ECOG randomized patients with advanced NSCLC to 1 of 4 new 3 of the 4 regimens used in ECOG docetaxel/cisplatin, paclitaxel/cisplatin. In the ECOG trial, the only direct comparison of similar regimens, response rates and survival times were similar between patients treated with cisplatin. ECOG was chosen as a plenary session presentation because it is an important trial that reflects the state of care in of metastatic NSCLC—the.
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The size of the trials varied, with the TAX trial including approximately more patients in each treatment arm than the ECOG trial. Services E-mail this article to a colleague Alert me when this article is cited Alert me if a correction is posted Alert me when eletters are published Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Download to citation manager.
N Engl J Med ; A neutropenia, B febrile neutropenia, and C peripheral neuropathy. Additional differences emerged when QOL data were evaluated.
Taxane-Platinum Combinations in Advanced Non-Small Cell Lung Cancer: A Review
In all the retrospective and prospective trials regarding prognostic factors in 5194 disease, PS has been shown to be an independent prognostic parameter [ 19 — 25 ].
The finding that second-line therapy of metastatic lung cancer benefits patients with NSCLC adds to the case for sequential single-agent therapy. Unfortunately data on second-line therapy were not gathered for this study.
Paclitaxel plus carboplatin versus gemcitabine plus paclitaxel in advanced non-small-cell lung cancer: Comparison of four chemotherapy regimens for scog non-small-cell lung cancer. Significantly more patients treated with VC experienced grade 3 or 4 leukopenia, neutropenia, nausea, and vomiting, and significantly more patients treated with PCb experienced grade 3 or 4 sensory neuropathy.
Prognostic factors in non-small cell lung cancer: The outcome of 64 PS2 patients enrolled in the clinical trial ECOG comparing four platinum-based combinations has been analysed in detail, after the accrual of PS2 patients had been stopped because of the perception of an excessive number of adverse events in this sub-group [ 27 ]. Patient and tumor characteristics were similar across treatment groups.
Platinum-based chemotherapy is the treatment of choice for patients with non-small cell lung cancer NSCLC. These combinations produced higher response rates and longer survival times than the older cisplatin or carboplatin combinations and, thus, have become the standard of palliative care for patients with advanced NSCLC and good performance status [ 16 ]. In the s, platinum compounds were combined with newer third-generation chemotherapy agents, such ecov vinorelbine and gemcitabine, and the taxanes docetaxel and paclitaxel.
Nonhematologic toxicities were generally similar between the two groups with the exception of more diarrhea in the irinotecan edog.
Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer.
Prospective randomized trial of docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy. The study confirmed a substantial incidence of grade 3 and grade 4 toxicities in PS2 patients, although not significantly higher than in patients with better PS. Design of ECOG Nonlinear pharmacokinetics of paclitaxel in mice results from the pharmaceutical vehicle Cremophor EL.
As expected there were significant differences in toxicity between the treatment arms. The original sample size was significantly larger, but the trial was stopped early when the interim analysis showed a significant benefit to the experimental arm in terms of improved overall survival.
These data should of course be kept in mind when treating PS2 patients, who are at a higher risk of toxicity. This study is one of the first to randomly compare a novel agent with chemotherapy versus chemotherapy alone. The panellists strongly disagree with this approach, which mixes together very different categories, leading to heterogeneous study populations. Because of its low aqueous solubility, the vehicle for paclitaxel is a purified polyoxyethylated castor oil, which has been implicated in paclitaxel toxicity [ 89 ] and in the nonlinear pharmacokinetics of paclitaxel [ 10 — ecov ].
Sub-group analysis from several randomised trials suggest that several new generation cytotoxic drugs are superior to supportive care alone in this category of 154. Recent randomised trials of platinum-free versus platinum-based combination chemotherapy in advanced NSCLC.
Eligible patients had measurable disease with a good PS. The primary analysis of the study showed that the combination was more toxic but it did not show advantage over mono-chemotherapy in terms of overall survival. The trial by DeVore et al.
The primary end point was overall survival, and the study was designed to compare each docetaxel arm with the vinorelbine arm; there was no intention of comparing the two docetaxel arms [ 13 ].
Columbia University Press ; — Prognostic factors for survival in patients with inoperable lung cancer. Different patients may have different benefit, different compliance and different toxicities from the same anti-cancer treatment.
Elderly patients have peculiar characteristics related to physiological ageing with progressive reduction of organ functions and are at risk of unexpected and unpredictable toxicity.
Lung Cancer Highlights
QOL was categorized as improved, stable, or declined. Baseline characteristics were well balanced across treatment groups. Commentary ECOG was chosen as a plenary session presentation because it is an important trial that reflects the state of care in of metastatic NSCLC—the leading cause of cancer-related death in North America.
The clinical evaluation of chemotherapeutic agents in cancer. Topotecan is one of most active new agents for SCLC. Both taxanes demonstrate radiosensitizing properties [ 21 ], and the taxanes have been evaluated as adjuvant and neoadjuvant therapy of NSCLC.
Grade 3 or 4 neutropenia, anemia, nausea and vomiting, and constipation were more common with VC, while grade 3 or 4 thrombocytopenia was more common with PCb and GC.
Comment in N Engl J Med. For example, the affinity of docetaxel for the tubulin-binding site is twice that of paclitaxel, and docetaxel is twice as efficient as paclitaxel at decreasing the critical tubulin concentration required for the formation of microtubules [ 7 ].
All the panellists participating in the meeting agreed that an important prognostic and predictive help for clinical management eclg derive from a proper sub-classification of PS2 patients. A first point of discussion was the evidence supporting the role of chemotherapy itself in PS2 patients. This Article The Oncologist August vol. For patients with extensive stage SCLC, there has been little progress over the past 20 years since the establishment of etoposide and cisplatin as the standard of care.
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