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 data with four cycles in these two most 15944 completed studies are remarkably similar to data using six cycles of therapy, leading Dr. While some of this is likely due to better drugs, much of the gain is from stage migration.
Lung Cancer Highlights
The hazard ratio of survival for combination chemotherapy was 1 when compared with vinorelbine and 0. There were no formal cost comparisons or quality-of-life evaluations.
The relative dose intensities were 0. In fact, it has been argued by some that the therapeutic index in advanced disease is too narrow to warrant subjecting patients to the unpleasant side effects of treatment [ 24 ].
Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer.
Lung cancer is the most common cancer in the world and the leading cause of cancer-related deaths in Europe and in other Western countries [ 1 — 3 ]. Several features of target-based molecules make these drugs potentially ideal treatments for unfit patients.
Moreover, it is a widely held opinion scog these 154 patients are at higher risk for severe toxicity, which would counterbalance the eventual small benefit expected. Phase III randomized trial comparing three platinum-based doublets in advanced non-small-cell lung cancer. Moreover, it should be noted that combination chemotherapy with carboplatin and paclitaxel produced a statistically significant higher incidence of several haematological and non-haematological severe toxicities neutropenia, thrombocytopenia, anaemia, nausea and vomiting, any severe toxicity than single-agent paclitaxel [ 37 ].
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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 ].
Consensus on clinical research. In adverse event terms, the taxane-platinum combination of paclitaxel-carboplatin demonstrated less grade 3 or 4 neutropenia and lower rates of febrile neutropenia than other taxane-platinum combinations but higher rates of irreversible grade 3 fcog 4 peripheral neuropathy than any of the other taxane-platinum combinations. The Japanese study showed an impressive survival advantage to the newer combination.
Several PS scales are available for clinical use: If this is confirmed, this may become the new standard of care for SCLC. Accepted March 22, The primary outcome measure was overall 15994 [ 14 ]. Search for related content. The discouraging survival, the lower compliance to chemotherapy and the fear of a higher risk of toxicity put a question mark behind chemotherapy administration in this category of patients.
Stronger evidence on the latter two points is expected from new clinical research specifically focused on PS2 patients affected by NSCLC. In vitro data showing a synergistic effect between taxanes and platinums [ 22 ] led to studies combining the two in patients with NSCLC. First, in terms of survival, in the largest prospective phase III study evaluating the efficacy of a taxane-platinum combination in advanced NSCLC, Fossella and colleagues [ 13 ] reported that DC was modestly superior to VC, with the median survival being about 1 month longer in patients treated with docetaxel.
With the aims of reviewing the evidence supporting each of these therapeutic options, possibly reaching a consensus for treatment of PS2 patients affected by advanced NSCLC in clinical practice, and suggesting the priorities for clinical research in this field, an European Experts Panel took place in Avellino Italy in April Ultimately new drugs against new targets are the future of lung cancer therapy.
A worse PS is characterised by lower response rates to chemotherapy, shorter time to treatment failure and shorter progression-free survival [ 2728 ]. Responses Submit a response No responses published. Survival determinants in extensive-stage non-small-cell lung cancer: J Natl Cancer Inst.
VC was generally associated with more adverse events than the other two regimens.
Taxane-Platinum Combinations in Advanced Non-Small Cell Lung Cancer: A Review
Randomized phase III trial of paclitaxel plus carboplatin versus vinorelbine plus cisplatin in the treatment of patients with advanced non-small-cell lung cancer: Receive exclusive offers and updates from Oxford Academic.
Additional differences emerged when QOL data were evaluated. PS2 patients reported the worst scores at baseline assessment. Paclitaxel is a natural product isolated from the Pacific yew, whereas docetaxel is a semisynthetic taxane analogue of the European yew.