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(Drug information on cisplatin) (Platinol) or carboplatin(Drug information on carboplatin) (Paraplatin)--combined with 96-hour, 24-hour, or 3-hour infusions of paclitaxel(Drug information on paclitaxel) (Taxol), or with docetaxel(Drug information on 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.