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(Drug information on cisplatin) (Platinol) and paclitaxel(Drug information on paclitaxel) (Taxol) to gemcitabine(Drug information on 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 acceptable toxicity.
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).