A landmark research trial by the University of Wisconsin Comprehensive Cancer Center showed that chemotherapy offers survival benefits for advanced, non–small-cell lung cancer patients. The study, presented at the 36th annual meeting of the
A landmark research trial by the University of Wisconsin Comprehensive Cancer Center showed that chemotherapy offers survival benefits for advanced, nonsmall-cell lung cancer patients. The study, presented at the 36th annual meeting of the American Society of Clinical Oncology (ASCO), was designed to compare three platinum-based chemotherapy regimens with a control arm of cisplatin (Platinol) and paclitaxel (Taxol). The regimens were gemcitabine (Gemzar) plus cisplatin, docetaxel (Taxotere) plus cisplatin, and paclitaxel plus carboplatin (Paraplatin).
The studys primary objective was to determine which of four different types of chemotherapy treatment is best for patients with advanced lung cancer, said Joan Schiller, MD, professor, University of WisconsinMadison Medical School, and lead investigator of the study. While all of the chemotherapy regimens used today are effective in the treatment of lung cancer, only the paclitaxel-plus-carboplatin regimen has shown to have statistically fewer life-threatening side effects.
Largest US Trial of Its Kind
The trial, conducted by the Eastern Cooperative Oncology Group, was the largest randomized trial of advanced lung cancer patients in the United States. More than 1,200 patients with previously untreated stage IIIB or stage IV nonsmall-cell lung cancer participated.
Results of the study showed no significant difference in survival among the three arms when compared to paclitaxel with cisplatin (the control arm). The median time of survival for all arms was 8 months; 1-year survival was 33.5% and 2-year survival was 12%. Median time to progression was 3.6 months for all arms.
The percentage of grade 4/5 toxicities experienced with each regimen were 68%/4% with paclitaxel plus cisplatin; 69%/4% with gemcitabine plus cisplatin; 61%/6% with docetaxel plus cisplatin; and 53%/3% with paclitaxel plus carboplatin. These toxicities included absolute neutrophil count, vomiting, and neuropathy.
Both the paclitaxel-plus-carboplatin combination and the docetaxel-plus-cisplatin combination are administered on day 1, every 3 weeks. Gemcitabine plus cisplatin is administered on days 1, 8, and 15 every 4 weeks. The paclitaxel-plus-cisplatin regimen includes paclitaxel administered on day 1 every 3 weeks with cisplatin administered on day 2. For cancer patients who have to go to the hospital or outpatient facility for treatment, this can represent a considerable difference in the convenience of drug administration.
More Treatment Options
Currently, only 25% of all lung cancer patients undergo chemotherapy as treatment for their disease. However, these newer chemotherapy regimens are helping to achieve 1-year survival rates of 35% to 40%, compared to 20% to 25% 5 years ago. Based on these data, it is expected that more lung cancer patients will be offered chemotherapy treatment.
Lung cancer is a major disease with traditionally bad outcomes because there have not been many proven treatment regimens, said Dr. Schiller. Our study shows that there is new hope for the treatment of advanced lung cancer patients that can help extend their survival with a better quality of life.