ASCO--Cycling docetaxel(Drug information on docetaxel) (Taxo-tere) treatments with cisplatin(Drug information on cisplatin) (Platinol) and vinorelbine (Navelbine) achieves better response rates in non-small-cell lung cancer (NSCLC) patients than can be expected from any of the components used alone or in traditional combination, according to the multicenter pilot study presented by Jean Viallet, MD, at a pos-ter session of the American Society of Clinical Oncology (ASCO) meeting in Philadelphia.
The goal of the alternating drug regimen in the phase II trial was to capitalize on the efficacy of each of the agents while avoiding any cumulative toxicity. "These three agents are arguably the three most active individual agents in the treatment of NSCLC," said Dr. Viallet, director of the Oncology Center at the Hospital Notre-Dame, Montreal.
Unfortunately, prior attempts at devising regimens pairing the agents have not been well tolerated.
Effects of Same Day Dosing
"When you try to give docetaxel with cisplatin or docetaxel with vinorelbine on the same day, the impact on the white blood cell count is such that a substantial fraction of patients are exposed to the risk of febrile neutropenia and infectious complications," Dr. Viallet told Oncology News International in an interview.
Traditionally, clinicians have reduced doses in an effort to compensate for this effect--with the result that efficacy is lost, Dr. Viallet noted. As an alternative strategy, Dr. Viallet and his colleagues cycled the treatments, giving docetaxel first and then, 3 weeks later, administering the cisplatin with vinorelbine.
Unlike the earlier strategy, which provided small, suboptimal doses to reduce the chance of cumulative side effects, here each patient received a full dose of each drug. "This way we would avoid the potential cumulative toxicity, while hopefully obtaining efficacious and perhaps even additive activity," Dr. Viallet said.