did the results of the trial show an increase in response rate, but more importantly, an increase in survival time in patients who received carboplatin and paclitaxel," said Dr. Rogerio Lilenbaum, director of the Thoracic Oncology Program at the Mount Sinai Cancer Center in Miami Beach and lead investigator of the study for the Cancer and Leukemia Group B (CALGB). "In addition, the results of the study clearly demonstrate that elderly patients and the sickest patients may benefit from this regimen."
Patients in the study who received the combination achieved a median survival of 8.8 months, compared with 6.7 months for patients who received paclitaxel alone. This represents a 24% increase in the duration of survival for those in the combination-therapy arm. In addition, patients in the combination arm experienced a longer failure-free survival (4.6 vs 2.5 months).
Equivalent Toxicities
"Typically, patients treated with combination chemotherapy experience more severe toxicity than those treated with single agents," said Dr. Richard L. Schilsky, associate dean for clinical research, University of Chicago, and chairman, CALGB. "However, the combination of carboplatin and paclitaxel resulted in only minimal increases in toxicity levels."
Although toxicity levels are slightly higher with combination therapy, the quality of life for patients was not compromised. The most common toxicity for each regimen was a decrease in the absolute neutrophil count (62% for the combination vs 32% for paclitaxel alone). Other side effects included febrile neutropenia (8% with the combination vs 5% with paclitaxel alone) and peripheral neuropathy (15% with the combination vs 13% with paclitaxel alone).
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